Green House Projects Let Elders Age In Homes In the first program of our 'What Works' series, we take a look at nursing homes. Dr. Bill Thomas developed the Green House Project where residents aren't patients, but elders, and the elders live together in group homes.
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Green House Projects Let Elders Age In Homes

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Green House Projects Let Elders Age In Homes

Green House Projects Let Elders Age In Homes

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This is TALK OF THE NATION. I'm Neal Conan in Washington. Today we start a new series on a very old theme, the fundamental human drive to solve problems. It's about ideas that many times look blindingly obvious in retrospect.

Why, for example, did it take decades that you only need to charge tolls one way on a bridge?

Some reflect technological or scientific advances. The microscope led to the discovery of germs, which eventually convinced medical workers to wash their hands and save many, many lives.

Not all problems are so easy, and that's where we want to focus our new series called What Works. Once a month, we'll address a problem and find at least one person who has had real, measurable success in solving it, and we begin with nursing homes.

That phrase itself might have set off a shudder. Very few of us would choose to live in one, but that's where many thousands of frail elderly people find themselves. Even at their best, nursing homes remain institutions - with no privacy, bright lights, hospital food, disinfectant, linoleum and boredom.

Dr. William Thomas is a geriatrician who decided we can do better. He's the brains behind the reinvention of the nursing home. It's called The Green House Project, and he joins us now from the studios at Cornell University in Ithaca, New York. Nice to have you on the program today.

Dr. WILLIAM THOMAS (Founder, The Green House Project): Glad to be with you, Neal.

CONAN: And let's start with that problem. Does that capsule pretty well describe the nursing home where you went to work after med school?

Dr. THOMAS: Well yes, you know, it does. What you described is really a premier example of institutional long-term care, where life is really governed by the staff and not by the people living there.

So that description holds pretty uniformly across many thousands of nursing homes in America.

CONAN: And your solution - well, first you tried making the nursing home homier.

Dr. THOMAS: Well yeah. You know, I think one of the important things to think about when you want to solve a problem, the way you were describing before, is the most important thing is to look at the situation from a sideways angle.

Many people, many really wonderful people, have spent a long time trying to make nursing homes into better nursing homes. And what really came to me was that the problem wasn't that the nursing home wasn't good enough, it was that we weren't addressing the real problem, which was loneliness, helplessness and boredom. If I approached it from that angle, I could get real change, and so that's what we've done.

CONAN: And how do you do that?

Dr. THOMAS: Well, I mean, the first thing is to stop thinking of nursing homes as if they were watered-down hospitals and really to start thinking of them as places where older people can live and grow.

And right there, that's a challenge for a lot of people, because if you think about people living in nursing homes, you think about people having stokes and living with dementia. How can they grow?

CONAN: Think of them as places where people go to die.

Dr. THOMAS: Wrong, wrong answer.

(Soundbite of laughter)

Dr. THOMAS: So when you maintain that idea of it's a place where people go to die, you try to make it sanitary and clean and proper and effective, but when you think about this is a place for people to grow, it opens up a whole universe of possibilities to you. And that's where we've been with our work.

CONAN: And again, how do you do it? Nursing homes typically have, what, 150 up to 300 patients.

Dr. THOMAS: Right. Well, when we started our work, we began with a philosophy called the Eden Alternative, and what it really said was life is better in a garden. And we have the power to take an institutional nursing home and make it into something that's more like a garden and less like a hospital.

And you know, visibly that means bringing in plants and animals and children and creating the sounds of birdsong, and children laughing, and people, you know, speaking warmly with one another.

So our first approach is really to change the environment and to say here's a garden where old people grow. Kind of the opposite of a kindergarten. But the idea that older people can have environments where they can thrive and grow, that's crucial.

CONAN: There are often serpents in Eden.

(Soundbite of laughter)

Dr. THOMAS: Well, it wouldn't be Eden without a snake. Well you know how I think about this has to do with the question of risk. If you look back at the story of the Garden of Eden, risk was an important part of the picture.

