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Prospects for Introducing the

to Japan
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.

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

Journal of Gerontological Nursing • Vol. 36, No. 3, 2010 47

istry of Health, Labour and Wel- from the top-down approach to would almost certainly be improved
fare, 2009). Thus, FEs have become management, both the staff and resi- if the Eden Alternative were to be
increasingly important in Japan for dents have a voice in decision making introduced to FEs in Japan. In con-
older adults and their families. (Hamilton & Tesh, 2002). As a result, sidering the possibility of adopting
staff motivation improves markedly, the Eden Alternative, it is necessary
Background and turnover is reduced. to understand the perceptions of care
FEs provide services focused on Since the Japanese branch of the workers and nurses, who would be
improving the lives of older adults, Eden Alternative was established in the driving forces in improving resi-
such as a unit care system that divides 2004, training for beginners and Cer- dent care under the Eden Alternative
residents into small groups for indi- tified Eden Associate Training has philosophy. Therefore, the purpose
vidual care, year-long events, recre- been conducted. To date, no FEs in of this study was to identify the
ational activities, and visiting volun- Japan have been certified as Eden Al- perceptions of FE care workers and
teers. In FEs, daily living assistance ternative facilities by the head office nurses regarding the lives of older
is provided by care workers (compa- in the United States; however, two adults in their facilities.
rable to certified nursing assistants FEs have conducted workshops as a
in the United States) and nurses, but preliminary stage for implementing METHOD
the ratio of three care workers to one the Eden Alternative, and ground- Design and Sample
nurse is a standard set by law and work is under way. Although some This study used a cross-sectional
thus the number of care workers is facilities have introduced pet therapy quantitative descriptive survey to an-
much greater. The position of the (Niiyama, 2003; Suzuki et al., 2002), swer the question “What are the per-
care worker was introduced in 1987 plant therapy (Kitade, 2003; Teraoka ceptions of care workers and nurses
working in FEs regarding the lives of
the older adults living there?” FEs
provide daily care services for frail
The Eden Alternative®, established in the United older adults and are supported by
long-term care insurance for which
States, has focused on improving the quality of life of the Japanese Ministry of Health,
nursing home residents by addressing the problems of Labour and Welfare has jurisdiction.
Five FEs were selected as a con-
loneliness, helplessness, and boredom. venience sample for this study. The
condition for selection was that the
facilities be located in medium-sized
as a social welfare profession to as- & Harada, 2003), and programs of cities with similar local environ-
sist residents in FEs with activities of volunteer visits from children (Ki- ments. Each facility was a midsize
daily living (Toyota, 2008). The role tabatake, 2000; Miyake et al., 2001: nonprofit facility with 100 residents
of care workers is important, but Sekido, 2001) to improve the lives of and a care provider-resident ratio of
employment conditions such as long their residents, they do not have the 3 to 1. In each facility, all care work-
hours and low pay are harsh, and Eden Alternative’s philosophical un- ers and nurses who assist in the daily
there is much stress among workers derpinning. life of the residents were invited to
(Mitoku, Morimoto, & Yano, 2008). Previous studies in Japan have participate in the study.
The high turnover of care workers shown that many residents are dis-
in FEs can negatively influence the appointed in the daily routine of the Procedures
quality of life of residents. facility, experience anxiety in estab- This study was approved by the
The Eden Alternative®, established lishing relationships with other resi- ethics committee of the participat-
in the United States, has focused on dents, and have little chance to make ing university in Japan. In a pre-
improving the quality of life of nurs- personal decisions (Komatsu, Hama- liminary survey to develop measure-
ing home residents by addressing the hata, & Magilvy, 2007; Matsuoka & ment tools, one FE was requested to
problems of loneliness, helplessness, Hamahata, 2004). Unfortunately, complete the survey. The researchers
and boredom (Bruck, 1997; Drew & such problems still remain largely went to the facility and explained the
Brooke, 1999). Facilities that have ad- unresolved. Many cultural differenc- study purpose and methods to the
opted the Eden Alternative typically es exist between Japan and Western head nurse. At the same time, written
create an atmosphere reminiscent of countries, such as ways of thinking, requests that explained the study’s
home, featuring plants, animals, and lifestyles, attitudes toward aging, purpose, methods, and voluntary in-
regular visits from children. Because and contrasts in the management of formed consent to the care workers
the Eden Alternative is a departure FEs; however, the lives of residents and nurses who would be participat-

