Running Head: PERSON-CENTERED APPROACH TO NURSING PRACTICE 1 Person-Centered
Person-Centered Care: At the Core of Assisted Living
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Person-Centered Care: At the Core of Assisted Living Josh Allen, RN American Assisted Living Nurses Association Board Member Assisted living attempts to distinguish itself from other housing and care models in the long-term care continuum through a focus on a residential (rather than institutional) model of care that em- phasizes choice, individualization, dignity, inde- pendence, and quality of life. Throughout the history of this relatively young model of care, as- sisted living advocates, providers, and profes- sionals have worked to maintain a focus on the resident, prioritizing individual needs and prefer- ences over organizational or institutional de- mands. This resident-centered approach to care and services mirrors in many ways the principles of person-centered care (PCC), as both emphasize quality of life as the driver of care and services. Although person-centered care is not a new care philosophy, in recent years it has become an important part of the national dialogue related to assisted living and other forms of long-term care. Some might argue that the very concept of assisted living is based on a person-centered phi- losophy, and in fact early assisted living providers used the term in the late 1980s to describe the changes they were attempting to implement in this new aging services model. However, as the culture change movement has grown, the term “person-centered care” has been expanded to in- clude elements that are not universally imple- mented by all assisted living providers, such as self-directed work teams and relationship-based operational cultures. The key elements of person-centered care can serve as a framework for individualized care and services that guide both the operational decisions of assisted living providers and the day-to-day activities of nurses working in assisted living communities. The Center for Excellence in Assisted Living (CEAL) recently published a paper on the topic of PCC titled “Person-Centered Care in Assisted Living: An Informational Guide.” This paper is the basis for this article. 1 Definition of PCC In the CEAL paper, person-centered care is de- fined as “a comprehensive and on-going process of transforming an entity’s culture and operation into a nurturing, empowering one that promotes purpose and meaning and supports well-being for individuals in a relationship-based, home environment.” Some use the term “person-centered care” rather loosely, using it to describe virtually any operational change within the organization, such as a new activity program. However, as pointed out in the CEAL paper, “to realize PCC outcomes requires deep organizational and operational system changes that reflect different values and beliefs about what constitutes quality care, a nur- turing environment in which to live, and a positive environment in which to work. Attaining PCC out- comes is a continual process. It can take years just to fully implement the structural elements of PCC depending on how evolved an organization is to begin with.” Implementing and achieving the goals of PCC requires the commitment of the staff and stakeholders at every level of an organization. When implemented successfully, a PCC philos- ophy can improve both quality of life and quality of care by shifting from a task-oriented medical approach that emphasizes efficiency to a care approach that honors “elders’ life experiences, choices, routines, and the natural rhythms and spontaneity of daily life.” Key Elements of PCC Although there is no comprehensive research examining the elements required to support the desired outcomes of PCC, the following structural elementsdbased on existing research as well as interviews with PCC expertsdare outlined in the CEAL paper: 1. Core Values and Philosophy 2. Relationships and Community 3. Senior Management-Owner-Governance 4. Leadership 5. Workforce 6. Services Geriatric Nursing, Volume 31, Number 5 391 American Assisted Living Nurses Association OFFICIAL SECTION OF THE OFFICIAL SECTION OF THE American Assisted Living Nurses Association
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Transcript of Person-Centered Care: At the Core of Assisted Living
American Assisted Living Nurses AssociationOFFICIAL SECTION OF THE OFFICIAL SECTION OF THE
American Assisted Living Nurses Association
Person-Centered Care: At the Coreof Assisted Living
Josh Allen, RNAmerican Assisted Living Nurses Association
Board Member
Assisted living attempts to distinguish itself fromother housing and care models in the long-termcare continuum through a focus on a residential(rather than institutional) model of care that em-phasizes choice, individualization, dignity, inde-pendence, and quality of life. Throughout thehistory of this relatively young model of care, as-sisted living advocates, providers, and profes-sionals have worked to maintain a focus on theresident, prioritizing individual needs and prefer-ences over organizational or institutional de-mands. This resident-centered approach to careand services mirrors in many ways the principlesof person-centered care (PCC), as both emphasizequality of life as the driver of care and services.
