Geriatrician and author Bill Thomas is best known for being at the forefront of a movement to improve life in long-term care facilities that came to be known as “culture change.” His “Eden Alternative” homes, built on a small scale and making room for amenities like plants and pets, were seen as a way to counteract the nursing home “plagues of loneliness, helplessness and boredom.” In 2003, he brought this message to Sarasota and more than 12 years later, the aging landscape has shifted.

Thomas’ latest attempt to change the way America sees later life is a piece of performance art he calls “nonfiction theater.” His “Age of Disruption Tour” recently swept through five Florida cities — but not Sarasota, an omission he promised to correct next time, when he and Smith met up again in Tampa for a short talk about long life.

Q: What has happened to culture change? It all made so much sense.

A: Looking back on it, I think culture change was making a powerful moral argument. It was compelling, and in many ways it was right and true. But that moral argument was never effectively translated into a practical argument.

I’m not saying anything wrong about people …

Q: There’s almost no one in the elder care business who hates old people.

A: Right. So reasonable people heard the moral argument, balanced it against practical considerations, and in nearly every case, practical considerations won. So there are these great moral champions out there who are flying the banner and advancing culture change, but the vast, vast majority did not accept the challenge to change the culture of their organizations.

And so 15 years later, most nursing homes are the same as they were 15 years ago. That’s what happened.

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