Dr. William Thomas

Bill Thomas calls himself “a nursing home abolitionist.”

“I want them to go away,” he says. “Our greatest adversary is the institutional mindset. That must go.”

Talk of culture change doesn’t matter as long as people retain an attitude of elders as “the helpless inmates of total institutions,” he says.

Looking back on the last decade of the culture change movement, Dr. William “Bill” Thomas, an international authority on geriatric medicine and eldercare, says it has progressed from the point of “being laughed at” to the subject of serious criticism.

An increasing number of organizations, regulatory bodies, corporations, non-profits, and unions are now seriously considering what happens when the concept of a nursing home is less of an institution and more of a real community where elders can thrive.

Now a professor at the University of Maryland’s Erickson School of Aging Studies, Thomas is a medical doctor who left the emergency room for geriatrics, surprising himself when he fell in love with elders and those who provide their care. It was then that he discovered he could make life better for them.

“I feel that’s what I was born to do,” he said, by phone from Maryland this week.

Direct Care Worker in Culture Change

When we asked him where the role of the direct-care worker fits into his vision, Thomas said, “Older people are held in low esteem in this country, so people who work with them are held in low esteem. First, we have to tackle ageism in this society in general, because it bears directly on the quality of life of those who work with elders.”

Thomas founded The Eden Alternative,  a philosophy and program that has worked to de-institutionalize nursing homes worldwide over the past 20 years. As we featured on our blog last month, he most recently developed the Green House, a radically new approach to long-term care where nursing homes are torn down and replaced with small, home-like environments where people can live a full and interactive life.

There are now 54 Green Houses around the country, either open or in development. While some are built from the ground up, others are transformed from the old model of the nursing home, receiving “bulldozer therapy,” says Thomas.

This means good things for both consumers and direct-care workers, when meaningful relationships are built on a foundation of dignity, equality, and mutual respect.

“One of the tragedies of long-term care,” says Thomas, “is you take big hearted, compassionate people and put them into itty, bitty little jobs. Culture Change holds promise to the extent that it’s willing to envision bigger jobs for the people doing this work – jobs that offer more decision-making autonomy and authority, better training and better pay. That’s what we’re fishing for out here.”

Better jobs and diversity of skills

The workforce you get is based on the jobs you have to offer, he says.

“Without attractive jobs, you can’t wake up and say we have a magnificent workforce. I oppose the idea of attracting new people into the field to take jobs that are not worthy of them. I don’t want to recruit people to work in the current authoritarian regime. I want people to be attracted to our field because we offer tremendous jobs with great fulfillment and personal growth.”

When we asked Thomas what skills workers will need in the future, he said, presuming the success of the culture change movement, those who work with elders will have the wellbeing of elders in mind. They’re going to need a wider range of skills because the focus will be on the people they care for and not on service to their department.

Workers will need to work cooperatively. With a more team-based system, they will need to carry out plans together, have greater communications skills, a wider range of technical skills, and community building skills.

“Healthy communities help those who live there and those who work there,” he says, adding, “we’ve got a big challenge to upgrade the workforce to match the philosophy of culture change. That’s going to take decades of work, actually.”

– Story by Dinah Cardin

For more information on how to ensure your workforce has the necessary skills to support culture change, contact Susan Misiorski, PHI Director of Organizational Culture Change, smisiorski@PHInational.org.