The Eden Alternative: Findings After 1 Year of Implementation

Abstract

The findings from this study indicate no beneficial effects of the EA in terms of cognition, functional status, survival, infection rate, or cost of care after 1 year. However, qualitative observations at the Eden site indicated that the change was positive for many staff as well as residents, suggesting that it may take longer than a year to demonstrate improvements attributable to the EA.

“There's No Place Like Home”: A Scoping Review on the Impact of Homelike Residential Care Models on Resident-, Family-, and Staff-Related Outcomes

“…Overall medication use was examined in 2 studies in Eden Alternative settings and 2 in nondementia-specific small houses. 18,27,44,45 None of the studies reported significant differences in overall medication use compared with traditional NH settings. One Eden Alternative study 44 and one nondementia-specific small house study 45 found no differences in the prevalence of pressure ulcers compared with traditional NH settings.…”

“…Three of the 5 studies focusing on Eden Alternative settings examined a physical functioning outcome and found no significant effects compared with traditional NH settings. 18,43,44 One of 2 studies in nondementia-specific small houses reported that residents in the small, homelike settings had or maintained functioning better than those in traditional NHs. 27 Kane et al 45 reported mixed findings with no significant differences in selfreported ADLs or instrumental ADLs among residents in the homelike compared with 2 traditional NHs, whereas based on Minimum Data Set quality indicators, residents in the homelike setting had less decline in the late loss of ADLs than residents in the comparison NHs.…”

“…41 None of the other physical outcomes were examined in dementia-specific small, homelike facilities. Three studies examined nutrition-related outcomes, 18,44,45 with one study in an Eden Alternative setting 44 and one in nondementia-specific small houses 45 reporting no significant differences in residents in homelike versus traditional NHs. In another Eden Alternative setting, Coleman et al 18 reported more nutritional problems among residents in the homelike setting than in the traditional NH, but without significant differences in weight or body mass index.…”

“…Of the 3 studies describing accidental falls as an outcome, both studies in Eden Alternative settings reported mixed findings with significantly more falls in the homelike environments during 1 of the 2 time frames measured. 18,44 One of these studies also examined fall-related fractures and reported no significant difference by setting. 44 Kane et al 45 compared falls in nondementia-specific small houses (Green Houses) and traditional NH settings and reported no significant differences.…”

“…16 In the United States, the Green House and Eden Alternative are examples of residential care models, designed to look and feel like a home environment that returns control, dignity, and a sense of well-being to care-dependent people, while providing high-quality, personalized care. 17,18 Indeed, over the years there has been greater emphasis to promote Green House homes, with currently more than 260 homes in 32 states open or under development. 19 In Europe, there is an increasing emphasis on providing residential care for older people with dementia in small-scale living arrangements.…”