The Eden Alternative

CURWOOD: For most of us, the mere thought of a nursing home draws a shiver. Many doctors hate working in them. They're trained to cure diseases and if one thinks of old age as a disease then treating it is a frustrating losing battle. Most of the more than 2 million residents of America's nursing homes hate them, too. They're stuck in sterile places with little stimulation, and where the only living creatures are medical staff and other elderly people in poor health. To cut down on restlessness and complaints, many residents are drugged.

But it doesn't have to be that way. Outside of nursing homes in the natural world, humans are surrounded by all kinds of life: plants, birds, mammals and people of different ages. So why not, thought Dr. William Thomas a few years ago, create an inviting human habitat for our ailing seniors? Dr. Thomas ran the Chase Memorial Nursing Home in New Berlin, New York. In 1991 he started bringing birds, dogs, and cats, plants and even children into his workplace. Many of the staff quit. But those who have stayed have witnessed an amazing turnaround.

Dr. Thomas called his approach the Eden Alternative, and he's written about it in his new book A Life Worth Living: How Someone You Love Can Still Enjoy Life in a Nursing Home. He says his dream is to change every nursing home in America from a place that merely treats patients into a haven for elderly human beings.

THOMAS: Really, there's 3 plagues, I call them, that rage in every nursing home. And they're the plagues of loneliness, helplessness, and boredom. And it's kind of interesting from a doctor's point of view, there just is no medical treatment for loneliness, helplessness, and boredom. Those problems can only be addressed in an environmental or an ecological way. I can only treat loneliness by providing companionship. When I first started out I looked at the possibility of hiring a person to be a companion for every nursing home resident.

CURWOOD: Hmm.

THOMAS: And I -- well, I did a budget up. It was going to cost $7 million a year.

CURWOOD: Ho, ho, I guess so.

THOMAS: And that just wasn't feasible. The next step was, we just stopped and said you know, people get all kinds of terrific companionship from animals. So that's where the idea of creating a human habitat inside the nursing home started to take shape.

CURWOOD: Human habitat. What do you mean?

THOMAS: Well, I came to realize that if I took a polar bear and dropped him off in the Amazon jungle, he would die. If I took a song bird from the Amazon jungle and dropped him off at the North Pole, could never survive. When I think about taking a sick, old, frail person and putting them in a nursing home, I'm putting that person into an environment or a habitat that's not good for them. So the answer is not prescribing more drugs or giving more treatments or doing more surgery. The answer is in re-inventing the nursing home and making it into a habitat that nourishes and supports the people who live there and work there.

CURWOOD: What does it look like when you come into a patient's room where you have the Eden Alternative?

THOMAS: Well, I think you can go through it by the senses. The sight is of a rich array of green growing plants placed around the room, and they make a very dramatic presence there. The smell can often come from flowers or herbs that are part of that green plant life in the room. The sound often will come from the parakeets, often up to 4 parakeets living in a single room chirping and reacting to each other and to the people who live there. The sound might also include the sound of kids tumbling into the room for a visit. Edenizing nursing homes really focus on having on-site child care, after-school programs, summer camps for kids. Anything you can do to have kids there in the nursing home regularly.

CURWOOD: So you're saying the present model for a nursing home is really like a desert, an emotional and a spiritual desert?

THOMAS: [Sighs] It makes a desert, it makes a desert look great.

CURWOOD: [Laughs] Really.

THOMAS: [Laughs] Oh yes. I mean, if you were to go into a nursing home and do sort of an ecological survey, it would be an ecological disaster area. You've got one species running rampant, homo sapiens. And maybe you've got a dead chrysanthemum over in the corner and that's it. It's the most unnatural environment we could almost possibly create. And that's what's the irony in this. You're creating a universe. For the people who live there, that nursing home is their entire world. And to choose to create an entire world for someone that is as sterile, stark, medically oriented, unnatural -- it's a tragedy.

CURWOOD: The prescription for loneliness, helplessness, and boredom --

THOMAS: Yes.

CURWOOD: -- is your approach. And you found that by incorporating animals and kids and plants into nursing homes, you solve these problems?

THOMAS: That's right.

CURWOOD: What happens?

