A Home More Like Home

By Harriet Barovick

Charles Fournier, a former army sergeant and nursing-home administrator who was accustomed to bossing people around, used to swear he would kill himself before he'd let anyone put him in a nursing home. So he was almost as baffled as his wife was when, after two strokes, he chose last year to live in one. Even this hardened military man couldn't resist a place with 40 birds, 25 rabbits, 12 cats and four dogs living there, noisy kids at an on-site day-care facility and committee meetings to attend to help run the place. "It's strange, I know," admits Fournier, 72. "The ones I worked at before were like warehouses. This one's comfortable and busy."

Fir Lane, the long-term-care facility where Fournier lives in Shelton, Wash., has embraced the Eden Alternative, a growing movement whose aim is to revolutionize and deinstitutionalize the long-term-care industry. By infusing centers with life, giving power to front-line caregivers and making the emotional care of residents a priority, Eden has taken hold at more than 300 homes nationwide.

Among Eden's staunchest supporters are state leaders. In some states, including New Jersey and South Carolina, officials have used fines collected from nursing homes to establish grants for Eden. In May the Institute for Quality Improvement in Long Term Health Care in San Marcos, Texas, published the results of a two-year study of five Texas homes at which Eden is implemented. The study showed dramatic reductions in infections and behavioral incidents among residents and lower rates of absenteeism among staff. Later this month, Bill Thomas, the impassioned geriatrician who founded the movement in 1991, will head to Washington, where Eden will be the sole focus of a hearing before the Senate Committee on Aging.

Taking its name from the biblical garden, Eden holds that even the best traditional nursing homes have been modeled on hospitals--with their rigid hierarchies, overdependence on medication and sterile cultures. Staff members at Eden homes have equal status and make decisions in teams. "Staff treat elderly the way they're treated by management," says Thomas. "You can have as many cockatiels as you want, but it won't matter if you don't overhaul the culture." That can be hard, says Anita Tesh, associate professor of nursing at University of North Carolina at Greensboro. "Once people see the atmosphere changes, they want to sign on. But it can be frightening to administrators to cede power."

At a cost of only $30,000 over two years, however, most of it for training, implementing Eden is no more expensive than standard homes, say administrators. Some have found it increases profits. And Eden can save lives. Before Fir Lane had been "Edenized," Denny Stasco, 58, says he arrived with MS, feeling as though he had "been dropped off at the bus station with no ride home." Now, as the resident ham-radio operator and mayor of his "neighborhood," or hall, Stasco says, "there's no time to feel bad." That goes for physical health as well. Jessie Walters, 79, a resident of the Oaks at Forsyth in Winston-Salem, N.C., recalls a grim prognosis from doctors after she had a massive heart attack earlier this year. "But I stayed in the hospital for only about a week!" says Walters. Why? "I wanted to get back to taking care of Cutie, my parakeet." She adds, "He needs me."

--By Harriet Barovick