Intervention models for nursing homes (I): The Eden Alternative

It's 8:00 in the morning. The sun shines today and there's a good temperature. I rested well; I didn't sleep much or little, what my body asked me. I feel strong enough to face the day ahead. Soon the nurse will come; I need some help to clean up and get dressed. I think I'm going to wear my blue checkered shirt with the pleated skirt today. I like it hot so I don't have to wear socks. I won't be reading the paper after breakfast today; the news has been repeating itself a lot lately. Instead, I'm going to ask Maria, my walking companion, to take me straight to the garden to check that the land of petunias hasn't dried up too much. When I brought them from home, they were a bit wilted, but now they are perfectly adapted. If my memory serves me right, I have a 12 o'clock appointment for rehabilitation. My legs don't move by themselves, but they still need a little stimulation. I'll be free by lunchtime. I don't have to cook today; I already spent some time yesterday washing potatoes to make the mash. I used to peel them too, but I'm getting less and less skilled with a knife. If I'm tired, I'll take a nap; if not, I think at 4 o'clock there was a computer workshop - yes, a computer workshop! We are printing photos that are sent to the centre's email address by family and friends to decorate our rooms and living room. I thought about it! Not everyone participates; many are terrified of new technologies and prefer to do other things: enjoy the colors. Alberto said he misses his grandchildren, whom he has always taken care of, and since they live far away and see little of them, he has offered to take care of the children of a family that lives very close by and works almost always in the facilities at night. You have to see! He even kicks the ball! My friend Maria, who has a very lucid mind, has organized a chess workshop and is teaching neighbourhood adults to play chess in the morning. I don't want to learn right now. When I finish the photos, I'm going to help out at the laundry for a while because there are lots of towels to fold: there are almost fifty of us here. By the time I get tired, it'll be dinner time. Tonight I will only watch TV for a while because tomorrow is Saturday and I have to rest for the cultural day: some of us who are natives of Murcia will teach the rest our folklore. We have been preparing it for weeks! I'm really excited that others know who I am and where I come from. 

Sounds good, doesn't it? This story is fictional, but it can be completely true; that of someone who is able to choose what their daily routine will consist of, what activities make them feel at home and act as a person, who preserves their independence as much as possible, and who is given the opportunity to explore their talents and abilities. She does not seem to be a resident who lives in a hospital centre and is chased around by boredom. This is possible, it is within our reach, and in fact it has already materialized in many senior centers that apply one-person-centered intervention models. 

Until the 1990s, there was only one model of care home in the world: the resident-centred medical model, which we spoke about in the previous post. Nursing homes were structures organised around a hierarchical hospital standard that tried to meet criteria of efficiency, standardisation, production and cost optimisation and with the regulations in force. The internal atmosphere of these places was very similar in all cases: a reception at the entrance and residents following very specific routines with few opportunities for development and personal expression. The priority was to cover physical needs and less attention was given to social and spiritual needs. 

A report by the United States Senate Special Committee on Ageing in the 1970s showed that half of the inmates in U.S. residences were worse off after admission because they spent 56% of the day doing nothing but in their rooms. Then the Nursing Home Reform Act, as part of the Omnibus Reconciliation Act (OBRA), decided in 1987 to introduce a number of innovations in the nursing home model to promote a cultural change in the services offered in these facilities. The aim was to draw attention to the values of each individual and to listen with more respect to the voices of the elderly.

In this context, the first real initiative came in 1991, from Dr. Bill Thomas. It was called The Eden Alternative (TEA). It is an international non-profit organization dedicated to creating quality of life for seniors and their caregivers. Its promoters defend that, independently of the age that one has, it is necessary to fight to continue growing. And this can only be achieved when care for the elderly does not become a one-way street, but a collaborative association. In TEA they prefer to call both nurses and interns "care partners", because both parties must give and receive to ensure the proper functioning of the center. Both strive to improve the community's sense of well-being by promoting a climate in which there is no room for what they call "the three plagues": loneliness, helplessness and boredom. 

Initially, TEA was intended for nursing homes, but over time it has spread to any elder care setting, including home care (Eden at Home). Any facility or caregiver interested in your project can have access to the necessary education in its principles and practices to ensure dignified aging of its residents. So, what do these principles consist of? 

The 10 principles of The Eden Alternative are:

1. Recognize boredom, loneliness and helplessness as major risk factors.
2. Create an elder-centered community where there is continuous contact with plants, animals and children. 
3. Facilitate the company of others. 
4. Exchange care between older people and nurses, family members, friends, neighbours, volunteers and other older people. 
5. Give free rein to variety and spontaneity in activities. 
6. Ensure access to meaningful activities arising from the initiatives of the inmates. 
7. Place medical treatment at the service of human care. 
8. Smooth out hierarchies by giving the maximum possible authority in decision making to the elders. 
9. To promote human growth in an infinite learning process. 
10. To have a competent directive capable of training others in this philosophy. 

Dr. Thomas envisioned a caring environment in which people could "live and thrive, not just wait to die. This required fighting the three plagues of nursing homes: against loneliness, by creating a community centred on the residents themselves, who were allowed contact with other living beings, capable of offering company, to whom they could give and from whom they could receive care; against boredom, by leaving room for creativity and the unexpected through the promotion of meaningful activities; against impotence, by ensuring that no one saw his or her growth possibilities diminished by medical treatment, by creating an environment in which feedback prevailed and by supporting self-determination based on respect for the ideals, aspirations and abilities of the elderly. One of the practices that makes this initiative so interesting, for example, is the regular, spontaneous and planned meetings between residents and carers in which important issues identified by the former are discussed and in which together they make decisions about the running of the centre. This is the way to create communities where life is worth living. 

This is demonstrated by studies that have been conducted on The Eden Alternative. One of them, conducted by The Texas Long Term Care Institute, showed that centers that have implemented this intervention model report 60% fewer incidents related to inmate behavior, 57% fewer patient ulcers, 25% fewer residents who go to bed, and an 11% increase in the census. Another from Elmhurst Extended Care revealed 63% fewer employee assaults and that nursing hours were reduced to zero. 

TEA's intervention model has so far trained over 30,000 professionals worldwide and has led to hundreds of senior centers being "Edenized. It has a team of trainers who take its philosophy outside the United States to places like Canada, Australia, New Zealand, the United Kingdom, Denmark, Sweden, Norway, Finland, Iceland, the Netherlands, Austria, Germany, Switzerland and Mauritania. If The Eden Alternative is in the top 10 of the most influential and successful innovations in the care of the elderly, why have we in Spain remained on the sidelines of this Edenic project?