AARP Reports on Person Centered Care for Older Adults

Reading “Moving Toward Person Centered Care,” the recently published report by the AARP Public Policy Institute resonated with me as I thought of the challenges two friends faced when directing care for ailing parents who live far from Chicago.

In both instances, fragmentation in the delivery of health care and long term supportive services created barriers for my friends to quickly gain a meaningful perspective of their parents needs within the context of possible solutions or options. Additionally, diagnoses requiring multiple care setting and providers often left their parent feeling objectified: suffering from a loss of dignity. Lack of adequate communication led to my friends feeling disempowered despite being critical stakeholders. Reading the report gave me hope that person (and family) centered care can improve the existing challenges posed by transitioning between care settings as well as promote communication, shared (and informed) decision making and empower of  older persons and their families.

Professor Tom Kitwood Initially conceived in the 1980's, person centered care (PCC) originated with the ground breaking work of Professor Thomas Kitwood, who founded the Bradford Dementia Group at the University of Bradford (UK).  Kitwood reasoned that viewing people with dementia in medical terms lead them to be seen as objects and as having no subjectivity or personhood. He posited that people with dementia do not lose their personhood, but rather can be maintained through relationships with other people. Within person-centred care, the personal and social identity of a person with dementia arises out of what is said and done with them.

In the 1990's innovators in long-term care began incorporating this philosophy to transform how skilled nursing facilities addressed all residents and families. The Pioneer/Culture Change Movement, Eden Alternative and the Green House Model (all discussed in previous posts) are notable examples. Parallel initiatives to transform assisted living and acute care centers also began to appear at that time. In 2010, ACHCA published its own report, "Person Centered Care In Assisted Living." Now, person and family centered care (PFCC) is attracting renewed attention as the number of older adults who require long term services and supports explodes and their adult children (and healthier spouses) are seeking a more holistic approach to coping with critical decisions. As described in the report PFCC is:

“…(a)n orientation to the delivery of  health care and supportive services that considers and older adults’s needs, goals, preferences, cultural traditions, family situation and values. It includes the person and the family at the center of the care team along with health and social service professionals and direct care workers…”

Ideally, PFCC would been seen as an essential component of care and would include breaking down the silos which exist between health care and long term supportive service providers. As noted in the report PFCC, is still not fully understood by many practitioners but it is hoped that Health Care reform, and its emphasis on greater integration of care delivery systems will provide incentive for better coordination and continuity of care. Among the salient facts necessitating a shift to PFCC noted in the report are:

  • Researchers estimate that two out of three older people with disabilities who receive LTSS at home get all their care exclusively from family members (mostly wives);
  • Family members are often the main source for managing continuity of care. A consistent family caregiver--across all transitions of care and care settings--will recognize his or her loved one as a whole person, not focusing exclusively on a specific disease, disorder, or episode of hospital care.
  • Frail older adults often rely on family to help them negotiate interactions with health care and social service professionals. While some older adults want full control over decision making, other may need or prefer to delegate decisions to their family caregivers.

Ideally, PFCC would been seen as an essential methodology and critical to success of care delivery to older adults. As noted in the report PFCC, is still not fully understood by many practitioners but it is hoped that Health Care reform, and its emphasis on greater integration of care delivery systems will provide incentive for better coordination and continuity of care. What do you think?

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    Bruce Lederman has over 25 years experience in the senior care field as a direct care provider and thought leader. Bruce was CEO and president of his own firm that operated skilled nursing facilities in Illinois. He is a former nursing home administrator and has consulted to numerous elder care providers on planning for strategic growth as well as process improvement. Recently he served as board chair of CJE SeniorLife, a leading non-profit elder care provider in the Chicago area. Bruce is currently employed as chief strategy officer for a company providing skilled nursing services in communities throughout Illinois and Missouri.

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