After an investigation confirmed that a nursing home resident died as a result of physical abuse by staff, the State of Minnesota has revoked the facility’s license, essentially putting it out of business. The death of this resident was just one instance of abuse and mistreatment at this facility. Other residents were sexually abused, physically abused, and subjected to emotional abuse.

I have come to believe that until we fundamentally change how we care for the elderly and disabled who cannot be cared for in their homes, we are fighting a Sisyphean battle against elder abuse and mistreatment. The very nature of our nursing homes contributes to an environment that fosters abuse. Nursing homes are rarely inviting spaces where anyone would wish to spend their time. They are often aesthetically unattractive and have an array of unpleasant odors. Residents, particularly those in need of the most care and attention, become a burden to poorly trained, poorly compensated, and undermanned staff. Residents do not want to be there, and their negative behaviors are exacerbated by the stress and disorientation the environment creates. Finding qualified, kind, and compassionate people to work in such an environment is a constant challenge for these facilities. There must be a better way. Over the next several weeks, I will be highlighting some alternatives to our current institutional model of nursing home care.

The Eden Alternative is one approach. The Eden Alternative was developed by Dr. Bill Thomas, who believed that three “plagues” of loneliness, helplessness, and boredom result in suffering among nursing home Residents. He worked to develop a new paradigm for institutionalized care that eliminated these plagues and created an environment where residents could thrive. Studies of facilities that use the Eden Alternative model have found vast improvements, including: 60% decrease in Behavioral Incidents, 57% decrease in Pressure Sores, 48% decrease in Staff Absenteeism; 25% decrease in Bedfast Residents, and an 18% decrease in Restraints. Other even facilities have experienced a reduction in staff turnover from 48% to 4%.

The Eden Alternative is based in Ten Principles:

1. The three plagues of loneliness, helplessness, and boredom account for the bulk of suffering among our Elders.
2. An Elder-centered community commits to creating a Human Habitat where life revolves around close and continuing contact with people of all ages and abilities, as well as plants and animals. It is these relationships that provide the young and old alike with a pathway to a life worth living.
3. Loving companionship is the antidote to loneliness. Elders deserve easy access to human and animal companionship.
4. An Elder-centered community creates opportunity to give as well as receive care. This is the antidote to helplessness.
5. An Elder-centered community imbues daily life with variety and spontaneity by creating an environment in which unexpected and unpredictable interactions and happenings can take place. This is the antidote to boredom.
6. Meaningless activity corrodes the human spirit. The opportunity to do things that we find meaningful is essential to human health.
7. Medical treatment should be the servant of genuine human caring, never its master.
8. An Elder-centered community honors its Elders by de-emphasizing top-down, bureaucratic authority, seeking instead to place the maximum possible decision-making authority into the hands of the Elders or into the hands of those closest to them.
9. Creating an Elder-centered community is a never-ending process. Human growth must never be separated from human life.
10. Wise leadership is the lifeblood of any struggle against the three plagues. For it, there can be no substitute.

The Eden Alternative challenges the idea of Residents as passive recipients of care, and requires providers to create dynamic, living environments with plants and gardens, animals, and programs that bring children into the facilities. The transformation of these environments leads not only to improved well-being for the Residents, but for staff as well. It is not a large leap to conclude that an environment that can lower staff turnover to 4% can also lower the risk of abuse and mistreatment.