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Posted: July 14, 2004

Professional Caregiving

"Person-Centered Care" is In,One-Size-Fits-All is Out

What did YOU do for fun this past weekend? When do YOU like to go to bed? How do YOU interact with friends? Do you prefer a bath before bed, or a morning shower? Do you like to garden or watch TV? Questions like these are not only asked, but acted upon, in settings where "Person-Centered Care" is being implemented across the country.

Person-Centered Care is a moral philosophy of care developed by Tom Kitwood and the Bradford Dementia Group in England in the late 1980s. Many facilities may have adopted individualized care for years as their resident care philosophy, but not until recently has the emphasis on individualized care come to such a head. The adult children of our present and future clients expect it.

If we were to do a self-assessment of our own social histories, including careers, family life, personalities and hobbies, each of us would have a different mapping of the ways we would want to be engaged if we were being cared for by others.

For example, if I could no longer live safely at home and needed the supervision and care offered in an assisted living facility, I would like my caregivers to know I would enjoy joining the gardening club, listening to James Taylor, bathing at night, and having coffee when I wake. I would not want to play video games or watch "reality" show reruns, which I imagine will also be among the activity choices in the care settings of the future.

Feels strange, but the activities offered to residents in facilities today would have felt strange in their imaginings 30 years ago! Those who are presently in assisted living, board and care homes, skilled care and adult day centers are dependent on their professional caregivers to engage them, care for them and promote independence.

Today, the choices residents or participants make are different due to varied interests and abilities, but the need to have strengths and abilities challenged remains the same for all of us. Person-Centered Care ensures that each person's individuality is core to the design of care for people with memory loss, and other debilitating illnesses.

Caregivers know how their family members relate in social experiences. For example, "My mom is gregarious and enjoys groups. She plays cards, loves to sing in a choir and has gone on many cruises and elder-hostel programs." This recreation history is significant and should direct decisions made in Mom's plan of care. Another resident may (and will!) have completely different preferences that will dictate decisions made about their care. This is done by gathering the detail from a social history, and it is the first step to creating a Person- Centered Care approach.

Why are these questions integral to our work with people with dementia and other disabling conditions? We have a new and growing market, with different life experiences, a more educated customer base, some with more resources, who may be more demanding and less willing to take a parent or spouse to a care setting that resembles that of decades ago.

The image of the traditional 1970s nursing home has been compared to an airplane flight. All strapped in, same food served, no permission to move around in the name of "safety," and treated as if they had no individual differences for comfort, food or care.

We have had to make significant changes in those settings because today's customer demands something better. They are demanding a cruise version of care -- superior customer service, a wide range of individualized activities and most important, a professional staff and care that is emotionally available to them.

More and more of today's successful care providers in the aging industry have taken the moral and philosophical step forward, (even if it also makes good business sense), where answering those and other questions tell the care provider exactly who this new resident is and how to accommodate his/her unique needs, preferences and strengths in ways hat support independence, self-esteem and quality of life.

When turning to care outside of the home, caregivers seek more than the typical services they have come to expect in nursing homes. Of course, they wouldn't consider settings that could not provide good healthcare monitoring, therapies, a pleasant and clean environment, tasty and nutritious meals, transportation that expands their loved one?s experiences outside of their residence, and a long list of other associated services.

More and more, however, caregivers are demanding an individualized plan of care that focuses on their family member's abilities, strengths and personal interests. No longer are generic programs and activities suitable for many customers who are shopping for care settings.

It really doesn't matter if caregivers are seeking long-term care residential settings or community based options such as adult day centers. Customers simply and clearly are seeking services that recognize the individual differences each prospective client brings to the setting. The newer, more progressively marketed facilities announce their Person-Centered Care approach to those who decide on their service, often the adult children of the aged.

What are the main components of the Person-Centered Care approach?

There are eight components integral to this care, and when implemented demonstrate that Person-Centered Care is not merely a slogan, or marketing tool, but a philosophy of care. How all eight are integrated into the design of the setting is what makes them most attractive to the Baby Boomer market, 's or a related dementing or other disabling illnesses. Here they are:

  1. Upholding the value of the person regardless of the level of functioning.
  2. Immersion of interactions in core psychological needs (love, comfort, attachment, inclusion, occupation and identity).
  3. Promotion of positive health.
  4. Reframing "problem" behaviors as a demonstration of a need being communicated.
  5. Reframing "problem" behaviors as an opportunity for communication with caregivers.
  6. Recognition that all action is meaningful.
  7. Hiring of staff who demonstrate emotional availability to persons in their care.
  8. Integrate all elements of positive person work.

Incorporating these components into the daily routine as an ongoing care philosophy of the setting helps the long-term care industry evolve from the time-worn medical model depicted by wheelchair-bound residents lined up along cold corridors, detached nursing stations and a "Bingo at 4 for All" design template. The airplane ride model is transforming into the cruise ship model, where choices, superior customer service, and attentive and engaged staff reign.

If you look closely at care environments that stress Person-Centered Care, you see residents engaged in meaningful activities and involved in programs that stimulate them, and one can overhear and witness staff truly attending to and addressing them. Alzheimer's patients are most dependent on this approach, as they have lost their ability to clearly express their needs, wants and desires, but this model begs to be incorporated into all care practices regardless of the resident's condition.

Professional care providers who implement this approach recognize that a one-size-fits-all care approach is not going to meet the personal differences that each new customer brings to the table. Their caregivers are learning to expect this shift in care philosophy and will seek it out.

Person-Centered Care is what I know I'll expect. I want to know that when I get there, I will cruise into the sunset, be invited to join the garden club, sing along to "Sweet Baby James" and get my bath at night. How about you?


Sylvia Nissenboim is a licensed clinical social worker and who has been working in the field of adult day services in the St. Louis area. She is the director of four adult care and enrichment centers for the American Red Cross and also operates a personal and professional coaching firm, LifeWork Transitions, specializing in caregiving concerns, adult day care management and other aging services, such as virtual coaching and family care giving support groups. She co-authored The Positive Interactions Program, is a national speaker, and has served as president of the Missouri Adult Day Care Association and as a member of the Missouri Governor's Advisory Council on Aging..

© 2004 Pederson Publishing, Inc. All Rights Reserved.
Commercial use, redistribution or other forms of reuse of this information is strictly prohibited without the prior written permission of Pederson Publishing.

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