Eden Alternative: The Texas Project




Ransom, Sandy

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Loneliness, helplessness, and boredom dominate the lives of many nursing home residents. Even though many regulations and programs are in place that are intended to assure quality of care, the confines of the nursing home environment and the widespread entrenchment of the "medical model" do not necessarily contribute to quality of life. Even the most modern and beautifully designed nursing homes sometimes seem to be pervaded with sterile overtones and lack the true warmth of a home. The Eden Alternative, a conceptual model developed by William H. Thomas, M.D., places the residents at the center of nursing home life. The nursing home is transformed into a "human habitat", an environment of diversity. Animals, plants and gardens, children and people of all ages form an integral, daily part of resident life. Residents regain a sense of worth as they care for the plants and animals and they share daily activities with the children as well as with each other. The management style is converted from a hierarchical model to a prototype in which decisions are moved closer to the residents. Staff members are empowered to form self-directed work teams and to take responsibility for managing their own work schedules. The Texas Eden Alternative project replicated Dr. Thomas' model in a different geographical location with a larger sample size. A multidisciplinary task force developed new instruments, recruited individuals willing to develop the Eden Alternative in their communities, and collected data. Resident and staff variables, which are known to influence the satisfaction and quality of life, were carefully gathered over a two-year time period. Although not all of Dr. Thomas' findings were validated in the Texas study, other outcomes showed promising trends. Both cumulative findings and results at specific individual homes have implications for continued research and future policy decisions.



eden alternative, long-term care, culture change, nursing home, person-directed care, Long Term Care Administration


Institute for Quality Improvement in Long Term Health Care. (2000). Eden alternative: The Texas project. (IQILTHC Series Report 2000-4).


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