Welcome to Eden - nursing home care; Eden Alternative

Nursing Homes, Jan, 1997 by Laura Bruck

They're injecting nursing homes with life - in all its forms

Being the sole physician and medical director of an 80-bed nursing home in rural New York State wasn't exactly Dr. William Thomas' dream job. He had, in fact, always done his best to avoid nursing homes. Nevertheless, Dr. Thomas rolled up his sleeves and started doing what was expected of him - taking care of residents' medical problems. Before long, though, he realized that "all the Lasix in the world wasn't going to touch what was really ailing those people" - the loneliness, helplessness and boredom that Dr. Thomas now refers to as "the three plagues of nursing homes."

He decided to find a "cure."

He believes he found one. Four years later, the mortality rate at Chase Memorial Nursing Home is down by more than 15%, medication use has declined significantly, nurse aide turnover has dropped by 26%, and residents' loneliness, helplessness and boredom have yielded to companionship, self-sufficiency and (many will tell you) a sense of joy.

Dr. Thomas' "cure" is a holistic approach to care known as the Eden Alternative. He describes it as "the creation of a 'human habitat' where people thrive, grow and flourish, rather than wither, decay and die." To create this habitat, "edenized" facilities are literally infused with life, in the form of plants, animals and children.

Bringing animals and children into nursing homes is not a new idea, it's how one thinks about it. Dr. Thomas cautions against "taking parts of a life well lived and turning them into therapy: affectionate touch becomes touch therapy, contact with animals becomes animal therapy." Instead, plants, animals and children are part of the day-to-day lives of the residents and staff of edenized facilities; they are not "therapeutic activities."

Plants are placed where people actually live, rather than just in the lobby for show. Rather than being part of a structured "pet therapy" program, animals in these facilities are considered therapeutic simply by virtue of being there, providing close and continuing contact. This is companionship, says Dr. Thomas, and "companionship is the only antidote for loneliness."

Ongoing school programs ensure that the same children return to the edenized facilities each day, giving them a chance to build relationships with the residents. "If nursing homes are truly medical treatment facilities," says Dr. Thomas, "children have no place there. If, however, they are genuine homes, children belong there everyday."

With this infusion of life comes the unexpected and, at times, even the chaotic. To the Eden Alternative, that is as it should be. It is this break in routine and monotony that makes life interesting and enjoyable. It is the ultimate enemy of boredom.

Change, especially of such a fundamental nature, is never easy in the nursing home, and facilities that commit to the Eden Alternative undergo nothing less than a total transformation. This requires, not surprisingly, a complete attitudinal shift from everyone involved. Dr. Thomas stresses that none of this is possible unless the people "at the top" are leaders, rather than simply managers.

Today, more than 100 skilled nursing facilities in Missouri, Texas, Alabama, North Carolina and New York have undertaken that challenge, and facilities in Minnesota, Michigan and Nebraska are preparing to do so. Dr. Thomas acknowledges that the process is a difficult, time-consuming one. But, he maintains, "none of those who have met the challenge would ever want to go back."

Initial resistance at Chase - and, believe it, there was quite a bit - came in the form of questions: "You're buying parakeets? Why not give us a raise instead?" "Do you really think I'm going to clean up after a dog? That's not my job." And so on, as one might imagine. Then there were the logistical problems - like the arrival of 120 birds and their cages (unassembled in flat cardboard boxes). "We stumbled and fell at times," Dr. Thomas recalls, "but we kept pushing. In the end, resistance became tolerance and, finally, acceptance as the vision began to materialize."

Of course, state surveyors would have serious problems with this - wouldn't they? Quite the contrary, says Dr. Thomas. Sanitary concerns are, of course, of primary importance, but are easily allayed by conscientious - and enthusiastic - staff. Beyond that, OBRA regulations focus on creating a "home" for facility residents, and surveyors have recognized this in the Eden Alternative (see "The Bureaucrat's Eye-View," p. 33).

For some providers, though, Dr. Thomas' message seems to compete with the unrelenting pressures of overregulation and underreimbursement. "I know I'll never reach the providers who feel that all obligation for change is on the 'outside,'" he says, "but they have been the minority in my experience. Most I know are adopting a proactive approach to change, rather than simply waiting for it to occur and then reacting. For these providers, the message is getting through loud and clear."

The Eden Alternative In Action