Eden Alternative

NurseJane · Feb 8, 2001

1 Corinthians 13: And now these three remain: faith, hope and love. But the greatest of these is love.

It sounds as if Tim has lost faith and hope that mankinds intentions as a whole are toward the good of all. Maybe a renewal in the form of a retreat or workshop might help to take some of the cynisism from your sharp words and negative views?!!

Tim-GNP · Feb 8, 2001

As a professional nurse GERONTOLOGIST I am fully aware, of the body of research that demonstrates positive correlations between perceived quality of life and the use of pet interventions in long term care [in fact, I have participated as the nurse clinician in a few of them with CTRS's].

Pet therapy is just that, a therapeutic modality. If you will see the original post, it asks about the Eden alternative concept. Animals do have a place in LTC. Their place is being used as a THERAPEUTIC instrument. NOT allowing them to run around and call it an 'alternative.' Because in so-called 'Edanized' facilities, I have seen demented residents who are not segregated from others [you know, the locked 'warehouses' many facility CEO's call "Alzheimer's Units"], ABUSE the animals [quite unintentionally, of course]. I also know the tragedy of a lovely dog that was backed-over by someone's wheelchair who forgot the animal was behind them sleeping!

Now in Nursing homes, staff is scarce... DANGEROUSLY so. Nurses do not have time to chase after animals. If they are going to be used [WHICH THEY SHOULD BE], it should be under the supervision of a rec. therapist, or like professional... not because a facility paid $250,000 for a program that supposedly makes their facility unique.

If you want to make your facility unique in todays LTC market... put that otherwise wasted money into staff salaries so that RNs, LPNs, and CNAs could be recruited to care for this vulnerable population.

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Tis with our judgements as our watches, none go just alike, yet, each believes his own.

-Alexander Pope

Tim-GNP · Feb 9, 2001

If you could intelligibly articulate how after obtaining money for free from a state grant, only to turn around and 'sell' your limited findings back to the tax payers for huge price tag constitutes my losing " faith and hope that mankind's intentions as a whole are toward the good of all," I would love to hear it.

If you interpret my belief that the thousands upon thousands of dollars that facilities pay to 'Edanize' their facility could be better spent on increasing the number of qualified staff to provide needed humanistic care for the nursing home residents as cynical--then, perhaps it is you who have some issues related to experiences grounded in reality.

As for your quote from Corinthians 13- I am sure there is a 'holy roller' web site you would find more appropriate to pedal your gospel than here.

nursejanedough · Feb 9, 2001

First of all, I am not Nurse Jane. If I quote scripture to anyone it is to me, cause man o man, I really need it. But getting back to the Eden thing. All I know is what I saw on 20/20 or 60 Minutes, I forgot. But the administrator saw it, along with other staff members. As I said, we talked about it at meetings (all those meetings!) and we all thought it was a good idea. We never got the birds, but we did get the fish aquarium. And we did get a plastic, but pretty waterfall thing when you walk in the front door. Plastic greenery, with plastic frogs, turtles, rabbit, it looks really nice.

We do have a volunteer that brings her greyhound dogs every month and the residents seem to enjoy it.

cinny071 · Feb 10, 2001

Oh yes,we have the Eden Thing!!

We have the dogs,cats,birds,fish,plants,sometimes kids,etc.,etc.

BUT guess what Adm. forgot?

They forgot to empower the staff!!

Yes this is a Big part of the Eden thing.

It all sounds very nice,but you need someone to take control of all these animals and plants,etc. Sorry but where I work staff does not have time to do their jobs right and I mean all depts!!

But if you somehow manage to "find time", your work will be given to someother staff person and soon you will not have a whole hella lot to do because you are such a GOOD EDEN ASS, I mean person!!!

We had a BIG Staff Meeting with other Nursing Homes invited and we all got green Tee shirts that Adm. would like us all to wear in support of the EDEN THING!

I think we need to get back to Healthcare first.

Tim-GNP · Feb 10, 2001

At work, I often joke that by the time I retire, I will become a Recreational Therapist instead of a G.N.P.! It would be fun to play games and arrange parties, etc. But as a nurse, our priorities must be patient care.

Before becoming a GNP, I worked in geriatric nursing in various administrative and direct care positions. I found that when I was a direct caregiver on the 3-11 shift- trying to be 'house' supervisor, plus med and treatment nurse of a 28 bed medicare certified unit, I did not have a lot of extra time.

Cinny071 brings up a great point. Maybe staff could be involved and 'supportive'-- that is until you have 2 CNA's call off on 3-11, and you're already down 1 or 2 LPN's and there was no RN to cover evening shift, so you're stuck with a double shift!!! Add the task of taking dogs out for a walk, and clean the bird cage and your job is totally out of control!!! Water the plants??? My priority needs to be making sure the residents get water to prevent dehydration, constipation, delirium, etc.

