by Caroline Snyder

I sense that the new director of Marian of St. Paul Health East Facility, 200 Earl St., will make an indelible mark on the care of nursing home residents in years to come.  A true visionary, Steve Tonsager has already enlightened my understanding of the need for a new concept in nursing home care.  A strong advocacy of a more patient centered residency than doctor oriented could bring about a transformation beneficial to all of us.  Marian could become a panacea to others in the nursing home health care community

Steve Tonsager became the new Director at Marian of St. Paul in April of this year.  He resides on the East Side of St. Paul and he and his wife have a family of 4 children.  He  jogs, plays tennis and does student work in the evenings.  He is a Lutheran minister specializing in the chaplainry of elders and has a degree in biochemistry.  He has been in the field of administrative health care business for the last 10 years and is an evening student at the American Academy of Acupuncture and Oriental Medicine.  Steve is developing an integrative health care model at Marian to better manage chronic illness and pain by incorporating complimentary therapies with traditional medicines.

Dr. Bill Thomas a physician from New York originated the “Eden Concept” a new way of thinking about nursing home care.  He researched the entire field and believes a revolutionary change of thinking about nursing homes must take place to enable residents to become empowered to make their own decisions relevant to their health care in later years.  Baby boomers will be living longer and there will be a greater number who will have to choose a nursing care facility that will listen to their needs and concerns.  Positive interaction with staff and administration will be conducive to good health care but also there must be an environment which promotes the philosophy of “living not dying” within the nursing home facility.   The aesthetic beauty and freshness of the campus at Marian invigorates this spirit.  Marian is almost a “Garden of Eden” in its own right.  The residents enjoy the view of Mounds Park and its spaciousness is conducive to outdoor activities and visiting with other residents in a natural setting.  
  
Employees in the health care profession also become more innovative in this environment.  Delivery of services by the staff would become more flexible and more creative if there is more input from the residents.  Studies have proven that the physical, psychological and spiritual needs of the residents are better fulfilled if residents participate in their health care management.  Complimentary medicines or treatments have proven to result in “avoidance of other costs by keeping someone healthy and avoiding lengthy hospitalization.”  It is a “cost avoidance” strategy which promotes better utilization of costly health care services.   Unfortunately HMO’s have tunnel vision and continue to prioritize conventional services.   The elderly are willing to investigate and accept other therapies but today it is almost all paid for privately.   Using federal moneys, the National Institute of Health has begun new research in this area.

Complimentary medicine is not intended to replace traditional Western medicines.   Complimentary therapies can bring new ways to improve the management of chronic health problems.  The use of Tai Chi, massage, herbs, meditation, and acupuncture are examples of complimentary therapies.  The impoverishment of the spirit, loss of meaning in life, the loneliness experienced is sometimes overwhelming for residents.  The purpose of the Eden Project is to alleviate suffering, encourage and develop new interests,  instill a purpose to life through creativity and exposure through other venues.  Decision-making, connecting with staff in an empathetic manner and providing more activities will result in a “non institutional” environment for the residents.  
  
A very integral part of the “Eden Project” is the promotion of the interaction of patients with children and animals.  The emotional and physical resistance to disease and depression has been accelerated and proven by research studies.  The “blending of ages” is a priority at Marian.   The societal value of integrating seniors with the younger population is beneficial to both.  A “meaningful engagement in the world and purposefulness in living” is highlighted in Steve’s proposed project at HealthEast Marian of St. Paul.   There are Junior Volunteers from the Middle and High Schools who participate on a regular basis and there are a total of 100 volunteers including organizations who put in 10,000 hours on a yearly basis.  

 A trip to Big Fork, Minnesota the last week in September is planned with 11 of his staff people who will meet with their counterparts who will provide some insights into the problems and how they were alleviated through the principles of the Eden Project.  This study will show how they have overcome the barriers presented by behavioral problems and how the staff can become more effective and alleviate the stresses incurred by the residents.  The staff is happier and friendlier and a “neighborhood” effect will result with residents becoming more empowered.

It is an exciting time for Steve.  This paradigm shift will create values which are the “right values.”  A creative culture of administration, staff and residents will result in a resident connection environment rather than one of disciplinary action.   A team effort will turn the system inside out and it will become a resident driven system.  Long term care is very regulated and stifles creativity.  It will cost more and even more regulations have to be put in place every time an infraction is committed.  More regulators including the Department of Health become involved and this ties the hands of the administration.  Thinking of the “big view” is Steve’s objective.  A new vision with Steve at the stewardship will provide a wonderful journey for all.   There is a new position which is officed at Marian called the Eden Coordinator who will be developing the Eden alternative at all of the HealthEast nursing homes.  Marian has become a “Healing Community which values the whole person.”