According to Federal Nursing Home Regulations, person-centered care means to focus on the resident as the locus of control and support the resident in making their own choices and having control over their daily lives. Person-centered care includes making an effort to understand what each resident is communicating, verbally and nonverbally, identifying what is important to each resident with regard to daily routines and preferred activities, and having an understanding of the resident’s life before coming to reside in the nursing home.
While the goal of person-centered care is universally required in every nursing facility, the journey to person-centered care is unique at every community in which you may work a shift. As a contract employee, you are responsible for providing care in harmony with the culture of the community in which you are working. That means you must recognize your own comfort level with person-centered care, understand the community’s level of development with person-centered care, and provide services that are acceptable to the resident and accepted by the staff of the client community. It is not your responsibility to point out a community’s short-comings as it relates to honoring resident choice. It would also be inappropriate for you to disregard the expressed preferences of a resident and provide them care they way that is easiest, or quickest, for you.
Person-centered care benefits the resident, care givers and the nursing facility in different ways. That does not mean that it makes tasks easier to complete. It does mean that the quality of care, quality of life, resident/family satisfaction and employee engagement are all better in person-centered environments.
Everyone has and underlying need to be “in charge” of their life. While we all make accommodations for the greater good—we drive on the right side of the road, we obey (most) other traffic laws, we seek gainful employment and often must adjust our personal schedules to coordinate with our work schedules, we pay for our water that the City or County deliver to our homes through underground pipes, etc.—we all kind of like deciding what we’re going to wear and what we’re going to eat and when we’re going to eat when we’re going to get up or go to bed. Historically, residents in nursing homes gave up some or all those controls and many, many more. For at least 15 years, some nursing homes have worked to become more resident-centered and have borrowed resident-centered approaches from organization such as the Pioneer Network, the Eden Alternative, and Kansas Medicaid’s PEAK program.
Being in charge of one’s care comes down to two very basic principles: autonomy and choice. Autonomy is the power to make decisions over our own lives and is a RIGHT inherent in each person. The best caregivers recognize autonomy is owned be each resident—they earned the right to make decisions many, many years prior to their need for around-the-clock care in a nursing facility. While some of their decision-making skills may have declined as a result of the illness or injury that brought them to a nursing home, they retain the RIGHT to make decisions and must be supported in exercising their rights. As a caregiver, your role is to in supporting resident autonomy may come in conflict with your responsibility to assure a resident’s well-being. It is your responsibility to understand the person-centered care plan for any resident for whom you provide services and to follow that care plan. It is your further responsibility to ask regular staff of the community to help you understand how to meet the specific needs of each resident with whom you may work.
Choice is selecting between two or more alternatives and making decisions about the who, what, when and where of daily life. Making choices also creates the responsibility for accepting the consequences and limitations of the choices made. Residents can and will make bad choices—haven’t we all made some of each? As a caregiver, your responsibility is to follow the resident’s care plan and support them in making choices. For the most part, agency staff do not know residents as well as the regular staff in a client community. There may be the rare occasion where you work in the same place with such great frequency that you have very detailed knowledge of residents who live there. Even more rare is the situation where you will care for a resident you have cared for in other settings. Using the care plan, asking co-workers for insights about specific residents, asking residents about their preferences and asking families about resident routines are all excellent ways to support autonomy, choice and person-centered care.
Ask and listen. Read and learn. These are key strategies you must follow to have any opportunity to provide the person-centered care residents want and regulations require. The care plan and your co-workers will help you “know the person” the care plan is talking about. A person-centered care plan will address not only the resident’s needs—biological needs, personal needs, spiritual and psychosocial needs, privacy needs, relationship needs, creative and expressive needs are all areas that may be addressed—it will also likely address preferences, strengths, etc. and the appropriate plan for providing care and services that will provide the optimal environment for the resident to attain and maintain their highest practicable level of functioning. This approach to care planning, when followed by you and other caregivers, is a wonderful way to provide care and services to residents in client communities because it is knowledge-based, embraces how a resident wants to live, makes the resident more important than the task and upholds the residents right to autonomy and choice.
It is easy to see why residents are more satisfied living in person centered environments. Families, for the most part, are also more satisfied in person-centered environments. You will still run across residents who want you to “control” the behavior of other residents and families who want you to raise the siderails or personal alarm on some who has had a fall. Please seek guidance and support from staff in the client community who may have helpful insights and direction for you.
As a general rule, staff in person centered environments are also more satisfied and engaged. In such settings, staff and residents have been found to have very close relationships. Staff appreciate the level of autonomy and decision making they are provided in following a person centered care plan and honoring resident choices. They appreciate the measured work pace that comes from allowing residents to sleep until they wake up naturally rather than the hurried pace that comes from Night Shift having to get up 10 residents before they leave so that Day Shift can get up everyone else in time for breakfast. In many communities, the biggest challenge to providing person centered care is employees who are uncomfortable with change, who desire to be in control of their work pace, who like to hurry and get “stuff” done so they can work in an extra smoke break and other employee-centered objections to person centered care. Managers and owners can be obstacles, too. Whether the rationale is to make a controlling family member happy or minimize the risk of a survey deficiency or create as efficient and organization as possible, managers and owners can make it very hard to assure residents have autonomy and choice. As an occasional worker in a client community, be attuned to the culture you are entering.
Remember, your responsibility is to provide care and services to each resident using person centered approaches. Read the care plan (and any other supporting information made available to you) and learn from it. Ask questions of other staff and the resident and listen to what you are told. If you have questions or concerns, visit with the charge nurse and seek understanding of how things are done in that community. All of those things will make it more likely you will provide person centered care to residents who will greatly appreciate your efforts.