The core philosophy: Shifting from a medical to a holistic focus
Traditional long-term care has historically operated on a “medical model,” focusing primarily on diagnoses, disabilities, and deficits. Care routines are often standardized and based on the facility’s schedule and staff efficiency, treating residents as passive recipients of care. This can lead to a loss of identity and increased feelings of loneliness and isolation.
In contrast, person-centered care is rooted in a holistic philosophy that views each individual as a unique person with a history, relationships, and distinct preferences. It moves beyond simply managing clinical symptoms to embracing the resident's emotional, social, and spiritual well-being. The goal is to nurture the human spirit and prioritize the quality of life as defined by the person receiving care.
Daily routines and autonomy: Whose schedule is it anyway?
One of the most immediate and visible differences between these two models lies in daily routines. In traditional settings, the facility's schedule dictates daily life:
- Residents wake, eat, and go to sleep at set times.
- Meals are served on a rigid schedule and menu.
- Bathing and other personal care tasks are scheduled for staff convenience.
Person-centered care, however, adapts to the individual’s preferences, not the facility's. Residents have the flexibility to make choices about their own lives:
- Flexibility in scheduling: Individuals can choose when they wake up, go to bed, and eat their meals.
- Personalized activities: Activities are tailored to the resident’s interests, such as gardening for a former hobbyist or music therapy for a music lover, rather than a single group activity for all.
- Spontaneity is welcome: Spontaneous activities and impromptu social interactions are encouraged throughout the day, fostering a more natural, home-like environment.
Staff roles and relationships: From task-oriented to relationship-centered
In the traditional model, staff roles are often task-oriented and structured around rotating assignments. This means a caregiver may perform a specific task for one resident and then move on to another, with different staff members caring for the same person on different days. This task-focused approach can be impersonal, limiting the development of meaningful relationships between staff and residents.
Person-centered care, by contrast, is relationship-centered. It features consistent staffing assignments, where a core team works with the same small group of residents. This approach fosters a deeper connection and understanding between caregivers and residents, helping staff learn about each person’s unique life story, preferences, and nonverbal cues. It empowers staff to make decisions and collaborate as a team to support the residents more effectively.
The living environment: From institutional to homelike
Traditional long-term care settings often have a clinical and uniform feel. The environment is designed for functionality and staff efficiency, with little personalization. This can contribute to a sterile, institutional atmosphere that increases feelings of loneliness.
Person-centered facilities strive to create a home-like and personalized environment. This includes:
- Personalized spaces: Encouraging residents to personalize their rooms with their own belongings, decorations, and furniture.
- Homelike design: Designing common areas to feel more like a community living room or home rather than a large, impersonal institutional space.
- Smaller living units: Some models use a “household model” with smaller living units to foster closer relationships and a greater sense of community.
The role of families: From visitors to partners
In traditional settings, family involvement is often limited to formal visiting hours and meetings. The family's role is typically secondary to that of the medical staff in decision-making.
Person-centered care views the family as a crucial partner in the care-planning process. Families are actively involved in decision-making and encouraged to participate in the resident’s daily activities. This collaboration creates a more inclusive approach that extends the family's support network into the facility, ensuring the resident's wishes are respected.
Comparison table: Person-centered care vs. traditional practice
| Feature | Person-Centered Care | Traditional Practice (Medical Model) |
|---|---|---|
| Care Focus | Holistic well-being, quality of life, identity | Medical diagnoses, disabilities, deficits |
| Decision-Making | Shared decisions, resident and family included | Centralized, provider-led decisions |
| Daily Routines | Flexible, based on individual preference | Fixed, based on facility and staff schedules |
| Staff Roles | Relationship-centered, consistent assignments | Task-oriented, rotating staff assignments |
| Living Environment | Homelike, personalized, community-focused | Institutional, uniform, functional |
| Family Involvement | Active partners in care and daily life | Limited to formal visits and meetings |
Challenges and outcomes of implementing person-centered care
While person-centered care offers significant benefits, implementing it requires a full cultural and organizational shift. Barriers can include:
- Lack of staff training and education
- Staffing shortages and high turnover
- Resource constraints and poor information exchange
- Resistance to change from staff and leadership
- Difficulty in engaging residents with complex conditions
Despite these hurdles, studies consistently show positive outcomes for residents in person-centered environments, including:
- Reduced agitation and depression
- Lower use of antipsychotic medications
- Fewer falls and hospital readmissions
- Increased resident satisfaction and sense of well-being
Benefits also extend to staff, with some studies showing increased job satisfaction and lower turnover when staff feel empowered and connected to residents.
Conclusion: A fundamental shift in perspective
The difference between person-centered care and more traditional practice in long-term care represents a fundamental shift in perspective: from a clinical, task-based model to a holistic, relationship-centered one. While the medical model focuses on managing conditions for the facility's convenience, person-centered care focuses on enriching the resident's life by honoring their autonomy, dignity, and personal history. By putting the individual at the heart of the care process, this modern approach not only improves physical and mental health outcomes but also transforms long-term care settings into true homes where residents feel respected, connected, and in control.
The National Consumer Voice on Long-Term Care
The National Consumer Voice on Long-Term Care is a key advocacy organization that promotes quality care for residents. Their resources emphasize the importance of person-centered care in upholding residents' rights and well-being. To learn more about residents' rights and person-centered advocacy, visit their website at https://ltcombudsman.org/issues/person-centered-care.