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Table 1
Demographic Characteristics of the Sample
Care workers (n = 139) Nurses (n = 41) Total (N = 180)
Variable n (%) n (%) n (%)
Mean age in years (SD) 41 (13.3) 47.3 (1) 42.1 (13.1)
Women 105 (75.5) 40 (97.6) 145 (80.6)
Men 34 (24.5) 1 (2.4) 35 (19.4)
Years working in current facility
<1 23 (16.5) 8 (19.5) 31 (17.2)
1 to 5 66 (47.5) 17 (41.5) 83 (46.1)
6 to 10 38 (27.3) 10 (24.4) 48 (26.7)
>11 12 (8.6) 6 (14.6) 18 (10)

Note. Percentages may not total 100 due to rounding.

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-

Journal of Gerontological Nursing • Vol. 36, No. 3, 2010 49

Table 2
Respondents’ Perceptions of Residents’ Life
Care Workers Nurses Total
(n = 139) (n = 41) (N = 180)
Variable n (%) n (%) n (%)
Always think residents feel helpless 13 (9.4) 8 (19.5) 21 (11.7)
Sometimes think residents feel helpless 84 (60.4) 16 (39) 100 (55.6)
Do not think residents feel helpless 10 (7.2) 3 (7.3) 13 (7.2)
Not applicable 32 (23) 14 (34.1) 46 (25.6)
Always believe residents are lonely 10 (7.2) 5 (12.2) 15 (8.3)
Sometimes believe residents are lonely 96 (69.1) 26 (63.4) 122 (67.8)
Do not believe residents are lonely 7 (5) 0 (0) 7 (3.9)
Not applicable 26 (18.7) 10 (24.4) 36 (20)
Always believe residents are bored 31 (22.3) 15 (36.6) 46 (25.6)
Sometimes believe residents are bored 96 (69.1) 18 (43.9) 114 (63.3)
Do not believe residents are bored 3 (2.2) 1 (2.4) 4 (2.2)
Not applicable 9 (6.5) 7 (17.1) 16 (8.9)
Decision making
Always feel residents make their own decisions 17 (12.2) 4 (9.8) 21 (11.7)
Sometimes feel residents make their own decisions 55 (39.6) 19 (46.3) 74 (41.1)
Do not feel residents make their own decisions 20 (14.4) 7 (17.1) 27 (15)
Not applicable 47 (33.8) 11 (26.8) 58 (32.2)
Residents’ aspirations
Caregiver knows very much what residents want 6 (4.3) 1 (2.4) 7 (3.9)
Caregiver knows some things residents want 52 (37.4) 12 (29.3) 64 (35.6)
Caregiver does not know what residents want 12 (8.6) 4 (9.8) 16 (8.9)
Not applicable 69 (49.7) 24 (58.5) 93 (51.7)

Note. Percentages may not total 100 due to rounding.

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%).

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Table 3
Respondents’ Perceptions of facility environment
Care Workers Nurses Total
(n = 139) (n = 41) (N = 180)
Variable n (%) n (%) n (%)
Having animals in facility
Agree 47 (33.8) 16 (39) 63 (35)
Reasons for agreeing a

• Animals make residents comfortable 39 (83) 12 (75) 51 (81)

• Animals relieve residents of loneliness 29 (61.7) 11 (68.8) 40 (63.5)
• Animals change residents’ daily life 22 (46.8) 9 (56.3) 31 (49.2)
Disagree 44 (31.7) 13 (31.7) 57 (31.7)
Reasons for disagreeing a

• Residents may have infectious disease 35 (79.5) 12 (92.3) 47 (82.5)

