Nursing homes are not static entities. New ways of approaching care continue to be developed. Three of the more interesting new developments are the Eden Alternative, the Green House Project, and the Pioneer Network.

The Eden Alternative. Imagine an approach to car­ing for frail older adults that starts from the prem­ise that skilled care environments are habitats for people rather than facilities for the frail. Such an environment has the potential to address issues such as boredom, loneliness, and helplessness. The Eden Alternative (http://www. edenalt. org) takes this approach.

Founded by Dr. William and Judy Thomas, the Eden Alternative approaches care from the perspec­tive of protecting the dignity of each person. It is based on the following 10 principles:

1. The three plagues of loneliness, helplessness, and boredom account for the bulk of suffering among our elders.

2. An elder-centered community commits to creat­ing a human habitat where life revolves around close and continuing contact with plants, ani­mals, and children. It is these relationships that provide the young and old alike with a pathway to a life worth living.

3. Loving companionship is the antidote to loneli­ness. Elders deserve easy access to human and animal companionship.

4. An elder-centered community creates oppor­tunity to give as well as receive care. This is the antidote to helplessness.

5. An elder-centered community imbues daily life with variety and spontaneity by creating an environment in which unexpected and unpre­dictable interactions and happenings can take place. This is the antidote to boredom.

6. Meaningless activity corrodes the human spirit. The opportunity to do things that we find mean­ingful is essential to human health.

7. Medical treatment should be the servant of genuine human caring, never its master.

8. An elder-centered community honors its elders by de-emphasizing top-down bureaucratic authority, seeking instead to place the maxi­mum possible decision-making authority into the hands of the elders or into the hands of those closest to them.

9. Creating an elder-centered community is a never-ending process. Human growth must never be separated from human life.

10. Wise leadership is the lifeblood of any struggle against the three plagues. For it, there can be no substitute.

Arguably, the Eden Alternative helped launch a culture change in nursing homes that has improved residents’ quality of life (Rahman & Schnelle, 2008). The main outcomes of this movement are resident – directed care and staff empowerment. Research indicates that the cultural changes resulting from the Eden Alternative are associated with less feelings of boredom and helplessness (Bergman – Evans, 2004).

Green House Project. The Green House concept is grounded in the Eden Alternative. It is a radical departure from the concept that skilled nursing care is best provided in large residential facilities. In con­trast, a Green House aims at providing older adults who need skilled nursing care a small, homelike environment that shifts the focus from a large facil­ity to a more homelike setting. Only 6-10 residents live there, in a dwelling that blends architecturally with houses in the neighborhood, making it much more homelike (Rabig et al., 2006).

The Green House concept emphasizes the impor­tance of encouraging residents to participate in their care through helping with daily tasks such as cooking and gardening, assisted by specially trained staff (Johnson & Rhodes, 2007). By emphasizing participation in one’s own care to the extent pos­sible, personal dignity is maintained, and quality

Where People Live: Person-Environment Interactions 177

of life improved (Kane et al., 2007). As a result, the Green House concept is spreading across the United States as a viable alternative to large nursing homes.

The Pioneer Network. The Pioneer Network (http:// www. pioneernetwork. net) is also dedicated to chan­ging the way older adults are treated in society, particularly in care facilities. The Pioneer Network focuses on changing the culture of aging in America irrespective of where older adults live. Like the Eden Alternative, this approach focuses on respecting older adults and providing maximally supportive environments for them. Their values are also similar in spirit:

• Know each person.

• Each person can and does make a difference.

• Relationship is the fundamental building block of a transformed culture.

• Respond to spirit, as well as mind and body.

• Risk taking is a normal part of life.

• Put the person before the task.

• All elders are entitled to self-determination wherever they live.

• Community is the antidote to institutionalization.

• Do unto others as you would have them do unto you.

• Promote the growth and development of all.

• Shape and use the potential of the environment in all its aspects: physical, organizational, and psychosocial/spiritual.

• Practice self-examination, searching for new creativity and opportunities for doing better.

• Recognize that culture change and transformation are not destinations but a journey, always a work in progress.

The Pioneer Network advocates for a major – emphasis on making nursing homes more like a home, and works in cooperation with the Centers for Medicare and Medicaid Services to work for revisions in nursing home regulations (Pioneer Network, 2008). This work is aimed at creating a new culture of aging.

What the Eden Alternative, the Green House concept, and the Pioneer Network have in common is a commitment to viewing older adults as worth­while members of society regardless of their physi­cal limitations. Treating all people with dignity is an important aspect in maintaining a person’s quality of life. Everyone deserves that.

Concept Checks

1. What are the types of nursing homes?

2. Who is most likely to be a nursing home resident?

3. What are the characteristics of nursing homes?

4. What are special care units?

5. Under what conditions can a nursing home be a home for its residents?

6. What is the communication enhancement model?

7. What are the issues concerning decision-making capacity in nursing home residents?

8. What are some new directions for nursing homes?