In our September 2008 edition of Ikigai, we highlighted the culture change efforts of Eden Alternative, an internationally recognized organization that's transforming the experience of long-term care for the elderly. Eden Alternative and the Seaton Foundation partnered to create Eden LifeLong Living for individuals with cognitive disabilities. The RidgeOak Living Community in Austin, Texas began adopting and applying the Eden LifeLong Living philosophies and principles of care, and in 2008 it became the first assisted living community for individuals with cognitive disabilities to become an Eden-certified home. Greg Walton is the director at the RidgeOak Living Program:

What is the difference between Eden Alternative and Eden LifeLong Living?

WALTON: The Eden Alternative seeks to create culture change in nursing homes and enhance the well-being of elders residing in those nursing homes whereas Eden LifeLong Living applies similar principles to a population of folks who require a long-term supportive setting throughout their lifetime, as a result of brain injury or other types of cognitive disabilities.

Why was the Eden approach appealing to you?

WALTON: It appealed to me because it's more compatible with my own personal and professional style, which is less formal than the institutional approach to care. It's a holistic, positively oriented way of being and thinking as opposed to the deficit-focused institutional model.

What were the first changes you made at RidgeOak?

WALTON:  One of the first changes we made was to add color to the dining room, which like the rest of RidgeOak had been painted a sterile white. Rather than simply going myself and picking out some paint, I asked the staff to pick out the color. When it was all done they learned that not only could my ideas for change make things better, but that they would have a voice in those changes.

Was it easier to make changes to the physical environment first?

WALTON: Yes, and the reason for that is because physical changes are almost always fairly simple and positive. So initially the goal was to get people receptive to change of any kind.

Was there one change in particular that you felt had the most noticeable impact on residents?

WALTON:  Yes. The widespread reduction of rules and restrictions has had a profound impact. At one point we had so many rules that no one, not even I, could keep track of them. It created a lot of tension and forced the staff into an authoritarian role instead of a supportive one.

Volunteering plays an important role in the Eden LifeLong Living approach. How is volunteering critical to well-being of the residents?

WALTON: We have residents that volunteer at the local Meals on Wheels program, the animal shelter and at a nearby church daycare. We found that there are lots of benefits to doing this. First it expands their world by putting them in contact with children, animals, elders and others in the community. Second, it creates opportunities for them to nurture and help others, instead of always being the care recipients. What a role reversal for them that has been! Finally and most importantly, it gives our folks a sense of contributing something valuable back to the larger community. Because they're needed, they feel more competent, useful and better about themselves. We all derive meaning from a personal belief that we matter to others.

What kinds changes have you seen in the residents since you adopted the Eden LifeLong Living approach?

WALTON:  Every single one of our residents, without exception, is happier, more outgoing and less likely to exhibit symptoms of their mental illness than they were before this journey. They have friends outside RidgeOak, they pursue a broader range of interests and require less medication. Feedback from families has not only been highly complimentary, but at times inspirational.

What about the staff? How did they react to the implementation of this new way of doing things? It's completely different from the traditional medical model of support.

WALTON: Initially there was a lot of uncertainty. Whenever you change an organization that is already functioning pretty well, you risk disrupting and destabilizing the routines of the people that are there. >From the outset, I tried to create very small, positive changes, and as the employees became more adaptable to change, the kinds of changes became more significant. Most employees embraced the changes because they saw there was a better way of providing service. However, some could not adapt and became barriers to our progress; eventually those individuals left the company.

What is the most important thing you've learned through this transformation process?

WALTON:  I've learned that when people have opportunities to participate in making decisions, they have a greater stake in the outcome.  They will work harder to make sure the decision accomplishes the goal it was intended to. So if you include people in the process, the outcome is much more likely to be achieved.