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All About the Eden Alternative in Nursing Homes
Jan L. Warner & Jan Collins


We receive frequent questions and comments from our readers about the quality of care provided in nursing homes, with many often expressing concern about the typical nursing home environment. Although many nursing homes in this country do provide excellent medical care, the impact upon an elderly person (and family members) of moving into an institutional setting can be striking. People who were once vibrant members of their communities become isolated and no longer have meaningful opportunities for growth and interaction. Many become broken-spirited and suffer corresponding declines in their health. Fortunately, a growing number of facilities are adopting an attitude of “It Can Be Different,” thanks in large part to a movement known as “The Eden Alternative.”

Led by Harvard-educated physician Bill Thomas, the “Edenizing” process is gaining steam across the country. Dr. Thomas’ approach for improving the nursing home environment rests primarily on the recognition that even when facilities provide outstanding medical treatment, residents may still be afflicted with what he refers to as “the three plagues”: Boredom, Loneliness, and Helplessness.

To combat these “plagues,” Dr. Thomas advocates the evolution of the nursing home environment into a “Human Habitat” that includes a multitude of diverse plants and animals. Opportunities for inter-generational relationships are also key, and are often accomplished by locating children’s day care centers within the nursing homes. The result is the transformation of facilities from regimented and impersonal institutions into true “homes” that bustle with activity and the spontaneity that makes life worth living. But as proponents of The Eden Alternative will be quick to tell you, true “Edenizing” involves “more than just fur and feathers.” The process also includes an entire shift in management philosophy that seeks to bring decision-making authority closer to the residents and staff.

As surprising as some aspects of The Eden Alternative may sound, they do seem to work. Cats coexist peacefully with birds, fish, and dogs. Children and elders interact freely and learn from each other. Staff and management work more closely together and are able to provide quality “care” (instead of just “treatment”). Even more importantly, nursing homes that have undertaken the “Edenizing” process report decreases in rates of medication, infection, and mortality; increased activity by residents; and improvements in staff morale and staff retention rates.

Several states have been impressed enough with the concepts of The Eden Alternative that they have chosen to provide financial support to nursing homes that are interested in implementing the process. Funds collected as fines from nursing homes that were out of compliance with Medicare and Medicaid requirements have been used in Texas and North Carolina to provide grants to homes wanting to “Edenize.” South Carolina has recently launched a similar grant program as one method of improving the quality of care in nursing homes. Other states, such as Georgia, are also actively providing education and other technical assistance through coalitions of government and private agencies.

We share this information to you to make you more informed as consumers of long term care services, and to let you know that more options are becoming available. If you are looking for a nursing home, inquire about whether they have plans to “Edenize” or to undertake similar changes. If you already have a relationship with a nursing home, encourage them to explore such possibilities. More extensive information about “The Eden Alternative” (including a listing of participating facilities) is available at “” SITE HERE or by calling (607) 674-5232. Your state Medicaid agency or your state health department may also be able to provide you with information about which nursing homes in your area have undertaken these types of initiatives.

Jan L. Warner
Jan Collins

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