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Taking the first steps – Our Eden Journey

I had the privilege of working at Rand Aid for almost 3 years. Working with the elderly has always been my passion and dream, and I couldn’t believe my luck when a position for an occupational therapist was advertised at a care centre in Lyndhurst, Johannesburg. The role of OT’s in elderly care is not always recognized in South Africa and I was so excited to apply for the position.  When I arrived for my interview I was amazed at the beautiful environment – the picture in my head of retirement villages and “old ages homes” was rather grim. From day one I realised that Rand Aid is an association with values that I can relate to and that they really aspire to be the best in the field of care for the elderly. 

Their retirement villages are holistic in many ways, allowing the residents to be as independent as possible, while providing all the necessary facilities to almost turn each village into its own little community.  Most of the residents in the villages are independent and are encouraged to form their own committees and organize their own activities and entertainment.  Residents who become less independent over time can remain in their own houses with private carers with ease, but the option of the care centre for sick days or for permanent residence is available if needed. 

My main focus was the care centre – planning Activity- and Stimulation programs for the residents of the different wings and managing the Occupational Therapy department.  I had never heard of person-centred care or The Eden Alternative before starting at Rand Aid (although the concepts are closely linked to the approaches that we OT’s use in our treatment), but I have to say that from the beginning I always felt that all the decisions Rand Aid made or changes they implemented was with the residents best interests at heart. 

Moving away from the medical model in a care centre is not easy, especially if the physical environment is very much structured in a “hospital way”.  And, in my view, people often believe that we care better for our residents if we can provide proper medical and nursing care.  In many cases that is also what the family expects when they leave their moms and dads in our hands.  In our team meetings we would often discuss these challenges and how difficult it was to get the residents involved in the programs that were offered as they were frail by the time the families brought them to us.  Making the decision to put your family member in a home is one of the most difficult decisions a person can make. Besides the financial implications, it is hampered with feelings of guilt and doubt about whether you are doing the right thing. On many occasions, residents are only placed in a care centre once they are bed-ridden and need 24 hour care.  We realised more and more that we needed to create a home away from home for our residents.  A place where family members could feel comfortable bringing their loved ones, even if in the earlier stages of their lives.  A place where they can visit and feel hope instead of despair when dealing with difficult realities like Alzheimer’s and Dementia. 

Looking back now, I realise that in many ways, Rand Aid was doing person-centred care without defining it even before we started our Eden journey. There was just a need for something else, something more, and we needed guidance to implement the changes we wanted. 

The answer came in a 3-day seminar presented by Geratec on The Eden Alternative.  For most people reading this, I would not have to explain Eden Alternative or person-centred care, but I think a good way to describe it is:  “A light bulb moment”. It just makes so much sense. When you listen to the inspiring words, it feels like someone is finally defining what you have been thinking about. You realise, you see the three plagues everyday:  residents feel lonely, helpless and bored. I was in fact employed to alleviate these exact feelings – even though it wasn’t defined like that in my job description.  So, my first reaction to the Eden Alternative was relief, hope and excitement.  Relief because there was an answer to the things that we had been struggling with, hope about creating that homely environment we wanted and excitement about all the changes we were about to go through. 

It didn’t take long to get management on board and slowly but surely we started warming the soil together. Patience is very important when you start your Eden journey I learned, as it really is important to get everyone involved, rather than have some that feel excited while the rest are left behind. 

In each three of the transformation processes, we’ve made tremendous progress.  Our physical transformation has included things like a new coffee shop for family members and loved ones to spend time together outside of the resident’s rooms.  This coffee shop changed the whole atmosphere at the care centre.  It is open for people from outside, all the different villages and for the residents of the care centre and it made such a difference.  What a wonderful feeling when you walk past the shop and see residents having cake and coffee and chatting and laughing.  Other changes included new looks for three of the wings:  Woodlands, Cedar Park and Lakeside.  Cosy little nooks were made to break the long corridors, different coloured paint made old portraits stand out more and textured objects were used on the walls for decorations.  Dining rooms looked a bit more like little cafes, lounges were moved around to have sitting corners to improve social interactions.  In short it is a complete break away from the typical care centre look.  In Lakeside some of the residents decided that their corner outside the dining room and lounge area had to be called “Lakeside Boulevard”, with the lovely new chairs and tables on the veranda where they love to sit on sunny days (or sometimes even on colder days, with their blankets wrapped around them).  Sensory gardens were put outside Lakeside and the Occupational Therapy department and the residents have the responsibility to look after these.  The flower beds are raised and a person sitting in a wheelchair can easily smell and taste the different plants or water the soil and tweak dry leaves.  What a wonderful experience it was to see the old care centre fading away and becoming the home we wanted for our residents.  A lot of work still needs to be done, but the amazing response to these changes inspires to continue changing the environment for the better. 

