For the past several months, I have been consulting as a speech/language pathologist at a nursing and rehabilitation facility in a small upstate New York town.
Initially, it seemed like the building was in the middle of nowhere…a small town that had likely seen better days. However, after a time, I realized it was a short distance from the nursing home Dr. Bill Thomas transformed and chronicled in his book “Life Worth Living.” A nursing home that offered a quality of life and quality of care unprecedented before that time. A transformation where people were surrounded by life: birds, dogs, cats, and plants, rather than the depressing, dreary institutional environments that give way to lackluster lives. Surrounded by life, residents found purpose in caring for something greater than themselves. That was the birth of the Eden Alternative.
Having grown up in rural, upstate New York, it struck Dr. Thomas that life on a farm—in
particular, the need to take care of other living things, whether plants or animals—could possibly the missing ingredient needed in the nursing home: life itself. He developed a proposal to bring life in every form into the nursing home. His proposal was massive—two dogs for each of the two floors, two cats for each floor, and plants and birds, one hundred of them. But these animals did not casually “pass-through” on a particular schedule as in many facilities.
They lived in the building. He also wanted to develop a program to have children become part of the daily lives and fabric of the nursing home.
Dr. Thomas personally lobbied lawmakers in Albany to obtain the necessary approvals and present his grant proposal. He was successful in both areas.
Implementing such a grandiose plan was not easy. As one could imagine, there was resistance on many levels. However, as life from the outside was brought inside, transformation began to happen. That has turned the tide in peoples’ attitudes. Residents who hadn’t spoken began to speak. People who hadn’t been walking suddenly began asking if they could take the dog for a walk. The parakeets were adopted and given names. The menagerie of animals grew to include rabbits and egg-laying hens.
Change in people’s behavior when caring for plants was demonstrated as early as the 1970s in a study by Judith Rodin and Ellen Langer. They divided residents into two groups.
Group 1 was given autonomy over their lives and surroundings. They were allowed to arrange the furniture in their rooms any way they liked, go where they wanted, do what they wanted, and with whom they wanted. Each person was also given a plant to water and care for. Isn’t this what we do in our own everyday lives?
Group 2 was told that the staff was there to care for them and water the plant.
The result of the eighteen-month-long study bears out what happened at Chase Memorial. The residents in group one who exercised autonomy over their lives and had responsibility for the plant
demonstrated improved health. There was little to no change for the residents in group two, and there was an increased proportion in the number of deaths.
A comparative study of the residents of Chase Memorial with another local nursing home over two years revealed similarly astonishing results. The number of prescription drugs needed fell by one- half, especially the need for psychotropic medications like Haldol. Total pharmacy bill costs fell to just 38 percent of the other facility, and deaths decreased by 1.5 percent.
THE GREEN HOUSE PROJECT—THE EDEN ALTERNATIVE
In 2000, Dr. Bill Thomas wanted to build a nursing home from the ground up that would incorporate what he learned from Chase Memorial Home. He wanted it to be affordable it was essential that it have a homelike feel as opposed to a the traditional hospital like environment that typify many nursing home facilities.
An organization in Tupelo, Mississippi, agreed to build what came to be known as “Green Houses.” Each home had ten to twelve private bedrooms with private bathrooms and was arranged around communal living areas and kitchen.
The residents, known as elders, were also involved in planning their own menus. There is a strong difference in culture and attitude in these Green Houses. The person centered care, with its emphasis on team building and leadership, provides greater satisfaction, greater sense of community, and more involvement from both staff and residents/elders.
Studies found that residents who lived in these Green Houses were happier and experienced a better quality of life. Furthermore, staff members were more satisfied with their jobs, and there was less staff turnover. Staff reported feeling less rushed, less stressed, and less guilty.
The Robert Wood Johnson Foundation in 2005 funded a five-year grant program in the United States to develop what is now known as the Green House Project. It is a nonprofit organization, the purpose of which was to develop and build alternatives to traditional nursing home facilities at various locations throughout the United States. After the initial five-year grant, the project continued.
Government agencies have become aware of the benefits of Green Houses, and this led the public housing authority in Loveland, Colorado, to build a Green House. Residents who live in a Green House experience more privacy, autonomy, satisfaction with food and a higher level of dignity. There is evidence that residents living in Green House Project homes demonstrate increased mobility, have more social interactions, and have fewer reports of weight loss and depression.
