by Tyra Phipps, Ed. D. (tyra.phipps@gmail.com)
Hooverwood located in Indianapolis, Indiana
What is the Eden Alternative? In 2004, the Eden Alternative task force included experts that listed seven primary Domains of Well-Being. Well-being is defined as a “path to a life worth living.” Dr. Bill Thomas answered the question, “What Are Old People For?” He states, “Well-being is a much larger idea than either quality of life or customer satisfaction. It is based on a holistic understanding of human needs and capacities. Well-being is elusive, highly subjective, and the most valuable of all human possessions.”
What follows from the Eden Alternative is a list of the unmet needs for people we care about:
IDENTITY—being well-known; having personhood; individuality; having a history
GROWTH—development; enrichment; expanding; evolving
AUTONOMY—liberty; self-determination; choice; freedom
SECURITY—freedom from doubt, anxiety, or fear; safety; privacy; dignity; respect
CONNECTEDNESS—belonging; engaged; involved; connected to time, place, and nature
MEANING—significance; heart; hope; value; purpose; sacredness
JOY—happiness; pleasure; delight; contentment; enjoyment
With the Eden Alternative, all aspects of daily operations are reconsidered and re-framed to focus first on the unique needs and preferences of the individuals
who live and work there. In establishing goals for personal and organizational growth, organizations must consider how to best live out each Principle to benefit the overall
well-being of Elders and their care partners, as well as the organization as a whole.
The departmentalized, task-orientation of institutional models have created a culture in long-term care that is characterized by pessimism and cynicism. By moving away from top-down bureaucratic approaches to management and moving decision-making closer to the Elders themselves, Edenizing organizations are creating a vibrant, empowered existence for the Elders they serve and the people who work closely with them in residential care environments.
The Eden Alternative mission recommends improving well-being of Elders and their partners by transforming the communities in which they live.
The vision is to eliminate loneliness, helplessness, and boredom.
The Eden values are innovation, integrity, community, empowerment, and passion.
On December 21, 2015, Dr. Gerald Thompkins wrote, “In 1999, we had to place my mother in Hooverwood Nursing Home (pictured above) in Indianapolis. Hooverwood, which was built for the Jewish community and a premier nursing home. They were very selective about who they admitted. By the 90s, they were beginning to admit a few blacks who had the financial means and education to reside there. But the overwhelming majority were Jews. My mother was a resident there for a very short period of time, probably less than six months. During that time, she developed bedsores on the heels of her feet. The nursing staff was not turning her nor were they getting her up to make her somewhat ambulatory. The sores were so deep, you could literally put the tip of your index finger into the wound. Her condition got to the point that she had to be re-admitted to St. Vincent Hospital. Her primary care doctor told me that gangrene was present and that amputation was necessary. I think my mom knew that she was dying and refused to have the procedure. She was admitted to Hooverwood around July of 1999 and died in November of that same year. My confidence in all assisted living facilities and nursing homes is non-existent. In 2000, Hooverwood sent me a bill for my mother's stay. I wrote them back informing them that she had died in November and that she had no assets. I also informed them that if she had any assets, we would not be paying anything due to their negligence that attributed to subsequent hospitalization and death. They never responded to my letter.”
On December 29, 2015, Ms. Diane Lutton contributed this personal story. “I can’t imagine what it must be like in long-term care. Bob’s mom is in a dementia ward over in Clearwater. Of all the people I know, she is the least likely one who should be there. She was always a wonderful person and served people all of her life. Then she stayed by herself too long. I truly believe she lost her mind. We tried to include her in our lives is much as possible. Took her places with us when we were doing festivals. She was a joy to have around. She is slipping away very quickly. I am just so sorry for this precious woman who was always there for me when I came out of the hospital every time! She is a precious soul. At times, she wants to go home and another time she think she is in home… So, so sad”
Finding Eden Alternative facilities is difficult. However, finding elements of Eden can help ensure that a loved one will have better care. This begins with management. Seek out a facility where management is not top-down! Find the facility where relationships are valued, rather than marginalized or ignored. Low turnover of staff is imperative. It will make the resident feel more secure, less fearful, and family members can be assured that their loved one’s needs are being met. Meaningful relationships do exist in long-term care facilities, but they are facilitated by the lower-level members of the staff that have the most contact with the elders. As of this writing, the demand for assisted living and nursing units with adequate staffing and care is far greater than the supply.
Questions for Consideration:
1. Does the Eden Alternative for elder care really exist? Yes, it does, but it is difficult to find. Start researching now and do the groundwork before the crisis stage.
2. The first thing to look for in trying to find the Eden approach is evaluating the management. Is it top-down? That in itself presents the worst model of elder care. Anyone in management should depend on the voices of the lowest level of workers to include nursing aides, dietary assistants, housekeeping, and maintenance. Talk to a nursing aide, or someone in maintenance and see how she or he feels about management. If the response is, “I can’t say anything or I may lose my job,” look elsewhere. Chances are this facility is rampant with paranoia among the staff and it will spill over to the loved ones you are trying to protect.
3. Do people sit around the facility staring into space without anything to do? Are the residents encouraged to attend activities that are boring? Even if the activity is engaging, notice if there are enough staff to help the elders who might need more encouragement to stay involved. All too often, residents are pushed in wheelchairs to an activity and just left to fall asleep. That is the facility where the task is accomplished and anyone on staff can say “We take them to activities all the time.” It does not mean that a loved one’s mind is engaged in conscious thought nor is there any meaningful socialization. Without any meaningful activities or human exchanges, residents in long-term care slip away mentally very quickly and give up.
4. To find the serenity of Eden, get beyond the entrance of any long-term care facility. Visit the floors and watch, look, listen. Is there a group of people falling asleep with an exercise video blaring on a television monitor? Is there music playing in the background over the loudspeaker system with the constant interruption of paging announcements that are even louder? Are there a number of televisions with loud volume coming from the rooms? Chances are that people in those rooms have lost hearing, may have even taken out their hearing aids and fallen asleep. A resident can only try to survive in that atmosphere. Anyone with dementia struggles even more to cope.
5. Wide awake in the middle of the night? Hungry in the middle of the night? Sundown syndrome usually affects people with dementia and begins at sunset. It can be a confusion and agitation that sets in early evening. These people are known as sundowners. They are awake during the night and sleep during the day, but it may not be just a behavioral issue. Part of the aging process involves a change in the brain. Circadian rhythms that once allowed an individual brain to release melatonin and move into sleep are interrupted for some unknown reason. This discovery is recent, so many people have suffered unnecessarily with the agitation and sleeplessness that led physicians to prescribe sleep aids. The ensuing problem with grogginess, confusion, and greater agitation only leads to a faster decline. Find out if the physicians at the facility prescribed melatonin for sleeplessness or sundown syndrome. In this case, the holistic approach is more beneficial for a loved one.
January, 2016