Nationally, 1.5 million persons live in nursing homes,1 many under conditions that we would not want for ourselves or for those we love. William Thomas, MD (developer of the Eden Alternative), articulated 3 common conditions that afflict nursing home residents: boredom, loneliness, and helplessness. Fortunately, there is a growing movement to change the culture of nursing homes so that they are more resident centered.
Changing the culture of nursing homes requires a concerted effort to provide stimulating activities and opportunities for spontaneity and meaningful social interactions for residents, while facilitating their sense of worth by caring for pets, gardens, and each other. Cultural change also involves creating a comfortable, homelike setting that is more like a community than a hospital. This includes making the nursing home less institutional and more homelike, with the addition of color, natural light, plants, pets, and home furnishings. However, the biggest change that is needed is to reengineer the resident care planning process to be resident centered and resident directed, which means that the wishes of residents, rather than the dictates of staff, determine activities, choice of meals, and schedules.