The Eden Alternative: Findings after 1 year of implementation

Background. This study examines the effects of the Eden Alternative (EA), a systematic introduction of pets, plants, and children into a nursing home, on the quality of life of nursing home residents. Methods. Two nursing homes run by the same organization participated. The study site began implementing the EA in November 1998. The control site continued traditional care. Patient-level data from the Minimum Data Set (MDS), Version 2.0, and aggregate data based on staff reports were used to compare the residents at the two sites in terms of cognition, survival, immune function, functional status, and cost of care after 1 year. Results. After adjusting for baseline differences, follow-up MDS data indicated that the Eden site had significantly greater proportions of residents who had fallen within the past 30 days (p = .011) and residents who were experiencing nutritional problems (p < .001). Staff report data indicated that, during the study period, the Eden site had significantly higher rates of residents requiring skilled nursing and hypnotic prescriptions, and more staff terminations and new hires. The control site had significantly higher rates of residents requiring anxiolytic prescriptions. Conclusions. 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.