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A fresh approach to nursing homes

Voice of Carolina (11/17/2002)

By Greer Reagin

For as many as 18,000 residents in South Carolina, home is a room in an institutional setting where they can receive the long-term care they need.

For some, these homes are a sterile place with few amusements or stimulations. For others, it's even worse -- neglected conditions and frequent staff changes breed medical problems ranging from painful bedsores to deadly mistakes in administering medicines.

There are alternatives to this model of nursing home care. And this month, South Carolina is hosting an international conference at Myrtle Beach which will feature discussions about an alternative that is aimed at changing the culture and practices of long-term care facilities.

One such approach is the Eden Alternative, which began in 1991 as the brainchild of Dr. William H. Thomas, a Harvard-educated physician. This approach seeks to eliminate what Thomas refers to as the "three plagues" of long-term care: loneliness, helplessness and boredom.

Eden seeks to remedy these plagues by providing opportunities for significant companionship, helping elders regain a sense of purpose and meaning, and encouraging them to relish variety and spontaneity.

A nursing home that adopts these principles and practices looks and feels different from the traditional long-term care institution. It has a variety of animals that live in the home (cats, dogs, birds, fish) and a variety of plants both inside and out (flowers, herbs, vegetable gardens). Children of all ages are part of everyday life and are used in the fight to combat loneliness, helplessness and boredom.

The heart of this alternative model is the spirit of the people who live and work in long-term care. In such homes, residents find empowered staff who are individually valued and see, and feel, a true sense of community.

Our nursing homes must de-emphasize the sterile, regimented, institutional model of nursing home care. Instead, we must seek to create homes, enriched human habitats, where all who reside and work within this environment are cared for, nurtured and helped to grow.

We can accomplish this by putting decision-making back into the hands of the elderly residents and those closest to them (their families and front-line staff). By taking a more holistic approach to caring for their residents, the staff's energy is focused on caring for the living rather than treating disability and disease.

Some states have formed coalitions to provide educational training and support for long-term care homes as they transition to becoming facilities using the Eden Alternative. The South Carolina Eden Alternative Coalition was formed in 1998 to do just that.

The coalition is a partnership of regulatory agencies, nursing home associations, advocates, nursing home personnel, and businesses in the long-term care industry. Coalition members include the South Carolina Department of Health and Human Services, the University of South Carolina School of Public Health and the South Carolina Nursing Home Association.

Other states that have formed successful coalitions include Tennessee and Michigan. Research on the effects of this approach has uncovered remarkable results.

Southwest Texas State University's Institute for Quality Improvement in Long-Term Health Care recently completed a two-year study of six nursing homes using the Eden Alternative approach. The study found reductions in the following areas: in-house pressure sores, number of residents taking five or more medications daily, number of residents taking anti-depressants and anti-psychotic medications, and number of safety restraints used.

For example, one individual home had a 96 percent decrease in pressure sores and a 35 percent decrease in the number of residents taking five or more medications daily. One home had a 58 percent decrease in its use of restraints, while another home found a 62 percent decrease in urinary tract infections.

In addition, staff absenteeism and nursing assistant turnover -- common problems in long-term care -- declined. These are important results for our current elders and for the rest of us who, if we live long enough, will one day be elderly, too.

Today there are 1.5 million Americans living in the nation's 17,000 nursing homes. Yet, there are only 200 nursing homes nationwide registered with the Eden Alternative, four of which are in South Carolina.

More of our long-term care facilities need to use this model. An estimated 40 percent of us are expected to spend some time in a nursing home in the future. Those who embrace an alternative philosophy believe that the world of long-term care can be different and are working diligently to make it a reality.