Although person-centered care is not a newcare philosophy, in recent years it has becomean important part of the national dialogue relatedto assisted living and other forms of long-termcare. Some might argue that the very concept ofassisted living is based on a person-centered phi-losophy, and in fact early assisted living providersused the term in the late 1980s to describe thechanges they were attempting to implement inthis new aging services model. However, as theculture change movement has grown, the term“person-centered care” has been expanded to in-clude elements that are not universally imple-mented by all assisted living providers, such asself-directed work teams and relationship-basedoperational cultures.
The key elements of person-centered care canserve as a framework for individualized care andservices that guide both the operational decisionsof assisted living providers and the day-to-dayactivities of nurses working in assisted livingcommunities.
The Center for Excellence in Assisted Living(CEAL) recently published a paper on the topicof PCC titled “Person-Centered Care in AssistedLiving: An Informational Guide.” This paper isthe basis for this article.1
Geriatric Nursing, Volume 31, Number 5
Definition of PCC
In the CEAL paper, person-centered care is de-fined as “a comprehensive and on-going processof transforming an entity’s culture and operationinto a nurturing, empowering one that promotespurpose and meaning and supports well-beingfor individuals in a relationship-based, homeenvironment.”
Some use the term “person-centered care”rather loosely, using it to describe virtually anyoperational change within the organization, suchas a new activity program. However, as pointedout in the CEAL paper, “to realize PCC outcomesrequires deep organizational and operationalsystem changes that reflect different values andbeliefs about what constitutes quality care, a nur-turing environment inwhich to live, and a positiveenvironment inwhich towork. Attaining PCCout-comes is a continual process. It can take years justto fully implement the structural elements of PCCdepending on how evolved an organization is tobegin with.” Implementing and achieving thegoals of PCC requires the commitment of the staffand stakeholders at every level of an organization.
When implemented successfully, a PCC philos-ophy can improve both quality of life and qualityof care by shifting from a task-oriented medicalapproach that emphasizes efficiency to a careapproach that honors “elders’ life experiences,choices, routines, and the natural rhythms andspontaneity of daily life.”
Key Elements of PCC
Although there is no comprehensive researchexamining the elements required to support thedesiredoutcomesofPCC, the following structuralelementsdbased on existing research as well asinterviews with PCC expertsdare outlined inthe CEAL paper:
1. Core Values and Philosophy2. Relationships and Community3. Senior Management-Owner-Governance4. Leadership5. Workforce6. Services
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7. Meaningful Life8. Environment9. Accountability
These structural elements are generally con-sidered a universal part of PCC. However, theprocesses necessary to support these elementsare unique to the organization/provider.
Importance to Assisted LivingNursing Practice
As nurses, we find ourselves balancing betweena medical approach to care that focuses on tasksand physical health issues and a holistic approachthat is more in line with the concepts and goals ofPCC. Because nurses are often charged with over-seeing and coordinating care and services forassisted living residents, we have a powerful op-portunity to drive a person-centered philosophywithin our communities and organizations. Bystriving to balance the medical needs of our resi-dents (e.g., intact skin integrity) with the prefer-ences and desires unique to each individual (e.g.,showering at night, rather than in the morning)nurses can play an important role in operationaliz-ing the sometimes abstract concepts of PCC.
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There is still much work to be done, includingmore research on identifying and implementingthe key elements of the philosophy, if the corevalues and outcomes of PCC are to be fully real-ized throughout the assisted living industry.Workforce issues, including a limited supply ofdirect-care workers, training inadequacies,concerns over staffing levels, and lack of in-volvement in decision making, also stand aspotential barriers. Despite these and other chal-lenges, assisted living has outstanding potentialto realize the goals of PCC. Nurses can be atthe heart of driving this philosophy of care intheir assisted living communities as the industryattempts to meet the needs of a growing elderlypopulation.
Reference
1. Person-centered care in assisted living: an informational
guide. Falls Church, VA: Center for Excellence in Assisted
Living; 2010.
0197-4572/$ - see front matter
� 2010 Published by Mosby, Inc.
doi:10.1016/j.gerinurse.2010.08.008
Geriatric Nursing, Volume 31, Number 5
