This review was posted in 2001.
Review of Life Worth Living: How Someone You Love Can Still Enjoy Life in a Nursing Home, by William H. Thomas. VanderWyk & Burnham, 1996, 208 pp.
Reviewed by Mary Meehan
When William Thomas was a young doctor, he tried to avoid nursing homes. When he had to do rounds in one during his residency, he "felt like a shipbuilder who had been mistakenly assigned to the salvage yard." He found that his patients "got sicker, weaker, and more withdrawn as time passed, and when one died, he or she was promptly replaced with another who was cruising down life's off-ramp." Not the ideal environment for a bright young graduate of Harvard Medical School.
Yet Thomas eventually served as medical director of the Chase Memorial Nursing Home in rural New Berlin, N.Y. He worked there from 1991-1995; now he works full-time in spreading ideas he developed there, as well as his new proposal for small-group homes.
His early experience convinced him that nursing homes are too obsessed with treating physical disease and too little concerned about three "plagues" of the human spirit: loneliness, boredom and helplessness. Indeed, because they are "total institutions"--similar in many ways to psychiatric institutions, military boot camps and prisons--nursing homes encourage the three plagues instead of alleviating them. Thomas says that the plagues "rage as fiercely in good homes as in bad ones."
Why not, Thomas and his colleagues wondered, transform the Chase home so it really would be more like a home and also like a garden--the Garden of Eden, for example? Life Worth Living explains how they brought children, animals, plants and flowers into Chase--not as sporadic visitors, but as integral members of the Chase community. They also moved away from a top-down staff structure to one that gives nursing aides more responsibility for their own schedules and work.
Thomas says that the "Edenized" Chase proved to have healthier residents than a traditional nursing home that was studied for comparison. There was a major reduction in infections at Chase--and in its annual death rate--after Edenization. There was also a marked decline in the use of medications, an important advance at a time when so many elderly people are over-medicated. (Administrators of other homes may be startled to learn that Chase reduced its drug costs by half.) And Thomas notes that reform of staff operations produced a significant drop in turnover of nursing aides.
Dr. Thomas is happy with the statistical improvement, but happier still with the improvement in residents' lives. "Mr. L.," for example, was a new resident whose wife had recently died. "He had lost his wife, his home, his freedom, and, perhaps worst of all, his sense that his continued existence meant something. The joy of life was gone for him."
Initial efforts to deal with Mr. L.'s depression were unsuccessful; in fact, he grew worse. He stopped walking and eating and simply stayed in bed. Offered two parakeets as companions, he accepted them "with the indifference of a person who knows he will soon be gone." But the parakeets fascinated Mr. L. He soon watched them closely, talked about them, and started giving advice about them to their caretakers. He also "began eating again, dressing himself, and getting out of his room. The dogs needed a walk every afternoon, and he let us know that he was the man for the job." Mr. L. was able to return to his own home a few months later. "The Eden Alternative," Thomas says, "had saved his life."
Even before it developed the Eden Alternative, Chase had built its own child-care center so its staff would have good care for their children and the home's residents would have interaction with the kids. Chase also started an after-school program that involves children with the residents, and it started a summer camp that does the same.
It began a volunteer program for local middle-school students; instead of bringing in large groups of children for a short time, it asks each volunteer to spend a day at the home, interacting with the seniors and helping care for animals and plants. Chase leaders also invited youth groups to use the home as a meeting center, and they even started a 4-H group. As Thomas says, children "are good for older people. The hubbub they so naturally create injects vitality into any environment. Their play, laughter, and song are potent medicines for the elderly."
Chase staff found parakeets to be ideal companions for many of their residents. "We've been able to place a bird or a pair of birds in the room of every resident who wants them," Thomas reports. "Now the sound of birds drifts up and down the hallways at Chase, reminding us of spring." The home has a "birdmobile," made over from a medication cart, which staff use to carry food and water to the many parakeets. "Naturally, residents gravitate to the birdmobile when it's in their vicinity. It becomes a mobile, rolling social occasion...," Thomas remarks. "Best of all, it has nothing to do with illness and treatment but carries a message of life and hope."
He describes Ginger and Target, the resident dogs at Chase. Besides providing companionship for the seniors, the dogs enhance their safety. Target, a retired racing greyhound "who rarely makes a sound, has barked incessantly and waited beside a fallen resident until help arrived" on more than one occasion. The vigilance of both dogs helps guard the building at night.
Thomas says that Chase's four resident cats "make no demands, yet they offer highly dependable affection....They are warm and soft to the touch, and their purrs soothe the soul."
He believes that houseplants, besides lifting the spirits of residents, contribute to their health by absorbing toxins from the air. He quotes a scientist who recommends peace lily, king of hearts, lady Jane, and weeping fig as "all-around poison eaters."
Chase had a beautiful lawn, but Thomas says that it "had to go" to make room for flower and vegetable gardens. Chase now grows many of the vegetables its residents eat. "Where once the view from our residents' windows was still and green, now residents watch the unfolding of the seasons, the natural drama of birth, growth, fruition, and decay."
I wonder, though, if nursing homes shouldn't seek a happy balance between all-lawn and virtually none at all? Although it is possible to grow a lovely winter garden, many gardens look dreary in late fall and winter. And there is much to be said for what an elderly friend of mine once called the "austere beauty" of lawns that feature non-flowering trees and shrubs. They offer simple, uncluttered peace.
Dr. Thomas offers practical suggestions for Edenizing a home, including many specifics on selection and care of animals. A nursing-home dog "must have a 'solid gold' temperament," he notes. And cats "are fussy about their litter box and may stop using it if it does not meet their standards." He lists many books and other resources that provide more information.
He stresses the need for strong leadership to overcome staff resistance to radical change. "Leadership is the life blood of this process," he says, "and nothing can be substituted for it." And: "Leaders must always have good answers to the question, 'Where are we going and why should we make the trip?'" He also emphasizes that residents of traditional nursing homes--and their families--can and should press for a change to the Eden path.
Many nursing homes around the country have Edenized themselves or are in the process of doing so. You can find information on their work by searching under "Eden alternative" on the Internet. Especially interesting, in the "Featured Stories" section of www.culturechangenow.com, is a report of remodeling that changed an oppressively medical atmosphere. A Kansas home had a large nursing station from which resident hallways extended like the spokes of a wheel. Staff spent too much time at the station, and not enough with the residents.
The solution was both radical and effective: removing the old nursing station and putting a waterfall and pond in its place. That cost only about $4,000 and was covered by an auxiliary group's donation. "Without further remodeling, the hallways were turned into separate neighborhoods and a smaller nursing station was placed at the end of each one. Rooms in each hallway have been converted to a multipurpose area where residents, or 'neighbors,' can congregate." The staff structure has changed from the top-down model to one of "care teams" for each neighborhood.
All of this resulted in a dramatic decline in falls and skin tears among residents, a drop in infection rates, a striking decrease in staff turnover, and a major increase in the satisfaction of residents and family members.
Dr. Thomas himself has gone beyond his original ideas and now advocates small-group "Green Houses" as alternatives to nursing homes. But can such houses meet the increased need for nursing care as our elderly population booms in coming decades? Or would it make more sense to build medium-sized homes that cluster residents in small, homelike units, as the Kansas home and others have done? A mix of small- and medium-sized homes might be another answer. [For more information on both Eden and the "Green Houses," see the more recent article on this web site, "Back to Eden?"] .
We can all benefit from his wisdom and his conviction that "all human beings retain a capacity for growth, no matter how small, until the last breath is drawn."