Compassion in Practice Week of Action - David Foster - 3Cs: Culture - Clash or Complement?

DF PhotoDavid Foster, Deputy Director of Nursing at the Department of Health, shares his experiences from his visit to the Eden Alternative in the third of our series of blogs from the Week of Action on Helping People to Stay Independent, Maximising Well-being and Improving Health Outcomes.

June Burgess is one of those warm people whose unassuming nature disguises her deep passion and commitment. She is the regional coordinator for the Eden Alternative in the UK and Ireland and she and Paul Bailey, an Eden mentor and trainer, hosted a day of visits for me to go to two residential and care homes with nursing and find out about her passion – the Eden Alternative.

In the mid-nineties, Dr Bill Thomas, a geriatrician from up-state New York, identified what he termed the “three plagues” of loneliness, helplessness and boredom as the biggest causes of suffering in American nursing homes.  He felt so strongly about the prevalent institutional model of care making people sicker that he founded the Eden Alternative.  His vision was to change that through implementing a model of person-centred care. It is now an international not-for-profit organisation putting choice, dignity, respect and purposeful living at the centre of care for older people.
The Eden Alternative is based on 10 principles clustered into 5 themes. They are:

 The problem

1: Loneliness, helplessness and boredom

The solution

2: Creating a human habitat where life revolves around close and continuing contact with plants, animals and children

The antidotes

3: Loving companionship is the antidote to loneliness

4: Opportunities to give as well as receive care is the antidote to helplessness

5: Variety and spontaneity is the antidote to boredom

Things we have to change

6: Meaningful activity is essential to human health – meaningless activity corrodes the human spirit

7: Medical treatment should be the servant of human caring, never the master

8: Decision-making closer to the resident

Driving the process forward

9: Creating an elder centred community is a never ending process

10: Wise leadership is the lifeblood of the struggle against the 3 plagues

The vision of eliminating loneliness, helplessness and boredom in this way creates a philosophy of a continuous process of culture change. It is not easy to implement, it takes real effort and commitment which has to be based on a desire to change. Staff have to recognise that their culture of care could be better.  This is a vital step in acknowledging that, whilst their current model of care does not lack compassion or competence, it might seem passive rather than dynamically and actively promoting a culture which is truly centred on the person needing care. For me, this has resonance with the national strategy for nurses, midwives and care staff, Compassion in Practice, and the 6Cs of care, compassion, competence, communication, courage and commitment. These values and behaviours were developed in consultation with the public, patients, nurses, midwives and care staff and are recognised as fundamental to the way care is given.

The Eden Alternative is not an abstract concept. June and Paul were able to show me some very real examples of how its practical application has been effective.

Staff who work in the homes I visited, which have adopted the Eden approach, described them as relaxing, homely and loving environments where people with dementia and other complex needs are (within reason) free to do what they want. This might mean getting out of bed whenever they choose, eating breakfast in their pyjamas, having fish and chips for tea, or doing the washing up.

Residents in Kingston House care home in Calne, Wiltshire have a wishing well in which they can drop their suggestions to the staff – a way of ensuring changes are led by the residents not the staff. One man there in advanced old age and mobile only in a wheel chair requested to go swimming, something he enjoyed doing in his youth and something he thought he would never be able to do again. Once all the cynicism from the staff about whether this would even be possible was swept aside, they approached the local pool and the life guards there were more than happy to help. They had the will and the ability and, it seems, were almost waiting to be asked. Now it is an activity that other residents also enjoy. It helped bring meaning and freedom back into one man’s life and now has spread to others at the home. And by the generosity of the life guards there is now a real connection with the local community and the residents of Kingston House.

At Mavern House, a nursing home in Melksham in Wiltshire, there is a flourishing choir formed of residents, staff and volunteers. The choir helps dispel the belief that residents, many with dementia, can’t learn new things because they are learning new songs. The choir helps to bring people together as equals. In one special example it has helped a son reconnect and communicate with his father (who has dementia) through singing. In the summer the choir performed at a garden party held at the home which was open to the whole community - a superb way of reducing the stigma of dementia and nursing home care across the generations.

From my visit to Wiltshire, there is clearly no clash between Compassion in Practice and the Eden Alternative; they are both models by which to improve the quality of care and the culture of care-giving. And there may be other models which are equally effective – the last thing we should do is reinvent the wheel. For me, the important thing is to embrace this diversity and encourage staff to embark on the process of continuous improvement which the people in our care deserve.

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