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Person-centered care in nursing homes

by Carol Bradley Bursack, Editor-in-Chief

Increasingly, nursing homes administrators are realizing that person centered care means happier residents, which in turn makes residents easier to care for. The old days of "managing" residents with drugs aren't gone, but they are fading. The best nursing homes have grabbed onto the fact that when elders are treated as individuals, and given individualized care, they respond. About time, right?

Culture Change Demands Person Centered Care

Culture change is the current buzz word for nursing home care advocates. The days of military style nursing homes set up for staff efficiency are beginning to wane as families demand better care for their loved ones, and boomers look at nursing homes and realize that one day they may live in one. This push from vocal advocates for vulnerable elders, with a little Boomer pride thrown in, is shaking up the industry. Not as fast as many of us would like, but nursing homes are, indeed, changing.

Enter the new age of person centered care. With person centered care, residents are no longer treated as just a generic elder in a string of elders. The staff in a good home these days will make a point of knowing something about what a person did for a living, what her interests are, where he grew up, where she lived, what he likes to eat and what food she hates.

Many person centered homes have curio cabinets next to the door of a resident's room. One reason this approach works is that these recognizable objects behind glass doors show the resident that this is his or her room. Also, however, the items in the cabinet help remind staff and visitors that this room is someone's home. The objects represent an individual life well lived.

Another favorite tool of person centered homes is a white board or bulletin board near the entrance of a room, where staff and visitors can not only read the name of the person who lives in the room, but details of that person's life. If the person was a firefighter, this would be noted. If the resident was an avid volunteer, that would be noted. Story boards about residents give staff and visitors some insight into the past of the person they will see, as well as ideas for topics of conversation.

The board is also a good place to write, "George prefers to be called by his first name," or "Mrs. Peterson wants to be called Mrs. Peterson." Food preferences and individual "quirks" are often noted on this personalized board.

Consistent Assignment of Aides is Important to Elder's Care

Over the span of two decades I cared for a total of seven elders. For a good fifteen years of that time, one or more of those elders lived in a nursing home near my house. We also made good use of in-home care. In both of these situations, having the same caregivers consistently assigned to elders was of supreme importance to the elders' happiness and wellbeing.

Before my uncle needed nursing home care, he had in-home care for eight hours each day. The agency we settled on needed to rotate staff, which is normal. However, to their credit, they tried to keep the staff consistent. For the most part, they could keep his caregivers to one of three women. He had a favorite of the three, but he knew that she couldn't work every day, so he was content with his three "girls."

On a rare occasion, a substitute was sent. At these times, my uncle was not a happy man. The agency tried to avoid this, but sickness or scheduling problems do occur. Whenever people ask me to suggest questions to ask when hiring in-home agencies, I tell them to be sure to ask if the agency values consistent assignments for their staff. Consistent assignment helps the caregivers know what their clients like and dislike and the elder more readily recognizes the caregiver. I ask families how they'd like a stranger showing up at the door to give them a bath. That question from me generally drives home the importance of this consistency.

Nursing homes have 24-hour care and changing shifts, but it's still important to provide consistency of caregivers. During some of the time I had elders in nursing home care, the trend was cross-training, with the idea that everyone should get used to taking care of all of the residents. There is some validity in this thinking from the management's point of view, but my elders hated that approach and so did I.

Who's on First? Who's on Second?

I watched my elders' moods change according to their assigned caregiver. It was obvious to me that Mom was happier when Darleen was on duty and was assigned to Mom. Darleen knew what Mom would like for breakfast if Mom's appetite was lagging. She knew when Mom wanted to have her bath, how to keep Mom warm and how Mom liked her magazines arranged if things got out of place after I'd left from my daily visit.

Darleen couldn't work every day, so Mom did have to put up with others. There was one caregiver named Phyl, who cared for all of my elders at various times. Mom wasn't fond of Phyl, as Phyl was a quick, nervous type.

However, my mother-in-law, just down the hall from Mom, adored Phyl. I think Phyl was more comfortable with my mother-in-law, and to some degree it showed. She tried, of course, not to let her feelings show, but we are human and elders are sensitive to body language.

Dad, who was on the same floor as Mom and my mother-in-law, also occasionally got Phyl. Phyl made Dad's head spin. I could tell by his body language that it was not a good match, so I was happy Dad was in the south wing and rarely had this caregiver.

For Dad, the magic caregiver was Sandy. When Sandy was assigned to Dad, I knew all was well in the world. I used to joke with Sandy that she needed to work 24/7 with no vacations, because only when she was working did I know Dad would be okay if he had one of his anxiety attacks. Sandy could get into Dad's head nearly as well as I did. She had a different way about her, of course, but she could make him laugh and he was totally comfortable with her. Sandy knew what he needed when he was in one of his psychotic extremes and she'd make sure he got it. Sandy loved dad and I knew it. They were a match made in heaven.

Perfection Won't Happen but We Can Try

No matter how dedicated to person centered care and consistent assignment of the same aides to the people they match best, perfection isn't possible. No one can work every day. Our loved ones won't have their favorites all the time. However, it's heartening to know that in most of today's good nursing homes, the bar has been significantly raised. Our elders are looked at as individuals and given person centered care with consistently assigned aides. We should aim for no less.

Not all nursing homes have welcomed this enlighten way of caring and staffing. Some still over-drug their residents. In some areas, it's hard to find even one home that offers enlightened care. The Pioneer Network has been formed to focus on getting all care agencies and facilities to provide person centered care. They are making great headway, but unfortunately there's still a long way to go.

Boomers must use their clout to insist on higher standards of person centered care and consistent assignment in aging care. We need it for our elders and will want it for ourselves. If, one day, someone comes into my room at the care home to give me a bath, I'll quite likely want to know who this person is.