• Some residents simply do not like animals 33 (75) 8 (61.5) 41 (71.9)
• Caregivers may spend too much time caring for the animals 27 (61.4) 7 (53.8) 34 (59.6)
Not applicable 48 (34.5) 12 (29.3) 60 (33.3)
Having plants in facility
Agree 97 (69.8) 31 (75.6) 128 (71.1)
Reasons for agreeing a

• Plants make residents comfortable 79 (81.4) 25 (80.6) 104 (81.3)

• Natural environment improves morale of all involved 43 (44.3) 18 (58.1) 61 (47.7)
• Residents would be able to care for a living object 40 (41.2) 15 (48.4) 55 (43)
Disagree 13 (9.4) 1 (2.4) 14 (7.8)
Reasons for disagreeinga
• Plants pose an obstacle to ambulatory residents 8 (61.5) 1 (100) 9 (64.3)
• Caregivers spend too much time caring for the plants 5 (38.5) 0 (0) 5 (35.7)
• Plants may introduce infections 4 (30.8) 1 (100) 5 (35.7)
Not applicable 29 (20.9) 9 (22) 38 (21.1)
Visits from children
Agree 84 (60.4) 18 (43.9) 102 (56.7)
Reasons for agreeing a

• Residents enjoy such visits 70 (83.3) 14 (77.8) 84 (82.4)

• Children relieve residents’ loneliness 46 (54.8) 10 (55.6) 56 (54.9)
• Residents feel encouraged in daily life 38 (45.2) 6 (33.3) 44 (43.1)
Disagree 16 (11.5) 9 (22) 25 (13.9)
Reasons for disagreeing a

• Children may cause accidents 14 (87.5) 7 (77.8) 21 (84)

• Children may spread infections 10 (62.5) 7 (77.8) 17 (68)
• Some residents simply do not like children 9 (56.3) 2 (22.2) 11 (44)
Not applicable 39 (28.1) 14 (34.1) 53 (29.4)

Note. Percentages may not total 100 due to rounding.

Respondents were allowed to choose more than one answer.

Journal of Gerontological Nursing • Vol. 36, No. 3, 2010 51

Table 4
Respondents’ Perceptions of their work
Care Workers Nurses Total
(n = 139) (n = 41) (N = 180)
Variable n (%) n (%) n (%)
Would like to see changes in manner of resident care
Always want to change care 33 (23.7) 5 (12.2) 38 (21.1)
Sometimes want to change care 80 (57.6) 27 (65.9) 107 (59.4)
Do not want to change care 6 (4.3) 1 (2.4) 7 (3.9)
Not applicable 20 (14.4) 8 (19.5) 28 (15.6)
Feel there is value in their work
Always feel a value 41 (29.5) 5 (12.2) 46 (25.6)
Sometimes feel a value 90 (64.7) 23 (56.1) 113 (62.8)
Reasons for always or sometimes finding value in their work a

• Residents keep smiling 109 (83.2) 22 (78.6) 131 (82.4)

• Residents express appreciation for caregivers’ help 92 (70.2) 15 (53.6) 107 (67.3)
• Residents trust caregivers 85 (64.9) 15 (53.6) 100 (62.9)
• Residents’ performance of activities of daily living improve 71 (54.2) 14 (50) 85 (53.5)
Do not feel a value 2 (1.4) 0 (0) 2 (1.1)
Not applicable 6 (4.3) 13 (31.7) 19 (10.6)
Would like to live in the facility in which they work
Yes 13 (9.4) 2 (4.9) 15 (8.3)
No 83 (59.7) 18 (43.9) 101 (56.1)
Reasons for no responses a

• Caregivers are always very busy 61 (73.5) 11 (61.1) 72 (71.3)

• Residents’ privacy is not respected 35 (42.2) 14 (77.8) 49 (48.5)
• Residents are bound by rules 34 (41) 8 (44.4) 42 (41.6)
• Residents are bothered by other residents 34 (41) 4 (22.2) 38 (37.6)
Not applicable 43 (30.9) 21 (51.2) 64 (35.6)

Note. Percentages may not total 100 due to rounding.

Respondents were allowed to choose more than one answer.