The individual who 'conjured' up the Eden alternative is an M.D.-- want to take a stab at how much he knows about the workings of a LTC facility? NOTHING. I had a chance to hear him speak live... I was not impressed. This is, perhaps why I feel so strongly against it. I just believe that there are priorities that take a front seat.

If I have extra time at the end of my work, it's not going to be to clean the fish tank, or give the dog it's heart-worm pills... It's going to be to sit with my patient and comfort them, talk to them, and just be there so that they know there's another human presence that knows they exist and that cares for them... maybe that does make me cynical. Maybe it makes me a nurse.

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Tis with our judgements as our watches, none go just alike, yet, each believes his own.

-Alexander Pope

nursejanedough · Feb 10, 2001

Ya'll are right about the Eden "thing". I still think it is a good "concept". When our facility first heard about it, we all thought it sounded good. The activity director was going to try to start it, but we quickly realized that no staff had time to deal with it. Then she tried to recruit community volunteers. All she was able to get donated was a fish tank and a plastic waterfall. But you are right, Tim and Cinn.

Any extra help/volunteers in LTC should be more hand holding, sitting and talking and giving comfort to many depressed elderly people. Getting that favorite ice cream they like. Listening to war stories and the olden days -it really is fascinating. And to that tube feeding,non verbal but eye following resident, just being there talking, changing a radio station, holding up their old family photos, etc. Or just rolling someone outside so their face could feel the sunshine every once in a while. I am no saint, but I did a little of this on my own time after work, but never enough. We needed volunteers to do that instead of feeding a dog or cleaning up cat poop. People don't realize that LTC's are becoming more like warehouses where people barely get fed, cleaned, talked to, and especially loved on. I think more dogs and cats get more attention in America than humans do.

ktwlpn, LPN · Feb 10, 2001

Originally posted by nursejanedough:
Ya'll are right about the Eden "thing". I still think it is a good "concept". When our facility first heard about it, we all thought it sounded good. The activity director was going to try to start it, but we quickly realized that no staff had time to deal with it. Then she tried to recruit community volunteers. All she was able to get donated was a fish tank and a plastic waterfall. But you are right, Tim and Cinn.
Any extra help/volunteers in LTC should be more hand holding, sitting and talking and giving comfort to many depressed elderly people. Getting that favorite ice cream they like. Listening to war stories and the olden days -it really is fascinating. And to that tube feeding,non verbal but eye following resident, just being there talking, changing a radio station, holding up their old family photos, etc. Or just rolling someone outside so their face could feel the sunshine every once in a while. I am no saint, but I did a little of this on my own time after work, but never enough. We needed volunteers to do that instead of feeding a dog or cleaning up cat poop. People don't realize that LTC's are becoming more like warehouses where people barely get fed, cleaned, talked to, and especially loved on. I think more dogs and cats get more attention in America than humans do.

Thanks again for all of your imput-I love a great debate.I mentioned to our admissions director yesterday some of what I have read here and was immediatly informed that "I must not be negative" Seems the powers that be have fallen for the Eden philosophy hook,line and sinker-so I will dutifully keep my mouth shut...can't wait to hear the reaction of the rest of the rank and file.Most of my co-workers don't have much of an idea yet of what will be involved in this process.I know that one change we have made is that when we recently interviewed for a new DON all depts were involved-now tell me what did the head of the Environmental Services dept add to the process? He is a man with a high school education.This is the Eden philosophy of empowering all staff..O well-I must be getting inflexible in my old age-plus how many trends have we seen come and go in our careers?I don't think that it is generally a good idea to jump on each passing band wagon-I have seen a lot of money and other resources wasted over the years...

ktwlpn, LPN · Feb 11, 2001

Originally posted by NurseJane:
1 Corinthians 13: And now these three remain: faith, hope and love. But the greatest of these is love.

It sounds as if Tim has lost faith and hope that mankinds intentions as a whole are toward the good of all. Maybe a renewal in the form of a retreat or workshop might help to take some of the cynisism from your sharp words and negative views?!!

O-PLEASE! Will a day long workshop or a weekend retreat change the opinions I have formed during my entire nursing career?I have seen the best and the worst over the years..and am still amazed by the ignorance and rudeness some patients and their loved ones are capable of displaying.This has nothing to do with faith or a lack thereof-it is realism.I am not a cynical person at all-just a nurse that knows how hard patient education can be when the patient is dumb as a doorknob-and I am not being cruel-just stating a fact.

Tim-GNP · Feb 11, 2001

The sad thing about the 'eden' thing is that I heard Dr. Thomas [the principle investigator, and now salesman of the program] speak. During his talk, he basically stated that he knew if he weren't a physician, no one would have paid any attention to ideas about how a nursing home should be. He used weak data, and his influence as a physician to get people to pay attention to his ideas of how a long term care facility should be 'outfitted' if you will.

