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Can a Nursing Home Be Like the Garden of Eden?
Posted on Mon, July 20, 2009 at 10:42 am
If you ask the founder of the ‘Eden Alternative’, Dr. William H. Thomas, he would offer a resounding ‘yes’. But he would carefully qualify that with a big ‘if’: if and only if nursing homes make fundamental changes to the way they provide care. He suggests that we must shift our focus from the medical model, to a holistic approach in which we view and support the whole person (psychological, mental, social, and physiological). Such a vision and paradigm shift can, evidently, make positive and lasting impacts on the health, happiness, and general well-being of all individuals.
Dr. Thomas was a Harvard trained medical student who spent some time working in a nursing home during his residency. After completing his work in a nursing home, he vowed to himself that he would never return because the atmosphere was one of death, decline, and chronic disease, all of which seemed to be the antithesis of the goal of medicine which is to rehabilitate, recuperate, or revive the patient. Because of this, he changed his focus to obstetrics with the goal of bringing new life into the world. However, after working in this department and the emergency ward, he truly missed developing the close relationships with patients. To his surprise, he accepted a position as the medical director and sole physician at a nursing home.
In his new position, he quickly realized that the fundamental problems with the way in which nursing homes provide care is that the focus was on treatment alone, and not care. To understand this difference, he offers the analogy of a parent giving care for a sick child compared to a physician dealing with the same situation. A parent takes the child’s temperature, determines that she has a fever, tucks her into bed with her favourite blanket and teddy bear, makes a fresh batch of soup, brings her her favourite juice, gives her some medicine, and cuddles with her until she falls asleep. This continues until the fever comes down. A physician, however, takes the child’s temperature, gives a dose of medicine, and advises her to return only if the fever continues beyond three days. The parent cares for the child, whereas the physician simply treated the child. Which approach do you think is more effective? What approach would you prefer for yourself?
In order for Nursing Homes to move to a philosophy of care, as opposed to merely treatment, Dr. Thomas outlined three fundamental principles of care which need to be carefully heeded:
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Recognize a person’s capacity to grow. If we hinder growth, disease is imminent. If we view older adults as stagnant and unable to grow, we will treat them accordingly, and they will lose their zest for life.
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Focus on an individual’s needs, instead of their abilities. We simply cannot view nursing home residents as functions of their needs, or merely based upon the medically prescribed (or not) reasons that they were admitted. Elderly people are much more than just dehumanizing descriptors such as ‘needs assistance with eating’, or ‘requires help with bathing and dressing’. We need to shift our focus to the abilities of nursing home residents, and recognize that encouraging and developing their abilities, likes, and interests, can be just as important, as tending to their needs.
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Care is continual. If a nursing home has a caring philosophy and staff care for residents, the home’s atmosphere will be one of warmth, comfort, and security. The feeling should be of a true home.
Today’s medical model focus requires us to think in terms of physical symptoms and problems, and to prescribe medications that are required to remedy a disease or illness. However, Dr. Thomas realized that there was much more to it, and came to the remarkable realization that heart disease, hypertension, and cancer were not the main causes of death among nursing home residents. Rather it was loneliness, helplessness, and boredom that slowly and relentlessly stripped away residents’ love of life and ultimately, caused death. The solutions then were easy to come by: residents simply needed proper care, variety, and companionship, which would be food for their souls.
It seems impossible not to smile at the sight of a child. They have an innocence, genuine happiness, and love of life that is infectious. Dr. Thomas’ designed ‘Eden Alternative’ homes have onsite child-care, after school programs, and summer camps. Children obviously benefit by participating in these programs, but residents gain from interacting with the children and feeding off their energy.
Animals are also integral to any Eden Alternative home, such that no home can truly be ‘Edenized’ without the presence of a variety of animals in large numbers. Each resident should have a bird in his/her room, which provides companionship, but more importantly, allows the resident to care for the animals and makes them feel needed. Residents that are cognitively impaired also develop a strong attachment to birds, which emphasizes the fact that all people, regardless of their cognitive ability have both a need to be loved, and to love.
Dogs and cats play an especially important role in an Eden Alternative home. Dr. Thomas writes about a dog which stood by the side of a resident who had fallen and barked until a staff came to their aid. Dogs and cats quickly become members of the family and residents become very protective of them and interested in helping staff care for and feed the animals.
Dr. Thomas outlines the principles of his ‘Eden Alternative’:
- Understand that loneliness, helplessness, and boredom account for the bulk of suffering in a typical nursing home.
- Commits itself to surrendering the institutional point of view and adopts the human habitat model that makes pets, plant, and children the pivots for daily life in the nursing home.
- Provides easy access to companionship by promoting close and continuing contact between the elements of the human habitat and residents.
- Provides opportunities to give as well as to receive care by promoting resident participation in the daily round of activities that are necessary to maintain the habitat.
- Imbues daily life with variety and spontaneity by creating an environment in which unexpected an unpredictable interactions and happenings can take place.
- De-emphasize the programmed-activities approach to life and devote those resources to the maintenance and growth of the habitat.
- De-emphasize the role of prescription drugs in the residents’ daily life and commit these resources to the maintenance and growth of the habitat.
- De-emphasize top-down bureaucratic authority in the home and seek instead to place the maximum possible decision-making authority either with the residents or in the hands of those closest to the residents.
- Understand that Edenizing is a process, not a program, and that the habitat, once created, should be helpful to grow and to develop.
- Is blessed with leadership that places the need to improve residents’ quality of life over and above the inevitable objections to change. Leadership is the lifeblood of this process, and nothing can be substituted for it.”
Although the principles of the Eden Alternative sound beneficial and enjoyable to residents, is there any proof that residents really do prosper in this environment? Dr. Thomas measured several variables before and after implementing the Eden Alternative in an Edenized home, and a non-Edenized home (control group). The average cost of medication per resident per day was just $1.44 in the Edenized home compared to $2.32 in the control group. The average cost per prescription was $14.41 in the Edenized home, and $16.80 in the control group. Compared to the control group, the Edenized home had lower monthly average numbers of prescriptions per residents and it significantly reduced the percentage of residents prescribed psychotropic drugs. By reducing the number of staffing hours needed for drug administration, the hours can be moved to activities that help reduce loneliness and boredom. After implementing the Eden Alternative, the home reported 15% few deaths, compared to the non-Edenized home. The statistics convincingly suggest that the Eden Alternative significantly benefited the health and general well-being of residents. When asked why the Eden Alternative works, Dr. Thomas responds simply, “Because it gives them a reason to live.”
For more information on the Eden Alternative, or to find out if there is an Eden Alternative home in your area, please visit www.edenalternative.org. Unfortunately, most Eden Alternative Homes are not named accordingly so are not immediately recognizable as an `Eden Alternative`. You will notice this if you set out to find one on our Canadian database of Nursing Homes on www.nursinghomeratings.ca.
Dr. Thomas’ (1996) book is titled, “Life Worth Living. How Someone You Love Can Still Enjoy Life in a Nursing Home”. Acton, Massachusetts: VanderWyk & Burnham.
Christine Taylor
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