NEW BERLIN, N.Y. - Mourning doves perch on an old man's shoulders. A greyhound snoozes in the sun. The air resounds with birdcalls, ragtime piano and the laughter of children skipping through a vine-draped arbor.
This congenial place is Chase Memorial Nursing Home. It's not a typical nursing home, to be sure. But if William H. Thomas has his way, it will be.
Dr. Thomas is on a mission to transform every nursing home in America into a place humming with life, where residents have a sense of community and purpose rather than loneliness and boredom.
He calls it the Eden Alternative, as in Garden of Eden. It's an alternative to the orderly, hospital-like environment that typifies modern geriatric facilities - what Dr. Thomas calls "hell on earth."
Chase was the first to undergo the transformation five years ago, when Dr. Thomas was medical director. More than 100 nursing homes across the country have followed suit, and many more conversions are in the works.
With his new book, Life Worth Living, Dr. Thomas hopes to inspire families of residents and anyone concerned about the elderly to join his crusade.
The book explains the Eden philosophy and provides a blueprint for putting it into action, from reorganization of staff into teams right down to the recommended type of cat litter.
With his bushy beard, rumpled shorts and well-worn Birkenstocks, Dr. Thomas, 36, doesn't fit the image of a doctor in looks or lifestyle. He built the solar-powered home where he lives with his wife and partner, Judy, and their three children. He also helps run an alternative school.
"Medicine is a fascinating way to earn a living, but my passion has always been homesteading," Dr. Thomas said in an interview at Chase.
"Now I can see that the Eden Alternative has elements of homesteading," Dr. Thomas said. "Growing vegetables. Enlivening the environment. Living close to nature. But that wasn't how it started."
It started when Dr. Thomas wondered why nursing homes are places people would rather avoid.
He planned to be a rural family doctor when he graduated from Harvard Medical School. He had no interest in geriatrics. "What good is treatment for people who cannot be cured?" he said.
Then he accepted an offer to be medical director at Chase. "It was more exciting than I ever thought possible," he said.
Chase, a nonprofit, 80-bed, modern facility, had an excellent record. But something was lacking. Like other conventional nursing homes, the emphasis was more on nursing than on home.
With the help of a $200,000 state and federal grant, Dr. Thomas developed the Eden Alternative at Chase to show how a radical change in outlook and operation could improve the quality of life for nursing-home residents.
The basic idea is to make life within a nursing home similar to life in the outside world. The Eden Alternative creates a diverse, sociable, dynamic human habitat where residents can feel they're useful members of a community.
Chase has two freely roaming dogs, four cats and 120 birds. Residents care for their own parakeets. They can work in the curving gardens of flowers, herbs and vegetables that have replaced the lawns.
Children are part of daily life, with after-school programs, a day-care center and a colorful playground and picnic area for families. There are hundreds of indoor plants, some covering trellises in sitting areas.
"I love my birds. I named them Rick and Ron," said Charlotte Baynes, 90, looking up from her wheelchair at the blue parakeets in her homey room. "This is the nicest place you could ever be if you're unable to live on your own."
"I was not in favor of this," said Roger Halbert, administrator at Chase for 25 years. "I wasn't a bird person. And I certainly wasn't in favor of two dogs and four cats."
Some employees and residents also were leery of the changes, Mr. Halbert said. But now he and virtually everyone else is a true convert.
"I wouldn't go back," Mr. Halbert said. "We were good before. But we're so much better now."
Despite fears, infections and allergies decreased. The number of medications used for depression, anxiety and other mental disorders was reduced from about six or seven per resident to two or three.
Other nursing homes report similar success with the Eden Alternative.
"It actually revolutionizes nursing homes," said Dr. John Morley, medical director at NHC Maryland Heights in St. Louis, a 200-bed nursing home run by a for-profit chain.
"It brings in a lot of visitors, children, volunteers," Dr. Morley said. "We've seen a lot of people who were very depressed do very well, when they hadn't responded to drugs."
Dr. Morley said one woman, a former jazz singer, was too depressed to get out of bed. Now she comes out and sings with her cockatiel on her shoulder.
At the 211-bed Tioga Campus in Waverly, N.Y., which was converted to an Eden home two years ago, administrator Maria Landy said "the difference in residents is dramatic."
"It has become a place to live instead of a place to die," she said.
Tioga Campus has 98 kindergarten children, 350 birds, 1,000 plants, a Shetland pony, six cats and six dogs, some of which can operate the elevators.
Ms. Landy tells of a woman who disliked physical therapy machines. Now she gets the arm work she needs by brushing a pony's mane. The animals also provide a stimulus for people with Alzheimer's and other forms of dementia.
"The more demented people are, the more they need this," Dr. Thomas said. "The average stay in a nursing home is three years. For someone who has no memories, who can't speak, who has no opportunity to connect, that's 1,000 days of solitary confinement."
Dr. Thomas is working with state governments in Missouri, Texas, Alabama, Indiana and North Carolina to promote the Eden plan. Through the Eden Alternative Foundation, he trains others to teach the ideas and methods.
"The Eden Alternative doesn't make a nursing home into a paradise. No way," Dr. Thomas said. "It's still a place you'd rather avoid.
"But we can make it more acceptable. When you focus on life right to the end, rather than disease and disability, it changes things around."