Introduction and History
Sherbrooke Community Centre is a Special Care Home and affiliate of Saskatoon District Health, Saskatoon, Saskatchewan. The facility is home for 270 people, 40 of whom are Veterans, and provides a Community Day Program for an additional 100 citizens of the city. Sherbrooke is a registered Eden Alternative™ Home and as such strives to alleviate loneliness, boredom and helplessness from the lives of its residents and community members.
The Sherbrooke mission is to promote quality of life and growth in a supportive and rich environment for people who are frail and disabled. Our approach is resident directed as opposed to resident centered. We strive to support individuality, normalcy and reality for the residents.
Sherbrooke was first created in the late 1960’s and was home for 326 residents. The original buildings, which had mostly four bed wards, were replaced in three phases of construction. The first occurred in 1987 and saw the creation of a therapy pool. In 1993, a four story, state of the art, yet traditional building, was built to provide accommodation for 160 people. This phase of construction also included some ancillary services: cafeteria and kitchen, commercial laundry, storage, purchasing and stores, and a greenhouse for residents. The third and last stage of construction was the Kinsmen and Veterans Villages, which provided a living environment for 103 residents plus a chapel, auditorium, community day program space, a gift shop and coffee kiosk, a child day care, a Snoezellen™ room, and therapy areas.
The Village design and operation is quite unique in terms of the special care homes of today. Nine to ten residents live together in houses, which are attached to the rest of the facility by an internal street. It is like having houses on any residential street with the exception that the street is internal and protected from the elements. The street is complete with street signs, sky lights, house fronts with peaked roofs, front porches with benches, and mailboxes and numbers for each house.
The idea of the street was met with support, but resistance to the house model was high from most groups with the exception of people who might at some time need the service. The potential consumers were instrumental in forming the concept for the design. Staff, residents, and others who were familiar with the traditional model, had difficulty imagining how this house model could possibly work. To date, the operation of the houses has surpassed our hopes and expectations.
The houses in the Village are supportive of people with all kinds of frailties, disabilities, and requirements for care. The houses are easily adapted to meet the specialized needs of most groups from adults to children, a variety of cultures, and groups with special functional needs such as those who live with Alzheimer’s disease. There are two basic designs for the eleven houses. Four of the houses, those on Poppy Lane, are home to Veterans and vary slightly from the seven on Telemiracle Way. The Kinsmen Foundation donated $1 Million for this project and in honor of them the major street was named Telemiracle Way.
Each house has its own front door from the internal street and a backdoor that goes into the backyard. The houses are a bungalow style with plenty of natural light through low silled windows. The floors are non-glare and the design of the house offers a circular path for those who need to pace. The doors are well marked with clear separation of private and communal spaces.
As one enters a house, a residential as opposed to institutional design presents itself. To one side of the front door is a closet for guests’ coats. To the other side is the kitchen which has every type of household appliance, including a sink unit of cupboards that can be raised or lowered to meet the needs of the user, and a stove that is controlled through a keyed switch. The kitchen is also complete with a computer where all supplies, including groceries, are ordered through Sherbrooke’s Intranet (internal computer network). There is a designated and locked cupboard for the storage of medications and clinical records for the residents of the house. Off the kitchen is a beautiful dining room with oak tables. Families and guests are welcome to join residents for meals.
The living room is adjacent to the dining room and both can be seen from the kitchen over the counter space. The living room boasts a gas fireplace, which is wonderful in the Saskatchewan winter climate. The fireplace is turned on and off with a switch located in a small laundry room located near the living room. Glass shields protect anyone who gets close to the fireplace. The living room also offers an exit to a protected patio where a gas lantern and bar-b-cue are located. There is a view of the garden through a decorative iron railing that encloses the patio.
The back door to the house is on route from the living room to the bedrooms. The hallway is very spacious and continues around to the front hallway making a wandering loop. The corridor is double loaded with the bedrooms on the outside and the bathrooms and laundry room on the inside.
There are five private bedrooms with their own sinks. The closet door in the bedroom opens to provide a visual barrier from the hallway to the sink. This is helpful if residents leave their doors open inadvertently. There are two semi private rooms that share a bathroom. The rooms are well designed in that the bed spaces are very separate and a visual barrier promotes a sense of privacy. The five residents, who have private rooms share two bathrooms, one of which has a shower. The entire bathroom becomes a shower making the task very easy for the disabled. All bedrooms and bathrooms have ceiling tracks for portable lifts. The absence of the floor model lift promotes a more normal appearing environment. The Veterans homes have ten private bedrooms each with their own two piece bathroom.
