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Life Worth Living
How Someone You Love Can Still Enjoy Life in a Nursing Home
The Eden Alternative in Action

by William H. Thomas, M.D.

From Chapter 6: Death in the Nursing Home

As part of the evaluation of the Eden Alternative, we looked at mortality rates at Chase and at our control facility. As I stated previously, each has eighty skilled nursing facility beds and draws both patients and staff from the same geographic area. Both nursing homes carry an average case mix and neither home has any specialized units. . . .
The data were divided into two groups: pre-Eden (the period before implementation of the Eden Alternative) and post-Eden. The first apparent trend was that during the pre-Eden period, mortality rates were rising at both homes. We believe that this rise reflected the trend toward quicker hospital discharge and the associated admission of sicker patients into the nursing homes. We analyzed the frequency of death in the pre-Eden phase at Chase and at the control home. It showed a total of sixty-seven deaths at the control facility and sixty-four at Chase; this difference was not significant. During the eighteen months after full implementation of the Eden Alternative, there were forty-seven deaths at the control nursing home and forty deaths at Chase; in other words, there were 15 percent fewer deaths at Chase. Moreover, the gap between the two grew during the final fifteen months of the study. In the next year the difference in the mortality rates grew to 25 percent.
How did this happen? Perhaps the residents at Chase were just healthier than the residents at the control home. However, we carefully compared levels of resident function at both homes and found no significant difference during the study period. Perhaps the residents at Chase simply received more comprehensive treatment than the residents at the control facility. Again, this does not appear likely. First, both facilities are staffed by comparably trained physicians. Second, there's a demonstrated decrease in the use of medication by Chase residents during the Eden period.
I believe that the difference in death rates can be traced to the fundamental human need for a reason to live. This view is not a conventionally scientific hypothesis. Human beings are capable of surviving and even flourishing despite hellish conditions when the struggle for existence has meaning for them. On the other hand, those who can find no good reason to fight for their continued existence are easy prey for disease. This is especially true of the frail elderly. In the typical nursing home, such reasons to live are usually confined to the residual contacts with family and community or even simply to a deeply ingrained obstinacy.
Given its core emphasis on the promotion of close, continuing contact with pets, plants, children, and the changing seasons, the Eden Alternative supplies an array of new reasons for living. . . .

All excerpts from Life Worth Living,
Copyright 1996 by William H. Thomas, M.D.

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