The Eden Alternative for the Health Care Industry
Excerpt from website: http://www.edenmidwest.com/about_eden.html
The Eden Alternative:
More Than Just Fuzzy Props and Potted Plants
A child's giggle.. a cockatiel's screech.. a bouquet's sweet fragrance.. the thumping tail of a dog greeting his elder master..
..these are a few of the elements in a new strategy many nursing homes are adopting to build caring communities for the living, rather than mere treatment institutions for the dying.
It's all part of the Eden Alternative, the brainchild of Dr. William Thomas, a physician dedicated to transforming the sterile environs that breed loneliness, helplessness and boredom into fertile gardens for nurturing social and spiritual growth for nursing home residents and staff alike.
"The traditional nursing home gives you three meals a day, but no reason to live," writes Dr. Thomas in his award-winning book, Life Worth Living. "We must get people hooked on living. That will result in fewer medications and lower mortality rates."
Preliminary results in monitored Eden Alternative pilot projects around the country seem to support his predictions:
In Texas, reductions of:
- 33% in the use of PRN medications for anxiety and depression;
- 44% in staff absenteeism, and
- 60% in in-house decubitus ulcers are reported.
In Milwaukee, the Lakewood Health and Rehabilitation Center reports a 51% lower staff turnover rate, and the use of restraint has dropped from 123 to 40 for an average population of 220 residents.
In upstate New York, the original Eden Alternative pilot home saw a 26% reduction in turnover of nurses' aides, and a 50% drop in residents' infection rates. Meanwhile, the project's medication costs fell while those at a control facility rose during the same period.
Even more intriguing, 25% fewer deaths were reported at the New York pilot home than at the control facility. That's because the Eden Alternative "..[satisfies] the fundamental need for a reason to live," rather than giving into disease and frailty, Dr. Thomas surmises.
The Eden Alternative has its roots in a 1990 pilot project seeded with a grant from the state of New York. Dr. Thomas collaborated with caregivers at an 80-bed to devise creative ways to serve residents who were experiencing dementia. He soon realized that he had no easy prescription to ease the complexity of suffering among the elders. They received plenty of care, but had no way to give of themselves; they were immersed in group living, but were profoundly lonely; and they were given diversionary activities with little variety or spontaneity, and were literally bored to death.
Confidence and respect was lacking among the staff, who felt that they had little input and control over their daily work.
Dr. Thomas and the caregivers devised a plan and set to work. They transformed the home by bringing in hundreds of plants, adopted animals - two dogs, six cats and over a hundred birds - as live-in pets, and incorporated people of all ages into the daily life of the nursing home.
The infusion of new life made a tremendous difference for residents like Sally who, out of loneliness, constantly pulled her call light to summon staff for simple questions or petty complaints. After adopting Elly the parakeet, Sally rarely used her call light as she busied herself with the care of her new pet.
But more than adding a few fuzzy props and potted plants, the pilot project germinated a new set of principles and tools to revolutionize the way care is provided in nursing homes. The staff was restructured into permanent care teams designed to serve a particular "neighbourhood" of elders according to their special needs. The teams - consisting of nursing, social services, housekeeping, dietary, activities and other staff with diverse skills - continually design and implement innovations in care together.
Each team participated in extensive training in communication and problem solving. As team members became more skilled, they took on additional responsibilities for the day-to-day operations. Some teams became responsible for self-scheduling. Many similar teams in homes across the country also consist of the elders themselves, family members, or advocates.
It's imperative, stresses Dr. Thomas in his newest book, Open Hearts, Open Minds, that all staff members be involved in creating a vision of how the Eden Alternative principles can be implemented in their nursing homes. Without this shared vision, combined with staff education about the principles, the implementation of the Eden Alternative will not succeed.
The entire transformation process from vision to implementation can take from three to five years, depending on the individual organization, says Dr. Thomas. Three to five years!
Why would anyone make that kind of commitment in an industry that is requiring more services for less reimbursement, and experiencing low census rates?
"Because it's the right thing to do," as Dr. Thomas states simply in his many training and motivational presentations.
The traditional system is based on an assumption that the elders' most important problems are disease, disability and decline, he says. In response to that assumption, we created treatment, the provision of competent comprehensive therapeutic services. Though it may be given in a compassionate and sensitive manner, treatment is different from providing care. Care is helping another to grow.
So our systems for "caring" are actually systems for "treatment." These systems ultimately stifle the elders' needs for psychosocial and spiritual growth. This, in turn, supports the stigma of nursing homes as a horrible place to die, rather than a desirable place to live and grow. No surprise, then, that dissatisfaction with this system is rampant.
Dr. Thomas is convinced that nursing homes can and will be different, and he is committed to making it happen now.
He is not the only one.
Over three hundred people have participated in intensive, Eden Alternative Certification programs, and more than a hundred nursing homes across the country have committed to the principles and have started the journey of transforming their homes. In North Carolina and Texas, grant programs have even been developed to aid facilities in training and education about the initial phase of the Eden Alternative process.
The Eden Alternative emphasize the need to collect research to add to the growing body of information on the outcomes of this revolutionary process, and provides software to aid organizations in collecting and tabulating data.
There is an active website, www.edenalt.com, that provides information and serves as a connection point for people to share ideas and to warn about pitfalls. Regional Coordinators have been appointed to promote education about the Eden Alternative, and create a registry program to recognize organizations that make a commitment to change. Here in the Midwest, we are also establishing an active presence on the web at www.edenmidwest.com/. There you will find more information on Eden Associate Training and other events, as well as pertinent news items and other helpful information.
Article written by Megan Hannan and Keith Schaeffer.