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Eden Alternative Tip of the Week
Posted May 24, 2010
Principles Three, Four, and Five are called the “antidote” principles, because each one provides an antidote to one of the Three Plagues of institutionalized Elders. These antidotes are not readily available in the traditional institutional model, and require a transformative process such as the Eden Alternative to be successful.
“Loving companionship” sounds pretty warm and fuzzy, but there are some very practical ramifications of this principle that guide operations in Eden Alternative homes. From a personal standpoint, the implication is that staff will form true relationships with the Elders in their care. This means knowing more about each Elder than his or her diagnoses and functional status. Personal preferences, life history, relationships, interests, spirituality, values–all are important in providing an optimal care environment.
From an operational standpoint, Principle Three suggests that the best care is provided by care partners who know the Elders well and can provide close and continuous contact. This means that agency staff and employees who rotate assignments cannot provide the optimum care. In an ideal Eden Alternative environment, there are no agency staff and care partners are permanently assigned.
This can meet with resistance among employees who wish to have a break from caring for particularly challenging Elders or their families. However, much of this “difficulty” stems from the lack of relationship a rotation system causes, which is seen by Elders and families as a lack of commitment to the person. By getting to know Elders and families, understanding each others point of view, and being “in it for the long haul”, most homes report that relationships actually improve and complaints diminish.
Permanent assignments aren’t just for nursing. How about medical, therapy employees, even housekeeping or building services? Regular assignments create community and a deeper knowing of the needs of the Elders and care partners in each neighborhood. Through our own elimination of agency staff and a move to permanent assignments, St. John’s has eliminated their $3.5 million agency budget of 2002, and is now agency free for more than 6 years. Full-time employee turnover has decreased from over 30% a decade ago to only 8.5% last year, with a nursing turnover of only 13%. This has huge implications for quality of care.
Finally, the formation of close relationships also greatly improves the care of people who live with dementia, particularly those who have difficulty communicating their needs, or are frequently distressed. The deep knowing that comes from having regular care partners helps them to be understood and have their needs anticipated, not just medicated.
St. John’s Home, Rochester, NY