You had this sort of paradise, and at the center of it was risk, and that's really what made it a human environment - the first Eden. And one of the problems we have in nursing homes in America is people try to take all risk away from the elders and to protect them to a degree that in some cases can be smothering.

And so one thing we teach people in the field, is that the only risk-free human environment is a coffin, and we'll all be there soon enough. So risk is a part of a garden, and it needs to be kept as part of the garden.

CONAN: Yet as I've read, the Eden was - well, it helped things, but it didn't go far enough, at least not for you.

Dr. THOMAS: Well not for me. I believe that we can change and improve the current system, but when you get down to the ground floor of my philosophical stance, I am a nursing home abolitionist.

I believe that America can outgrow the mistake it's been making for the past 40 years, which is institutionalizing older people. But in order to be a real abolitionist, I really had to bring to the table an alternative - something that was not a nursing home - to help people who can't live at home.

CONAN: And that is the so-called green home.

Dr. THOMAS: Well, green house.

CONAN: Green house, yes.

Dr. THOMAS: So you know, a one-word greenhouse is a place that grows plants. A two-word green house grows people, and that's what green houses do. They're places - non-institutional environments, where elders who can't live at home, who need skilled nursing home - where they can have a life worth living.

CONAN: Typically, they are eight to 10 people who live there. They're residents, not patients.

Dr. THOMAS: Well no, not residents, elders. They are the elders of the house. Resident - the term resident really connotes a status as a inmate in an institution. So these green houses are homes for elders.

CONAN: And how do they bring about that dignity that you're looking for?

Dr. THOMAS: Well, I mean, the first thing - you mentioned before, some nursing homes have 140 people, 300 people, 500 people living there. The first thing we understood is that human care, real, genuine human caring, does not scale.

You can't have economies of scale with caring. Just like, you know, if you say well, I grew up with my 130 brothers and sisters, that's - you can't have a family experience with 130 siblings.

So the first thing we knew we had to do was create a small environment where everybody could really know each other, and you could really depend on relationships to be at the center of what you did.

CONAN: So a family-sized group.

Dr. THOMAS: Yeah, family-sized, exactly. You know, the idea - rather than factory-sized, we wanted to make the green house family-sized.

CONAN: You said you can't get economies of scale for care. You can get economies of scale for other things, medical attention, doctors, nurses, various kinds of equipment.

Dr. THOMAS: Yeah, well - I'll grant some of what you say but not all. I mean, actually really good medical care requires a knowing relationship between the patient and the provider, but here's where you can get scale.

But here's where you can get scale: payroll, accounting, billing, the kinds of business operations. All of those things - those things scale up very nicely, but knowing what Neal Conan likes for breakfast, knowing when Neal Conan wants to get up in the morning, that does not scale.

CONAN: That does not scale. As you look at the situation - one of the things, for example, that I read about that really affected me was that smell of disinfectant that so characterizes nursing homes. Instead, in a green house, the smell that most people remember is the smell of food being cooked there.

Dr. THOMAS: Right. You know, we are creatures of habit, all of us human beings. And one thing we've learned by reading the research in the field and talking with elders and their family members is that food is a central component of well-being for our whole life but especially in old age.

Oh, my, my, to have good food as an older person, it's a gift with a multitude of benefits. So in the green houses, we really focus on preparing the food that the elders want the way they want it prepared when they want it. And again, I can run a food service for 300 residents in a nursing home that will never be able to give you the food you want when you want it.

So that's where scale works against you in the nursing home but works for you in the green house.

CONAN: Nursing homes, like a lot of other institutions, take up the entire block or the entire area of land to which they - that they've been assigned to. Yours have land outside, yards.

Dr. THOMAS: Yeah. Well, you know, people - it's a sad truth that, and here we are in the spring of the year in the northern hemisphere, and there are many, many, many, hundreds of thousands of elders who are not - who are living in nursing homes who are not going to experience that breeze, that warm, April, spring breeze on their cheek.