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

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Table 5
Respondents’ Perceptions of work relationships
Care Workers Nurses Total
(n = 139) (n = 41) (N =180)
Variable n (%) n (%) n (%)
Experience a difference in opinion with superiors
Always 20 (14.4) 3 (7.3) 23 (12.8)
Sometimes 72 (51.8) 27 (65.9) 99 (55)
Never 16 (11.5) 1 (2.4) 17 (9.4)
Not applicable 31 (22.3) 10 (24.4) 41 (22.8)
Experience a difference in opinion with coworkers
Always 10 (7.2) 7 (17.1) 17 (9.4)
Sometimes 89 (64) 25 (61) 114 (63.3)
Never 6 (4.3) 0 (0) 6 (3.3)
Not applicable 34 (24.5) 9 (22) 43 (23.9)
Have the opportunity to discuss problems with coworkers
Always 30 (21.6) 12 (29.3) 42 (23.3)
Sometimes 87 (62.6) 25 (61) 112 (62.2)
Never 13 (9.4) 1 (2.4) 14 (7.8)
Not applicable 9 (6.5) 3 (7.3) 12 (6.7)

Note. Percentages may not total 100 due to rounding.

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

Journal of Gerontological Nursing • Vol. 36, No. 3, 2010 53

logical effect on facility residents,
but that they also have positive
keypoints effects on cognition and immune
The Eden Alternative in function (Sugihara et al., 2006). At-
tempts to incorporate a natural en-
Japan vironment for its soothing effect on
residents are likely to increase.
Otsuka, S., Hamahata, A., Komatsu, M., Suishu, C., & Osuka, K. (2010). Prospects for
Introducing the Eden Alternative to Japan. Journal of Gerontological Nursing, 36(3), 47-
The majority of respondents
55. in this study also favored bring-
ing children to visit the facility, an

1 The Japanese branch of the Eden Alternative® was first estab-

lished in 2004, yet only two elder care facilities have entered the
preliminary stage for formally implementing the Eden Alterna-
activity the residents enjoyed. The
reasons given were that children’s
visits eases residents’ loneliness
tive. and invigorates their lives. How-

