While my training and education make me an elder law professional, I find that term to be limiting. My goal has always been to be an authority on successful aging. One of the ways I do that is by constantly scanning the horizon in search of new approaches that might work well for my clients. This article is the first in a three-part series that explores some of the most interesting new developments in long-term care. This week we look at the trend toward person-centered care.
First, a bit of history. One of the most well-documented efforts to transform nursing home culture is known as person-centered or patient-centered care. This movement had its beginnings in the 1980s after consumer groups exposed substandard care in some U.S. nursing homes, as well as instances of even more dire problems like abuse and neglect. In 1987, Congress passed a sweeping set of nursing home reforms that required facilities to provide individualized, or “person-centered,” care. As a result, some providers began to move away from the institutional model of nursing home care and toward a more homelike environment in which residents could have a say in their day-to-day lives. In 1997, leaders in the industry formed the Pioneer Group to advocate for person-centered care and create a movement for “culture change” in the nation’s nursing homes.
At an event not long ago, I came across The Person-Centered Way, a book written by James H. Collins, Ph.D., one of the movement’s current proponents and a consultant who helps long-term care facilities implement the person-centered care approach, which represents a 180 degree shift from the old institutional model that is designed around the needs of the facility and the people running it.
In person-centered nursing homes, life is designed around the needs of the residents rather than the needs of the facilities. The goal is to make life as normal and as home-like for residents as possible with care that is consistent with the residents’ and families’ preferences. Those preferences and habits are then translated into customized daily routines. Collins is passionate about the issue because he believes that long-term care has been too institutionalized for far too long. “No one wants to live in an institution,” says Collins, whose training programs help long-term care facility leaders understand person-centered care innovations and how to implement them. “For years I knew there were better ways to provide quality of care and quality of life. As long as we focus on the human being, it is possible to do a much better job.”
What makes a person-centered nursing home different?
- The focus is on the individual, not the illness. The resident’s comfort and pleasure are prioritized over the cure or rehabilitation of an often-chronic or incurable illness.
- Residents are offered choices and encouraged to make their own decision about personal issues like what to wear or when to go to bed.
- Interactions with staff members are different. Staff members are taught to related to residents in a positive, life-sustaining manner.
- Attitudes and routines related to food preparation are transformed. Instead of having a dinner hour where everyone is expected to gather, residents can eat meals according to their own schedule preferences.
- The facility is more homelike and less institutional. For instance, larger nursing units with 40 or more residents are replaced with smaller “pods” or “households” of 10 to 15 residents each with each resident having access to a common living area or kitchen. There’s no overhead public address system. Who still has one of those in their home anyway?
- Relationships between caregivers and residents are fostered, as is caregiver continuity. The same nurse’s aides provide ongoing care to a resident.
- Staff members are empowered with the authority and the training to respond on their own to residents’ needs. Care teams are a common feature.
- The traditional top-down command-and-control management environment has been replaced by a flattened hierarchy. Frontline staff have the authority to make decisions regarding residents’ care.
- The improvement of care quality is an ongoing process, not just a superficial change or provision of amenities.
When you’re evaluating options for long-term care for a loved one, a facility that employs a person-centered approach is always worth a second look.
If you’re interested in learning more about person-centered care, this article from the AARP Public Policy Institute offers a good starting point.
