Abstract
Every creature has a habitat in which it thrives, and one in which it withers. Human beings wither in institutions. Yet increasing numbers of our elders are entering nursing homes and assisted living facilities every day. The Eden Alternative, and the new Green House Project, offer a fundamentally different way of looking at elderhood, grounded in a philosophy of developmental aging. Caring for our elders in places that are much more like gardens and much less like institutions results in enhanced quality of life and improved clinical outcomes.
AFTER years of contemplating the meaning of quality of life and working to create a useful definition, I have come to believe that quality of life entails living a life that is full and fully human. This sense of fullness stands in sharp contrast with life as it is lived in an institution. Emptiness causes pain. It is the repressed knowledge of this pain that causes guilt among family members when they visit. The contrast with their own full and often vibrant lives can be striking.
When I first got out of residency and started caring for elders, I would write in the space for cause of death things like, "Died of a broken heart," and "Gave up on living." The state health department didn't approve. Back they came with red ink. From the health department's point of view, these were not valid causes of death. But you know they were, and I know they were.