Some thoughts on the Eden Alternative

I recently spoke at a conference for nursing home staff with Brent Pace and our topic was how to apply the principles of the Eden Alternative within nursing homes. I really like the idea of the Eden Alternative and the wisdom in the principles as they are outlined. However, anyone who has been in a nursing home knows that it is no easy task to apply these principles in a meaningful way. Many are underfunded and understaffed and even more resist the fundamental change that would be necessary to really incorporate the ideas of the Eden Alternative. Although you may see some plants and even some animals you rarely see the spirit of the Eden Alternative being applied in nursing homes.

As we worked through some ideas about change with our audience, which was mostly social workers, we heard some good ideas from people who had made the effort to effect change in their facilities. One of the most profound things I heard was from a social worker who said that we need to make the environments more like homes where nursing takes place rather than the other way around. I really like this idea because I think it gets at the heart of the problem with most nursing homes – they don’t pay enough attention to the individual needs of their residents. I understand that it is easier and more efficient for the staff if all of the residents do things the same way (if they eat the same food and bathe the same way and even if they are all in wheel chairs so it is easier and quicker to move them around), but this forced homogenization does not make for good quality of life. When this issue is raised there is the common refrain – we do not have enough staff to do things differently.

While I think the problem is more complex that just under staffing, I do think that many facilities are understaffed in the social service and recreation areas and this often leads to programs that are designed so that everyone can participate. These programs are often very simple and of little interest to the higher functioning residents. One possible solution to this is to get more people in from the community to help. I offer three possible sources of extra help 1- university students – find students that have to have service learning hours as part of their classes and get them to into the facility to get those hours 2- family members – many family members have special skills that could be put to use in the nursing home (teaching crafts or other skills – musical performance) and 3- the unemployed – work with the local agencies to get people who are unemployed to volunteer in the nursing home while they are looking for a job – it will be a great service and could keep them from feeling unproductive. 

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