Being Mortal: Medicine and What Matters in the End

Lou was impressed from the first moments of the tour, when the guide mentioned something Shelley barely noted. All the rooms were single. Every nursing home Lou had ever seen had shared rooms. Losing his privacy had been among the things that scared him most. Solitude was fundamental to him. He thought he’d go crazy without it.

 

“My wife used to say I was a loner, but I’m not. I just like my time alone,” he told me. So when the tour guide said that the Florence Center had single rooms, “I said, ‘You must be kidding!’” The tour had only begun and already he was sold.

 

Then the guide took them through it. They called the place a Green House. He didn’t know what that meant. All he knew was, “It didn’t look like a nursing home to me.”

 

“What did it look like?” I asked.

 

“A home,” he said.

 

That was the doing of Bill Thomas. After launching the Eden Alternative, he had grown restless. He was by temperament a serial entrepreneur, though without the money. He and his wife, Jude, set up a not-for-profit organization that has since taught the Eden principles to people from hundreds of nursing homes. They then became cofounders of the Pioneer Network, a kind of club for the growing number of people committed to the reinvention of elder care. It does not endorse any particular model. It simply advocates for changes that can transform our medically dominated culture of care for the elderly.

 

Around 2000, Thomas got a new itch. He wanted to build a home for the elderly from the ground up instead of, as he’d done in New Berlin, from the inside out. He called what he wanted to build a Green House. The plan was for it to be, as he put it, “a sheep in wolf’s clothing.” It needed to look to the government like a nursing home, in order to qualify for public nursing home payments, and also to cost no more than other nursing homes. It needed to have the technologies and capabilities to help people regardless of how severely disabled or impaired they might become. Yet it needed to feel to families, residents, and the people who worked there like a home, not an institution. With funding from the not-for-profit Robert Wood Johnson Foundation, he built the first Green House in Tupelo, Mississippi, in partnership with an Eden Alternative nursing home that had decided to build new units. Not long afterward, the foundation launched the National Green House Replication Initiative, which supported the construction of more than 150 Green Houses in twenty-five states—among them the Leonard Florence Center for Living that Lou had toured.

 

Whether it was that first home for a dozen people in a Tupelo neighborhood or the ten homes that were built in the Florence Center’s six-story building, the principles have remained unchanged and echo those of other pioneers. All Green Houses are small and communal. None has more than twelve residents. At the Florence Center, the floors have two wings, each called a Green House, where about ten people live together. The residences are designed to be warm and homey—with ordinary furniture, a living room with a hearth, family-style meals around one big table, a front door with a doorbell. And they are designed to pursue the idea that a life worth living can be created, in this case, by focusing on food, homemaking, and befriending others.

 

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