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

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do not encourage small children to Cabinet Office, Government of Japan. (2009). Japanese Journal of Health Behavioral
White paper about aged society. Tokyo: Science, 18, 36-47.
visit their grandparents, and so it is
Gyousei. Sekido, K. (2001). The role of aged persons in
rare to see children in these facili- Care Work Foundation. (2007). Employment day service centers during exchanges with
ties. In winter, many residents are situation of care workers and key points young children: The case of welfare facili-
infected with norovirus or influ- from survey of work attitudes. Retrieved ties with both child care centers and day
enza. These viruses spread rapidly from service centers. Hospice and Home Care, 9, 208.
through facilities, all of which are
Drew, J., & Brooke, V. (1999). Changing a Sugihara, S., Aoyama, H., Sugimoto, M.,
cautious about infection preven- legacy: The Eden Alternative nursing Takeda, S., Ikeda, N., & Asano, M. (2006).
tion measures. home. Annals of Long-Term Care, 7, 115- The psychological, cognitive and immu-
121. nological effects of horticultural therapy
CONCLUSION Hamilton, N., & Tesh, S. (2002). The North on the elderly living in a nursing home.
Carolina Eden Coalition: Facilitating en- Japanese Journal of Geriatric Psychiatry,
The results of this study indicate
vironmental transformation. Journal of 17, 967-975.
that many care workers and nurses Gerontological Nursing, 28(3), 35-40. Suzuki, M., Yamamoto, K., Matsui, Y., Ko-
believe that FE residents are help- Ike, T. (2008). Effect of the implementa- jima, E., Oyama, N., Kanda, M., et al.
less, lonely, and bored, and the re- tion of public long-term care insurance (2002). Analysis of individual effects
spondents could not decide on what scheme on changes in the consciousness and processes of animal assisted therapy
of nursing home care staff and quality of (AAT) for elders with dementia. Health
residents actually wanted. However,
care: Based on qualitative analysis. Bulle- Care, 44, 639-646.
these caregivers would like to im- tin of Kochi Women’s University, Series of Takeuchi, T. (2007). Why people quit—Job
prove the current manner of care. Faculty of Social Welfare, 57, 53-65. turnover. Nursing care insurance infor-
Opinions were split on keeping Japan Ministry of Health, Labour and Wel- mation. Information of Long-Term Nurs-
animals in the facility, but most re- fare (2009). A survey of care service ing Care, 8(7), 52-55.
facilities/welfare facilities. Retrieved from Teraoka, S., & Harada, H. (2003). Horticul-
spondents welcomed the placement tural therapy that contributes to improv-
of plants and visits from children. hw/kaigo/service07/kekka1.html ing the QoL of institutionalized elders
This indicates that care workers and Kitabatake, M. (2000). Three cases of older who require care. Quality Nursing, 9,
nurses in Japan want to improve the persons with dementia becoming more 581-587.
lives of FE residents and are search- active in music therapy sessions with the Toyota, M. (2008). Challenges and outlook
participation of young children. Japan for care worker education. Journal of
ing for ways to do so.
Biomusic Association, 18, 122-125. Health & Social Services, 6, 155-167.
Currently, junior high school Kitade, S. (2003). Effect of horticulture
students in Japan can experience therapy in care facilities for the elderly. About the Authors
caring for older adults in FEs dur- Japanese Journal of Total Care, (Suppl.), Ms. Otsuka is Assistant Professor,
ing summer vacation as part of their 92-94. and Dr. Hamahata is Professor, Seirei
Komatsu, M., Hamahata, A., & Magilvy, J.K. Christopher University, School of
classwork, and new FEs are being
(2007). Coping with the changes in living Nursing, Hamamatsu, Shizuoka, Dr.
built next to kindergartens or nurs- environment faced by older persons who Komatsu is Director, Seijyuji Nursing
ery schools to provide occasions relocate to a health-care facility in Japan. College, Mie County, Mie, Ms. Suishu is
for contact between FE residents Japan Journal of Nursing Science, 4, 27- Professor, Wakayama Medical Univer-
and children. The notion of keep- 38. sity, School of Health and Nursing Sci-
Matsuoka, H., & Hamahata, A. (2004). The ence, Wakayama City, Wakayama, and
ing animals in facilities is still not
process until long-term residents of geri- Dr. Osuka is Professor, Aichi Gakuin
discussed, but there are times when atric healthcare institutions come to pre- University, Faculty of Psychological and
volunteers bring dogs to facilities as fer staying in the institution rather than Physical Science, Department of Health
a special event for the enjoyment of returning home. Quality Nursing, 10(7), Science, Nissin, Aichi, Japan.
residents. Attempts are being made 53-63. The authors disclose that they have
Mitoku, K., Morimoto, H., & Yano, K. no significant financial interests in any
in Japan to improve the lives of
(2008). Characteristics of occupational product or class of products discussed di-
older adults from various aspects, stress factors of employees at facilities for rectly or indirectly in this activity. The
and it may be that the introduction the aged based on a work demand-control authors acknowledge research support
of ideas such as the Eden Alterna- model. Kawasaki Medical Welfare Jour- from their universities.
tive would rapidly improve the care nal, 18, 121-128. Address correspondence to Shizuka
Miyake, Y., Takeda, N., Sibamoto, H., Otsuka, MSN, RN, Assistant Professor,
of older adults and make the work
Kawada, K., Aida, K., Egusa, M., et al. Seirei Christopher University, School
more meaningful for caregivers. (2001). Investigation of social gatherings of Nursing, 3453 Mikatahara, Kita-ku,
with institutionalized aged people who Hamamatsu, Shizuoka, Japan 433-
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Ando, T. (2001). Older people and pet ani- dents. Shikoku Journal of Public Health, Received: April 24, 2009
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Bruck, L. (1997). Welcome to Eden. Nursing Practical procedures for AAT with small doi:10.3928/00989134-20100202-03
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Journal of Gerontological Nursing • Vol. 36, No. 3, 2010 55

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