Person Centered Care – Where do I begin?
Debbie Hommel, ACC/MC/EDU, CTRS

With the new Requirements of Participation, there is much discussion of Person Centered Care and Person Centered Care Plans. Is this a new idea or one that has been around for a while and is being packaged differently? Why is it suddenly in favor and why is everyone talking about it? The notion of person centered therapy has been around since the 1950’s. It transcended into the long term care realm through the culture transformation movement and references within the revised F-248 guidelines in 2006. Most recently, discussions of person centered care and care planning have accelerated within the Center for Medicare and Medicaid Services (CMS) Requirements of Participation (ROP).

If we were to start at the beginning and look at the meaning of personhood, one would see the notion of person or personhood varies greatly. There are social, psychological, theological and biological definitions of personhood – all open for discussion and debate. Most definitions agree however that at the core of personhood is the qualities that make us distinctly individual. They also agree that personhood is a state of having human characteristics and feelings. So, what does this mean to those working in long term care communities? In the most fundamental sense, person centered care means acknowledging the elder as an individual. Regardless of diagnosis, functional ability, or cognitive status – the elder should be given consistent opportunities to continue to live their lives as the individual they are.

You are probably thinking that you do this already. Activity professionals learn early in their careers to assess individual needs and to create programs and approaches based on those needs. However, do you feel your community as a whole has truly embraced this idea of individualized, person centered care? Most activity professionals have encountered barriers in providing individualized care. Policies? Staff attitude? Rules of the facility? Corporate Structure? Rules of the administrative staff? Many activity professionals feel their hands are tied on occasion or feel they are the only department who focuses on what the elder wants. The new ROP will begin to break down these barriers we have encountered. The ROP, which is a law that must be met, clearly defines person centered care and interdisciplinary responsibility.

In order to generate change and embed the philosophies of the person centered care movement into our long term care systems, the activity professional can become the Person Centered Care Champion of the community. We need to educate ourselves as to the different person centered care approaches and means to integrate them into our facility systems and cultures. Once we are the Person Centered Experts, we can begin to persuade others to understand, accept and practice this way of providing care.

Understanding the language is the first step. The following terms define Person Centered definitions. We may not utilize all the terms, but understanding the differences of each will contribute to our ability to educate, guide and lead others.

Person Centered Definitions
Client Centered Therapy: Developed in 1951 by Carl Rogers, a behavioral psychologist, as a form of counseling where the counselor focuses on the way a person perceives themselves rather than how the counselor perceives the individual. Prior to this, the main approach was for the therapist to identify problems in the individual and issue a “treatment”. Rogers suggested the client should be involved in the process and drive their own treatment.
Person Centered Counseling; Dedicated therapy which emphasizes going in the client’s direction, at the clients pace and in the client’s unique way of being.
Person First: A set of principles that set the person before the task and put the needs of the person first. This term became popular in the 1980’s when Tom Kitwood, founder of Bradford Dementia Group introduced “person centered approach” to dementia care.
Person Appropriate: This term was introduced in June 2006 with the revised guidance for F-248. The term replaced “age appropriate” and refers to the idea that each resident has a personal identify and history that involves more than just their medical illness or functional impairment. Activities should be relevant to the specific needs, interests, culture, background of the individual for who they were developed.
Person Centered Activities: Individualized activities that provide therapeutic benefit. Technically, activity departments have been providing person centered activities for years.
Person Centered Language: Words which acknowledge and respect long term care residents as individuals. Use of less institutional and ageist terms is a step toward changing attitudes.
Person Centered Care Planning: This is a form of care planning where the resident is central and drives the plan of care. A common trait of this style of care planning is the care plan is written in the first person. The problem, goal and interventions are stated in “I” terms, from the elder’s perspective.

Understanding the language is the first step. Working them into practice is the next step.

Watch your thoughts, they become words.
Watch your words, they become actions.
Watch your actions, they become habits.
Watch your habits, they become character.
Watch your character, it becomes your destiny
~Lao Tzu

 

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