HealthStream’s vision:  To improve the quality of healthcare by developing the people who deliver care.  To that end, we are always looking for individuals and organizations that exhibit best practices that can be shared throughout the healthcare industry.  One such example is Eden Alternative, a nonprofit organization dedicated to improving the way healthcare for the elderly is delivered in America.  While this article will focus on Eden Alternative’s groundbreaking approach to elder care, their driving philosophies can be applied to virtually any healthcare environment.

What’s Wrong with Elder Care Right Now?

When dealing with younger patients, addressing the concerns of their lives outside of care is rarely a necessary concern.  By definition, acute care hospitals focus on getting the patient back to a healthy life as quickly as possible.  Senior citizens’ lives often are often the actual environment where they are cared for.  By treating seniors with the same mindset of treating everyone else, something important is lost in translation:  Life.

“One of our most important principles focuses on the need for plants, animals, and children to be a big part of elder care.  Leadership must give permission to do things that are not on the schedule.  Chaos helps sometimes.  Even just a scene of a dog chasing a cat can light up a room full of senior citizens—and it lights up the staff as well!” said Judy Thomas of Eden Alternative.

Healthcare providers are (understandably) focused on procedures, schedules, and order.  The science of healthcare delivery often dictates such an approach.  But Eden Alternative seeks to change this paradigm, because living can sometimes be the best ‘medicine’ you can give a patient.

Who is Eden Alternative?

The Eden Alternative has the potential of remaking the experience of aging and disability across America and around the world. It is a powerful tool for improving quality of life. To make that happen, however, they seek to teach others about what The Eden Alternative is and how they can use it to transform the communities in which they work. They create coalitions of people and organizations that are committed to creating better social and physical environments for people. They are dedicated to helping others create enlivening environments and the elimination of the plagues of Loneliness, Helplessness, and Boredom.

The core concept of The Eden Alternative is strikingly simple. We must teach ourselves to see the environments as habitats for human beings rather than facilities for the frail and elderly. We must learn what Mother Nature has to teach us about the creation of vibrant, vigorous habitats.  The Eden Alternative shows how companion animals, the opportunity to give meaningful care to other living creatures, and the variety and spontaneity that mark an enlivened environment can succeed where pills and therapies fail. Their goal is to help people weave together the philosophy of Eden Alternative with the real world of daily practice.

The Eden Alternative’s Ten Principles of Elder Care

Eden Alternative was founded by Bill and Judy Thomas and is operated on a farm in Sherburne, New York.  To frame their vision, here are the Ten Principles of Eden Alternative:

1.  The three plagues of loneliness, helplessness and boredom account for the bulk of suffering among our Elders.

2.  An Elder-centered community commits to creating a Human Habitat where life revolves around close and continuing contact with plants, animals and children. It is these relationships that provide the young and old alike with a pathway to a life worth living.

3.  Loving companionship is the antidote to loneliness. Elders deserve easy access to human and animal companionship.

4.  An Elder-centered community creates opportunity to give as well as receive care. This is the antidote to helplessness.

5.  An Elder-centered community imbues daily life with variety and spontaneity by creating an environment in which unexpected and unpredictable interactions and happenings can take place. This is the antidote to boredom.

6.  Meaningless activity corrodes the human spirit. The opportunity to do things that we find meaningful is essential to human health.

7.  Medical treatment should be the servant of genuine human caring, never its master.

8.  An Elder-centered community honors its Elders by de-emphasizing top-down bureaucratic authority, seeking instead to place the maximum possible decision-making authority into the hands of the Elders or into the hands of those closest to them.

9.  Creating an Elder-centered community is a never-ending process. Human growth must never be separated from human life.

10.  Wise leadership is the lifeblood of any struggle against the three plagues. For it, there can be no substitute.

“We seek to create neighborhoods—not a staff/patient environment.  One of the best ways to accomplish this is through sharing decisions.  Ask the seniors, ‘What would you like to do today?’  By encouraging active participation from everybody—staff and elders alike—you have effectively conquered one of the three plagues of the elderly:  boredom.  But the principle to give as well as receive care can be incredibly transformational for any elder care facility.  Give them the opportunity to share recipes, choose menus, water the plants, feed the animals, and help other elders, and you have given their day—their life—purpose.  You’ve made living worthwhile,” said Judy Thomas.

Typically, elder care is designed to give, give, give.  Give meds, give therapy, give instruction, give counseling.  It is this approach that drives helplessness among our elderly.  The human spirit requires giving and receiving.  This is why Eden Alternative promotes the presence of plants, animals, and children.  But they don’t stop there.  “If all you do for elder care is add plants, animals, and children, then you end up with a facility that has plants, animals, and children.  You’ve got to create a culture to support living—and that takes organizational changes, strong communication, recognition, and empowerment, for both the staff and the elderly,” said Judy Thomas.  “You’ve got to build a home, not a facility.”

The Results

Carole Ende, Eden Alternative Support Associate, understands that people unfamiliar with the Eden Alternative approach often need quantifiable proof of its efficacy.   “How can you measure warmth?  When people visit elder care centers that have embraced the Eden Alternative principles, they often are left pleasantly perplexed.  They can feel that something is different.  It feels like home,” said Ende.  “However, Eden Alternative principles aren’t just the right thing to do—they also produce quantifiable results.”  

Elmhurst Extended Care in Providence, Rhode Island has been partnered with Eden Alternative since 2002, and has been participating in Eden Alternative training, seminars, and retreats. Everyone knows that culture change is a long process. The people at Elmhurst were smart about not coming back from those inspiring experiences with Bill & Judy Thomas and announcing massive change all at once—they didn't set the doom loop in motion! Instead, they asked themselves what they could stop doing to allow relationships to develop among staff and residents in their 192-bed organization. So they stopped moving nursing assistants around the organization and implemented permanent assignments, and then they let the "units" evolve into neighborhoods.  The results they have achieved speak for themselves:

“It is common for Eden-centered facilities to see a drop in turnover, an increase in census, and a decrease in unfavorable clinical outcomes.  It’s not only the kind thing to do—it’s the right thing to do!” said Judy Thomas.