Person centered care is an approach to health care that puts the patient or resident first. In this article, we will highlight important elements of person centered care, provide several examples of person centered services, and describe its impact on patients. You will learn why person centered services are important for nursing homes and how you can implement them into your long term care facility to improve the quality of care provided to your residents.
Person Centered Care and Person Centered Services
Person centered care, previously “patient centered care,” focuses on the individual needs of patients while considering their environment, abilities, feelings, experiences and wants. Of course, this type of care is not just limited to patients in acute care but rather includes residents in long term care facilities as well. Health care providers who take this approach to care are able to optimize the patient experience by providing patients and family members with ample opportunity to assist in making medical choices. Under person centered care, all clinical decisions are made with empathy and deep respect for patient values, preferences, and rights.
Put simply, person centered services are about taking the time to get to know your patients and residents. “It is only by knowing a person that you can figure out what matters to them,” said Dr. Mike Wasserman, former President of the California Association of LTC Medicine. In his recent appearance on the LTC Heroes podcast, Dr. Wasserman discussed the field of geriatrics and its relation to person centered care. He also explained why he emphasizes the need for long term care administrators to collaborate with clinical professionals and implement a person centered approach in nursing homes.
Geriatrics and Person Centered Care in Nursing
Any discussion of person centered care must include geriatrics, the medical field specializing in age-related physical and cognitive changes that promotes healthy aging among the senior population. Geriatric professionals, such as geriatricians and geriatric nurses, are specially trained to care for older adults and provide regular support and treatment for the senior population. They are, thus, critical components of all long term care facilities.
Geriatrics focuses on patients’ and residents’ quality of life rather than just diagnoses and treatments. For instance, instead of simply instructing a patient with heart issues to eliminate consumption of high sodium foods, a geriatrician would look beyond cardiac health and assess how that requirement could also affect the patient’s emotional wellness. Imagine the patient’s favorite food is corned beef sandwiches and losing the ability to eat them would greatly diminish their quality of life. In this case, according to Wasserman, a geriatrician would “let them eat their corned beef sandwich and give them a little extra dose of diuretics.”
Additionally, Wasserman explained, while general internal medical studies often present death as a negative outcome, geriatricians recognize that “if you’re frail, if you’ve lost your memory, and if you’ve suffered a lot, death is a relief and might be a good outcome.” Ultimately, he articulated, geriatrics is about understanding who the patient is and how treatments affect their overall wellness.
Geriatrics is, thus, driven by person centeredness, so much so that, as Wasserman put it, “[It’s almost as if] geriatricians invented person centered care.”
Key Elements of Person Centered Care
The essential components of person centered care can be remembered as “The 4 C’s”:
Care – Person centered care is more than simply finding a treatment to an illness; when caring for a patient, it is important to remember that the person’s needs and wants are paramount. This means understanding what makes that individual unique and tailoring care practices based on those identifying traits. As Wasserman remarks, “You have to know your patient. You have to know who they are as a person.”
Culture – In person centered care, it is important to always take the patient’s culture, values, and lifestyle preferences into consideration. This means that nurses might use a patient’s native language when speaking to them or allow them to select their own outfits. It also means that patients are given control over some of their care decisions, such as what time they go to bed or eat dinner.
Communication – Person centered care involves regular communication with the patient. This may take the form of meetings with patients or their family members, where they are given updates on how the patient is doing and what services will be provided. It might also involve meeting one-on-one to obtain feedback from the patient about care so that it can be improved over time. Additionally, communication is required for health care professionals to provide patients with information about their treatment options so that they can make informed decisions for themselves.
Collaboration – Person centered care recognizes that patients have a right to determine how they care for their health. After communicating necessary information with the family and patient, decision-making should happen in partnership with the patient and his or her family. This can take the form of collaborative meetings in which patients and their families meet with a nurse or physician to discuss the next steps.
