Dec 17, 2020

Cooking, washing, cleaning: The Swiss aged care home where residents continue with everyday activities

 

A couple of years ago, HelloCare published an article about giving aged care residents the freedom to eat whenever they choose, rather than at set meal times.

The article, Should Aged Care Residents Be Allowed To Eat Whenever They Want?, attracted a flurry of responses saying the piece did not take into account practical realities, such as residents being of a generation that enjoys routine, the higher cost of residents eating at different times, and the health and safety risks of residents cooking food they have grown themselves.

We were grateful for the feedback and the discussion that ensued.

But one comment in particular attracted our attention. It was from Vincenzo Paolino, the founder and managing director of Almacasa, an aged care home in Switzerland that focuses on exceptional ‘quality of life’ for older people.

“We found solutions for every [one] of your arguments against normal life and activities,” he wrote. “Human beings are not meant to live in hospital-style institutions.”

“As a provider of long-term care in Switzerland, we have very successfully introduced small household-style places where even people with very high need of care live together in a ‘normal’ environment”, wrote Paolino. 

Residents can continue to take part in daily activities, like cooking, as long as they wish to, he said. 

“People with dementia and with physical conditions have the same human rights as we do. And they want to be as useful as possible, they want to have a reason to get up in the morning.”

We reached out to Paolino to find out more.

Almacasa_WL_042
A dog provides comfort.

Based on the Eden Alternative philosophy

Paolino said Almacasa evolved from the founders’ interest in the Eden Alternative, which HelloCare has written about here.

Eden was founded by Dr Bill Thomas, who came across a problem he couldn’t solve while working in an aged care home. A patient was seeing Dr Thomas about a rash, but she also said she was lonely. Dr Thomas was able to prescribe a cream for the rash, but he didn’t have a remedy for the loneliness.

A staff member puts her arm around a resident. Image supplied.
Staff member puts her arm around resident.

From this, Dr Thomas his wife, Jude Thomas, developed The Eden Alternative, which aims to tackle loneliness, helplessness and boredom in aged care homes. 

Their philosophy is based on the foundational ideas that the antidote to loneliness is loving companionship, the antidote to helplessness is the giving and receiving of care, and the antidote to boredom is variety and spontaneity.

Paolino and his partner, Liliane Peverelli, were early followers of the “culture change” fuelled by the Eden Alternative.

Though not a certified Eden home, due to adaptations they have made to suit their Swiss location, they still use Eden’s 10 principles daily to reflect on their values. 

Engage residents with high-care needs

The foundation of Almamaca’s care is in getting the residents to engage in everyday life. 

Resident and staff member. Image supplied.
Resident and staff member.

If residents aren’t engaging in the everyday, “what comes next” after showing and getting dressed in the morning? “Waiting for lunch? Staring at the elevator door? That‘s not what we want,” Paolino told HelloCare. 

“We very seldom have bedridden residents for long. Most of our residents stay active and part of the group as long as possible compared to conventional nursing homes,” Paolino said.

“The activities of daily life are there to watch and participate in if people want to: washing, cooking, cleaning.”

“We have no artificial ‘cooking therapy’ sessions. We just have to cook, because otherwise there would be no food on the table,” he said.

With the resident’s permission, family members are encouraged to join in to daily activities. 

Residents are also enabled to remain engaged as much as possible with the local community, with visits both to and from the home.

While residents are encouraged to take part in daily activities, they are not obliged to. 

“I remember one of our residents, a 92-year-old woman with serious health conditions including cancer in a late stage, who was very proud to iron every day and not only to do the work but also to instruct our young students on how to do it right. 

“She felt needed and she had a purpose in her life. She passed away having lived until the very end.”

At Almacasa, around 20% of staff are registered nurses, around 30% are skilled nurses who have undertaken a three-year apprenticeship, and 50% are certified nursing assistants. 

“The heart of Almacasa is in everyday life and also in skilled nursing available for palliative care and other complex situations. We have all grades of dependency,” Paolino explained.

The home has been extremely successful in Switzerland. “We have long waiting lists,” Paolino observed.

Keeping pace with the times

Resident concentrates on a game of chess.
Resident concentrating on a game of chess.

Almacasa has its own Facebook page that celebrates not only what is happening inside the home, but also stories of ageing from all around the world. 

Photos of Sophie Loren, still beautiful at 85, and Iris Apfel, a creative beacon at 99, provide positive role models for ageing.

Paolino has also reached an agreement with the city of Zurich to open an LGBTI+ home for senior residents in 2023. 

It will consist of 25 affordable housing apartments and three living communities for residents with high-care needs, in the style of Almacasa.

Reform aged care homes into places to live

Paolino has a word of warning for us all about how we care for the older members of our communities.

“We have to fight against loneliness, helplessness and boredom in our facilities for old people. 

“We have to reform them into places to live. 

“Because that might be our future,” he cautioned.

What are the 10 Eden principles?

Resident cooks in the communal kitchen.
Resident cooking in the communal kitchen.

The 10 Eden Principles are:

  • The three plagues of loneliness, helplessness and boredom account for the bulk of suffering among our Elders.
  • An Elder-centred community commits to creating a Human Habitat where life revolves around close and continuing contact with people of all abilities, plants and animals. It is these relationships that provide the young and old alike with a pathway to a life worth living.
  • Loving companionship is the antidote to loneliness. Elders deserve easy access to human and animal companionship.
  • An Elder-centred community creates opportunity to give as well as receive care. This is the antidote to helplessness.
  • An Elder-centred community imbues daily life with variety and spontaneity by creating an environment in which unexpected and unpredictable interactions and happenings can take place. This is the antidote to boredom.
  • Meaningless activity corrodes the human spirit. The opportunity to do things that we find meaningful is essential to human health.
  • Medical treatment should be the servant of genuine human caring, never its master.
  • An Elder-centred community honors its Elders by de-emphasizing top down bureaucratic authority, seeking instead to place the maximum possible decision-making authority into the hands of the Elders or into the hands of those closest to them.
  • Creating an Elder-centred community is a never-ending process. Human growth must never be separated from human life.
  • Wise leadership is the lifeblood of any struggle against the three plagues. For it, there can be no substitute.

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  1. Thank you. You just gave me some hope that things could actually improve for Elders. The more our Elders know about options like this, the less likely they are to end their life when an aged care admission is the only remaining option

  2. The Eden principles are so simple yet so meaningful.
    Isn’t it frustrating that bureaucracy gets in the way.
    I’d support the idea that training for all Ministers of Aged Care should include a week’s stay.

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