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When 84-year-old Tillie Venear moved from a conventional nursing home to a different kind of facility, one based on a philosophy of care called the "Eden Alternative," she seemed to regain her once-spunky personality and even recall memories that had seemed lost to Alzheimer's disease. What was it about her new surroundings that accounted for her improvement?
Unlike in controlled studies with lab animals, it's impossible to pinpoint neurological changes that a so-called "enriched environment" might trigger in a human being. It's also difficult to tease out what factors—social, emotional, and cognitive—are most at play when someone like Tillie Venear becomes more lucid. But her case is not unique, and it's possible to define the sort of environment in which she and others have thrived.
In our virtual world, explore the eight essential elements of what Dr. William Thomas, founder of the Eden Alternative movement, calls a "human habitat." Unsurprisingly, the characteristics that make a home more hospitable for older folks are qualities that can benefit people of any age.—Susan K. Lewis
Companion animals help combat what Thomas calls the three plagues of most long-term care facilities—loneliness, helplessness, and boredom. Animals live at Eden homes, rather than just visit as part of therapy programs, so that both animals and humans can form strong bonds. Even frail older people feel empowered and needed as they assist with pet care. While pets may not stop the advance of Alzheimer's disease, research has shown that animals can relieve anxiety and enhance socialization in people with dementia.
Staff members see themselves as "carepartners" doing important work, not menial laborers changing bedpans and administering medications. They are consistently stationed in the same areas, called "neighborhoods" or "households," as those under their care, so they can build meaningful relationships with them. Such relationships not only help the elders, leading in some cases to a reduced need for medication. They also improve job satisfaction for the staff, who learn from residents. Thomas notes, "Elders teach us patience, tolerance, forgiveness, compassion, unconditional love—all those things that make us human."
Autonomy and choice
In some nursing homes, residents rarely make decisions for themselves and can't set the rhythm of their daily lives. In the Eden Alternative, elders choose when to get up, what to eat, what activities they want to do, and when to go to bed. They may also plan meals and social events, create traditions, and even help with the interviewing and hiring of staff. While residents with dementia may not be capable of such broader decision-making, they can still exercise choices that enhance their dignity.
Relationships with children
Children don't simply drop by to sing carols on holidays. Instead, they are an integral part of an Eden home, forming meaningful relationships with residents. There may be on-site day care, where the children of staff interact with elders, as well as ties to nearby elementary schools and summer camps. Children benefit by hearing the life stories of older people, and they bring vitality and spontaneity into elders' lives. Research has shown that even patients with severe dementia become more engaged in activities when children are involved.
Being known well
No one should be known as a room number or diagnosis. All individuals—residents and staff alike—should be recognized for their uniqueness and their part in the community. Some residents can share their talents and mentor others. Everyone should have opportunities for growth that draw on his or her interests and abilities. Even older people with dementia are more likely to take on new challenges if they are known well by those around them.
Connections with nature
The Eden movement is built on the metaphor of a garden in which all inhabitants thrive, but actual flower and vegetable gardens also play a role in this nurturing. Tending tomato plants or tulip beds, elders have the satisfaction of doing meaningful work and the pride of sharing the harvest. Studies have shown that gardens comfort patients with dementia, and specially designed "healing gardens" can even stimulate positive emotions and memories.
Traditions and celebrations
"Meaningless activity corrodes the human spirit," says Thomas. "The opportunity to do things that we find meaningful is essential to human health." Elders and staff join together with family members to create their own traditions around holidays, birthdays, anniversaries, and even simple pleasures like watching a baseball game. By taking part in traditions and rituals, new residents and staff blend into the social fabric of the community.
Meals with good friends
Few pleasures beat sharing good food with people we know well. Planning and making meals are also among life's most basic activities, yet in conventional nursing homes, older people are removed from these rituals of daily life. In Eden homes, if they choose, residents take part in creating meals. They also have "refrigerator rights"—access to kitchens and foods they like at all times. Various strategies help ensure that even socially withdrawn elders feel comfortable joining staff and fellow residents for meals.
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