The Benefits of Person Centered Care
Person centered care shifts attention from a medical condition to the patient’s own experiences and preferences, helping patients feel more empowered during the care process. Additionally, person centered care can change the culture of a hospital or facility, resulting in increased well-being among patients and staff. Some specific benefits of person centered care include:
- Increased patient satisfaction – Person centered care acknowledges the patient’s values and desires, which makes them feel more valued. With greater say in treatment plans, patients will be more receptive to the care they receive. By giving the patient control over their schedule, environment and daily activities, their quality of life also improves.
- Increased job satisfaction among staff – When healthcare providers recognize that their patients are pleased with the care they provide, they will feel like they’re making a difference in somebody’s life and have a greater sense of pride in their job.
- Better health outcomes – The AMA Journal of Ethics Research has concluded that practicing person centered care results in shorter recovery times, decreased emergency room visits, and reduced use of healthcare resources.
Examples of Person Centered Services
While person centered services can vary, they all share common themes of providing patients with a fulfilling lifestyle, giving patients power over decisions, and recognizing individual patient preferences. Here are some examples of services:
- Online portals for patients to easily access their health information, schedule their own appointments, and easily send messages to their doctors or nurses – The NEJM Group of the Massachusetts Medical Society found that technology-based tools – like online portals and wearable technology – empowers patients, giving them control of their health care outside of physician offices.
- Customized care plans that are curated specifically for each patient – Rather than prescribing the same medications and recommending identical treatment paths for all patients who share a particular issue, person centered care looks at each person’s preferences and designs a treatment plan in accordance with their lives. For example, if someone has back pain and enjoys gardening, then they might be given tasks such as watering plants or making sure their garden gets weeded regularly.
- Family rooms inside hospitals for patients to remain connected with their families – These not only keep families involved in the patient’s care, but also give patients a sense of comfort in an otherwise isolating environment. An example of this is family-friendly postpartum rooms.
Patient Centered Care in Nursing Homes
Now that we have explained patient centered care generally, we will move to how it applies to long term care facilities. While some benefits of person centered care in nursing homes are similar to those of hospitals, long term care has its particular issues that can be solved through implementing a specific approach to person centered care. In this section, we will discuss the importance of person centered care in nursing homes and provide examples of services your facility can offer.
Why is person centered care necessary in LTC?
Those living in long term care facilities are often at their most vulnerable. They may have a disability or may have been uprooted from their homes and placed in a new environment alongside unfamiliar faces. It is, thus, imperative that nursing homes adopt person centered practices to help residents feel at home and appreciated.
How a person centered approach can improve your facility
There are a great number of issues related to LTC, such as staffing problems, elder neglect, and lack of quality, for which person centered care can be an effective solution. By using person centered care in your facility, you will:
- Increase wellness among residents: Person centered care can greatly improve your residents’ health, both mental and physical. For example, when residents are able to participate in activities of their choosing, they will feel more engaged and less isolated, reducing the risk for depression, anxiety, or other mental health issues.
- Increase facility reputation: As resident wellness and quality of life increases, the reputation of your facility will too. Family members will be more comfortable with sending their parents or grandparents to a nursing facility that recognizes their opinions and wants and gives elders a sense of autonomy.
- Reduce burnout among staff: As previously mentioned, person centered care is known to be effective in increasing job satisfaction among staff members. This will result in a reduced burnout rate as caregivers come to enjoy their jobs more and feel less fatigued. Compared to other settings, skilled nursing facilities have the highest nurse burnout rate at 37%. Less burnout among nurses not only means you will have a full staff, but it also protects your residents from neglect and other forms of elder abuse.
How to incorporate person centered care into LTC facilities
Implementing person centered care into your facility can be a daunting task, involving extensive staff training, cultural changes, and the creation of new facility practices. Making such adjustments is never easy, so here are some ideas to get you started:
Activities that are tailored to individual interests – Instead of holding the same activities every week, obtain feedback and create new events in accordance with what the residents prefer. This provides them with an opportunity for socialization, mental stimulation, and physical exercise while still allowing them to feel in charge of their own care.
