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With their roots in Dickensian workhouses and modeled on hospitals, nursing homes in many ways have earned the dread of old people, especially those who can still remember the stigma of America's poorhouses and county homes.
"The terror people feel is real," said geriatrician Bill Thomas, in Salt Lake City on Thursday to boost a new type of long-term care called the Eden Alternative.
Because policymakers in the 1960s decided to help ailing elders by placing them in heavily regulated institutions, nursing homes today can seem more like jails than the kind of gentle, caring collectives Thomas envisions.
"It is highly stigmatizing to have to surrender your freedom to get the care you need," Thomas said during a break in a daylong conference that drew about 140 long-term care professionals.
Thomas, a professor at the University of Maryland, Baltimore County, is the founder of the nonprofit Eden Alternative, an education business that teaches nursing-home administrators how to transform the way they take care of elders.
The Eden Alternative doesn't require formal certification for nursing homes, such as Alpine Valley Care in Pleasant Grove, one of the five Eden homes in Utah. Rather, Eden homes employ a set of beliefs and practices that makes residents' dignity and autonomy the top priority, with the residents at the helm of the ship.
"It's not anything like a franchise," Thomas said. "It's more of an honor society."
Part evangelist, part smart businessman and a bit of a '60s throwback (he's 51), Thomas went to Harvard Medical School and says his favorite practice was in the emergency room. A part-time stint as a nursing home doctor led him to an encounter with an old woman who told him, "I'm so lonely."
From there his passion for caring for old people changed to a mission to reform nursing homes.
Ålthough many of the 100 nursing homes in Utah employ similar principles, only five call themselves Eden homes. They are all run by Huntsville-based Mission Health Services.
Gary Kelso, president of Mission Health Services based in Huntsville, said going the Eden way is doing the right thing.
"Once you get some success stories," Kelso said, "you're very willing to jump into the risk."
Thomas and other advocates note that nursing home regulations focus on downside risk, the things that can go horribly wrong. Many of the worst abuses of old nursing homes, such as tying people to bed rails, no longer are tolerated. But institutional rules, such as making everyone eat at the same time, making staffers wear hospital scrubs and making a charge-nurse station the center of activity, still are common.
The regimentation inhibits the kind of natural life elders too often lose when they seek long-term care, advocates say. By contrast, Eden homes allow animals, encourage outings and fresh air exercise, have gardens and living-room like spaces for families to visit with elders and staffers.
They also adhere to federal regulations.
Thomas really would like to abolish nursing homes. "The reason it hasn't been done before is, it's not easy. And no one has done it perfectly," he said. "But I don't have to make it perfect. I have to make it better than the standard nursing home. I can do that."
The Eden Alternative
Founded by geriatrician Bill Thomas two decades ago, the nonprofit educational organization has gone global with its resident-centered nursing home ideals, claiming more than 15,000 trainers in Europe, Australia and Japan. For more information: http://changingaging.org