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Can person-centered care be saved?

May 1, 2009
by Katherine E. Goethe, PhD, and Martha E. Leatherman, MD
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As other fields adopt and, unfortunately, dilute culture change principals, long-term care must stay true to its purpose

Person-centered care (PCC), a part of the culture change movement in long-term care, has been called an “attitude,” a “transformation,” and a “gold standard of care,” and its popularity is sweeping through the long-term care industry. Already, it is the biggest thing in assisted living marketing since the term homelike.

Unfortunately, like many popular trends, the concept of person-centered care is already being watered down and overused. The concept is even being adopted by other industries. For example, a builder in Florida now advertises “women-centered homes.” What do such obvious attempts to exploit the concept signal to consumers? How far does it go? Will there next be “child-centered day care,” or “pet-centered veterinary clinics?” Consumers wonder if assisted living facilities have not been person-centered all along, then what have they been “centering” on?
 

Nursing Homes/Long Term Care Management, November 2005
The death of culture change?
by Bill Keane, MS, MBA, LNHA

To address the dilution of culture change and PCC, Bill Keane, chief operating officer of Harbor Senior Concepts of Illinois, wrote in Nursing Homes/Long Term Care Management in November 2005:

 

To many who saw the early principles of the Eden Alternative as just another “fur and feathers” fad, culture change has become the ongoing fad of fun things to do as work plans, resident census, risk management, and survey processes permit.
 

How can the industry preserve the real impact of PCC without diluting the core ideals? To answer this question, we need to look back to the beginnings of the concept itself.

The Roots of Culture Change

The culture change movement in long-term care was specifically designed for nursing homes. At the time, nursing home care was based on a hospital model. Although the patients were ill and needed care, they were not ill enough to warrant daily physician monitoring, and hospital beds were needed for more intensive cases.

The mind-set of hospital expectations filtered into nursing homes: When admitted to the hospital, a person expects the medical illness to be treated. Unlike hospitals, however, people actually lived in nursing homes and expectations were different. Because of the disconnect between the inception of the nursing home in a medical model and the actual use of the nursing home as a quasi-residence, people rightly perceived the nursing home as an institution that was cold, disease focused, and saw people simply as room numbers. In such a setting, diseases might be “managed,” but all hope of any quality of life for the individual was lost. In such a context, culture change was indeed a welcome transformation.

Culture change has as its basic precept the care of the person rather than management of a disease. With the advent of culture change, the days of bathing only those people on the right or left side of the hallway on certain days, residents lining up for a set mealtime with no menu choices, medications given only at certain times of day, and nurses’ stations built like bunkers were quickly disappearing. Culture change makes sense in nursing homes, as does its major tenet—person-centered care.

Actually, the concept was not original to nursing home care. The wheel had already been invented by Carl Rogers, an influential psychologist and psychotherapist who was the founder of “client-centered psychotherapy.” Rogers developed client-centered counseling as a way to increase the psychotherapy patient’s active participation in the process and to emphasize a nonjudgmental format for psychotherapy. The word “client” in the business world is akin to “customer.” A client is one who seeks something needed (a service or a product), makes choices and decisions, and can negotiate in obtaining what is needed. Thus, Rogers replaced the word “patient” with “client” to de-medicalize the relationship and empower the patient/client.

Similarly, the concept of PCC, when applied in the long-term care setting, seeks to de-medicalize the relationship between resident and caregiver, increase the long-term care resident’s active participation in the process of care, engage the staff and the resident in a relationship, and provide a nonjudgmental format for care. The term “resident” implies that the person is at home. Much like changing “patient” to “client,” changing “patient” to “resident” eliminates a perceived stigma. “Resident” becomes an empowering term that says, “I am at home and I am in charge.”

A Look at PCC in Action

Perhaps the best way to view the ideal of PCC is to imagine how differently you would provide care if that resident was your own family member. You would take into account personality factors, personal history, knowledge of likes and dislikes, and so on.

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