When you think of culture change in long term care you usually think of efforts to deinstitutionalize big nursing homes, not private homes.
After all, if The Eden Alternative® and The Green House® Project models are designed to make long-term-care facilities more “home-like”, why would you need culture change in a real home?
In fact, home care is in need of culture change just as much as traditional nursing homes, said Dr. Bill Thomas, founder of the Eden Alternative, which has recently branched out to provide culture change training to community and home-based care providers through the Eden at Home initiative.
“The first lesson people need to learn whether looking at Eden or Green House or any other culture change model is that it’s not the building that ‘institutionalizes’ care — it’s the culture,” Thomas said. “And in our culture, even home-based care quickly takes on an institutional feeling.”
Which is a problem, because more than 12 million people currently receive home care services, compared to about 1.5 million people who live in nursing homes. Tens of millions more Americans depend on family members and friends for home care. CMS estimates there are only 33,000 certified home care providers, which means the vast majority receive their care from unlicensed family members or friends at a projected cost of $72 billion annually.
“When we focus exclusively in culture change on the transformation of nursing homes we forget a huge population,” said Laura Beck, Eden’s learning and development guide. “We can’t change the culture of long term care unless we get everyone on board.”
So how does it work? the Eden Alternative’s Ten Principles and core mission to eliminate the three plagues of helplessness, loneliness and boredom apply to anyone in daily life. What sets Eden at Home apart from other home-based care models is the emphasis on “aging-in-community,” rather than “aging-in-place,” Beck said.
Just like the original Eden Alternative movement, Eden at Home is based as a grassroots model where Eden at Home Care Partner Workshops are given at the local level to bring communities together to embrace the concept of mutual inter-dependence.
“As a culture, we really, really resist asking for or accepting help.” Beck said. “There’s a fear that if you can’t independently ‘age-in-place’ you will end up in a nursing home.”
The key to changing that mentality is teaching people how to create healthy, inter-dependent relationships. This involves improving communications and problem-solving skills in order to shift away from a task orientation (giving care to people) to a relationship-centered orientation that engages with people to provide care and support.
Just as there are no “care-givers” in Eden-registered nursing homes, the Eden at Home model is based on mutual care partnerships. The care partner concept means rather than looking at the needs of caregivers and elders separately, you recognize how the wellbeing of both are intricately intertwined.
This process can’t happen unless all the the stakeholders are brought to the table. It’s not enough to focus on training more home-care providers; elders, family members and community stakeholders must be involved.
This is the approach taken by the Culture Change Network of Georgia, founded by Kim McRae and Walter Coffey. They’re building an Eden at Home network across the state by bringing together stakeholders from across the spectrum of care — from elders and their family members to home care agencies, nonprofits and local Area Agencies on Aging.
“What’s so exciting about Eden at Home in Georgia is that they were able to get the strategic collaboration with all the key stake holders in place from the very beginning,” said Eden Alternative CEO Chris Perna.
For more information on Eden at Home trainer certification, contact Eden Education Coordinator Meredith Burrus.