The promise, practice, and problems of the Eden alternative: one facility's learning experience

Nursing Homes, Dec, 2003 by Bethany G. Sampsell

It is estimated that 76 million baby boomers are getting ready to enter long-term care (LTC) facilities over the next 25 years. Many were privileged to grow up in a health-conscious environment that promoted various forms of social and recreational diversity. These future LTC residents will demand independence and physical activities, and will exhibit intellectual curiosity, spirituality, caring, tolerance for others, and self-forgiveness.

Clearly these baby boomers will not be satisfied with the current LTC routine of being cared for with standard medical treatments only, a focus that promotes a healthy body, but does nothing to foster a healthy mind and spirit. (1) In view of this, the traditional LTC facility is in desperate need of reform. In the traditional LTC environment, the residents relinquish control of their lives and become isolated from the community. (2) Staff controls personal activities such as bathing, dressing, and toileting. Life becomes a burdensome, scheduled daily routine.

Long-term care is becoming an increasingly competitive market, forcing facilities to adopt nontraditional principles to attract new residents. The Eden Alternative[TM] (EA) is one such option that may hold the answers to many of the issues faced by these facilities and their residents. Its implementation, though, presents challenges.

The following discussion describes the process of "Edenization," as applied in one large facility, and the resulting successes and problems of that process. The facility in question has all levels of care, but the main focus of Eden implementation has been in the 450-bed LTC setting where residents receive around-the-clock care.

Successes

A number of successes have been realized. Residents are now more involved and more responsive to new activities such as walking the facility's animals, sharing time with children from an of campus day care center and local school The residents are participating increasingly in their own care. This change in the "nursing home environment" has been accomplished by making the residents' needs a priority and the facility's needs secondary.

Examples of this prioritization include allowing residents to choose their bath times, mealtimes, and wardrobes. Staff is taking an active role in working with and learning about each resident; as staff work and interact with each resident, and review the resident's history, they learn about the resident's work history, family and significant others, hobbies, habits, and likes and dislikes, and they incorporate this knowledge in helping manage the resident's daily life.

Basic to the EA, animals, plants, and children play an active role at the facility. Dogs, cats, birds, and fish are all visible, and the residents join, at least in part, in caring for and loving them. Children from the on-campus day care come and seek instructions from residents, who teach and mentor them, and actively participate with them in activities. Family members look forward to visiting the residents because they too enjoy the transformation from the typical, sterile LTC setting to a more homelike environment.

The manner in which managers interact with the nursing staff and CNAs is slowly changing. The facility recognizes that it needs continued improvement in its approach to management; decision-making power is gradually being distributed to frontline staff, such as CNAs, allowing them to respond to residents' needs and wants. For example, if a resident would like to change his/her mealtime or wants to eat outside instead of in the dining room, the CNAs are allowed and encouraged to make these changes without first seeking approval from their managers. As a result of these efforts to divest decision-making power, the organization has experienced a significant decrease in staff turnover and a significant increase in overall staff satisfaction.

The facility continues to invest resources in getting residents and staff to understand and promote the Eden concept. The organization is indeed transforming into an Eden facility, realizing that it takes time, commitment, and a willingness to recognize and learn from mistakes to achieve the goal of Edenization.

Challenges

Nevertheless, three years after implementing the EA, the organization continues to face significant challenges. For example, the facility's large size has been an inherent obstacle to implementation. Attempting to educate sufficient numbers of the right employees, residents, and management on the EA concept has proven difficult. Although the organization has provided numerous educational sessions, only seven management-level employees have actually gone through the training necessary to become certified "Eden Associates." Most of the certified associates are middle--to upper-management-level employees who have responsibilities across the campus in areas other than LTC, and who do not provide day-to-day frontline care. Training too few employees with too many diverse responsibilities along with not fully involving the frontline staff (CNAs and LPNs), most particularly by failing to select one of them to be an associate-has led to an insufficient level of education regarding the EA, particularly among those who conduct day-to-day patient care.