The Eden Alternative nursing home care model and its effects on elderly quality of life

¶ … Eden Alternative is a nursing home care model that was developed in the U.S. In the early 1990s with the goal of completely transforming the long-term care facilities into habitats that are habitable by combating boredom, loneliness and helplessness, the three major "plagues" that affect institutionalized elders (Thomas,1994;CUPE,2000). The Eden Alternative as an operational nursing home model involves the creation of a human habitat by the intentional introduction of plants, animals, birds, gardens as well as visiting children into the care facility. The Eden model effectively restructures the care delivery process so as to in this paper, we investigate the reasons as to why the Eden Alternative program/philosophy is a suitable choice for improve the quality of life for seniors/elders within nursing care facilities as well as why it should be adopted as their standard of care.

Problem statement

Social isolation, physical attacks, misuse of medication as well as restraint form some of the worst conditions to which the elderly population is exposed to in the United States. These factors have been shown to pose serious risks in the health of the elderly population. Social isolation for instance, has been linked to increased alcohol abuse since they may use it to relieve the depression as well as boredom that stems from their unfulfilled expectations. Boredom which may results due to marginality and social isolation may worsen schizophrenia and depression Felmet, Zosook and Kasckow,2010). Boredom, loneliness and helplessness has also been linked to increased suicidality among the elderly (Seidel,2004;Cattan et al.,2005).The Eden Alternative seeks to provide a habitable condition for the elderly for them to enjoy a livelihood devoid of boredom, loneliness and helplessness. This in the end would allow the to have a holistic lifestyle and health which would in turn improve their longevity.

Research question

In this paper, we seek to answers the following research questions;

1. To what extent does the Eden Alternative improve the physical, mental and psychological health of the elderly population?

2. What is the lived experience of the elderly who are taken care of using the Eden Alternative method of care?

3. How has EA been integrated into the national care of elderly patients?

4. How has EA been integrated in nursing therapy?

5. What are the documented benefits of EA in patient outcomes?

The aim of this paper is to investigate the proposition that the Eden alternative is the better choice for elder care.

The Eden Alternative model was propose as a way of improving the quality of life for the elderly patients in nursing homes across the world. The model employs the principles of anthropology and ecology as the basis for creating a diverse human habitat that consists of gardents, plants, pets as well as an interaction which is multi-generational as opposed to the more traditional model of nursing home. The nursing home staff are also taken through an intensive training regime prior to implementing of the Eden Alternative. The intention of the Eden Alternative is to create a habitat that is healthy. Other than a change in the environment, the management's hierarchy is also change. Organizational decisions are therefore made by staff at all levels of the organization. Fun and spontaneity therefore become parts of the system.

Adoption of the Eden Alternative concept

Brownie, Neeleman, and Noakes-Meyer (2011) wrote an article that explored how the Eden Alternative can be established in Australia and New Zealand. He pointed out that the Eden Alternative ™ is a rather contemporary approach to the concept of long-term care and was specifically designed in order to combat the plague of old age. This is achieved by incorporating elements of companionship, spontaneity, variety and a sense of purpose into the daily experience of the aged individuals.Otsuka et al. (2010) carried out a study to establish the prospects for introducing the concept of the Eden alternative to the Japanese care system. They pointed out that no care facility and officially and formally incorporated the Eden Alternative philosophy of care into their systems. Their work was however aimed at the identification of the perception of the nurses and other care workers on the lives of elderly patients in the care facilities to consideration of incorporating the philosophy of Eden Alternative in the Chinese elder care. The participants generally recognized that the elderly suffer from intense boredom, loneliness and helplessness and there is therefore a general need to adopt the Eden Alternative as a way of reducing their suffering from the three plagues.

Petersen and Warbuton (2010) conducted a study aimed at investigating the effectiveness of the Eden Alternative. The setting was an integrated health service facility in rural Australia where the philosophy of Eden Alternative was implemented. The study was quantitative in nature and explored the opinions of the staff. The results indicated that the Eden Alternative is easily accessible to all of the staff who participates in aged care. There is however tension within its implementation since it is a person-centered care. The study concluded that this form of care could be innovative and therefore there is need to explore the concept of innovation in the context of aged care.

Baumann (2008) wrote an article that explored the ties between the Eden Alternative philosophy and the classical Chinese Confucius philosophy. The article describes the Ox Mountain Parable of Meng Tzu with a link to the Eden Alternative. The implications of the connection for the nursing practice are considered.

Methodology

The study involved the evaluation of the impact on the quality of life of the elderly from the implementation of the Eden Alternative philosophy. This was achieved by carrying out a quasi-experimental study involving two nursing homes. One of the homes implemented the Eden Alternative Model while the other did not. The quality of life was then examined by a thorough comparison of the changes that was realized by the participants over a two-month period. Minimum Data Set MDS

data as well as interviews were used to evaluate the cognitive level of the participants.

This research project was aimed at determining if the implementation of the EA model had a positive impact on the residents' quality of life in nursing homes. The project involved comparing certain elements of the residents in two different nursing homes. One of the nursing homes implemented the EA model while the other did not. The inclusion criterion for the participants was having lived in the care facility for a minimum of twelve months prior to the beginning of the data collection process.

