Bringing life to the facility - management tips from Christian Retirement Center administrator Nicki Grant

Nursing Homes, Oct, 1999 by Laura Bruck

Nicki Grant is an unintentional pied piper of cats. "Wherever I go, homeless cats seem to find me," she says. During her nearly 12 years as the activities director at Bethesda Christian Retirement Center in Hayward, California, this has worked out well for both the cats and the independent and assisted living residents.

"The cats are spayed or neutered, given their shots and placed with our residents," she explains. Some residents bring their own cats with them to the independent and assisted living cottages, and one resident brought her dog. "Having a pet helps to ease the transition from home to a long-term care setting," says Grant, who provides the cat owners with litter and food, and even makes an occasional cat care "house call."

But it wasn't until Ted Grant, Bethesda's administrator - and Nicki Grant's husband - told her about what he had learned at an Eden Alternative seminar that she began to think about new ways of enriching the lives of Bethesda's skilled nursing residents, many of whom have Alzheimer's or other dementias. The Eden Alternative is Dr. William Thomas's prescription for the loneliness, helplessness and boredom experienced by many nursing home residents: the infusion of life into nursing homes via the constant presence of plants, animals and children. (See "Welcome to Eden," Nursing Homes 1997;46(1):28-33.) This philosophy greatly interested Grant, who hoped to implement the parts of Dr. Thomas's concepts she felt would best meet Bethesda's needs.

Selling the Idea

The Board of Directors gave Grant the go-ahead - as long as the funding came from a source other than Bethesda's operating budget. That's when Grant got busy. She had someone design and build two types of bird cages: small, mobile cages for resident rooms (which could be rolled in and out of the rooms so as not to interfere with daily care) and larger cages for common areas. She then took photographs of residents "sitting and staring at the walls." Armed with the photos and one of the cages, complete with two parakeets, she held two family meetings to explain the benefits of the Eden Alternative. The response was overwhelming, and the families donated more than enough money to get the project off the ground.

Grant then needed to win over the staff. "Initially, they were understandably concerned about the prospect of additional work, but were reassured when they heard that a core group of five or six supervisors from various departments would take on the bulk of the responsibilities." Additional concerns were allayed during six in-services, and the residents gave their consent for the new two- and four-legged "residents" during a Resident Council meeting.

The Transformation Begins

Working quickly before enthusiasm waned, Grant put out the word about her desire for animals in need of a home. In the meantime, the group of supervisors purchased several large plants for the facility's common areas, while family members bought plants for the residents' rooms. Finches, parakeets and cockatiels came in by the dozen - mostly from private bird owners - and canaries and lovebirds were purchased at the pet store.

The local animal shelter and veterinarians responded to the request for gentle, declawed cats, as did private cat owners. First to arrive was Milk, an older male who had actually been a therapy cat at a nursing home. Four others followed shortly, each with its own personality and routine.

An Evolving Vision

The beauty of Dr. Thomas's concept is that facilities can do as much or as little as they choose, adapting the ideas to their own specific needs. Grant, who is careful to say that Bethesda is not an "Edenized" facility, explains that her visions for the project changed during the first months of implementation.

For example, when scheduling problems squelched her vision of an after-school program for the employees' children, two or three housekeepers agreed to bring their preschool children to work with them every day. When it proved too difficult to keep an eye on Katie, an adopted collie, during the workday, the dog became a Grant family pet. Three employees with small dogs gladly agreed to bring their pets to work with them.

This core group of supervisors promptly responds to problems as they arise. A lock was placed on one of the bird cages after a resident put dangerous objects in the cage, and one of the cats failed to adjust to the new environment and was added to the Grant family menagerie. When Milk died less than a year after his arrival, the staff comforted the residents who had grown attached to him.

Hard Work Pays Off

The animals at Bethesda aren't part of a structured pet therapy program; they are therapeutic just by virtue of being there. Residents and staff quickly formed relationships with the animals and chose their favorites. "We've never had a single complaint," says Grant, "and there would be an uproar - especially from the nurses - if there were ever to be talk of discontinuing the program."

Today, there are birds in eight resident rooms, and the residents are often seen talking to and watching the birds in the three large cages in the hallways. The assisted and independent living residents frequently come to the main building to check on the animals.