THOMAS: Well, we get people to connect with the living things around them and participate in the care of those living things. So people become not just recipients of care, but caregivers as well. That's one of the problems that conventional nursing homes is so terrible, is you're saying to people, "You're not connected any more. You don't belong any more. You're going to be here and we're going to treat your diseases and we're going to do everything for you." That's terribly, terribly unnatural and very damaging to the spirits of the people who live there.

CURWOOD: Can you give me an example of how this helps an individual?

THOMAS: Well, I mean, I'm going to tell you a story about a parakeet that saved a woman's life. You know, we got started with the Eden Alternative, and there was a woman who I was taking care of at the time who'd had a stroke and wasn't able to speak. And she was kind of withdrawn and not doing well from a number of

perspectives medically. But she agreed to take on the care of a small parakeet in her room. And she really started to enjoy that and it became a really important part of her daily work. Her daily life became to include the well-being of this parakeet. Well one day, I was making rounds and I was called down to see her; she was not feeling well, had a high fever, terrible pain in her abdomen. We sent her out to the hospital. She was evaluated by the surgeon and taken to the operating room and had really a major operation. When she came back to the hospital floor she got very agitated and was trying to communicate something to the nurses and they couldn't figure out what it was. Finally a family member came in to see her and could sort of figure out, it's her bird, it's her bird. She wants to know who's taking care of her bird. And we had a flurry of phone calls between the hospital and the nursing home where we began to, we reassured her oh yes, we'll make sure that your Tweety is taken care of. And absolutely, she'll be safe, we'll watch over him for you while you're gone. And she settled right down. She recovered really very quickly from the operation and came back to the nursing home, and immediately her very number one concern was checking in on Tweety and making sure that he was okay and he had been properly cared for in her absence. I think that bird saved that person's life because her love for that animal gave her a reason to fight through a terrible illness and come back and recover and be stronger than she ever was. I could never have given her a drug that would have caused that reaction; it had to come from her heart.

CURWOOD: Now, you've been talking about these wonderful beneficial effects of the Eden Alternative. Can you quantify some results?

THOMAS: Yeah. You know, we did a research project where we looked at a couple of factors that I think are really important.

CURWOOD: Okay.

THOMAS: We looked first at use of drugs in the nursing home, or medication use. And we compared ourselves to a control nursing home that was same size and matched to us statistically speaking. Over the Eden Alternative period the controlled nursing home drug costs continued to rise like they are in nursing homes all across America. In the Eden home the utilization of drugs dropped sharply. By the end of the study the nursing home that did the initial Eden project was saving $75,000 a year on drug costs, and I'll tell you that's a lot of bird seed.

CURWOOD: And that's out of how big a budget? [Laughs] That is a lot of bird seed.

THOMAS: Yes. The drug costs had been cut in half. The second thing we looked at was the infection rate. Our hypothesis or idea was that people who have a reason to live are going to be more resistant to infection. And again we compared ourselves to a control, and we found that the infection rate dropped 50%.

CURWOOD: Medications in half and infections in half?

THOMAS: Yes, that's true. And as a physician let me tell you, there's no way -- even if I went to that nursing home every single day and saw every patient every day, I could not get that kind of preventive impact with regular medical treatment. It came from the human habitat. And the last thing, and I think probably the most important, is that we looked at the death rate. In the first year of the Eden Alternative the death rate dropped 15% and in the second year of the Eden Alternative it dropped 25% compared to control. You have to imagine sort of walking through this nursing home and realizing that given the size of the nursing home, at the end of that year there were 8 people alive who would have been dead in a conventional nursing home. And if I had been tinkering in my basement and had come up with a drug that could do that, it would be unbelievable. It would be front page news in the New York Times. But it's not a drug. It's a taste of the natural world brought back to the lives of people who really need this.

CURWOOD: Now you've gotten this started in upstate New York. Is the idea spreading?

THOMAS: Our latest count is that there are over 100 homes around the country that are in the act of Edenizing process.

CURWOOD: A hundred homes.

THOMAS: And one of the exciting things is, nearly every day now we get word from another home that is starting up on the process and wants more information from us or wants some advice. And it is absolutely delightful.

CURWOOD: Thank you so much for joining us.

THOMAS: You're welcome.

CURWOOD: My guest has been Dr. Bill Thomas, author of Life Worth Living: How Someone You Love Can Still Enjoy Life in a Nursing Home. Thanks for taking the time with us.

THOMAS: You betcha.

(Music up and under: Beatles: "When I'm 64.")