A list of all of the residents was obtained from the two facilities as well as their admission dates. All of the necessary charts of eligibility were reviewed ads well as the data obtained from the Minimum Data Set (MDS) which were recorded by means of the Chart Review Form as well as the Minimum Data Set Cognitive Performance Scale (MDS-CPS).

The Minimum Data Set Cognitive Performance Scale (MDS-CPS) is a scale which is generated from the 5 MDS elements (comatose status, ability to make decisions, short-term memory, ability to make oneself be understood as well as eating).The scores from the scale ranged from 0 (for, no impairment) to 6 ( for, very severe impairment) as pointed out by Hartmaier et al. (1995).

The residents who scored two or less on the MDS-CPS were then asked in a kind way to willingly be part of the interview.

The interview involved the completion of the Dementia Quality of Life Instruments as suggested by Brod, Stewart, Sands & Walton (1999),the Personal Interview Form, the UCLA loneliness Scale, as suggested by Russell & Cutrona (1991) and the Geriatric Depression Scale which was suggested by Yesavage & Brink (1983). The data that was obtained from the control facility was also included.

The independent variable

The independent variable is implementation of the Eden Alternative Model

Dependent variable

The dependent variable is the Quality of Life since it changes with the level of implementation of the independent variable (Eden Alternative).

Quality of life (QoL) is a rather subjective perception of an individual's happiness level of satisfaction with his/her life (Oleson,1990)

Description of the instruments

The Minimum Data Set is a comprehensive as well as mandated tool of assessment which is used by various nursing homes in order to access the functional, psychosocial, cognitive and mental status. It has to be completed with a period of 14 days after submission with a regular update at certain interval of time (Morris et al.,1990).The MDS must be administered by a registered nurse.

The selected items on the MDS scale that were necessary for conducting cognitive assessment are known as the Cognitive Performance Scale CPS as pointed out by Hartmaier, et al. (1995). The reliability of this scale ranged from .40 up to .75 as noted by Morris et al., (1990).

The Chart review Form was employed in the collection of demographic, background as well as health information from the participants. Some of the information which were collected included; age, race, sex, length if stay as well as marital status. The MDS data was related to the participant's cognitive pattern, number of medications as well as disease diagnoses.

The UCLA Loneliness scale (Russell and Cutrona,1991) was employed for the measurement of loneliness for the participants.

The Geriatric Depression Scale (GDS) was employed for the measurement of boredom, helplessness as well as boredom (Yesavage & Brink,1983)

The Dementia Quality of Life instrument was used in the measurement of the participants' quality of life (Brod, Stewart, Sands & Walton,1999).

Hypothesis

H1= Quality of life for the participants in the home that incorporated Eden Alternative Model improved

H0= Quality of life for the participants in the home that did not incorporated Eden Alternative Model did not improved

Data collection and analysis

The officials of the institution provided the investigators with the list of all residents who had already been in the facility for more than a year. The charts were then reviewed to see the people who satisfied the inclusion criteria. The MDS-CPS was employed for establishing the participant's cognitive status. The other instruments were also administered.

Microsoft Excel was then used for data entry while Statistical Package for Social Sciences (SPSS ) v.17 was used to analyze the data.

In order to accurately establish the difference between the experimental and the control group, the pretest scores were compared with the posttest scores. This allowed the investigators to have control over the effects of factors such as testing and instrumentation, history, maturation and history (Campbell & Stanley,1963).

As was noted by Cook and Campbell (1979), an analysis of the difference between the pretest and the posttest scores is insufficient for determining the difference between the experimental and control group.

The frequency distribution of the pretest and the posttest were first determined. These frequency distributions were carefully examined for group mean, variances and skewed distribution. The significant differences that may exist between the two groups were then examined using a t-test. Co-variance analysis was then used so as to evaluate the level of significance of the change that was noted from the pre-to post intervention stage as suggested by Huck & McLean (1975).

Results

This study was aimed at evaluating the impact of the philosophy of the Eden Alternative on the participant's quality of life. In this study, the independent variable is the successful implementation of the concept of Eden Alternative while the dependent variable is the participant's quality of life. The Dementia Quality of Life instrument was used in the measurement of the participants' quality of life (Brod, Stewart, Sands & Walton,1999) iun an interview format.

The sample N=26 in the control environment and N=34 from the intervention institution.

Descriptive statistics of the Intervention Institution (N=34) and the control institution (N=27)

Intervention group

Control Group

Significance

Age (Mean Year +/- SD)

76

(10.790)

79

(11.900)

.2961

Length of stay

Mean Year +/- SD

37.79

(44.950)

44.04

(36.750)

.5561

1-denotes t-test

Dementia Quality of Life Tool indicated no significance difference between the two groups

UCLA Loneliness scale indicated a difference at the posttest stages

Geriatric Depression scales indicated a difference at the posttest stages

.Summary

The study indicated that the participants who are in a nursing home that implements the Eden Alternative model experience an improvement in their quality of life as evident from the reduction in the level of loneliness, helplessness and boredom.

Conclusion

This study has indicated that the Eden Alternative is indeed the best alternative for the institutionalized elderly since it effectively reduces the three plagues (loneliness, helplessness and boredom) while improving the quality of life anmd general well-being all of which are related to longevity.