Notes from an Eden Alternative pioneer.

Asbury Care Center is the 104-bed nursing home component of a CCRC known as the Methodist Home in Charlotte, NC. The nursing facility is striving to be just that: a home, a place to live, not a place to die. About five years ago, we began to totally change our way of providing care - from a clinical approach to one that recognizes the resident as a whole being. We decided to reexamine the idea of what a nursing home should be and remove the barriers that prevent us from making this change. It was after we had made that commitment that we found out about the Eden Alternative in the fall of 1995.

The founder of the Eden Alternative, Dr. William Thomas, has said that there are three plagues in nursing homes that have never been addressed: loneliness, boredom and helplessness. To counteract these, residents need companionship, variety and a chance to feel needed. Dr. Thomas, a New York nursing home medical director, launched the Eden Alternative in 1991, looking for ways to make nursing homes into homes and not hospitals. When we had determined that we had the same goal, we invited the Eden Alternative to Charlotte to train us in October 1995. We wanted to bring life back into the lives of the residents, using the Eden strategies of exposing them to large numbers of animals, plants and children.

Central to the concept of Eden at Asbury is building and empowering staff for total commitment and participation in the project. By December 1996, we had formed multidisciplinary teams led by staff from various disciplines that met regularly to discuss residents' needs and capacities. These teams were responsible for supporting the "edenizing" of Asbury, ensuring that all Eden elements were being nurtured. They are also responsible for working on resident-centered issues and continuing to improve residents' quality of life. The teams are important to the Eden approach, but too many facilities, unfortunately, sidestep this part of the process.

In spring of 1997, we began introducing the animals, plants and children into the home. We now have five dogs and six cats that roam free on our three floors, along with finches, canaries, parakeets and an aquarium. Aviaries on each floor were built by the grounds manager in his free time, and residents have canaries in their rooms. In the afternoon, cockatiels and turtledoves visit via birdmobile, with Ace the cat hitchhiking atop it. We selected our dog and cat pets using the Delta Temperament Profile from the Delta Society, a Washington-State-based organization that specializes in animal training. (They can be reached at 800-689-6898, ext. 23.)

We've found that pet allergies are not a problem, probably because of our large spaces and efficient air-cleaning systems, as found in most nursing homes, as well as to exceptional housekeeping standards. We adhere, of course, to requirements that prohibit the animals from entering kitchens and dining areas.

To give our residents contact with a younger generation, we have a child care center on campus, and residents interact with the little ones three times a week. To get older children involved, a Girl Scout troop and a Brownie troop meet here, and many of the badges they earn involve interacting with our residents. High schoolers come in as part of a community service program to visit with and read to residents, run their errands and assist staff. Even when outside groups come for something like a carol sing, children are encouraged to begin interacting with residents by playing ball and working puzzles.

Since no Eden is complete without a garden, we have a lot of greenery in the facility. There is an outdoor courtyard where residents can grow tomatoes, cucumbers and peppers for our tables, as well as flowers for our centerpieces. They can also raise cuttings in their rooms, and we have special horticulture projects, such as strawberry pots.

We are also starting a memory garden in remembrance of residents and staff who have died (an idea I borrowed from somewhere else). It makes our place more of a home.

The cost of edenizing requires more a change of heart than change in the pocketbook. No additional employees have been hired, and costs have been minimal compared to the facility's overall budget. Most of the funding for things like supplies comes out of our operating budget. We have also had to pay for a dog run and a watering system for the overhead plants. Many supplies and services have been donated, with pet rescue groups donating food and medication, the Metrolina Caged Bird Society donating birds, local vets giving us discounts, and former police K-9 trainers volunteering to help provide obedience training for dogs.

Unlike a scheduled program or one-time-only project, the whole concept of Eden is to reintroduce the idea of spontaneity, challenge and a variety of experiences - life as a whole - to residents. The best thing about Eden is that it is a total redirection of care, and one that never ends. There is no plateau. We are always evolving, always edenizing. Our teams look for problems and ways to solve them; our empowered staff members look at resident needs and how to meet them. They continually do this through projects large and small: from slipper socks for dementia patients, to wheeled storage areas in rooms to reduce clutter, to programs for improving overall communications. This approach has demanded a lot of education and training for our staff, for the residents and families, and for the community. It has also brought us the unexpected benefits of being a wonderful marketing experience, leading to much favorable print and television coverage.

Asbury was one of the first three facilities in the state to edenize, and it was the first facility in the nation to be recognized as fulfilling all of the Eden Alternative's 10 Principles. The Asbury Care Center has been named as a model by state agencies and by the Eden Alternative, and it is the recipient of the AAHSA Excellence in Practice Award.

We are now collaborating with the University of North Carolina-Greensboro School of Nursing to assess and evaluate the Eden initiative here. Both here and at other facilities, the UNC is looking at variables such as the overall use of drugs (especially psychotropics), the incidence of falls, and infection and mortality rates. It is still too early to report quantifiable outcomes. We at Asbury have seen no staff turnover related to edenizing; rather, staff have been very receptive - they gain more control over making their work meaningful and are involved in fewer interdepartmental disputes. Meanwhile, subjective indicators have shown higher levels of resident and family satisfaction and happiness.

The Division of Facility Services of the North Carolina Department of Health and Human Services is a supporter of the Eden concept. Through the work of the NC Eden Alternative Coalition, which I chair, it hosted an Eden conference for more than 450 attendees last fall. It was held to promote the edenizing concept throughout the state. The division is also using a portion of the survey fines it collects to provide $250,000 in grants to 13 facilities that are adopting the Eden principles.

Long-term care has to change, and we know that. Residents and families are beginning to demand more than a clinical setting to live in, and we have a moral and ethical obligation to give it to them.

Miriam Stermer is the administrator of The Methodist Home, a CCRC in Charlotte, NC. She is an Eden Associate, certified in training Eden techniques, and can be reached at [phone].