They're not going to feel it, because you know, a large institution, it requires planning and dedicated effort to get a person out of the room, into the elevator, out of the lobby and into the outdoors. But in the green house, you just open the door. You open the door, and you can be outside.

And we believe that elders, in addition to really enjoying good food, also enjoy being in contact with nature, and with the seasons, and with the outdoors and the sun.

CONAN: We're talking about nursing homes and what works to make them better. NPR's Joe Shapiro has covered this story. He'll join us in just a moment to take your calls.

What's worked for you to improve life in nursing homes? Give us call, 800-989-8255. E-mail us, We'd also like to hear from those of you who've been listening to this and say well, you know, it sounds good, but it might just be sounding too good to be true.

800-989-8255; e-mail Stay with us. I'm Neal Conan. It's the TALK OF THE NATION from NPR News.

(Soundbite of music)

CONAN: This is TALK OF THE NATION. I'm Neal Conan in Washington. This is the first installment of a new series we call What Works. We seek real solutions to some of the hardest problems. Today, that problem: nursing homes.

Our guest is Dr. William Thomas, a geriatrician and the brains behind the reinvention of the nursing home called The Green House Project. Also with us is NPR science correspondent Joe Shapiro, who covers aging for NPR and has reported on The Green House Project.

We want to hear from you, of course, as well. What's worked to improve life in nursing homes. If you've worked there or have direct experience, give us a call: 800-989-8255, e-mail We'd also like to hear from those of you who think this might sound a little too good to be true. You can also join the conversation at our Web site. That's at Click on TALK OF THE NATION.

And Joe Shapiro's with us here in Studio 3A. Thanks very much for coming in.

JOE SHAPIRO: It's good to be with you.

CONAN: And in the field of social policy like this, it's not easy to know what works a lot of the time.

SHAPIRO: No, it's - often it's trying things and learning from those, and I think with Green House, we're learning how to build these small group homes that are friendly and work well, but we're also probably learning from that experience how to give better care in traditional nursing homes.

CONAN: You've reported on this project for a few years now.

SHAPIRO: I did. I've known Bill for over a decade. I met Bill at a meeting of what was called the Nursing Home Pioneers, a group that came together to do a culture change to try to change the way nursing homes are done, met in 1996 or 1997 around this time in Rochester, New York.

And then four years ago, I went down to Tupelo, Mississippi, where Bill started the first green houses. There were four back then. And since then, the green house has spread. They've got more than 50 in more than a dozen states, and they've got about 130 under development.

CONAN: And makes us think they work?

Dr. THOMAS: Well, there's been some study that shows that people who live there say they're - they do more of themselves. They're less depressed. They may use less medication.

From my own experience, I was there with Bill in Tupelo, and I met a woman in Tupelo named Mildred Adams(ph). When she first came to the green house - she'd been in the traditional nursing home, and she'd stopped talking. She wouldn't feed herself.

She didn't even - she didn't walk. She didn't talk. She moved into the green house. The story is - the first day, her son - the first day, she goes to lunch at the big table, the common table where she's eating with the other 11 women in the small group home, and her son starts feeding her. And she says give me that spoon.

First time he'd heard her talk in over a year, and right away she started talking, walking, feeding herself. And when I met her, she was singing gospel music to me and telling me stories of her life.

CONAN: You work on the NPR science desk, and I know the editors there - they want statistics, Joe, they want numbers, they want facts.

SHAPIRO: Well, Rosalie A. Kane at the University of Minnesota had done a study, and they did find that residents were at lower levels of depression and doing what Mildred Adams was doing, more self-care.

Dr. THOMAS: Joe, if I could add, too…

CONAN: Dr. Thomas, go ahead.

Dr. THOMAS: One of the important parts of the finding was that the people who worked there were more pleased with their work than people who are working in a typical nursing home. I think that's also important to consider.

CONAN: Let's get some listeners in on the conversation. Again, 800-989-8255, e-mail We'll start with Karen(ph) calling from San Francisco.

KAREN (Caller): Hi, thank you. I applaud Dr. Thomas and what he's trying to do, but my question is, in this utopia and ideal part of Green House is, what is the cost to this? Because there are a lot of Medicaid patients that can't afford that. I mean, this sounds very, very good, but it would be very expensive.