For the personal and organizational transformations, we were pleased to have the Geratec Team to help us with this process – as these transformations are more difficult to implement than the physical ones. We continued with the necessary training.  Three more people attended the Eden Alternative Associate course.  Rayne Stroebel presented to the management team as well as the board members of Rand Aid the many benefits of Eden Alternative and why it makes so much sense to start the Eden journey – not only for the Ron Smith Care Centre, but also for the other parts of Rand Aid.  We then had the Open Hearts, Open Minds course to start with the culture change needed in our organization.  Nursing staff, managers and some of the residents attended this course and everyone was so touched when realizing how much life there is still to be lived – even for those persons who seems too far gone.  After that we had an assessment done by Geratec, where all services provided by us where looked at and measured, upon which feedback were given.  This gave us many stepping stones to implement further changes.  It was amazing to see how people’s mind sets changed.  We focused on the language we use when speaking about our residents and the care provided and the different activities.  Residents were more involved in decision making – by forming small committees where they could say what changes they would like to see or to talk about the things they enjoyed.  Care training started in the different wings.  These training sessions were attended by the carers and the residents and it was wonderful to see how well people participated.  Training sessions included things like physical exercises, Activities of Daily Living – how important it is for the residents to do as much as possible on their own and how the carer and the resident could work together to make changes.  Residents and carers were communicating to each other in new and personal ways, finding out personal bits that they never knew about each other.  Walking programmes were implemented and the importance of all these activities was discussed with the carers and the residents.  As I walked through the centre, I was amazed to see how little things started to change.  Carers dancing with residents even when the OT is not there to start a group or put on the music, residents’ skills being used to teach other residents or carers different activities and vice versa.  After implementing the changes suggested by Geratec, we did the “Matron to Mentor” training which got a lot of positive feedback.  And recently Rand Aid purchased the “Path to Mastery” to direct them and guide them as they continue with their journey.

There are also a number of other projects that has evolved since we’ve been motivated by the Eden Alternative’s philosophy.

RAVE (Rand Aid Volunteer Experience):  Rand Aid was started by volunteers in 1903.  As the organisation grew, more professional staff had to be employed and the input of the volunteer in daily operational activities diminished.  Eden Alternative has helped us to realise how essential it is that we reconnect with our roots The personal touch of volunteers and the unconditional love they bring, offer companionship to the residents that need it most.  We started a proper volunteer program when we realized how much our residents  can benefit from it, with a volunteer manual, job descriptions for the various volunteer tasks as well as on-going training to empower and educate.  We use the same person-centred care principles when placing the volunteers as it is equally important to get to know them and see where they feel they can contribute most and to understand what each one of them has to offer.  It has been wonderful having volunteers.  They often say that they feel they get so much more from volunteering than expected and that they would not miss Scrabble or a stimulation group or just sitting and getting to know a resident in our coffee shop, for anything. 

 Dementia Support Group:  We also realised we needed to offer support to the family members of our residents.  We started with talks about Alzheimer’s/Dementia.  Even though family might know their loved one’s diagnosis, this does not mean they have any understanding of what it means.  Education sessions are so important because people are better equipped to deal with the realities of the disease if they understand what causes them.  We were astounded by the number of people that came to the sessions, hungry for knowledge about these conditions. The sessions showed us the great need for a support group to complement our other services. Our support groups are led by a professional counsellor and we have only received positive feedback from family members. 

It is also so important that family members understand the changes that we make to our care programmes.  They need to be on board.  Some family members for instance might not understand why their mother needs to make her own bed in our care centre.  They might not see how a simple activity like this can still make a person feel worthwhile.  It is thus our task to help them understand these things and work together to create a better care environment. Education and empowerment of the family members are just as important as it is for our staff members.

The OT Programme:  “Meaningless activity corrodes the human spirit.  The opportunity to do things that we find meaningful is essential to human health.”   After attending the Eden Alternative courses, we also reviewed our activity program.  Person centred care is all about what is viewed as meaningful activity for each individual and how can we help each person to still participate in those activities.  We realised our program had to become more than just a few activities a day that takes place in the OT department, but that there rather had to be many opportunities for participation in meaningful activities. These activities can take place on the different wings, or in the gardens, at the pond, at the coffee shop and also sometimes in the OT department.  This changed our focus from the few individuals who would come to the OT department for the same activities (as they have been doing for years), to reach many more residents every day.  In order to help us understand the resident and to see what they value as meaningful we had to change some of our admission documents.   We developed a new care plan (guided by our knowledge of person-centred care and the Eden Alternative principles) and this is filled in by the family members or by the resident before they move in to the care centre.  The different care partners that will be involved will then discuss this information beforehand in order to gain a better understanding of the resident.   They will then also know the kind of activities the resident will be interested in and can seek the assistance of the Occupational Therapist in order to help getting them involved. 

Rand Aid was full steam with their Eden Alternative journey when I had to leave (due to personal circumstances) a month ago.  While I was part of this process, it felt very challenging at times and, in the moment, the changes sometimes felt small and slow.  But looking back now, I am amazed at the amount of change we have undergone since that first Eden Alternative Association course.  There are too many too be mentioned.  But what I love about Rand Aid is that they never say:  “We’ve done enough”, but rather:  “What more can we do?”  It is with excitement that I observe their journey from a distance, holding them in my heart at every step.

 

Charlene van Zyl

July 2013

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