Professional Documents
Culture Documents
®
to Japan
ABSTRACT
To date, no elder care facilities in Japan have formally introduced the Eden Alternative® philosophy of
care. The purpose of this cross-sectional descriptive study was to identify the perceptions of care workers
and nurses regarding the lives of older adults in care facilities to consider the prospects for introducing
the Eden Alternative to Japan. The participants included 139 care workers and 41 nurses who responded
to a survey questionnaire based on Eden Alternative principles developed by the researchers for this
study. More than half of the participants indicated that they sometimes thought the older adults expe-
rienced feelings of helplessness, loneliness, and boredom and hoped for changes in the manner of care
to improve the lives of residents. Participants were also in favor of the residents having plants and visits
from children, but opinions about having animals on site were split. The fact that the survey respondents
noticed the problems indicated by the Eden Alternative suggests there is great potential for introducing
the Eden Alternative to Japan.
I
n Japan, the percentage of older adults are urgently needed to address who will care
exceeded 20% of the population in 2000 for this population and where this care will be
and reached 22.1% in 2008. The aver- provided. Since the implementation of Japan’s
age life expectancy is 79.2 for men and 86 for long-term care insurance system in 2000, de-
women, and the aging of Japanese society is signed to resolve such issues, the number of
unmatched anywhere in the world (Cabinet older adults admitted to facilities where ev-
Office, Government of Japan, 2009). The chal- erything is covered by that insurance has been
lenges brought about by Japan’s aging popula- increasing. Older adults with health problems
tion include an expansion of nuclear families, who cannot live independently at home usu-
older adults living alone, a rising population ally decide to move to a facility for elders (FE)
of old-old adults, and increasing medical to receive care. Long-term care insurance is
costs. In particular, the number of older adults accepted in 9,327 facilities, with 690,358 older
living alone is expected to rise, and measures people currently living in them (Japan Min-
© 2010/Stockphoto
Shizuka Otsuka, MSN, RN; Akiko Hamahata, PhD, RN; Misa Komatsu, PhD, RN;
Chizuko Suishu, MAED, RN; and Keiko Osuka, PhD, PHN, RN
ing in the study were organized into questionnaire contains 14 questions responses were given on a 3-point
envelopes with the self-administered and consists of four subscales: per- scale (3 = agree, 2 = disagree, 1 =
survey questionnaires, and the head ception of residents’ life, percep- not applicable), and the reasons for
nurse was asked to distribute them. tion of own work, perception of responding agree or disagree were
After this preliminary survey, the environment in the facility, and per- requested.
questionnaire was revised, and the ception of work relationships. De- Perceptions of one’s own work
study officially began. mographic characteristics collected included questions on changes in
Like the preliminary survey, re- included age, gender, type of work, the manner of care and the value of
searchers for the main survey went to and number of years working in the work, with responses given on a 4-
each facility to explain the study and current facility. point scale (4 = always feel to 1 =
asked the head nurse to implement it. In the preliminary survey, 33 care not applicable). The respondents
Written requests and questionnaires workers and 7 nurses responded. who chose always feel and some-
for a total of 210 care workers and The reliability for this sample (n = times feel about value in their work
nurses at five facilities were put into 40) was acceptable with an over- were asked for the reasons. Respon-
envelopes. The questionnaires were all Cronbach’s alpha coefficient of dents were also asked if they would
distributed in envelopes that could 0.81; coefficients for the four sub- like to live in the facility where they
be sealed so the respondents could scales were 0.96, 0.75, 0.82, and 0.73, worked (e.g., “Do you think you
not be identified. Collection boxes respectively. would enjoy living in the facility if
were arranged in each facility, and Perceptions about helplessness, you were in the same situation as the
the researchers went to the facilities 3 loneliness, boredom, decision mak- residents?”). Responses were given
weeks later to collect the responses. ing, and aspirations in residents’ lives on a 3-point scale (3 = yes, 2 = no,
were queried. For example, for the 1 = not applicable), and reasons for
Survey Instrument question, “Do you feel the residents no responses were requested.
