There is something wrong with an industry in which the majority of workers in it would say that.

We are caught in a model of medical treatment of our elders which suffocates the spirit of those who are "cared for" by it. I put care in quotes because we call it care, but, to borrow from Dr. Bill Thomas, founder of the Eden Alternative, care is what we do with our loved ones; treatment is what we do with cases. In Long Term "Care" we are immobilized by the prospect of being fined by the inspectors or sued by the lawyers or fired by the Board of Directors; we have lost sight of how to truly care for and love our elders.

Our current generation of elders is truly "The Greatest Generation", to borrow from Tom Brokaw. They survived the Great Depression, fought a war on two massive fronts at once and transformed this country from a second-tier industrializing nation into the greatest economic, technological and political force in the world. However, in the interest of what we see as economy of scale and assembly line efficiency we treat their frailties and illnesses in sterile institutions. We, as a culture, also tend to devalue the wisdom of our elders. "Ageism" is one of the last prejudices to go unnoticed in America.

Interestingly, the problem has become so pronounced that the federal government is beginning to address it. The Centers for Medicare/Medicaid Services (now CMS, formerly HCFA) is shifting emphasis from demanding that processes be in place to demanding that outcomes be achieved. These outcomes are based on a resident focus, rather than an institutional focus. This is the second stage of a wave of change that must, and hopefully will, sweep through services for our elders. The first stage was the founding of volunteer movements aimed at reforming nursing homes; these would include the Eden Alternative and the Pioneer Network. The Eden Alternative involves a vision for culture change in senior living.

A related and unnoticed problem is that the elders who are forced to give up their homes often must also give up their closest supporters, their companion animals. These pets are almost invariably taken from their owners and place in shelters "for adoption". Usually this results in their being destroyed. It is possible for these pets to accompany their owners or to be placed with new owners who will commit to bringing them to visit the old owners on a regular basis ("Double the Love" program).

The Tennessee Edenizing Foundation was founded to promote change in our nursing homes and assisted care living facilities and residential homes for the aged. In spite of being an all-volunteer organization with a small group of dedicated workers, we have managed to garner some state funds and a not-for-profit designation. Our vision is to mount a scientific research study comparing outcomes in resident-focused homes versus institution-focused homes. We want to undertake a widespread program of advertising to the public the fact that there are more "user-friendly" models for caring for the elderly; models that we would not hesitate to place our parents in or even live in ourselves, if the need presented itself. We want to provide supportive consulting services to help existing facilities make a transition to the new culture and to support piloting new models (such as the Green House Model, the Household Model, and the Bounceback Model).

To have a widespread and lasting impact we need a full time staff to design and implement a funded research program, a public education program and to provide training and support materials to facilities on the cutting edge of change. We hope you share our concern for our elders and parents…and ourselves in the years to come.