There's a nursing home out here in Concord where I visited the grandmother of a deployed soldier, and the conditions were horrific, but it was all she could afford.

CONAN: Joe Shapiro, can you help us with this?

SHAPIRO: The costs are the same, once it's built, for a patient. They use the same means of funding that any nursing home does. What is expensive, what's tricky, what makes this hard to do overnight is - and the fact, and the reason why they're largely being built by not-for-profit nursing-home operators, is that you have to start from scratch to be a nursing home abolitionist, as Bill said.

You need the land. You need the money to build something new, and often the not-for-profits are doing this. They are the ones who are doing this because they often have foundation money, or they can start a fundraising campaign.

So it often takes extra money to get it going, but once it gets going, then it pays for itself, right, Bill?

Dr. THOMAS: Yes.

KAREN: I want to leave you just one comment, and then I'll go off the air. As long as most of these institutions are for profit, from what I have seen out there in talking to the nurses and nurse's aids that are unionized, they say as long as they are for profit, that will not happen in some of these large nursing homes because cost and profit are the two primary issues.

I applaud you, Dr. Thomas, and I wish you well because this is what I would like to see in the future. Thank you.

CONAN: Karen, thanks very much, and she raises a very good point, and I think we need to clarify. Dr. Thomas, as I understand it, you can't take an old nursing home, a current nursing home with 300, 350, 500 patients and transform it into a green house.

Dr. THOMAS: No. You can't, and I mean, I wish that you could because, as Joe pointed out, it would be a lot easier for us. But in fact, you - the environment we create, there's an important need for privacy, and so every elder in a green house has a private room and a private bathroom.

And when you think about the soldier's grandmother that was mentioned in the call, you know, her grandson's serving in Iraq, and she shares a toilet with a stranger. You know, there's something wrong with that.

So to amplify on what Joe was saying, it costs - we find it costs about 10-percent more to build green houses than it does to build a standard replacement nursing home. However, and this is also as Joe said…

CONAN: For the equivalent number of beds.

Dr. THOMAS: The equivalent number of beds. But once it's built, it does not cost more to operate. And so this is what's challenging for us and what's encouraging to us, because we know that for that same dollar that's taking care of that soldier's grandmother, that same dollar could be spent taking care of her in a green house if it existed in her community.

And I'll just say that one of the really terrific bits of news we have for listeners is that the Robert Wood Johnson Foundation has gotten behind this idea, and they're supporting a 50-state replication project so that we're able to put green houses in all 50 states.

So then we think the example will help providers in different states get behind the model and spread it even further.

CONAN: An e-mail question from Samuel in Denver. How do these green houses work with people with Alzheimer's and dementia?

Dr. THOMAS: Well, Joe's reported on this, but I'll just say as a physician that there's a concept for people living with dementia called cuing. And that is when you're living with dementia, sometimes your environment's a little confusing, and if you have more cues to help you remember what's going on, you live a better life with less anxiety and less stress and so on.

And the green house cues older people more appropriately than a large institution does, because it draws on a lifetime of living in residential settings rather than living in an institutional setting.

CONAN: And Joe, I'm going to ask you to follow up on that and the associated question, does the green house cream off the best off of those nursing home patients, people who were patients in nursing homes and now would be elders in green houses?

SHAPIRO: In Tupelo, they moved everyone out of their traditional nursing home into the green houses. So it wasn't creaming. They took everyone. The - and I personally like the idea that they integrate people with Alzheimer's and dementia with everyone else, and it seems to work well.

The one thing that is a little difficult in that is that you - you have to have the aids - they call them shabazzeem(ph) in the green house. They have to…

CONAN: They call them the what?

SHAPIRO: Well, this is something that - this is part of Bill's idea is that if you want to change the way we provide nursing home care, remember he says he doesn't call them patients or residents. They are elders, and the people who work there, he didn't want to call them aids. He was - he changes the hierarchy.