The survey questionnaire was de- suffer from helplessness?”, respon- Perceptions of work relationships
veloped by the researchers for this dents answered using a 4-point scale were also queried (e.g., “Does your
study on the basis of a pamphlet (4 = always feel, 3 = sometimes feel, opinion differ from that of your
obtained by one of the researchers 2 = do not feel, 1 = not applicable). superior?”) on a 4-point scale (4 =
during introductory training for the Perceptions of environment in- always, 3 = sometimes, 2 = never, 1 =
Eden Alternative, as well as a ques- cluded questions about having ani- not applicable).
tionnaire by the Japan branch of the mals, plants, and visits from chil-
Eden Alternative used to survey dren. For example, for the question, Data Analysis
the daily lives of older adults who “Do you agree with keeping ani- Descriptive statistical values
receive care in Japanese FEs. This mals such as dogs, cats, or birds?”, were calculated based on the num-
bers of care workers and nurses, as RESULTS The care workers’ and nurses’
well as their years of working in The demographic characteristics perception of the life of residents are
the facility and mean age. The fre- of the respondents are listed in Table shown in Table 2. The majority some-
quency distribution of individual 1. A total of 210 questionnaires were times thought the older adults in the
perceptions about the daily lives distributed, and 180 were returned, facility experienced feelings of loneli-
of residents, relationships at work, for a response rate of 85.7%. The ness (67.8%), boredom (63.3%), and
and the introduction of plants, respondents included 139 care work- helplessness (55.6%), but approxi-
animals, and children visiting the ers and 41 nurses. The overwhelming mately one third of respondents did
facility was calculated based on majority of respondents were wom- not know whether residents were able
the numbers of care workers and en (care workers = 75.5%, nurses = to make their own decisions. In addi-
nurses. Analyses were performed 97.6%). Most respondents indicated tion, more than half of the respon-
using SPSS version 12.0 for Win- they had worked at the current facil- dents were not sure of the residents’
dows. ity for 1 to 5 years. aspirations (51.7%).
Table 3 lists respondents’ per- life (49.2%). In addition, respon- The majority (71.1%) of care
ceptions of their facility’s envi- dents thought that animals would workers and nurses were in favor
ronment. Opinions about having motivate residents to go on living of having plants in the facility be-
animals such as dogs, cats, or birds and that the residents would enjoy cause they thought plants would be
in the facility were almost equally having animals. On the other hand, a source of comfort for residents
divided between agree, disagree, one third of respondents (31.7%) (81.3%) and that it would be good
and not applicable. One third of did not agree, citing concerns about for residents to care for a living ob-
respondents agreed to having ani- residents having an infectious dis- ject (43%). Approximately half of
mals in the facility (35%), stating ease (82.5%), the fact that residents the respondents (47.7%) respond-
that animals are a source of com- simply do not like animals (71.9%), ed that a natural environment im-
fort for residents (81%), relieve and that caregivers would have to proves the morale of all involved.
residents’ loneliness (63.5%), and spend too much time taking care of The reasons why some respon-
bring changes to the residents’ daily the animals (59.6%). dents disagreed (7.8%) were that
the plants would pose obstacles Respondents’ perceptions of their residents’ well-being (71.3%), that
for ambulatory residents (64.3%), work are shown in Table 4. More the residents’ privacy was not re-
caregivers would have to spend than half (59.4%) of the respondents spected (48.5%), that the residents
too much time caring for the plants indicated that they sometimes want- were bound by rules (41.6%), and
(35.7%), and that the plants might ed changes in the manner of care that that some residents were bothered
introduce infections in the facility would improve the life of residents. by other residents (37.6%).
