(Not) the Same Old Story

Typically, an Eden nursing home is divided into neighborhoods, with a staff that knows the residents personally -- their background and interests as well as their medications. There's all sorts of activity: children playing, dogs and cats visiting rooms, birds chirping. The institution becomes a close-knit community teeming with life.

The transformation, however, is often arduous. Creating an Eden home involves major organizational and cultural change, because the facility has to think differently about care, priorities, and old habits. For instance, the residents have more input into how the facility operates, as do the staff members who work closest with them -- a shift that often proves difficult for traditional-minded administrators.

"Out of all the people we've talked to about creating Eden homes, no one says, 'This is a horrible idea,' " says Jude Thomas, who conducts Eden workshops with her husband. "But some people think that all they have to do is bring in a dog, and everything will be better. It won't be. This is an entirely different philosophy. It's a total change."

Voices in the Garden (Part I) Jane Lough, administrator, Toomsboro Nursing Center, Toomsboro, Georgia: "This one lady, Mrs. Miller, dressed nicely every day and got her hair done once a week for the first year and a half she was here. Then she went into the hospital for pneumonia, and when she came back, she wouldn't get out of bed. She gave up. So I got her a blue parakeet named Mercy, and we put the cage on an IV pole next to her bed. She would feed it crackers and sing to it. After three or four months, she got up, got her hair done, and started going everywhere with Mercy. She'd tell people she loved that bird."

Mission: Overcoming the Three Plagues

After graduating from Harvard Medical School, Bill Thomas had his heart set on the emergency room. He liked the action and the adrenaline rush. But in 1991, after completing his residency in family medicine at the University of Rochester, he tried something different: becoming the physician at Chase Memorial Nursing Home in New Berlin, New York. He discovered that he enjoyed working with the elderly, getting to know them, hearing their stories. He also discovered that nursing homes were seriously flawed -- even the best-performing facilities. At Chase, the equipment was up-to-date, the staff was dedicated, and the inspection record was spotless. Yet the residents were miserable. "What appalled me was how lonely and bored they were," Thomas says. "It was painfully obvious to me that they were dying in front of my eyes."

He concluded that nursing-home residents suffer from three plagues: loneliness, helplessness, and boredom. They feel lonely because they've been uprooted from their family, friends, and even their pets. They feel helpless because they've lost control of their lives; for the most part, they eat, sleep, get dressed, and bathe according to the institution's schedule. Finally, they feel bored because the few activities that are available to them, such as watching television, aren't meaningful or fulfilling. "Care for the elderly is not simply about health care or medicine or technology," Thomas says. "It's about creating the right environment and caring relationships that sustain an older adult in his last years."

While working at Chase, Thomas received a $200,000 grant to improve life for the facility's residents. The experiment gave rise to Eden Alternative. Bringing animals into nursing homes was not a new idea, but in the past, they were usually brought in for visits. They didn't live on the premises, as Thomas prefers. That way, the animals become companions, and the residents grow attached to them. As one of the 10 Eden principles says, "Loving companionship is the antidote to loneliness."

If the elders -- Thomas finds the term more dignified -- are able, they lend a hand in grooming or feeding the animals, watering plants, or reading with children. These activities not only allow residents to engage in everyday physical therapy, but they also satisfy another fundamental human need, one that often gets neglected: giving care, as opposed to only receiving it.

At Eden facilities, residents and staff are partners. Whenever possible, the two groups work together, voting on what type of pet to add or what type of decorations to put up. Staff members understand that what they call the workplace is a far more intimate and personal place to residents: It's home. And that understanding shapes decisions. Eden removes hierarchical or autocratic management. Like the residents, the certified nurse assistants, who make up the bulk of the staff, have more control over their schedules and help make decisions about how to divvy up work. "What you find is that as the managers do to the staff, the staff does to the elders," says Thomas. "So if you treat the staff well, the elders will benefit."