So you have - and he uses the word shabazz(ph). I think - you made that up, didn't you, Bill?

Dr. THOMAS: Well, it comes from Ancient Persia.

CONAN: It might as well have been.

(Soundbite of laughter)

SHAPIRO: But you came up with that because you were trying to make a point that language makes a difference, just like the environment makes a difference. So he's changing the whole structure there.

One problem that they - well, one problem actually that they've solved or addressed in the greens house is there's a high level of turnover among nursing home workers

CONAN: Nursing home workers.

SHAPIRO: Among workers. That's a big problem. In the Green House, they have given the aides who - they've given them more pay, more training, but most importantly they've given them more power and more, sort of, say in - more importance in the day-to-day running of the Green House. So…

CONAN: And one nurse toward how many Green Houses?

SHAPIRO: Well, it's an aide…

CONAN: Mm-hmm.

SHAPIRO: I'm not sure.

Dr. THOMAS: Well, it's - here's how - and for people listening who have -familiar with long-term care. There's four hours of time, eight - care time, per elder per day in a Green House. That's four hours. In the rest of the United States, in a conventional nursing home, people are often very happy if they have three hours of aide time per elder per day - per resident per day.

So we actually staff - are able to staff the houses at a higher level of caregivers than you can in an institution.

CONAN: As well as having more continuity for the shabazzeem. Okay.

Dr. THOMAS: Yeah.

SHAPIRO: Yes. Very good. Wow, Neal. You picked right up on that. That's great.

CONAN: Well, I'm planning to check in tomorrow. Let's see if we can get Anne(ph) on the line. Anne is calling from Savannah, Georgia.

ANNE (Caller): Hello. I just want to say that I think the Green House sounds absolutely incredible. And I think that you can keep the cost low when you have people who are properly trained and you're acknowledging the individual and allowing them to flourish with autonomy and seeing them as people rather than as numbers, which so many - so much of the time is what happens when they're institutionalized.

CONAN: Is there a but in there, Anne?

ANNE: There is no but in there. There is no but in there. It's about proper training. And I was an activity director for a short time at one of these places and they incorporated people with all cognitive levels, you know, if they had Alzheimer's or dementia or not, and I would go in and do current events. I would read from the newspaper and we would have discussion groups. And everyone would take a turn and raise their hand and say what they thought. And we would have wonderful discussions that were exciting. And I would see their eyes light up and would get excited. And I knew them by name and I actually cared about what they were talking about. I treated them like I would treat anybody else: with dignity and respect. And they flourished…

CONAN: When you say - one of these places was a conventional nursing home or a Green House?

ANNE: It was an assisted living facility, so it was sort of a maybe cross between the two, but it didn't have the individualized attention. And it didn't have mealtime where people could go and get what they wanted when they want it. It was still very institutionalized. And I saw a lot of the social breakdown, which is another word for institutionalization is social breakdown syndrome.

Because you're not interacting, you're not being treated like you would be in society, your social skills breakdown and you have more anxiety and more depression. While when you're treated like a friend, like a person who matters, and when you're being treated as if you're seen - like, wow, I love your outfit, your earrings look beautiful. They dress up and they get excited about their day. And it really makes all the difference in the world.

And that's another way that cost goes down is when you have less anxiety and less depression, you really do have less need for medication and medical treatment which, you know…

CONAN: Mm-hmm. Anne, thanks very much. We appreciate the phone call.

ANNE: Thank you.

CONAN: We're talking about what works today.

You're listening to TALK OF THE NATION from NPR News.

And, Dr. Bill Thomas, go ahead. I didn't mean to cut you.

Dr. THOMAS: Oh, I'd love to jump in. She - Anne's raising a point that needs to be made much more, which is - we're talking about long-term care here. We're talking about chronic care for older people. And what's happening in our field with the Green House and Eden Alternative and Culture Change and - this reform movements that's happening in long-term care, I believe, actually has a good possibility of influencing acute care.