(35.7%). More than 88% of respondents al- Table 5 lists respondents’ per-
More than half (56.7%) of care ways or sometimes had a positive ceptions of relationships at work.
workers and nurses welcomed visits view of the value of their work. This More than half of the respondents
from children to the facility, stating was felt especially when the residents expressed that their opinions some-
that the residents enjoy such visits would keep smiling (82.4%), express times differed from those of their
(82.4%), that residents’ loneliness appreciation for their help (67.3%), superiors (55%) and their cowork-
would be relieved (54.9%), and the express trust in them (62.9%), and ers (63.3%). However, many of them
residents would feel encouraged in when the condition of the residents’ (62.2%) also responded that they
daily life (43.1%). A few respon- activities of daily living was improv- sometimes had opportunities to dis-
dents thought it was good for the ing (53.5%). Slightly more than half cuss problems with colleagues and
children to get to know people (56.1%) of the respondents did not other professionals.
much older and more experienced think they would enjoy living in
than themselves. However, 13.9% the facility where they worked if DISCUSSION
of respondents disagreed, stating they were in the same situation as Looking at the respondents’ at-
that children may cause accidents the residents. Some of the reasons titudes toward the lives of older
(84%) or spread infections to the why they did not want to live there adults, more than half of both care
residents (68%), and because some were that caregivers were so busy workers and nurses responded that
residents simply do not like chil- with other tasks they had no time to FE residents were helpless, lonely,
dren (44%). properly devote themselves to the and bored. One third of respondents
2 Facilities for elders have become increasingly important for older ever, respondents were split on the
adults and their families in Japan; however, the lives of residents idea of keeping animals. Those who
have not improved. supported the idea said that animals
have a soothing effect on residents
3 Care workers and nurses noticed the problems in the lives of old-
er adults indicated in the Eden Alternative, such as helplessness,
loneliness, and boredom, and hoped to improve the current man-
and bring change to residents’ lives,
whereas those against the idea cit-
ed problems with infection, that
ner of care. Respondents also welcomed the placement of plants animals are not liked by all older
and visits from children, but opinions on having animals on site adults, and that caring for animals
were split. was troublesome. Pet therapy has
4 The Eden Alternative would rapidly improve the care of older been shown to have a positive ef-
adults and make work more meaningful for caregivers. fect on older adults (Ando, 2001),
but there is still much concern
about the problem of hygiene.
did not know whether the residents when residents are satisfied with the Opinions against plants, animals,
were able to make their own de- care. The employment conditions and children in the facility were
cisions, and almost all wanted to for care workers in FEs in Japan based on reasons such as infections,
change the current manner of care. are poor, and a high percentage of the responsibility of caring for
From these findings, it seems that workers leave the profession when them, residents’ preferences, and
care workers and nurses identify they lose a sense of meaning of potential accidents, but these are
problems in the lives of the older their work (Care Work Foundation, thought to be due to the busyness
adults for whom the Eden Alter- 2007). If residents can lead energetic of caregivers and the environmen-
native is intended, and that they and satisfying lives in FEs using the tal characteristics of facilities in Ja-
are not satisfied with the care that Eden Alternative, caregivers’ sense pan. Land is scarce and expensive
is currently provided (Ike, 2008). of doing valuable work would also in Japan, so there are few single-
However, more than half of the likely increase. For care workers to story FEs. Most are buildings of
respondents had no opinion about work with a sense of meaning, care three or more stories, with 25 to 30
what the residents actually want- needs to be provided so that resi- people per floor and limited to 100
ed. Thus, even if the caregivers see dents feel satisfied with life in the residents. The first floors are usu-
problems in the residents’ lives, facility (Takeuchi, 2007). Introduc- ally offices and day service facili-
they have not discovered specific ing the Eden Alternative as a spe- ties, with residential rooms on the
care methods the residents desire. cific means of improving care in the second and higher floors. It is rare
The majority (88%) of care facility may lead to both better lives for facilities in cities to have gar-
workers and nurses said they felt for residents and a sense of doing dens, and there is no space to keep
value in their work when residents something worthwhile among care small birds or dogs. Ornamental
smiled often, thanked the caregiv- workers and nurses. plants are placed in the first-floor
ers, and expressed trusted in them. A majority of care workers and entryway, but these are simply in-
This indicates that care workers nurses agreed with the idea of hav- terior decorations. Most of the
and nurses have person-to-person ing plants in the residents’ living residential rooms are crowded with
interactions with residents, and that environment. Research has shown four people to a room, so there is
they feel their work is meaningful that plants have not only a psycho- no space for plants. Japanese FEs