A neatly dressed group of students hovers over a table, eagerly holding paint brushes, while a volunteer art teacher explains the afternoon's watercolor project.
She gives each student a sample painting, providing inspiration for each to create his or her own rendition.
A student once asked that her finished paintings be donated to a nursing home. The only thing awry about the woman's request was that she was living in a nursing home, recalls Melanie Fabian, a social worker at St. John's Living Center in Jackson.
"To her it felt like she was at home," she said.
That's the essential goal of the Eden Alternative: to examine the status quo in long-term eldercare and find creative ways to change the culture of nursing homes and put elders' needs first.
Communities throughout the state are reinventing long-term care with the help of the Eden Alternative and the Green House Project. The 2007 Long-Term Care Choices Act pushed Wyoming to become a national leader in long-term eldercare. The act awarded grants to three towns to explore alternatives to traditional nursing homes and removed limitations on the number of beds allowed in those communities.
"Because we are a small state, we have a different mind-set than some of the larger states. We still look at people as people and not just as numbers," said Virginia Wright, interim superintendent of the Wyoming Life Resource Center in Lander. "I've worked in many states, and I have never seen as high of standards as I have seen here."
Wright moved to Wyoming to live permanently about 15 years ago after coming here initially as a two-year consultant. Before that, she worked in group homes for people with intellectual disabilities in four other states on the East Coast.
The Eden Alternative
The Eden Alternative is a philosophy based on 10 principles that seeks to remedy loneliness and other causes of suffering among elders. It was founded in 1994 by Harvard Medical School graduate Dr. William H. Thomas, an international authority on geriatric medicine and eldercare.
At one time, Thomas worked in a traditional, long-term care facility. With the help of an elder there, he woke up to what was really going on, he said. He realized if he was not addressing loneliness, helplessness and boredom, he was not doing his job.
He said depression is fairly common in nursing homes, but it is a clinical illness, and there is good treatment for it.
"Whereas with the pervasiveness of loneliness and boredom, there is no pill that can offer relief," he said. "It requires a social solution."
Providing loving companionship, opportunities to be of service, engagement in meaningful activities and instilling variety and spontaneity in daily life are the antidotes lined out in his Eden Alternative model.
"It makes perfect sense to me," said Heather McKee, administrator of the Sublette Center in Pinedale. "The worst thing you can do for someone is to have them lose their dignity and sense of individuality. We want our residents here to thrive - to maximize their skills and gifts that they continue to have."
St. John's Living Center in Jackson is the first assisted-nursing facility in Wyoming to be registered as an Eden Alternative home.
There, residents are asked to assist one another as a means of sharing their talents.
"The residents foster new friendships and share bonds this way," said Connie Hansen, activities director.
Once when a player piano was delivered, a resident stormed into her office, fearing she was replaced, she said. The resident played the piano at group gatherings as part of her contribution to the community.
In keeping with an Eden Alternative principle which states that elders deserve easy access to human and animal companionship, St. John's Living Center accepts resident pets, such as cats, dogs or birds, so long as a resident or caregiver agrees to oversee its care.
Intergenerational programs, open dining and unrestricted visiting hours are other changes implemented by St. John's Living Center and other homes that have associates trained in the Eden Alternative.
The caregivers are relationship oriented rather than task oriented at St. John's Living Center, Hansen said. And there's a consistency among the primary care workers. The same certified nursing assistants work with the same residents each day.
Keith Stevens, who has been a CNA at St. John's Living Center for three years, said he witnessed people with dementia who were regularly acting out become naturally calm and gentle as a result of participating in a Bible study he leads as part of the Eden philosophy.
"They are no longer living in an institutional setting. It is not a white, sterile environment," he said. "It is more homelike, and it's like taking care of your friends."
These relationships between caregivers and residents are not just good for the residents; they reduce caregiver burnout. The national turnover rate for caregivers is over 100 percent per year, according to Thomas.