Everything she was saying about what makes good care actually makes good care in the emergency room and in the hospital. And yet, we have hospitals that often do not treat people as individuals and often force people to kind of conform to the routines of the hospital. And one of the things I believe I'm going to see in the future is more and more influence coming out of the field of long-term care and in to the field of acute care.

CONAN: And, Joe Shapiro, let me ask you - she also raised a point that might confuse people. Assisted living - what's the difference between a nursing home? We've heard the difference between a nursing home and a Green House, and assisted living.

SHAPIRO: Assisted living is - doesn't have the higher - as high a level of medical care. Although, in fact, often in assisted living, you see a very similar kind of patient.

CONAN: Mixed.

SHAPIRO: Some more patient mix, yeah.

CONAN: And the costs and all that sort of stuff?

SHAPIRO: Well, assisted living, it tends to be more expensive. It's often more private…

CONAN: Private insurance?

SHAPIRO: Private pay.

CONAN: Private pay.


CONAN: Here's an e-mail requested from Angela(ph) in Conifer, Colorado. And let me just see if I can get into the light here.

Since it is a small and intimate environment, what's the process to match up personalities to ensure a positive experience? Dr. Thomas?

Dr. THOMAS: Well, that's actually a great question because we don't actually try to match up personalities to make a good experience. Instead, we work with the shabazeem, the people working in the house, and the elders and the families around a shared commitment to create a respectful community in the house.

You see, I actually think it's the wrong idea to sort of try to move elders around like they were pegs in a box, you know, and say, well, these ones will go together and these ones won't.

What's better - I find in my work and in my experience - is to help people get excited about creating a community for themselves, where even though you have differences with another person who's living in the house, you're able to see that person as an individual and able to kind of work through your conflicts.

In fact - and I'll wrap up with this - one of the problems that we face in traditional institutional long-term care is that everybody wants to make conflict go away. Everybody wants to suppress conflict, whether it's between the staff or with the residents. And in the Green House, we say, oh, we've got conflict? Let's talk about it. We're human beings, we're going to have conflict. So that's the approach we take in the Green House.

CONAN: That's Dr. Bill Thomas, geriatrician and founder of the Eden Alternative, creator of the Green House Project. Also with us NPR's Joseph Shapiro. We're talking about what works.

When we come back, we're going to be talking about more of your ideas about this nursing home proposal. We'd also like you to tell us about a problem you'd like us to explore to find the best solutions for our next edition of What Works. Call us, 800-989-8255. E-mail, Stay with us for that.

I'm Neal Conan. TALK OF THE NATION, NPR News.

(Soundbite of music)

Right now, we're talking about a new kind of nursing home, a concept created by our guest, Dr. Bill Thomas, call it the Green House Project. He's a geriatrician who also founded the Eden Alternative. This is the first in a series of programs we call What Works.

In a few minutes, we're going to ask for your suggestions on problems that you'd like to see us explore, anything from potholes to flight delays to homelessness and see if we can come up with the best solutions for you. You can start calling in now, 800-989-8255. E-mail,

Dr. Thomas is with us from the studios at Cornell University in Ithaca, New York. Joseph Shapiro, NPR's science correspondent, is with us here in Studio 3A.

Let's get another caller on the line. Michael(ph) calling. Michael's in Hillsborough, North Carolina.

MICHAEL (Caller): Hi, yes. I work in a rest home here in Hillsborough, North Carolina. And it's a pretty standard facility. They have assisted living, regular nursing home facilities, and about six months ago, they added a coffee shop. And we sell locally roasted coffee and it's made a world of difference for the residents. You know, I have residents that come down and I'll talk with them for an hour, an hour and a half, and their guests, you know, so they don't have to sit and talk in their room with their friends and family who come. I think it's a wonderful thing. All nursing homes should have coffee shops.

CONAN: So it's the equivalent of a living room where people can sit around and talk to each other.

MICHAEL: Yeah. You know, it makes it like a community coffee shop, you know? How you'd go with friends or neighbors to your coffee shop, kind of the same thing.

CONAN: And does it set up with couches and comfortable chairs?

