The Eden Philosophy transforms the lives of residents, staff and the bottom line.

This is part two of a two part article by Pam McDonald that describes how the processes of embracing the The Eden Alternative Principles radically changed the lives of elders, staff and family at Elmhurst Extended CareYou can Read Part One Here – Editor

Question Everything

For the next couple of years, Rick said he and his staff continued to question everything – food service, the dining room and TV, buffets on every floor, food available 24 hours a day — they would pilot changes on one floor before they implemented it throughout the community. After seeing the changes, a state inspector from the Department of Health asked Rick to explain The Eden Alternative to him. The next time Elmhurst offered the training, inspectors from the Department of Health participated.

Rick noted that, up until then, inspectors had encouraged communities to rotate staff assignments, so they could avoid burn out and wouldn’t become overly bonded to the elders. But, as part of their Eden Alternative changes, Rick encouraged staff to become care partners with the elders, so they were given permanent assignments of specific people. “The staff really got to know the elders,” Rick said. “They could raise the level of care and customize routines around each person.

“Our turnover rate before permanent assignments was 46 percent,” Rick noted, “which was the 8th lowest in the state of Rhode Island. But after our first year with permanent assignments, turnover dropped to 4 percent” (no that is not a typo).

Saying Goodbye

Another outcome involved elders, families and staff responses to a death in the community. “Our procedure had been,” Rick explained, “that when someone died, the funeral director took the body out the back door past the dumpster, the housekeepers came in, cleaned and sterilized the room, and Admissions was lining up a new person who moved in the next day.”

“Death was really affecting everyone; there was just so much disenfranchised grief, especially among the housekeepers who had a purely social relationship with the elders. So, we decided to develop a ‘dying with dignity’ policy to give the elders, families and staff the time and space to grieve and to honor that grief. We wanted to develop rituals with the elders involved.

“One of the elders told me he didn’t want to go out the back by the dumpster. He wanted to go out the same door he came in. So now, when an elder is dying, a care partner stays with him or her if they have no family. Staff is always present, their favorite music is played, and their hands and arms are massaged with soothing lotions. If the family wants, we arrange meals and for them to stay overnight.

“Now when an elder dies, the funeral director comes in to transport the body, but the staff drapes the body bag with a pall cloth and they accompany the funeral director and family out the front door. Someone usually recites a poem or says some words for and about the elder we’ve lost or the group will sing or pray together.”

“Recently, during a procession, one of the staff started singing ‘You Are My Sunshine,’ which was that elder’s favorite song, and everyone else joined in.

Later, the daughter of that elder said, ‘During her last days on earth, my mother was treated like a queen.’”

Rick recalled that this was a far cry from what happened with his mother some years ago. Even though he had helped her pick the home where she lived her last days, when she died he was handed her personal belonging in a plastic garbage bag. “What were they saying about how they valued her?” he asked.

Fulfilling The Promise

Elders at Elmhurst Extended Care Center are experiencing many of the benefits promised by The Eden Alternative, including reduction in psychotropic drugs and medications in general. Restraints have not been used in over a decade, and there is less depression as well as improvements in the mortality rate.

Now it is rare for a elder to call out, “Help me, help me” or to ask, “Are you my son?” or to wander around a room wondering aloud, “Why won’t God just take me.”

As Rick explained, “We see expressions like these as unmet needs and we work to determine how we can help. As a result of that approach, our elders require significantly fewer medications that typically mask unmet needs.”

“We’re going to continue to educate people on The Eden Alternative,” Rick concluded. “With imagination and a shoestring budget, we’ve been able to empower our elders and staff. We’re able to take Dr. Thomas’ philosophy and make it our own, and that allows us to make a difference in the lives of the elders in our care.”

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