There is a service corridor that joins each pair of houses to provide storage rooms, a housekeeping room complete with floor sink, and a tub room with a century whirlpool. These amenities are shared between the two groups. There is also an additional exit door to a green space where garden boxes are located.
The houses lend themselves to the formation of a more family-like group with the small number of residents and constant caregivers. The houses tend to take on the personalities of those who live and work there. The décor and furniture placement is different in each house as the inhabitants take ownership. This is especially noticeable during special seasons such as Christmas. Each of the houses displayed a personalized Christmas tree and festive environment.
The Daily Living Assistant
The staffing of the houses in the village is based on the principle of normalcy. The staff is multi-skilled. The “Daily Living Assistants” are qualified Special Care Aides, and have also completed a national housekeeping course, the “Food Safe” course, and a medication administration course with practicum. The staff is skilled in all areas of running the household from providing personal care to cooking meals, to maintaining an infection free environment and being skilled at the odd game of cards. The Registered Nurses work in a model that resembles a Home Care one with the exception of not having to travel to see their clients.
The commitment to the residents is very strong. The staff members freely share their personal gifts and talents to improve the quality of “their” residents’ lives. The staff members are welcome to bring their children to participate in the life of the house. Staff members working on special holidays such as Christmas have been know to have their children join the residents and themselves for Christmas dinner. The residents love this sharing of family. The environment lends itself to this kind of flexibility and intimacy. The alleviation of loneliness is supported.
The Eden Alternative
Sherbrooke is a registered Eden Alternative™ home. The Eden Alternative™ is a powerful tool for improving the quality of life for people who live in long-term care facilities or are isolated in the community. It is a new way of thinking about eldercare and has the potential of remaking facilities and communities. The Eden Alternative™ is not a program, but rather a total philosophy that seeks to address what Dr. Bill Thomas calls the Three Plagues of Nursing Homes: loneliness, helplessness and boredom. Dr. Thomas discovered that medical treatment is necessary but insufficient for quality of life and needs to be the servant and not the master of care.
The Eden Alternative™ was adopted at Sherbrooke after planning for the construction of the Village was complete. We believed that the environment we were constructing would support this philosophy, which above all else demands a change in organizational culture. We did not realize how much simpler the environment would make our work.
The Eden Alternative™ grows easily in an environment like Sherbrooke’s Village. Staff and residents seem to have different expectations of how things can happen, based on the opportunities afforded by the physical environment. The smaller number of people, who have close and continuous contact, supports the development of intimate relationships, the antidote to loneliness. This is both rewarding and painful. It is more difficult for the staff and residents when there is a death in the house. Even with this being the case, the staff members find their work so much more meaningful that they report they would never go back to the “old way” of doing things. Residents and families also speak of the increased intimacy and comfort they experience in this environment.
The house environment also supports residents and their families being involved in the day to day chores and activities of life. Residents can assist with any small part of getting a meal on the table, or in the clean up. This is very beneficial to the cognitively impaired who might not make a substantial contribution but who benefit from participation. There is also opportunities to do laundry. The model supports the alleviation of helplessness.
Eight of the eleven houses have at least one pet. There are dogs, cats and birds. This helps with loneliness and in addition creates spontaneity and variety, which addresses the boredom often experienced in these settings. The animals are a drawing card for children, who then wish to visit or volunteer. The residents benefit greatly from the companionship and vitality of the children.
The Village houses promote our philosophy of resident direction or in Eden language “the idea that decisions belong with the Elder or as close to the Elder as possible” (Thomas, 1999, page108). With the small environment and number of residents and staff, decisions can be made quickly with lots of consultation with those affected. Examples are the residents choosing their own china, deciding where pictures should be hung, where the couch works best, what food to serve for supper, whether or not they want a pet, and so on. The opportunity for decision making at this level increases dramatically when you don’t have to worry about other departments and groups of residents. The Daily Living Assistant has the freedom to juggle her or his work depending on the needs of the resident. There are no “department” routines, barriers or competing agendas.
Creating the Village environment has been a wonderful challenge and accomplishment. The pace of life in the houses is more relaxed and normal. Both residents and staff are having more fun than they did previously. Staff is able to really make a difference for the residents and in their own work lives by expressing their individuality and sharing their gifts. Residents and families are pleased with the physical and social environment and grateful for the caring and talented staff with whom they share their lives. The Eden philosophy continues to grow in this warm soil. The journey is well underway.
For further information about Sherbrooke please contact me:
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Suellen Beatty, CEO
Sherbrooke Community Centre
401 Acadia Drive
Saskatoon, Sk. S7H 2E7
Phone (306) 655-3660 Fax (306) 655-3690