SUNNYSIDE -- The halls of Hillcrest Manor used to be highways of road rage where agitated seniors were wheeled to unwanted activities after being abruptly awakened and told to eat breakfast off a tray.

But in time, tension melted, faces relaxed and the streets quieted. Hillcrest Manor became as close to Eden as any nursing home could be.

In fact, Hillcrest is Eden. In 2003, it was certified as an Eden Alternative long-term care facility, one of only nine in the state. The Eden Alternative grew out of the experience of an upstate New York physician in the 1990s who was struck by the loneliness he encountered among nursing home residents.

Dr. William Thomas, a recognized worldwide expert in geriatrics, developed a philosophy of caring for the elderly that no one could argue against but which experts say is difficult to practice.

Eden requires long-term care administrators, nurses, aides and other employees to view the places where seniors live as their homes rather than as facilities for the frail. The presumption is that "elders," as residents are called, don't give up their autonomy when they enter an Eden home.

Whatever their physical or mental condition, Eden elders are free to rise at will, eat when they want, sing to their pets and keep a garden. They also see the same nurse's aide everyday, which creates a bond. Aides have authority to make decisions about their elder's care, a practice that research has shown improves care.

Spontaneity is encouraged, regimentation and boredom are not.

Eden-certified nursing homes aren't necessarily better than other homes. All long-term care facilities are regulated based on the respect they show the elderly, according to Dr. Wayne McCormick, chief of long-term care services in the geriatric division of the University of Washington School of Medicine.

But he said Eden facilities are particularly devoted to the practice, not just the idea, from the top administrator down to the housekeeping staff.

"What's different about the Eden Alternative is its penultimate emphasis on autonomy as the very highest level of respect for all human beings," McCormick said.

Eden is also a lot of work. "It takes talent and communication to say, 'Here's what we intend to do and here's the nuts and bolts of how to do it.' Otherwise it's just a lot of words."

Geriatric mental health specialist Katie Lies visits Hillcrest Manor weekly as part of her job at Central Washington Comprehensive Mental Health in Sunnyside. "Dramatic" is the word she uses to describe the difference before and after the adoption of the Eden Alternative.

"I would walk into the building and there was so much tension," says Lies. "People were fussy because they were awakened at the same time everyday and served breakfast whether they wanted it or not. It got them off on the wrong foot."

Under the Eden Alternative, Hillcrest Manor reports it has experienced a moderate decline in the prescription of psychotropic medicines, such as antidepressants, for elders.

Lies said she now finds that residents need her less often. When someone appears depressed and won't get out of bed, Lies will pick up one of the house cats. "We'll just sit there and pet the cat, and pretty soon the elder will reach over and pat my hand. You make a connection."

Some skeptics dismiss the Eden Alternative as a "fur and feathers" approach to long-term care, but Mary Arthur, the administrator at Hillcrest Manor, said the concept doesn't start with animals.

"You can't bring in a cat or dog and call it Eden," said Arthur, 69, who has run Hillcrest Manor since 1985.

Arthur began looking into the Eden Alternative in 1999 at the invitation of Jeff Marshall, chief executive of Kirkland, Wash.-based Eagle Healthcare Inc., which owns Hillcrest Manor.

Marshall said he encourages each of Eagle's 12 facilities in Washington, Idaho and Oregon to explore "cultural change" to improve resident care. Eden, he said, isn't for everyone.

For instance, Eden probably wouldn't work very well in a large, multicultural urban area where residents may not have lived in the area for very long. Big cities have diverse economies, so residents may not share a sense of place or commitment to the community, which is vital to Eden.

But in smaller towns like Sunnyside, where residents and employees may already know each other and share a background in agriculture, Eden can flourish. Marshall said it also works well in Camas, a mill town, where Eagle operates the Highland Terrace nursing home.

And Eden definitely doesn't work without administrators like Arthur, said Marshall.

"Mary has stood out as leader, fully engaging all her staff in continuing training on the concept," said Marshall. "And she has terrific energy."

When she first heard about the Eden Alternative, Hillcrest's director of nurses, Marsha Van de Graaf, was skeptical. "Anytime you are asked to change, it's hard," she said.

But after returning from a three-day training session in Leavenworth, Wash., Arthur and Van de Graaf decided it could work. As they trained employees, they met with resistance from some who didn't want to change their schedules and others who didn't want to let the elders make their own decisions.

Eden teaches that nursing home professionals must give up a fair amount of control to both the residents and the staff. Arthur said that was hard.

"I am the classic Type A manager, a dictator," she said. "It was my job on the line if this failed and that was a scary thing."

Physical changes in the facility would also be necessary to make it more like home. Traditional nursing stations were demolished, beds were ripped out to make the rooms bigger and the plug was pulled on the public address system. While there was an upfront cost to change the look of the building, Marshall said the operating costs at Eden nursing homes don't vary much from traditional homes.

When the staff told Arthur they wanted to turn vacant land next door into a park for the elders, she balked. "I envisioned a doctor's office and a parking lot."

Staff prevailed and Memory Lane Park has rose gardens, a gazebo, a glide swing and room for outdoor barbecues and even a pet cemetery.

For Arthur, one of the biggest hurdles was the pets. "I even said, 'Over my dead body will there ever be a dog in here.'"

While there is no Hillcrest Manor dog -- yet -- a Labrador puppy has made routine visits, successfully coaxing reluctant elders from their rooms. Butterscotch, once a stray cat, now makes daily rounds. Birds abound.

Arthur also reworked the nursing home's top-down organizational chart. Before, elders weren't even listed. Now the chart is a circle and the elders and their families are in the middle. Everyone else is a servant.

"Elders have spirit, history and intelligence and we need to start recognizing that," said Arthur, who recently delivered the message of Eden to the first-ever Central Washington Elder Abuse Prevention Conference in Yakima.

Arthur is widely admired among long-term care professionals, not least for Hillcrest Manor's record of four straight years of perfect scores on state inspections.

In the highly regulated nursing home industry, that's unheard of, said Jeff Hyatt, co-owner of Hyatt Family Facilities, operator of several long-term care facilities in Yakima.

"She must be doing something right," Hyatt said.

* Leah Beth Ward can be reached at 577-7626 or lward@yakimaherald.com.