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Injection of Life Can Make Institution a Home

Happier days are being celebrated at nursing facilities, say supporters of an experimental approach to enrich residents' lives.


WASHINGTON — 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 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," said 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.


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."

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