"Staff stability is an important part of quality. In order to get that, you have to have a plan," Thomas said.
According to Thomas, published research from the University of Minnesota shows that organizations that embrace this philosophy of care do better in state surveys. Caregivers are more likely to stay on the job, and it is better for the elders and their family members, creating a greater degree of confidence.
Adopting the philosophies of the Eden Alternative requires culture change, which can take time.
"One of the things they say at Eden is that it's a process," said McKee, of the Sublette Center in Pinedale. "We continue to seek ways that we can help our elders both at the nursing home and in the community."
Eden Alternative around Wyoming
While St. John's Living Center in Jackson is the only facility in the state registered as an Eden Alternative home, eldercare providers throughout the state are trained in the care model, and many homes have implemented its principles. Here are just a few examples of how some homes have incorporated Eden Alternative philosophies:
- At the Wyoming Retirement Center in Basin, the ideas behind Eden Alternative were used to create a human habitat in place of a traditional hospital-feeling environment when updating the facility. The center had a large, central nursing station that was built in the 1980s. The nursing station was removed and hardwood floors, nice lighting and electric fireplaces were installed, essentially creating a more open and friendlier environment, said Superintendent Jack Tarter. The center also has children from Kiddie Kamp, the day care center provided for employees' children, visit the residents and participate in activities with them, said Anita Cox-Mills, the facility operations manager. One resident has a weekly story time with the children.
- At the Sublette Center in Pinedale, caregivers are trained to treat all residents as moms or dads or grandparents to create a real family atmosphere, said administrator Heather McKee. "We tell staff that this is the residents' home, and we are privileged to come into their homes to take care of them," she said. Like many of the long-term care facilities that are implementing the Eden Alternative, the Sublette Center encourages all of its residents to make their rooms as homey as possible. That means bringing in mementoes, personal furnishings, family heirlooms and pictures, according to McKee. "Our residents do call it home," she said. "Having their own personal belongings makes them feel more comfortable and helps improve health and their general state of well-being."
- At Westview Health Care Center in Sheridan steps toward culture change began about five years ago, according to Tonya Murner, admissions and marketing director. One thing they did to create a sense of place familiar to Sheridan was to hang 1930s-era photographs on the walls which spurred conversations and memories for the residents who recalled the people and events in them.
- At Platte County Memorial Hospital in Wheatland, the vision is to move from the medical model to the elder-centered model, but the biggest obstacle has been staff and administration turnover. "We need the same people to create the family-feel," said Kris Kennedy, the director of nursing.
The Green House Project
Taking the Eden Alternative philosophy a step further is the Green House Project, another brainchild of Thomas, which debuted in 2002.
A conventional greenhouse conjures images of plants, thriving and blossoming in a nurturing environment.
"That is how the Green House Project got its name. It grows people," Thomas said.
The Green House is a departure from traditional nursing and assisted-living homes. Rather than housing 100 patients, one house comprises about 10 residents, each with his or her own private room and bathroom. Individual cottage-style houses are clustered with other houses, but each is stands on its own and operates much like a family unit with consistent teams of caregivers and residents working together in community.
Residents cook meals and eat in a central dining room, as well as engage in household activities from doing laundry to gardening. It is similar in concept to the Eden Alternative, but is a home built from the ground up rather than utilizing an existing facility.
"The Green House Project is the Eden Alternative and Dr. Bill [Thomas] with a blank piece of paper redesigning what eldercare could be like," said Denise Hyde, community builder for Eden Alternative.
There are more than 60 Green Houses around the U.S., and Thomas said Wyoming's rural nature lends itself to the cottage-style concept. Rather than elders having to leave their communities, families and churches to live in far-away, large institutions, the smaller-scaled, community-based Green House is more responsive to the needs of elders from rural communities, he said.
Facilities pay to use the Green House brand, and in return receive support such as professional assessment of architectural plans, on-site training, frequent teleconferences on pertinent topics and provisions of a financial model. The organization also maintains a Web site and hosts an annual meeting.
