Injection of Life Can Make an Institution a Home

In the hallway, Bella and Diva are asleep once again, snoring as only contented dogs can snore, eight legs splayed in the air. One floor up, there is the smell of baking bread. In the gardens out back, a visitor and her young daughter happily explore the playground.

Nothing is particularly unusual about that scene in Fairfax City, Va.--except that it’s unfolding at a nursing home, a setting more typically associated with loss and dying than joy and living.

Across the country, more and more people are asking why long-term-care facilities can’t be like the Fairfax Nursing Center, the boxy, red-brick building where Bella and Diva monitor the front door by night and an administrator occasionally roller-skates through the halls by day.

Nursing homes, they insist, can be places where laughter and spontaneity abound, where the elderly give as well as receive care, where a diversity of species--canine and feline, feathered and planted, toddler on up--create a natural habitat.

The idea once sounded like a kooky impossibility. But inspired by a Harvard-trained, Birkenstock-shod family physician from rural New York, it’s a growing movement known as the Eden Alternative, the name William Thomas gave his vision six years ago.

“You’ve got to change the culture of a nursing home,” Thomas says. Anything else “is just decorating.”

“Edenized” homes are popping up in places such as Virginia Beach, Va., where each Tuesday the Seaside Health Center hosts a local Brownie troop meeting, and the Methodist Home in Charlotte, N.C., which offers canaries and finches for any interested resident’s room. In Waverly, N.Y., the Tioga Nursing Facility built an on-site kindergarten to maximize opportunities for young and old to mix.

A precise definition does not exist, but all those facilities share a commitment to change the system. Supporters say an Eden home emphasizes quality of life as much as quality of care and encourages residents and employees alike to play a role in making that happen. It requires a willingness to experiment, especially on the part of management.

“The care that a resident receives is usually done in three or four hours of the day,” noted Robert Bainum, Fairfax Nursing Center’s owner. “They have 20 hours left to live a life.”

State and federal regulators initially were skeptical about the prospect of, say, several hundred birds living in a nursing home. But many have become believers, especially with research beginning to show lower medication use, fewer infections and less employee absenteeism and turnover at Eden sites.

Still, some experts say that in an industry often resistant to change and under tremendous pressure to cut costs, companies will not rush to adopt the Eden Alternative unless it proves to be both cost-effective and practical.

Some of the best evidence already around comes from women such as Arless Almany and Virginia Wagner, both residents at the Fairfax City facility.

For months, Almany has had a pet project: fattening up a snow-white cat that inexplicably adopted her. Almost any day or night, Angela can be found curled into a perfect ellipse on her mistress’ bed or wheelchair. “If she stays here, I’m content, and if I stay here, she’s content,” said Almany, 72.

Wagner’s affections lie elsewhere, but her bottom line is the same: “Don’t let anything happen to those dogs,” the 77-year-old woman cautioned, turning to take a glimpse at Bella. “They make it more like home.”

The Eden Alternative is the latest reform effort for nursing homes, which have come a long way since repeated scandals in the 1970s and ‘80s revealed care that was inadequate at best and criminal at worst. Patients’ rights now are written into law. Ombudsman programs operate in every state. The use of physical restraints has dropped dramatically.

People fear the system still is broken. A recent study of seriously ill hospital patients found that one-fourth of them were “very unwilling” to move permanently to a nursing home and that 30% said they would rather die. And yet, 1.6 million increasingly fragile Americans live in long-term-care facilities, a number that will rise sharply as the country ages.

“They have not been homes to people; they have been institutions,” said Mary Tellis-Nayack, vice president of clinical services for Beverly Health and Rehabilitation Services, the country’s largest nursing-home chain. Beverly and Genesis Elder Care, another large national company, are planning several Eden pilot projects.

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From the start, Eden’s goal has been to vanquish the three “plagues” that Thomas and his wife and partner, Judy, believe afflict nearly all long-term-care facilities. They recite them like a mantra: loneliness, helplessness and boredom.

“These people are intensely lonely,” William Thomas said. “These people have vast stretches of nothingness.”

According to the couple, for whom Eden is both a mission and a business, nursing homes must stop treating every situation like a medical condition and worry more about nurturing emotional needs. End the rigid hours that residents must keep for meals, baths and bedtime; let them sleep in some mornings if they choose, Judy Thomas says. Throw out the time clock and let workers schedule themselves, William says.

Many people call the Thomases pioneers, one of four or five groups in the country that are on the cutting edge in their field.

“I think they have an enormous contribution to make,” said social worker Carter Williams of Rochester, N.Y., who is nationally known for her opposition to the use of restraints in nursing homes. She too has a physician-husband who works in geriatrics: Frank Williams, a former director of the National Institute on Aging, who talks about how Eden has “caught fire.”

“It’s the rare place that has shown much imagination in going beyond regulations,” Williams said.

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The Eden movement remains loosely organized, spreading largely by word-of-mouth or the two books William Thomas, 38, has published in the last few years. In Sherburne, N.Y., about an hour southeast of Syracuse, he, Judy and two employees work out of a modest office within the one-room schoolhouse that the couple built for their two sons and several neighbors’ children.

They keep informal track of the many facilities that have contacted them for information or sent officials to weeklong training conferences--usually booked months in advance. They say they know with certainty of more than 100 Eden homes from Massachusetts to California.

With charismatic energy, William Thomas travels an ever-widening speaking circuit these days. His Ivy League medical degree and teaching position at New York’s Upstate Medical Center are part of the reason people are paying attention, and he’s beginning to be able to offer them more than just anecdotes.

In Texas, research being conducted by Southwest Texas State University at six Eden facilities has shown some dramatic results in the last year, with use of anti-anxiety and antidepressant drugs dropping 33% and employee absenteeism decreasing 44% at five sites.

At Chase Memorial Nursing Home in New Berlin, N.Y., just down the road from Sherburne and the first Eden facility in the country, medication usage per resident remains half that of its pre-Eden days. Despite its current menagerie of three dogs, five cats and more than 100 birds, allergies and infection rates are lower too.

Every weekday afternoon this past fall, students from the elementary school only a baseball’s throw from Chase’s back porch arrived for a junior-senior horticulture program. Margaret McDonald, 76, could be counted on to be there.

“It brings us very close together,” McDonald said. “It’s like family in here.”

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Other states are coming around. In North Carolina, officials organized a September conference that attracted 450 people from as far away as Nebraska and Arizona. It is even dangling grants of as much as $25,000 to encourage facilities to adopt Eden techniques.

Missouri Lt. Gov. Roger B. Wilson was so struck by the stories he heard that he asked his state’s Division of Aging to help promote Eden. About 60 facilities there are in the process of implementing programs.

“Eden’s the way to go, no question in my mind,” said Norman Andrzejewski, an area administrator for the New York state health department. He has watched since 1991, when the 80-bed Chase Memorial, with Thomas as its new medical director, risked both regulators’ wrath and community ridicule by trying to reinvent itself along Eden lines.

“There’s much more activity, much more noise,” Andrzejewski said. “And the noise isn’t people calling out. It’s the noise of conversation and laughter.”