Recently, person-centered care in nursing homes has been receiving a great amount of attention. Organizations have developed with the sole purpose of advancing the philosophy and approaches of this model of care. More nursing homes have undergone culture change by using a person-centered approach. And, there is an increasing amount of publications written about person-centered care, person-first care, patient-centered care and resident-centered care in nursing homes. Although the philosophy behind this care model is not new, some of the specific approaches and methods used in nursing homes today are rather new and very exciting. It takes a total commitment, from the administration to floor staff, to make person-centered care work. If there has been some hesitancy in implementing this type of care in your facility, its time to get excited about the best way of delivering the most highly individualized care there is. And, yes, you can do it!
First of all, leadership must believe in the person-centered model of care. This is no easy task for some administrators and directors of nursing, who have been used to more traditional forms of care. It involves more than prettying up the facility with more home-like creature comforts. It is a philosophy of care that truly puts the resident in the center of the care process. Routines, schedules and tasks become secondary to the needs, desires and pace of the resident.
Second, leadership must get all employees on board with this type of thinking. Nursing, social services, activities, dietary, housekeeping and laundry, and therapies must be educated and shown the benefits of this kind of care in order to believe that it can and will work in their facility. Skilled nursing homes have traditionally provided institutionalized care under the old medical model that places medication passes, treatments, dinning schedules, and pre-scheduled activities before the needs of the resident. Leadership must emphasize that person-centered care essentially turns this old model of care upside down.
Third, leadership must get residents and families involved in designing, customizing and implementing person-centered care through active participation in one-on-one discussions, resident council meetings, and family focus groups. Administration and staff cannot make all the decisions that go into care without critical input from those they care for. Residents provide important information concerning care issues such as when they like to wake up in the morning and when they like to go to bed, what they like to eat and when they would like to eat, preference of a bath, shower, or some other bathing experience, preference of caregiver, and where they would like to live in the facility. Families offer details on their loved ones history, likes and dislikes, religious and spiritual preferences, past occupations and careers, and hobbies. All of this input helps staff to create a more unique and individualized resident-centered care environment and experience.
Fourth, leadership gathers all of the ideas and information they have collected from residents, families, and staff and rolls out their special version of person-centered care in their building. Their model of care may include breaking down long hospital-like hallways and corridors (which are very common in many nursing homes) into smaller neighborhoods or communities of 6 to 8 residents. They may wish to have caregivers assign themselves to each neighborhood and provide consistent assignments. They may want to provide cross-training for nursing assistants in activities and housekeeping and create a new position: the person-centered specialist. They may endorse natural waking and retiring, liberalized diets, easy access to outdoors, and spontaneous activities 24 hours a day. These are just a few ideas that facilities can include in their journey through person-centered care.
Last, all employees must feel person-centered care in their hearts. This is where real care from anyway. It can also be where true culture change comes from, turning their once traditional and institutional facility into a person-centered home where residents want to live, families want to visit and staff want to work. Employees must also understand something else very important about person-centered care: it is not an end unto itself. Instead, it is a process, a ongoing journey, and one in which mistakes will be made and processes changed in order to constantly improve not only the quality of care in nursing homes, but the quality of life itself.
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