A 2004 report presented to the United States Congress from researchers at the School of Public Health at the University of Minnesota found that a more socialized model of care, along with empowering staff to serve those elders who needed skilled nursing care demonstrated statistically significant, favorable outcomes over traditional facilities.
In November 2008, Max Baucus (D-MT), chairman of the Senate Finance Committee, said that the Green House Project model “has shown promise for both improving the quality of life and care in these settings.”
The Green House concept is not solely about the architectural design. It is based on a philosophy about prioritizing the individual and providing compassionate and respectful care. This is the concept at the heart of the design.
Upon finishing my 3-month stint in this small nursing home, I began to query: upon seeing what Chase Memorial delivered regarding improved quality of life and quality of care, why hadn’t other facilities in close proximity adopted even in small-part what was clearly a successful care model?”
What is even more troubling is learning that the new ownership of Chase Memorial has retained only sparse remnants of the Eden environment. Despite that fact, the reputation for what it offers to residents and patients in the form of quality of care and quality of life is well-known in the area.
Our elder citizens deserve respect for the lives they have lived. Sadly, one can say the greatest number of living environments in the US do not provide a “life worth living.” They are mediocre at best; people remain lonely, isolated, and without the warmth and love that is a fundamental human need.
This is the unfortunate state of eldercare in America. In order to be the best advocate for an elder person—your mother, father, husband, wife, grandmother, grandfather, sister, brother, beloved aunt or uncle, or even a close friend—it is vital to take a hard look at how the elderly are being treated in these facilities.
The term nursing home is better suited for what the situation is meant to be. These places are intended to be a person’s living environment, a person’s home, a place where they have to live for various reasons as they continue their life’s journey. As such, these “nursing homes” should provide a comforting living environment with the proper care to accommodate an individual’s physical, mental, or
functional limitations.
As of September 2013, it is estimated that 70% of adults aged 65 years and above will require long-term care at some point in their lives, with an average length of stay of 3.2 years. Additionally, a little over 20% of those 65 and above will require care for 5 years or longer. The annual cost to the American economy was estimated to be $475.1 Billion.
Our aging population does not appear to be receiving care equal to the amount of
money being spent.
How we care for this segment of our population reveals much about our society and our
underlying values. The assurance that every individual deserves the highest quality of life as they continue through life’s journey is one that each of us wants for ourselves.
This is our basic human right. We are all responsible for being part of this discussion, for as we are all “evolving elders,” we will eventually be part of this population. As Stanislaw Jerzy Lec said, “No snowflake in an avalanche ever feels responsible.” The funding, staff development and training, research, and continued oversight of our long-term-care facilities will determine the quality of our future. Each one of us should be willing to speak out on this issue, not only for our loved ones but for ourselves.
Wikipedia defines old age as: “nearing or surpassing the life expectancy of human beings and thus the end of the life cycle.”
In some way, we’ve created a brand, an image in people’s minds, of what older people are like, how they behave, what they are able to do, and how much they can still contribute. Yet some people act “old” at forty, and ninety-year-olds who act in a way much younger than their chronological age. We’ve all heard the rare individual who says, “I’m ninety years young.” This is not a contradiction in terms, not something to be laughed at, but an attitude to be admired. I’m sure I am not alone when I say I have known individuals in their eighties and nineties who are alert, spry, and have a sharpness of wit second to none. According to a theory known as stereotype embodiment, as a child, if you think older adults are weak and frail, that will most likely
become a self-fulfilling prophecy as you yourself age. A person can unconsciously internalize this idea across the span of their lifetime.
Thus, attitudes toward aging are essentially a social stigma that is artificially manufactured as a result of societal and social thought.
A young man at a conference shared with me a philosophy he heard from a gentleman friend from Ghana, which reflects a total departure from the traditional way of thinking, which, if adopted, can impact our attitudes towards older adults.
It is said that when a young child dies in America, we mourn it as a tragedy for the loss of the potential and an unfulfilled life; but when an “old” person dies, though mourned, we consider that they have lived a full life and reached their potential. However, death is
viewed from a different perspective in Ghana. When a young child dies, the child’s passing, while tragic, represents an unfulfilled life, and therefore, the loss of what has not yet been revealed is not as tragic as the loss of an old person. When an elderly person dies, it is considered that a library is lost.
“The greatest disease in the West today is not TB or leprosy; it is being unloved, unwanted and uncared for. We can cure physical diseases with medicine, but the only cure for loneliness, despair and hopelessness is love.” ---- Mother Theresa
When will our society love our elders?