Author:
Kim Warchol, President and Founder of DCS at CPI
What is Person-Centered Care?
Person-centered care can be simply defined as “Putting the person first.” The person first? “Before what,” you might ask.
- The PERSON before…Our schedules, our priorities, our conveniences, our “usual way of doing things,” our need to rush, our “one-size-fits all” approach, and our preferences.
- The PERSON before…The diagnosis, the (often negative and limiting) labels, preconceived beliefs and opinions, and the myriad of (often unintentional) judgement and biases, like ageism.
Benefits of a Person-Centered Approach
It has often been said that person-centered care is a cornerstone of quality dementia care, and I couldn’t agree more. Many positive outcomes have been associated with implementation. It is highly effective when used as a therapy treatment modality, an activity, and in daily life. Let’s first explore how one family uses person-centered care in their life.
I introduced Theresa in a previous blog. She is the wife of Bob, a man who was diagnosed with Lewy Body dementia about 7-years ago. Bob lives at home. Theresa has family support and some hired help; however, she is the primary care partner.
When Theresa and I talked about Bob and his illness, it was clearly ALWAYS “Bob” first. For Theresa, Bob had an illness, but Bob wasn’t an illness. Theresa said, “Bob is definitely still there. He knows the people he likes, and he smiles a lot. He knows what he likes. He still LOVES chocolate, so he gets a lot of it to enjoy every day.”
Theresa talked about the importance of advocating for a loved one with dementia, for their best interest, and on their behalf. She described a scenario saying, “Sometimes when the tv is on and Bob sees the news, he thinks what’s happening on tv is happening to him (this is called misperceptions). We saw his upset and knew this wasn’t good so we put on the cooking channel, which is something he may have put on for himself to relax and enjoy. I noticed how he awakens when it’s on. He sits up straighter to watch those cooking shows. He will even cross his legs, just like he used to, and make a comment about the show (despite his limited verbal ability).”
As I listened, I found myself so impressed with Theresa’s person-centered care skills. She knows how important it is to incorporate his preferences and interests into the day and she also knows the importance of observations to help determine effectiveness. Many may not have noticed the differences in how he responded positively or negatively to the different tv shows. Some may have only taken note of a negative response. And those subtle responses like a casual cross of the leg, are especially elusive for care partners, and yet these are so meaningful. They are nonverbal communications of how someone feels. In this case, Bob was communicating his feeling calm and content.
I am so impressed with Theresa and her seemingly innate way of caring skillfully for her husband with dementia. I think at the heart of it all is her love for Bob. Theresa shared, “I look into his eyes, and he looks back at me. I think…. it’s YOU. That helps.”
It’s impossible to teach someone to feel that kind of love or to hold compassion for another human being. But I believe we must hold love or compassion in our heart or person-centered care may not be valued and prioritized. Love and compassion are the gateways to wanting to put the person first.
Theresa and I also discussed stages of dementia, and the importance of knowing the characteristics of the stages for so many reasons. While acknowledging this, Theresa once again included person-centered care as the cornerstone that it is. She said, “Yes, a person with dementia does go through stages. The disease fits into categories. The person doesn’t.” Well said, my friend. Theresa has so much to teach us, and I will continue to share her with you in subsequent blogs.
Person-Centered Treatment
In my own experience as a dementia specialized Occupational Therapist, I have seen “what matters most to a person,” to be used in treatment, and it can create miracles. As one example, we created a section of the therapy gym called Function Junction. In it, we had sections related to the strongest interests of our resident group, and we created an activity/therapy space around those themes. We created a grocery store, a garage/workshop, an office, and a casino. We included furnishings and accessories that were used as modalities to facilitate range of motion, balance, strength, and cognitive exercise. Once we tapped into interests and motivation, the level of participation and the outcomes went way up for our clients with dementia.
In one specific patient case, we saw remarkable improvement with a lady who, in addition to having moderate dementia, was extremely deconditioned and unable to stand or raise her limbs against gravity without assistance. Other medical professionals had given up on her, but we took a unique person-centered approach.
We learned she loved going to casinos, so we used that station in our therapy sessions. When unable (or unwilling perhaps?) to walk in parallel bars or stand in a standing box, she readily followed our cue to stand and pull the arm on the slot machine. She stood longer each day and she reached higher and without assistance pulling the arm, watching the machine spin, and listening to the exciting sounds.
I don’t believe her rehab goals of improving range of motion, strength and standing tolerance could have ever been achieved if we had taken the traditional therapy approach. Participation in traditional therapy exercises requires good cognitive skills and the ability to understand reasons for exercise even when exercise may not be valued. But by using person-centered care in treatment, we tapped into her motivation and long-term memory thereby circumventing her need to follow directions and use reasoning, which were her areas of significant cognitive weakness.
