Denise Hannah, Washington Home and Hospice, Washington DC
"Compassionate Touch® has given our volunteers a stronger sense of purpose by using touch to connect with our patients and ease their final days and hours."
Person-Centered Care: Why It Matters
Vol. 11, Issue 04
A Changing Culture
You can't appreciate why person-centered care is such a hot topic today without a glimpse of how nursing homes developed. In 1900, older adults were mostly cared for by family. Impoverished elders found themselves in local "poor farms" or "almshouses" known for bad conditions. Keep in mind the average life expectancy in 1900 was 47.
With today's life expectancy at 78.9, medical advances have made it possible to live for years with chronic illness. In 1954, a federal law provided funding for building nursing homes that were affiliated with hospitals. Those facilities were designed like hospitals which became the standard and most of these facilities adopted the medical model of healthcare.
In the last decade, the Culture Change movement has begun to transform the culture of aging in America and bring person-centered care to the nursing home (or care community, as it is now called) industry. Spearheaded by the Pioneer Network, this movement is creating a less institutionalized and more humane environment that supports the elder's life, dignity, rights and freedom. Now, even the Centers for Medicare and Medicaid Services (CMS) are on board. This is a major step forward since CMS is the federal program that makes all the rules governing nursing homes, not to mention paying the bills.
CMS states its "vision for long-term care is that the system will be person-centered; that is, the system will be organized around the needs of the in-dividual rather than around the settings where care is delivered."
Person-centered care is a moral philosophy of care that honors individual history, personality and preferences in one's daily routine. The focus is on the person rather than on the illness or disability, and the person's voice is heard in decisions about how to best provide care.
We each have things that are important to us in our daily lives and how we would want others to relate to us.
To illustrate this, I'll use myself as an example. If I were in a situation where I needed long-term care, I would want my coffee and time for quiet read-ing in the morning, a bath at night, to be served fresh vegetables, to go outdoors often and watch the birds, listen to the music I love like James Tay-lor and Ella Fitzgerald, have a weekly massage and PLEASE no bingo!
Person-centered care is more than choosing our activities and the food we eat. At its core is community and the relationship between the elder and care partners. Planetree, a non-profit organization, facilitates person-centered care in healing environments. I especially like its holistic model of care and have abbreviated it for the purpose of this article. Their holistic model includes:
- Recognize the importance of human interactions, fostering caring relationships among elders, families, employees, and volunteers.
- Enhance each individual's life journey by offering opportunities for personal growth, self-expression, and the fulfillment of individ-ual dreams.
- Support independence, dignity, and choice with a range of options that support an individual's autonomy, lifestyle, and interests. Elder's decisions are respected.
- Surround elders with people whom they can depend on and encourage individuals to actively build trusting relationships. Enable elders to maintain connections to family and friends.
- Support spirituality as a source of inner strength and a fulfilling life.
- Promote paths to well-being with innovative programs for elders and staff that maintain health and fitness and that complement Western scientific medical care.
- Empower individuals through information and education maximizing physical, psychological, and financial well-being.
- Recognize the nutritional and nurturing aspects of food as a source of pleasure, comfort, and fellowship.
- Offer meaningful arts, activities and entertainment creating opportunities for camaraderie, laughter, and creativity.
- Provide an environment conducive to quality living incorporating public and private space, residential decor, natural light, and views of nature.
Best Practice in Culture Change
The Institute for Caregiver Education identifies massage therapy as a best practice in culture change indicating the following benefits:
- Fosters well-being without medication.
- Builds strong bonds between caregiver and resident (elder).
- Reduction in weight loss, pain, agitated behaviors, sleeplessness and falls.
- Increased resident and staff satisfaction.
As massage therapists, we know the positive impact of touch to improve physical, emotional, and spiritual quality of life. Isn't it wonderful that now the long-term care profession is recognizing what we have known for years about the benefits of massage? Look again at the holistic model described. As a massage therapist, how might you contribute to each item?
Become an advocate for massage in care communities.
Learn about culture change initiatives in your state. Most states have organizations dedicated to advancing person-centered care. A place to start is the Pioneer Network state coalitions. Go to www.pioneernetwork.net and click on "State Coalitions" in the menu where you will find a directory.
Educate care partners. Network with long-term care professionals and provide information on the benefits of focused touch and sensitive massage for elders.
Request massage therapy services. If your role is to find a care community for a family member, make it a point to ask if the community offers massage therapy.
Develop your skills in serving elders in care settings and start a program in a local community.
Culture change will impact all of us in some way. Perhaps it represents a career opportunity. We might have a family member or friend in a care community. Or maybe one day we may find ourselves in need of long-term care. Regardless, we each have an opportunity to contribute to this important shift in the care of our elders.