The North Carolina Eden Coalition: facilitating environmental transformation

The Eden Alternative, created by Harvard educated physician Dr. William Thomas, is a model for transforming skilled care facilities from institutions based on a medical model of care into human habitats that promote human growth. This change is accomplished through decentralizing the organizational structure of the facility to empower front-line care-delivery staff, and through introduction of plants, animals, gardening, and children into the daily lives of residents. Because the Eden Alternative is a trademarked name, only facilities recognized by the Eden Alternative registry are allowed to use the name. However, any facility may adopt the philosophies embodied by the Eden Alternative, and implement the principles for transforming their facility. In 1996, the North Carolina Division of Facility Services formed the North Carolina Eden Coalition (originally named the North Carolina Eden Alternative Coalition). This was the first organization of its kind in the country. The success of the Coalition has led it to become a model for implementation in other states. Currently, North Carolina leads the country in the number of registered Eden Alternative facilities, and has a large number of other facilities that have instituted some form of environmental enhancement. The Coalition functions as a consumer-driven advisory and educational body rather than a formal regulatory standard body, and endorses implementation of the principles and philosophies embodied in the Eden Alternative. The Coalition has proved to be a successful, cooperative effort among regulators, providers, advocates, and other experts to implement the philosophies of the Eden Alternative without regulatory basis. Because the Coalition was formed under the auspices of the Division of Facility Services and operates with its ongoing cooperation, it is in an excellent position to clarify and influence policies and regulatory issues concerning transformation of long-term care environments in North Carolina. This article explores the history, structure, function, mission, and goals of the North Carolina Eden Coalition. Examples of issues the Coalition has addressed in promoting environmental transformation in North Carolina's skilled care facilities are also included.