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Other Effective Ways to Deliver Person-Centered Care
As we can see, a person-centered approach is powerful, when used by therapists as a treatment modality and in daily life by family. Unfortunately, our health care clients have shared that their staff has difficulty understanding tangible ways to implement person-centered care. So, let’s explore a few practical suggestions for how hired staff can deliver person-centered care.
Get to know who the person is. Don’t stop at simply learning their diagnosis.
- What to learn: Where the person grew up, what they did for a living, valued roles, important people and pets, hobbies, and meaningful experiences, etc.
- Ideas for delivery and why it is so important:
- Use what you learn in conversation. This is especially important before engaging the person in any activity as it can help build trust and therapeutic rapport. As an example, take a moment or two to talk about something important to the person in care, BEFORE you ask them to get up and accompany you into the dining room. Gaining trust is essential for agreement.
- Use what you learn in activities. This taps into long-term memories (a strength in dementia) and captures attention. As examples, play a favorite game the person has played all their life instead of introducing something new. Or reminisce about the city where they grew up and include photos of landmarks in that city.
Get to know and follow their typical patterns. Don’t ask the person in care to conform to your schedule.
- What to learn: What time they like to get up and go to bed, preferred naps/relaxing time and locations (e.g., bed or comfy chair), mealtimes, toileting schedules, morning ADL routines (preferred order of doing things), etc.
- Ideas for delivery and why it is so important:
- Build daily care plan around the persons typical, preferred routines such as:
- Stick to typical wake-up and go to bed times which keeps normal circadian rhythms intact, helping promote better sleep.
- Encourage use of the toilet to match any known patterns. Learn their typical patterns for urinating and defecating and assist them to the bathroom at that time. This can help improve continence, avoid embarrassment, preserve dignity, and reduce extra care time needed to clean up after incontinence.
- Plan meals around preferred times. It’s especially important to learn the meal in which the person typically ate the most so that meal can have the most calories, helping to prevent unnecessary weight loss.
- Build in rest periods according to preferences. The balance of activity and rest becomes especially important for aging well and reducing sundowning (this change in behavior late in the day can occur due to becoming overstressed).
- Build daily care plan around the persons typical, preferred routines such as:
Get to know likes and dislikes. Don’t take a one size fits all approach.
- What to learn: Food and drink preferences including type, brands, and temperature. Shower or bath preferences including time of day, temperature, and other important little details. Preferred music and other activity preferences and hobbies.
- Ideas for delivery and why it is so important:
- Include an abundance of things the person likes such as:
- Insert food likes in meal plans and snacks which can help increase attention and interest, and memory of how to eat/drink, which helps to increase consumption.
- Honor any known bath or shower preference. This can increase compliance with an activity that can often be refused. Be sure to honor the details of the experience such as preferred temperatures or privacy needs for an extra person-centered boost.
- Don’t assume any strong dislikes go away with dementia. Be sure to learn types of people, animals, and environmental conditions (e.g., unpleasant temperatures, aromas, and sounds) that create a negative response. Do your best to limit interactions with the people or animals that cause stress. And, create an environment (the rooms or outdoor spaces) that avoids exposure to things that can create discomfort, stress, or fear.
- Include an abundance of things the person likes such as:
Get to know stress triggers and any history of trauma. Don’t think “behavior” just happens. Often, there is a reasonable, identifiable cause.
- What to learn: Any history of abuse or trauma. Get to know what makes the person feel uncomfortable, unhappy, frightened, angry, or out-of-control. Look at their behavioral profile for any history of phobias, or things that create distress such as….“Being in small spaces creates high anxiety because he/she is claustrophobic.” “Being alone triggers her fear.” “Too much noise causes him to become overwhelmed and shut down.” “She is fiercely independent and resists when control is taken away.” “Loud bangs can trigger memories of him being in the war and create agitation or aggressive behavior.”
- Ideas for delivery and why this is so important: Avoid putting the person in any situation that is known to create stress and trigger negative behavioral reactions. Creating the right care conditions helps the person to live in well-being, keeps all safe, and can reduce problems such as falls, elopement, and use of drugs to “control behaviors.”
In conclusion, isn’t this really the way we all want to be treated? Person-centeredness matters in all human relationships- not just in dementia care. And, if we have an illness in which we can’t speak for ourselves, we can only hope we are as fortunate as Bob, to have an advocate for our personhood and well-being like his loving wife Theresa. Person-centered care is a cornerstone for quality of life for all.
Want to know more about Person-Centered Care and how to deliver? Our Dementia Capable Care training programs include this as one of the core training components. And, we have developed many assessments, care plans and other tools to help implement Person-Centered Care in practice. Visit our Solutions Page to learn more, or Call: 866.954.1910 Email: dcssolutions@crisisprevention.com
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Posted: February 2024
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