MICHAEL: No, we have a couple of those. This is - you walk into it, it really looks just like an ordinary coffee shop, you know? Tables, chairs, and we do all sorts of sweets and things like that.

CONAN: Dr. Thomas, you describe yourself as a nursing home abolitionist. But in the meantime, there may be ways like that coffee shop to make them a little better.

Dr. THOMAS: Yeah. Actually, in - we can - that's great hearing of that story. I'm encouraged by it.

And actually, I've traveled a fair amount in Scandinavia and what you find there is that environments where the care for older people often, not always, but often, they build in services or businesses or - for the community right in so that there - the elders are part of the mix of the community. And I think it's a great strategy. We ought to use more of in the U.S.

CONAN: Michael, thanks very much.

MICHAEL: Thank you.

CONAN: And let's see if we can go now to Melissa(ph). Melissa with us from Louisville.

MELISSA (Caller): Yes, hi. My grandmother had the benefit of being in an Eden Alternative home last year. She lived at home until she was 95 and still was mentally alert and her worst fear ever was having to go to a nursing home. And this type of home situation was so amazing for her because as we transitioned her from her home where she'd been independently, she was in the Eden Alternative home with animals, gardens, light, all the things that were really important to her about continuing to (unintelligible), and she was able to, you know, interact with the residents, just the whole philosophy that Dr. Thomas has come up with is just so amazing. And it made it a good experience for us, even though it was something that we dreaded for many, many years.

CONAN: Yeah, the nursing home is one of those words, phrases that we dread -Alzheimer's another one, and too often, I think they may go together.

MELISSA: Right. And she did - you know, the thing for her was that she was mentally alert until the day before she died. And it just - you know, the thought of having to be somewhere where she was in an institutional setting was just her worst fear and our worst fear. So just the fact that it felt like home, it was a homey-type environment where she could continue to be herself and thrive instead of, you know, like the people he's given examples of just kind of becoming catatonic or, you know, becoming non-communicative.

CONAN: Melissa?

MELISSA: The fact that they had been in that type of environment, you know, was - it was great for us and. And the staff was - he said the staff satisfaction also seemed to be much higher in an environment like that, and I believe that it is.

CONAN: Melissa, thanks very much. Appreciate it.

MELISSA: Thank you.

CONAN: Joe Shapiro, one last question, is there any prospect of - well, you said these are mostly nonprofit institutions that are adopting this because they have different kinds of resources. Any prospect that this is going to become much more mainstream?

SHAPIRO: I think a lot of nursing homes that exist today are pretty old. The boom in building nursing homes was in the '60s and '70s, so as places have to replaced and build new ones - and this is a good model to do it, something that's small, more home-like.

If you're competing for people to come and you're competing against other facilities, and if you make something that's more friendly and home-like and you can build something that's small like this, then that will attract customers.

CONAN: Joe, we're going to ask you to stay with us.

Dr. Thomas, before we let you go, we're going to ask you one question that you might not expect. Is there one problem in the world outside of the nursing home situation, one problem that you'd like to see us tackle on this series?

Dr. THOMAS: Yes. You know what, here's what I need. I want to know how - if somebody can show me how to protect kind of the real economy of real jobs, and people making real things and real services, protect that economy from the finance economy, which gets so big and powerful and sort of distorts the way we live.

I'm a hands-on guy. I'm a person who really believes in local initiatives and local businesses. And I'd love to know how we can kind of restore the protection of the real economy from the finance economy.

SHAPIRO: How's that for a - Neal, go solve that one, would you?

CONAN: We'll be back with that in a couple of minutes. Okay. Dr. Thomas, thank you so much for your time today. We appreciate it.

Dr. THOMAS: Thanks. Bye-bye.

CONAN: Bill Thomas is a geriatrician, professor at the University of Maryland's Baltimore County's Erickson School, founder of the Eden Alternative, creator of the Green House Project, with us today from the studios of Cornell University in Ithaca, New York.

We want your ideas about problems that need to be solved that we can feature on this series, 800-989-8255. E-mail us,

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