Meal services that offer a variety of selections – Rather than providing limited and repeating menu options, learn about each resident’s food preferences and ask your dining staff to curate dishes that satisfy those preferences. If appealing to the preferences of a large number of residents at once is too overwhelming, you can roll out a new meal once a week based on the suggestion of a particular resident. As you introduce these new dishes, eliminate any old ones that residents do not enjoy. Slowly but surely, you will be able to organize a full menu of dishes that all residents enjoy. Additionally, consider increasing the amount of dishes offered at each meal to give residents more choices. This provides residents with more control over their food intake, giving them a sense of independence.
Adjust policies in accordance with residents’ preferences – Not every policy needs to be set in stone, and no voice is more significant than that of the resident. Joe Mason, the administrator of the Prairie Manor Care Center, joined the LTC Heroes podcast to talk about how he improves the resident experience by being flexible. He mentioned doing away with bibs in the dining room and allowing residents to choose the paint color of their rooms.
Regular meetings with residents and families – By living in a nursing home, residents are likely to see caregivers more than their own families. To mitigate loneliness, you should visit with residents regularly to ask about their careers, their families, or any interesting stories from their youth. Make a sincere effort to get to know them as people and befriend them. When possible, meet with family members to learn about any cultural nuances and incorporate family preferences into the resident’s care.
In order for your facility to fully implement person centered care into its practices, there needs to be a culture change. According to the Alzheimer’s Association, “culture change” refers to the shift from an institutional model to a person-centered model of care. While culture change includes incorporating the person centered services mentioned above, adjustments must also be made to your facility’s language.
Slight changes to the rhetoric your staff uses can make residents more comfortable with their situation, as opposed to feeling reduced to someone who is merely elderly and needs assistance. In fact, the change from “patient centered care” to “person centered care” was made with this philosophy in mind. While they are synonymous, the latter term allows the resident to be viewed as an individual human being and not a burdensome entity identified by his/her old age or illness.
Here are some examples of changes in phrasing that every LTC facility must make:
- Suffering from → Living with
- Lobby → Living room
- Nourishment → Snack
- Unit → Neighborhood
- Nursing home → Community
For the Alzheimer’s Association’s full guide on culture change, click here.
Geriatrics and Nursing Homes
Because of the close connection between geriatrics and person centered care, incorporating person centered care into your facility must involve your top clinical professionals: your medical director and director of nursing. These two individuals are well trained in the field of geriatrics and have the necessary knowledge to help successfully implement person centered approaches. Wasserman’s conversation on LTC Heroes highlights the centrality of consulting the two in all facility decisions, even administrative and financial.
“A good administrator is going to engage their director of nursing and their medical director. They’re going to listen to them,” Wasserman stated.
To illustrate this point, he offered the hypothetical of an administrator concerned with spending too much on food. In this scenario, the facility would likely start purchasing more carbohydrates, a more affordable form of nutrition. However, a high carbohydrate diet will worsen the health of those with cognitive impairments, Wasserman warned. Consequently, “by saving a few cents every month on your food costs, you’ve worsened the outcomes and the clinical care of your residents.”
Had a medical director been involved in the financial decision described above, a harmful outcome would have been avoided. Thus, in order to truly put your residents first and have a fully person-centered facility, you should be collaborating with medical professionals at all times.
Person centered care is an approach to patient care that places the patient’s needs and desires first. It focuses on understanding each person and focusing their treatment plan around preferences and culture. This type of care is important for nursing homes because it can improve the quality of life of residents. Making the shift to person centered care involves changing your facility’s services and culture. While implementation of such changes may appear to be complicated, transitioning to a person centered facility will result in increased satisfaction among your residents and staff, making it a sound investment.
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