A habitat for humans, not a cold institution

Reforms: Radical changes that make nursing homes humane turn out to be good medicine

Life After 50

September 26, 1999|By Mary Moorhead | Mary Moorhead,Knight Ridder/Tribune

Are nursing homes destined to be understaffed medical institutions where the sick and demented sit in wheelchairs, staring and waiting to die? Is change possible?

Back in 1991, as administrator of New York's Chase Memorial Nursing Home, the Harvard- educated Dr. William Thomas decided change was necessary. Striving to eliminate "loneliness, boredom and helplessness" and to create an ambience like the "outside world," Thomas secured a $200,000 state and federal grant and initiated radical reforms.

To the normal array of hospital beds, medications and shiny linoleum floors, Thomas added "freely roaming dogs, four cats, 120 birds, flower and vegetable gardens and children." Nursing-home residents soon watered and fed their own plants and cared for the pets and birds. A children's after-school program and a day-care center became part of daily life. There was even a picnic area for visiting families.

Thomas calls his revolution a "Human Habitat" and the ensuing program, now spreading slowly throughout the country, is the Eden Alternative. Thomas presents the Eden Alternative in his book, "Life Worth Living" (VanderWyk & Burnham, $17.95), and his supporters have developed a comprehensive program designed to help nursing homes understand and develop a "Human Habitat."

"The Ten Principles of the Eden Alternative" asks traditional nursing home administrators and staff some unorthodox and challenging questions. What companionship is provided to combat loneliness? What opportunities do residents have to give care? Are plants, animals and children the axis around which daily life turns? How many residents share a dog or cat? Are residents given the opportunity to help children grow?

Equally provocative, the 10 principles emphasize a novel approach to staffing. Stressing staff education and interdisciplinary teamwork, Eden strives "to de-emphasize the top-down bureaucracy in facilities" and give maximum decision-making authority to residents and those closest to them. The principles ask: Are there planning teams consisting of residents, family members, staff and community? Are teams empowered to make decisions?

And the Eden Golden Rule states, "As management does unto staff, so shall staff do unto residents."

I can picture nursing home administrators really sweating about these proposed staff changes and the thought of 120 birds in a facility. You're probably thinking: "That's impossible. How would you control all those animals? What about infections and allergies? What would the State Department of Health Services inspection team do?"

At Chase, infections and allergies actually decreased, as did medication usage for depression, anxiety and agitation. Furthermore, Debbie Cavallo, Eden's enthusiastic head of Western Region 8, said both residents and staff do well under the changes. In one facility, staff turnover was reduced from 106 percent to 12 percent. Also, studies of "Edenizing" facilities by the Southwest Texas State University Institute for Quality Improvement in Long Term Health Care have reported decreases in pressure sores, medication usage for anxiety and depression and staff absenteeism.

Thomas' book describes how he won over the New York State Department of Health Services and the Regional Surveyors office. Surveyors were so impressed with Eden's results, they "overlooked" the 137 animals. Additionally, the state passed legislation that permits nursing homes to pursue all aspects of the Eden Alternative.

Perhaps, as Eden's mission statement says, it can be different. More nursing homes should consider joining the growing coalition of homes that are "habitats for human beings rather than institutions for the frail elderly."

For more information, call Debbie Cavallo at 619-484-1661, or check out the Eden Alternative Web site at www.edenalt. com. Or contact the Eden Alternative, 742 Turnpike Road, Sherburne, N.Y., 14360; or phone 607-674-5232.

Mary B. Moorhead is a licensed family therapist and elder-care specialist. Write to her at 1664 Solano Ave., Berkeley, Calif. 94707. Or e-mail her at mbmoorhead@aol.com.

Senior events

Fitness program: Take a six-week low-impact exercise program and improve overall fitness, muscular strength and flexibility, Tuesdays and Thursdays from Tuesdaythrough Nov. 2 at 2 p.m. at Good Samaritan Hospital, 5601 Loch Raven Blvd. $45. Call 410-532-3838 to register.

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