At some point in life, you can't live on your own anymore. We don't like thinking about it, but after retirement age, about half of us eventually move into a nursing home, usually around age 80. It remains your most likely final address outside of a hospital.

To the extent that there is much public discussion about this phase of life, it's about getting more control over our deaths (with living wills and the like). But we don't much talk about getting more control over our lives in such places. It's as if we've given up on the idea. And that's a problem.

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Certainly, nursing homes have come a long way from the fire-trap warehouses they used to be. But it seems we've settled on a belief that a life of worth and engagement is not possible once you lose independence.

There has been, however, a small band of renegades who disagree. They've created alternatives with names like the Green House Project, the Pioneer Network, and the Eden Alternative ? all aiming to replace institutions for the disabled elderly with genuine homes.

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"The No. 1 problem I see," Dr. Thomas told me, "is that people believe what we have in old age is as good as we can expect." As a result, families don't press nursing homes with hard questions like, "How do you plan to change in the next year?" But we should, if we want to hope for something more than safety in our old age.

"This is my last hurrah," the woman I met said. "This room is where I'll die. But it won't be anytime soon." And indeed, physically she's done well. All she needs now is a life worth living for.

Atul Gawande, a surgeon at Brigham and Women's Hospital in Boston and a New Yorker staff writer, is the author of the new book "Better."

This satellite broadcast and Webcast will provide for State Agency surveyors and supervisors as well as nursing home providers a discussion concerning aspects of medical and nursing care as well as diet planning that two innovative nursing homes have changed due to their commitment to culture change. The show includes CMS policy guidance concerning compliance and the survey process from CMS Central office and Regional office personnel.

We talk a lot about how important community is for elders and while they don?t replace personal contact, the Internet and email have opened many doors, some of them surprising, for elders to connect with others and have their voice heard.

Because computers have become one of society?s main sources of communication, information and entertainment, I would like to encourage nursing homes to find a way to offer computer access and simple training to residents so they are not left out of this very large part of our culture and community. In fact, a staff person could help a resident set up a blog as an individual activity. A blog is a great opportunity for an elder to document their history, tell stories and lend perspective to friends and family far away as well as the folks in their nursing home. If you are in the process of a deep and long-term culture change, get an elder to blog on your own website to give updates and comments on the change from a resident?s point of view. Who?s going to be the first to do that?

But, we?re doing more than advocating for livable communities, we?re helping to build them. Our idea is that attractive model livable communities will entice other cities and towns to follow suit - all across the country.

Last fall, I was in Hartford, Connecticut where we announced with our partner, Rebuilding Together, that Asylum Hill, one of that city?s most historic and architecturally striking neighborhoods?and now, sadly, one of its poorest?would be one of our model communities. We?re working to turn Asylum Hill from a neighborhood in distress to a model livable community where people of all ages can live safely and independently and take part in community life. It will be an attractive model for other neighborhoods.

Our other model towns include Burlington, Vermont; Traverse City, Michigan; and El Paso, Texas. In making these communities more livable for older residents, we will be promoting livable communities for all?across the nation."

The living proof that Teresian House is really HOME, and that the elders who live there feel at home, is evidenced by the following which is shared with you with Sister Mary?s permission.

Sister Mary Ranney is a 95-year-old Religious of the Sacred Heart. She moved from the convent retirement center, Kenwood, to Teresian House (located on Washington Ave), some months ago. She wrote the following which was included in the Sisters? community-wide newsletter. (?Bunny? is the name of one of the Sisters who visit there weekly. There are, incidentally, Sisters there every day VISITING, HELPING, ADVOCATING, as a part of their job description.)