Dr. Bill Thomas was inspired to create the Eden Alternative when he realized he could not provide a medical intervention to elders that complained of loneliness. Opposite of the institutional and better-known nursing home concept, the Eden Alternative would focus on battling loneliness, boredom, and helplessness. Later, he founded the Greenhouse model, which rest on two pillars: “It is better to live in a house than a warehouse,” and “people should be the boss of their own lives.” To find more information about the Eden Alternative Principles, visit edenalt.org.
Steve McAlilly, CEO of Methodist Senior Services teamed with Dr. Thomas and together they opened the first Greenhouse (GH) of the Nation in 2003 in Tupelo, Mississippi. Under Methodist Senior Services in MS, Unidine has four accounts that utilize the Greenhouse Model. Currently, Tupelo has ten greenhouses, totaling 112 rooms for elders. Each greenhouse has a minimum of 2 Shahbazim, one to every 5-6 elders. A Shahbazim or shahbaz, is a combination of a homemaker and a certified nursing assistant (CNA). The goal is to have the same staff working in the same homes so that they are always familiar. There are no residents or clients, everyone living on campus is referred to as an “elder” because no matter the age, we can learn from them.
The three core values in the greenhouses include Meaningful Life, Empowered Staff, and Real Home. Meaningful life is determined by the individual through autonomy and control. For example, if cooking brings meaning to an elder, they are invited to help prepare meals. Empowered staff includes receiving personal information from the elders, learning their day-to-day life, and serving them to the best of their ability. Staff build close relationships to the elders and each home becomes a family. Real Home includes the physical environment where the elders reside. They are encouraged to have photos of their family, come to the dinner table to eat, and to decorate as they feel comfortable.
It is the Registered Dietitians (RD) responsibility to follow the guiding principles as well. Convivium, meaning “with life,” leads the Dietitian, concentrating more on the experience of eating and not just the food. The company, the conversation, and the food are all an experience.
There is a kitchen in each greenhouse where the food is cooked. You can smell the food being cooked throughout the home. Eating around a table brings a sense of belonging and provides increased food and fluid intake, noticeable increase in mood, and often weight stabilization or desired weight gain.
Encouragement of dining with other elders is often the first intervention when an elder has decreased nutrient intake at meals. Those suffering with dementia and decreased intake, will often see others eating and enjoying the food and will take cues from them. Unidine’s Nutrition Care Manager, Timmi Bishop, works with the greenhouses in Tupelo, MS. She states “I don’t go to an elder’s facility or room to see them; I go to their home. I visit with them. I eat cookies and sit around the table with them. I know them and I know their families. They are not just an assessment; they are everyone’s family. I laugh with them, I cry with them, and I mourn them when they leave us. I serve them as I would my own grandparents.” Bishop previously worked for a traditional nursing home and reports the greenhouses have a visibly positive impact in relation to nutrition and general well-being that she is thankful for on a daily basis, especially during a global pandemic.
During the COVID-19 shutdown, traditional long-term care (LTC) saw 23% weight loss >5% x 30d from February to April, while Greenhouses saw 7% weight loss >5% x 30d. Many traditional LTC residents experienced isolation and rapid spread of the virus while the greenhouses continued communal dining and the virus was isolated to houses rather than entire facilities which in turn slowed the spread.
Registered dietitians (RD) are an important part of the interdisciplinary team and work closely with homemakers, nursing, and other medical staff. The dietitians serve as liaisons between kitchen and houses. It’s the RDs job to review the menu the shahbazims and elders create weekly in order to provide a well-balanced diet that caters to everyone’s individual preferences in the house. They identify high-risk elders and monitor by analyzing anthropometrics, biochemical data points, as well as cognitive and physical function to determine nutritional well-being and overall health.
RDs also have the pleasure to host engaging activities, nutrition lessons for the elders, and help communities implement nutrition programs, such as Unidines signature program Fresh Benefits, where fortified foods encourage food-first over nutrition supplements. This makes the environment feel more like home. Puree with Purpose is another proprietary program that makes all elders feel dignified. Cooks prepare and mold foods to look like real foods instead of a baby food-like meal, while also maintaining dysphagia standards for those with swallowing issues.
Since making the switch to Unidine, who possesses a fresh food pledge, the greenhouses enjoy foods from scratch, responsibly sourced and environmentally conscious foods, as well as fresh fruits and vegetables. Unidine RDs focus on the well-being of all the elder’s needs including supporting community nutrition and regulatory knowledge and skills. RDs take on a multifaceted roll in the greenhouses, not only benefiting the elders from a nutritional standpoint, but by taking on a global approach to health and well-being.
By Timmi Bishop, MS, RD, LD, Unidine Nutrition Care Manager
Timmi is a registered and licensed dietitian working clinically and supporting foodservice performance on a campus with LTC, skilled rehab, assisted living, and independent living. Bishop is an acting Nutrition Care Manager with Unidine at their Methodist Senior Services account in Tupelo, MS. Her favorite activity is visiting and laughing with her elders. Her goal is to obtain her gerontological certification in the new year.
At Unidine, the Regional Directors of Nutrition support the development of dietitians through clinical documentation evaluation and teaching clinical skills to improve quality of care to the patients served. Our competency training for dietitians centers around performing the NFPE, documenting malnutrition criteria and obtaining a diagnosis of malnutrition so dietitians are prepared, knowledgeable and able to make informed interventions to improve patient outcomes.