What is Person-Centered Care?

Dear Dr. Jeff: Our mission statement asserts a commitment to “person-centered care,” as have those of every long-term care facility and chain for which I worked. never really understood what this means, particularly in an era computerized health records with automatic default orders, mandatory check boxes on templated practitioner notes, admission periodic assessments all tailored the Minimum Data Set, insurance- algorithm-generated lengths stay, vendor-created menu cycles that repeat two weeks, standardized infection control practices treat residents potential sources contagion. Journal editorials articles emphasize quality improvement is achieved through improved systems care. Where does person fit into this? Is there any prospect we can bring unique individual back center Jeff responds Many things changed over 12 years written column 40 spent attending physician medical director nursing homes. In — my last “Dear Jeff” column, want return one core questions believe many prior columns addressed aspects topic. no doubt when Steven Levenson takes responsibility answering he will add more insights perhaps correct few errors omissions. It was honor take from beloved David Brechtelsbauer assumed presidency AMDA – The Society Post-Acute Long-Term Care Medicine, it be turn former president who literally wrote book direction found posting goal maximizing bottom line increased investors bonuses senior management. Yet United States corporate industrial process whose product billable patient days, lives experienced by patients secondary consideration. Even profess nonprofit status typically adopted slogan “No margin, mission,” first voiced Sister Irene Kraus, founding Daughters Charity Health System chairman Catholic Association American Hospital (Wall Street J, Jan. 7, 1998; https://on.wsj.com/3h33WPQ). Multimillion- billion-dollar corporations systems, regardless ownership or sponsorship, cannot not their activities persons under Although recent news reported pressure facilities chains large shareholders investment trusts improve quality, motivation concern declining reputations occupancy rates may imperil investments. Institutions offer (read: sell) services, but individuals provide Nursing home delivered teams professionals legions employees. These including nurses, physicians, dietitians, social workers, rehabilitation therapists come occupations codes ethics place primacy respecting autonomy personhood using our professional skills knowledge benefit. are values learn during education training, obligated pass them team members, especially certified assistants lion’s share hands-on Language matter. understandable reluctance insist politically phrases, choice words reflect patterns thought. transition “nursing homes” facilities” reflects change organizational mindset. organization name division “long-term care” “post-acute recognizing new concentration highly reimbursed short-stay rather than 80% beds used long-stay had been “acute” months years. Patients assigned units living floor home. Rather, they temporarily placed institution, often institutional charm psychiatric hospitals, school dormitories, prisons. (One such prisons, dormitories tend joy food.) expect adapt adapting special needs person. Of course, old homes were very homelike, reflected aspirational someday achieved. If nothing else, vastly different power relationship between compared his her own home, even if Medicaid paying rent. Maslow’s hierarchy well-known construct useful assess how meeting residents. Based psychologist Abraham theories (Psychol Rev 1943;50:370–396), portrayed pyramid, physiologic its base comprising basics air, food, water, sleep, shelter, clothing. institutions generally supply these biologic adequately better previous arrangements functionally dependent level above labeled “safety.” somewhere basic required life need free pain other major discomforts threats. Recent efforts address past trauma (trauma-informed phrase federal requirements) work prevent threats resident’s sense safety environment. Typically, resident has most facilities, only protection against liability lawsuits. Families also frequently mention justification placement, dementia. absolute safety, at risk falls, safe environment abuse neglect should right human being. effective systems. On simplest level, then, person-centered element. Medications prescribed based diagnoses known responses allergies. Nurses direct problem areas (no puts dry sterile dressing everyone hips wound locations), initiate preventive measures minimize identified risks. higher levels comprise psychological needs. where differs routine care, characteristics each resident. 21st-century medicine pays lip service notion mind body connected. Numerous studies endless observations confirmed complex interactions emotional well-being health. distress worsen bronchospasm, gastric acid production motility, blood multiple cardiac function, healing, muscle recovery rehabilitation, immune “physical functions” well-documented. But beyond factors, central aspect third pyramid belonging love. Included category friendship, family, physical contact, sexual intimacy. though routinely family love, cultivating being you belong treated valued member community plan. A requires “seen” accepted Among best struggles diversity, equity, inclusion focus attention systemic discrimination so groups within society women, color, immigrants, LGBTQ communities. already face denigration age, functional, cognitive limitations. When recognize value worth make belong, way fourth hierarchy: respect, esteem, recognition. Completion Set (MDS) requirement near universal compliance. includes some demographic data, limited information regarding typical habits preferences virtually about goals formative experiences. Unfortunately, too minimum regarded complete. For example, despite important role plays people’s identity, almost available residents’ charts. rare “Occupation” item demographics page, it’s usually filled word “Retired.” several decades revealed (except politicians) checking box either Male Female describe complexity activity gender identity. Similarly, standard religions “None” begin diversity religious belief, experience, practice categories growing group themselves “spiritual religious.” Therapeutic recreation interviews record enjoys “listening radio” do differentiate among lover talk radio still mourning Rush Limbaugh, devotee FM classical music stations, variations two. Nor sometimes listen times another. currently nonagenarian speak happily sings along gospel day. gathered disruptive behaviors impairment provoke further investigation, hopes identifying mitigating maneuvers. Person-centered As told deserve respect. fact, respect function give others. business model salaries uses marketing slogan. us reality changes throughout facility. Begin “history” becoming true story.