The Eden Alternative looks set to find its niche in Australia’s new consumer directed care model. INsite talks to Sally Hopkins about the changing face of community care over the Tasman.

Australia’s new consumer directed care (CDC) model was introduced for new community care packages in July 2013, with a total conversion to CDC to be rolled out by July 2015. The country’s Living Longer, Living Better aged care reform package explains CDC as “a way of delivering services that allows consumers and their carers to have greater control over their own lives by allowing them to make choices about the types of care and services they access and the delivery of those services, including who will deliver the services and when.”

Sally Hopkins, business development manager for Eden in Oz & NZ Ltd, is excited about the new CDC model and the positive effect it will have on community care services.

“Services received into the home enable and support people, assisting them with more difficult tasks and generally ensure that they have some contact with the outside world on any given day,” says Hopkins.

“It is not a service to take over someone’s life and to ‘tell them’ what to do. Rather it is a partnership in care which has the capacity to enable both the individual and the service provider to grow.”

It is not difficult to understand Hopkins’ enthusiasm for Australia’s change in approach to consumer directed care, as the principles of the Eden Alternative play nicely into the new CDC model.

What is the Eden Alternative?

The Eden Alternative is a philosophy of person-directed care that focuses upon empowering residents, staff, families and other stakeholders to provide a better life for older people. It hinges on ten key principles. The first identifies loneliness, helplessness and boredom as the key causes behind the bulk of elderly suffering. The next nine principles go on to identify the challenges and the solutions to providing a person-centred care environment for all residents.

Its origins lie in the United States, where it was founded in 1991 by Dr William Thomas, a Harvard-educated physician and board-certified geriatrician. EdeninOz & NZ was established in 2001.

Those familiar with the care philosophy will probably have come across it through residential care facilities, as it initially took root in rest homes. A number of homes in New Zealand have adopted the approach; Elizabeth Knox Home & Hospital is a well-known advocate, as is Enliven Presbyterian Support.

It has since expanded its reach to all care settings, including home care and residential care for people living with different abilities.

“It is a flexible approach that can be applied just as easily to transforming the culture of an entire organisation, as it does to the daily challenges of caring for someone at home,” says Hopkins.

However, until recently there hasn’t been as much emphasis on employing the Eden Alternative in community care settings. The new CDC model in Australia looks set to change this.

“In a culture that typically views ageing as a period of decline, the Eden Alternative philosophy asserts that no matter how old we are or what challenges we live with, life is about continuing to grow,” says Hopkins. “Building on this new paradigm, it affirms that care is not a one-way street, but rather a collaborative partnership.”

CDC and the Eden Alternative

Under the Eden Alternative approach, caregivers and care receivers are described as “care partners”, each an active participant in the balance of giving and receiving that is alive in every moment. Together, care partner teams strive to enhance wellbeing by eliminating the three plagues of loneliness, helplessness, and boredom.

Hopkins says the relationship between the customer (consumer) and the service provider can be enhanced by taking a consumer directed approach to the care support that is being provided.

“Our focus should be on capacity building and enablement. Rather than focusing upon what the client can’t do, let’s focus upon what they can do.”

Hopkins suggests that in taking a CDC approach there are some key issues that need to be considered:

How well do we know our clients? The social profile (or whatever label it is given) has the capacity to be more than a ‘likes/dislikes’ form.

What is the client’s daily routine currently? How can we support this and enhance it further?

Risk assessments on capacity should be conducted to enable people to ‘do’ for themselves, not to take away these things, e.g. moving in and out of a shower stall – the client only needs a chair to sit on.

Educating families, care partner teams and organisations about the service (not servile) role that the care partner plays.

Hopkins stresses that developing a care support plan is much more than a clinical support document.

“How do we find what is important to the person? How do we enable them to continue to live a life with meaning? Each person has a history – a life that has been and continues to be full and rich. When we visit a person in their home, many of the items we see give us clues about who this person is. For example: there is a photo of a gentleman with a gold medal – what is this photo telling us? How do we start the conversation? What can we share together? In understanding the person with the medal, we also gain a clearer picture of who this person is. We start to see the person and not the disease, a clear shift in our thinking; this person has been active in the past.”

Staff empowerment is important in the area of consumer directed care. Hopkins says that staff need to know and understand that when they go into someone’s home to provide a service support function, they also have the opportunity to develop meaningful relationships that will enhance the lives of both parties. It is not about abdicating their role in supporting the older person. The support teams are a critical link between the person and residential services that may be required in the future.

“The provision of great consumer care support is more than just the medical or physical treatments being provided, such as personal care, medication management, and so on. It’s about discovering the uniqueness of the individual and ensuring that our services are enhancing wellbeing and not stripping them of their identity.

“Care Support teams need education in CDC as it does require a shift in the way we see older people, and the culture of care focus also needs to be changed.”

Of course, Eden Alternative is just one organisation adjusting to the new policy.

It is still early days for the new CDC model, but New Zealand’s aged care and community support sectors are eagerly watching to see how its Australian counterparts adapt to the changes, and what impact it will have on care delivery.

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