Green Houses are licensed nursing homes that accept private payment, insurance, Medicaid and Medicare. The average cost to stay in a traditional long-term care facility versus a Green House is comparable, with the average cost for long-term care $6,661 per month in the United States and $5,870 a month in Wyoming.
Currently, there are three official contracted Green House Projects in Wyoming, each in various stages, according to Melissa Honig, project guide for the Green House Project.
- Sheridan is the closest to breaking ground on a plan to build four homes on more than two acres about one mile west of Sheridan Memorial Hospital. Green House Living for Sheridan received a grant from the 2007 Long-Term Care Choices Act. The group has to raise $800,000 by March 31 to obtain an $891,000 grant from the Wyoming Business Council, according to Doug Osborn, board president and a former state representative. The group has raised about $2 million to date. In a last-minute push, Gov. Dave Freudenthal flew in to attend a reception in Sheridan in mid-January, commending the community for taking this on with a true Wyoming "can do" spirit.
- In Jackson, a group of committed eldercare professionals and citizens, the Jackson Hole Elders, is looking to build six Green Houses. Executive Director Sylvia Vroman sees it as a solution to improving the relationship that aging people have with their future. Jackson Hole Elders received two grants: one from the 2007 Long-Term Care Choices Act has been awarded and another from Robert Wood Johnson Foundation. The next step is acquiring the land and establishing a capital campaign. The group has partnered with St. John's Medical Center and is studying market feasibility, Vroman said.
- The most recent community to be accepted to the Green House Project is Riverton, which plans to build homes known as Meadowlark Cottages on five acres of donated land. Riverton received a community development block grant to conduct a financial feasibility study.
- * The Care Center in Lovell is unique in that it is the only center in the nation currently benefitting from the Green House Project without building an actual facility. The Care Center was accepted to the project as part of the 2007 Long-Term Care Choices Act grant to determine how it could implement eldercare changes within the current infrastructure, making the existing nursing home better, according to Osborn.
Those in other parts of the state are following similar paths to transforming elder and long-term care, though not specifically through the Green House Project. In Pinedale, where the Eden Alternative was implemented in the Sublette Center, a group of citizens initiated a senior housing coalition to envision the future of senior housing, according to Sublette Center administrator Heather McKee
"We are focusing on aging and place rather than institutionalizing our elders," she said. "We are hoping to build partnerships in Sublette County in order to build communities and expand the Green House Project [idea] to serve a greater number of people."
In Casper, the nonprofit Wyoming Dementia Care is poised to build homes that are suitable to residents who have dementia and Alzheimer's disease, according to Mary Hein, board chairwoman. It is using the Green House idea, but not the copyrighted label, Hein said, because at about $100,000 for the whole service package, it is cost prohibitive.
Bill Luker donated 17 acres at East 12th Street and Newport in Casper where Luker Village will be built in memory of his wife, Betty, who died with Alzheimer's disease. The village will consist of a group of cottages that will house up to 12 residents. The homes will be designed to make things as homelike as possible, Hein said.
"One of the things about this plan is that the residents need less medication, eat better and are happier," Hein said. "Needing less medication is a big issue in terms of overall health."
Though not an eldercare facility, the Wyoming Life Resource Center in Lander has been a leader in the cottage-style concept. It is an intermediate care facility for people with intellectual disabilities. In the mid-1990s, staff moved away from the medical model and went to an interdisciplinary team approach in which the guardians, parents and individuals are all involved in a model of care based on the Eden Alternative. Residents live in small houses known as community buildings, similar to the Green House Project concept, and not in dormitories, Wright said.
Learn more about Thomas' philosophies behind the Eden Alternative and Green House Project in his book, "In the Arms of Elders: A Parable of Wise Leadership and Community Building."
* Teresa Griswold is a healthy living activist who is passionate about making a positive difference in the lives of others. Visit her at www.healthylivingactivist.com. She lives in Jackson.