Caring, Elder-Centered Communities

An inevitable part of life is loss. No one knows this more than elders who, due to declining health and incapacity, are forced to give up their homes. Remaining in one's home should always be the goal. Many programs, like those offered through the local HESSCO Elder Services, help elders remain in their homes by offering assistance with daily living, home-delivered meals, adult day care, and respite for stressed family caregivers. But when elders need 24-hour nursing care, or when Alzheimer's disease has taken its toll, all the homecare support in the world may not be enough.

We often hear the horror stories about nursing homes, reports of substandard care and neglect. We rarely, though, hear about those that are doing things right, where elders are given a chance, not just to exist, but to thrive. Physician-farmer William Thomas has created a nursing home model that does just that. Thomas' approach, recently profiled in US New & World Report, is unique but simple, innovative, but born of pure common sense.

Thomas brought his perspective as a farmer - of nurturing, planting and growing - to the world of nursing homes. In the early 90s, he instituted dramatic changes in the upstate New York nursing home he directed. This is no ordinary nursing home. It has dogs and cats and birds and plants. Instead of rigid rules - waking residents at the same time for breakfast, providing care according to the convenience of shift workers - the home has a resident-focused approach. People eat when they're hungry, sleep when they're tired, talk when they're feeling sociable, remain silent when they want to think and reflect.

The positive results of this approach were seen in statistics: a 50 percent decrease in infection, 71 percent dip in daily drug costs for each resident, and a 26 percent drop in nurse's aide turnover. The Eden Alternative, as it is called, is a philosophy that views nursing homes as "habitats for people rather than facilities for the frail."

Thomas has converted more than 500 nursing homes in the U.S. and abroad into models that replace scheduled institutional care with more humane elder-centered care.

Another of Thomas' innovations, the Green House Project, has led to the construction of over 100 nursing homes with small clusters of houses. The smaller units are designed for 8 to 10 residents, and include private bathrooms and kitchens.

They are described as "intentional communities where elders can receive assistance and clinical care without the assistance and care becoming the focus of their existence." Unlike standard institutions, these places are much more like home.

Concepts like "smaller size, client-centered and intentional programming" are nothing new. School systems have known for years that smaller is better. Middle schools are often organized into teams, creating an environment that fosters personal connections between students and teachers. Large high schools work to create more intimate schools-within-schools. And everyone knows that small class sizes are preferable to larger ones.

Good quality child care is child-centered, intentional. It builds everything - the physical environment, activities, the way staff interact with children - around the developmental needs and interests of children. Quality programs for older school-age children plan with kids, not for them. They address the unique needs of adolescents by providing opportunities for physical activity, social interaction, leadership and meaningful activities connected to the real world.

Likewise, nursing homes should be designed to meet elders' social and emotional needs as well as their physical ones. Innovative models like the Eden Alternative help combat loneliness, helplessness and boredom by giving residents opportunities to have contact with real life: children, plants, animals. They offer variety and opportunities for people to be spontaneous. And, perhaps most importantly, they give elders a chance to engage in activities that are meaningful.

These models show that sometimes the best solutions are straightforward ones that don't require manuals or complicated formulas - just common sense, and the determination to turn a simple but great idea into reality.

(This column was originally published on townonline.com June, 2006)