A Focus on Person-Centered Care in Nursing Homes and At Home

by Rose Broyles

Here is an excerpt from an article I read, regarding Person-Centered care. It’s interesting because it describes the conditions many of our loved ones are living in. The person described reminds me of my mom in many ways.

There was no medical reason for Maude’s rapid decline and death. Though in the middle stages of Alzheimer’s, she could still do for herself many of the daily tasks of living—she just needed help filling in the gaps. So they took her to the county’s finest nursing home, a deficiency free facility where they efficiently and methodically saw to her every bodily need.

When she first arrived she could still clean and dress herself, though slowly, and she needed help with the soap and buttons. But they did it all for her, pulling her up from her pillow every morning promptly at 6 and hurriedly washing and dressing her without her participation. She often fought them, but would eventually surrender and become like a mannequin in their hands.

She could have walked, slowly, to the dining room. But to ensure she got to breakfast on time, they routinely plopped her into a wheelchair and whisked her down the corridor until she could no longer walk at all.

She had always loved gardening and the outdoors, and she longed to investigate the rose bushes outside her window. But there was no one to take her, and staff thought it too risky to let her go alone.

She was intelligent and could have conversed with her caregivers. But they knew her only by her dementia and assorted frailties, thus she was much diminished as a person in their eyes. Often, they talked about her to others in her presence as if she was not there.

With each benign act of neglect Maude retreated further within herself, and it was not long before she spent her days drooling and slumping like a rag doll in her wheelchair. The light in her eyes slowly faded until it was gone forever.

This was one of the reasons why Josie and I decided to pull our parents out of assisted living. We had our reasons and they in no way mean that those type of facilities are bad for anyone. We just felt that they were too “clinical”. Mom’s quick declining condition really was a result from her numerous falls. Although, I think  the lack of emotional person-centered care that was missing from the facilities also contributed to her deteriorating condition.

However, with respect to this article, Megan Hannan describes the unfortunate circumstances to which society has put elders in. She talks about our “youth-oriented” culture and how we are made to believe that seniors have nothing left to contribute.  Much of our focus is placed on their weakness rather than their strengths. Focus is placed on treating the physical ailments much more than satisfying the emotional needs. If a senior has dementia, some of the aggression or frustration displayed is dismissed as a part of the condition. Many staff members assume that you cannot communicate with someone with dementia.

I know first hand that this is NOT true. I’ve never held that belief. Although it is difficult to have any type of lasting conversation with Mom I don’t treat her as if she doesn’t understand what I’m saying. I always ask her how she’s doing. I even joke with her. Her comprehension is still intact. She KNOWS most of what we discuss. We have to remind our caregiver of that. We don’t talk about Mom as if she’s not in the room. We include her in our conversations.  It’s really not our caregiver’s fault though, this is something that she was accustomed to working in other facilities in the past. 

Hannan goes on to describe the long-term system and the culture that exists.  The system downplays any type of personal relationships that develop as a result of caregiver-patient interaction. Caregivers are evaluated by how well they keep the patient clean rather than the quality of care they give. It reminds me of the true life-based movie “Patch Adams.” Hunter “Patch” Adams is a physician who founded the  Gesundheit Institute in West,Virginia. He was criticized in the past  for his approach to healthcare by his colleagues and superiors. He has always encouraged the fostering of a relationship with a patient, as he believes that treating their emotional health also results in better physical health.  

Unfortunately, his approach is not mainstream. Hannan questions whether we are surprised at why seniors who were once healthy become depressed and disoriented because of this emotional void.

Changing the Focus to Person-Centered Care

Many eldercare advocates have pioneered “person-centered” care at various levels. The purpose is to raise awareness among caregivers and families about helping rather than treating the senior in question. For example, my dad can’t walk. He needs assistance in dressing. However, instead of dressing him, we assist him by pulling his shirt over his head if he can’t reach. Or, we bring his toothbrush and a basin to him so he can brush his own teeth. We just clean the basin when he is done. When Mom eats, we try to encourage her to feed herself, and guide her hand if she can’t quite get the spoon in her mouth.

The point is to allow the senior to maintain independence, and at the same time, providing security for them should they need it. Understanding that a dementia patient’s outbursts may be an attempt to communicate, rather than dismissing it as gibberish or behavioral problems. As for the caregivers themselves, alleviating their stress by having them cross-train in different areas, and keeping them educated may help them deal with patients better and at the same time, provide them for opportunities for advancement. 

I believe in Hannan’s approach and I hope to see more of the same kind of methods practiced in facilities nationwide, as well as at home.