I will be the first to admit, he is a dynamic and charismatic speaker. He told some wonderful and compelling stories, and has even had some success with some people. My WHOLE point behind the eden alternative is: WHY THE HELL ARE YOU CHARGING FOR IT?

I worked as a graduate MSN student on a project funded by a New York DOH grant- [which by the way, had results that were found to be statistically significant], and during the dissemination process, guess what we charged people who wanted the program???? The cost of photocopying the book {approximately $7, which included S&H}. Call me crazy, but I think that any good that comes from research funded by tax dollars belongs to the people. I guess this line of thought will keep me a poor NP for the rest of my life.

I have had colleagues who worked in 'edenized facilities' also. They have told me the horror stories. The residents are the ones who should be [according to the program] taking care of the plants and animals. But, guess what? With the acuity of resident that PPS forces NHA's to admit to SNF's, nowadays, if they can care for plants and animals, then their ADL functional scores on their MDS make their CMI is too low to admit to keep in a SNF!

That means that the activity staff gets stuck caring for the plants and animals. Residents in SNF's already suffer from a lack of human contact-- let's put even more constraints on the time our staff members have to spend providing one on one visits with them.

WenRob430 · Feb 16, 2001

Originally posted by ktwlpn:

Originally posted by Tim-GNP:
I for one, am against the Eden alternative. The original research findings [i.e., the alleged benefits] were really not all that statistically significant. It's a HUGE price to be 'Edenized.' I have a problem with it's developer 'selling' the program, since it was researched and developed using New York state grant monies. I think that anything that is developed and can be beneficial, that comes from grant monies, belongs to the people, and thus, should be given free of charge [with the exception of mailing and photocopy fees, etc.].

There was recently a whole article in Provider magazine that discussed the development of the Eden alternative. I knew some of it-- but not as much as the article in Provider magazine knew!!! VERY INTERESTING STUFF.

Also, in terms of the 'mechanics' of it, I know a few facilities in New York that are on their way 'back' from Eden. In theory the residents are the ones who should care for the plants/animals, etc. However, it usually turns out that activity staff get stuck maintaining the menagerie. This is unfortunate when those staff members could be better utilized providing one to one visits to residents who NEED such interventions.

A properly constructed pet therapy program [which could be coordinated by a good C.T.R.S.] is usually a better alternative.

In my humble opinion, if your facility has the money to spend 'edenizing'- spend it instead on increasing staffing, and hiring additional activity professionals to provide more individualized care to the residents.

Thanks for all the input...I too would like to know where the money will come from-our benefits have been cut-corporate offices were downsized and several depts. took major budget cuts recently(dietary?hello-now the residents eat brocoli stems instead of the florets...housekeeping?staff hours cut back-less staff in house on the weekends.Now I have my very own mop,bucket and supply of cleaning solutions in my med room)These actions were taken in order to give the rank and file a significant raise...But recruitment and retention is a big problem in this area for every facility....We do have a wonderfully trained black lab,birds and a big fat rabbit...and the activity aides do care for them all....It's a never ending problem--we will spend big bucks on bells and whistles in every health care setting but put the well being of the direct caregivers on the back burner....

I for one do not like the eden plan at all. I want to leave work after my 8 hour shift. I love animals but I cannot walk a dog and take care of 36 demented residents and pass 500 meds per shift not to mention treatments, charts rnp and general nursing care.Its getting so bad where I work we need a committe to form a committe. We have more useless inservices and I really think manegement thinks we should just live at work and forget our families.I have 6 mandatory inservices not too mention in house ones. Not all Eden but they are getting to that. We had dogs and half the staff hated them! I personally think the whole idea needs a staff of its own they are killing the good nurses with all this overload!

anniek · Feb 16, 2001

I work at a large facility where the Eden alternative was in place when I started there, The Front lobby if filled with plant life and a small water fountain, and there are about 5 dogs and probably an equal number of cats (1 for each unit in the facility). There is an Eden staff week days as well as weekends, they provide for the care of the pets. The only time nursing staff may have to do this is if the cat threw up on the floor, so far this seems to work out well. There are also birds in resident rooms, and a large cage in the hall with 3 birds, at least on my unit.

There are residents that love to see the dog and/or cats and the birds and there are residents that don't want the dog inside. The dogs seem very perceptive in staying away from the residents that don't like them.

The first cat on my unit was very friendly with the residents and slept on there beds/ in there closet/or on there window sill, he was old and ill and now we have a new cat that is happy to sleep at the nurses desk, usually on the chart that you are charting on at the moment. I never was much of a pet lover but they all seem to live in harmony, and for the residents that enjoy it I think its worth it.