Well-being is a much larger idea than either customer satisfaction or quality of life. It is based on a holistic understanding of human needs and capacities. “Well-being is elusive, highly subjective and the most valuable of all human possessions.” – Dr Bill Thomas in his book, What Are Old People For?

Well-being can be simply defined as “a contented state of being.”  Satisfaction, wellness, and happiness are concepts that are often used interchangeably with well-being. However, satisfaction is based on expectations. If others don’t meet them, we are not satisfied. Wellness implies healthiness, which may peak and decline over time. Happiness, too, is a human emotion that comes and goes. In contrast, well-being evolves and develops over a life time, deepening as we grow into our full potential as human beings.

Well-being is the path to a life worth living. It is the ultimate outcome of a human life. It leads us to ask the following questions: What are the components of well-being? What do we need to experience contentment? Through a collaborative effort involving a task force of culture change specialists, The Eden Alternative has identified seven primary Domains of Well-being: identity, growth, autonomy, security, connectedness, meaning, and joy.

A question that has long-challenged those committed to changing the culture of care is:

What makes life worth living, and how do we measure it?

Pioneers of culture change contend that aging and living with unique health challenges need not be about decline and despair, but instead, a chance to joyously soar to new heights of human growth and awareness. We hold lofty goals for how we care for each other, seeking environments across the continuum of care that foster community rather than loneliness, meaningful activity rather than boredom, and self-reliance rather than helplessness.  

The traditional model of health care has much lower goals — simply to mitigate decline.  Elders and others accepting support often feel as though they need to give up their autonomy in order to receive the assistance they need. Family members agonize over the prospect of “placing” loved ones in long-term care environments. Employees, who give their hearts and souls to caring for Elders and other individuals accepting support, experience the frustration of the broken system of care.

The Culture Change Movement Facilitates Well-Being …

“Culture change” is the common name for a global initiative focused on transforming care, as we know it, for Elders and individuals living with different physical, developmental, intellectual, and psychological abilities. It advocates for a shift from institutional/medical models of care to person-directed values and practices that put the person first. Person-centered/person-directed care is structured around the unique needs, preferences, and desires of the individual in question. Through this approach, decisions and actions around care honor the voices and choices of care recipients and those working most closely with them.

The ultimate goal of culture change is well-being for all — all care partners (the Elder or individual accepting support, employees, family members, and volunteers), the organization, and ultimately the community. Eden Alternative SPAIN promotes the concept of care partnership, which affirms that care is a two-way street, focused on ensuring the growth and well-being of everyone involved in the care relationship. It acknowledges that the quality of our relationships is the key to our success, and that care and well-being is for everyone, not just the individuals receiving treatment or services.

While the person-centered/person-directed model of care challenges us to change our attitudes, beliefs, and values, it also redefines how we measure the quality of outcomes — a need growing increasingly urgent, as more and more organizations begin the culture change journey. The institutional/medical model has well-defined measurements, focused mostly around quality of care issues, with outcomes posted on various websites for all to see. If used properly, they are effective for determining if an Elder is receiving appropriate physical care, but they fail to measure the nuances of a life worth living. To address this deficit, we need to define a new way to articulate and define our success.

So, what is quality of life? How do we define genuine caring?

As human beings, we are inclined to pay more attention to the negative rather than the positive, to see the limitations rather than the possibilities. Our language and our societal perceptions reinforce the view that aging and/or living with physical, developmental, intellectual, or psychological challenges equals decline or disability.

Well-being, as a frame of reference, requires us to focus on the strengths, possibilities, dreams, and goals of each individual. Doing so, we define quality of life in terms of what each individual can do and what they have to offer their communities.

Many organizations believe they are “living culture change,” when in reality, they only talk about it.  The goal is the development of a simple, well-articulated frame of reference that drives home what it is we all want for ourselves and for our loved ones: well-being.

Eden Alternative SPAIN recognizes the importance of measuring well-being among all members of the care partner team. It is our contention that in a true community, we can only experience true well-being, if those surrounding us are also.

(Information above taken from:  Revolutionizing the Experience of Home by Bringing Well-Being to Life: The Eden Alternative Domains of Well-Being® Copyright 2012, Rev. 2020, The Eden Alternative®)

Please review the Domains of Well-being white paper for detailed information on each of the following domains: 

IDENTITY — being well-known; having personhood; individuality; having a history

GROWTH — development; enrichment; expanding; evolving

AUTONOMY— liberty; self-determination; choice; freedom

SECURITY — freedom from doubt, anxiety, or fear; safety; privacy; dignity; respect

CONNECTEDNESS — belonging; engaged; involved; connected to time, place, and nature

MEANING — significance; heart; hope; value; purpose; sacredness

JOY — happiness; pleasure; delight; contentment; enjoyment