What is activation in long-term care? Understanding a Person-Centered Approach

According to a study published in the journal ScienceDirect, person-centered nursing care is a significant predictor of increased patient activation in hospitalized older adults. This concept of patient activation is crucial in understanding what is activation in long-term care? as it moves beyond passive reception of care toward active participation.

Quick Summary

Activation in long-term care refers to an individual's knowledge, skills, confidence, and willingness to actively participate in managing their own health and care. It emphasizes empowering residents to make informed decisions and take proactive steps toward their well-being, moving away from a purely reactive, passive care model.

Key Points

• Shift in Philosophy: Activation moves long-term care from passive reception of care to active resident participation in their own health decisions.

• Activation vs. Engagement: Activation is the resident’s internal state (knowledge, skill, confidence), while engagement is the external process and interventions by the care team.

• Measured in Levels: Activation exists on a scale, from feeling overwhelmed and disengaged to being confident and self-managing. Care is tailored to these levels.

• Strategies for Success: Methods to increase activation include personalized care plans, targeted communication, and assistive technology that promotes independence.

• Positive Outcomes: Increased activation leads to better health behaviors, improved clinical results, enhanced resident well-being, and lower healthcare costs.

• Empowering Families: Activating family members to become skilled and knowledgeable partners in care further strengthens the resident’s support system.

The Core Concept: Moving Beyond Passive Care

Activation in long-term care is a progressive and person-centered approach that focuses on empowering residents to be active participants in their own health and well-being. It's a fundamental shift from a traditional model where residents simply receive care, to one where they are encouraged and supported to use their own knowledge, skills, and confidence to engage in healthy behaviors and manage their care. This includes everything from simple daily decisions to complex chronic disease management. The goal is not just to provide medical assistance, but to foster independence, purpose, and a higher quality of life for residents.

The Difference Between Activation and Engagement

To fully grasp what activation entails, it's helpful to distinguish it from the broader term of patient engagement. While the two are often used together, they represent different aspects of the same goal.

• Patient Activation: This is the internal, individual state. It is a measure of a person's readiness, knowledge, skills, and confidence to take control of their health. It’s about building a resident's capacity to manage their own care.
• Patient Engagement: This is the external process. It describes the collaborative interaction between the patient and their care team. It includes all the interventions, communication strategies, and environmental factors designed to increase a resident's level of activation.

A Practical Analogy

Imagine learning to drive. Activation is the individual's confidence and skill behind the wheel, while engagement is the driving instructor's lessons, feedback, and the safe car they provide. Both are essential for success, but they focus on different parts of the process.

The Levels of Activation

Patient activation is not a binary state but a continuum, with individuals at varying levels. A common tool used to measure this is the Patient Activation Measure (PAM), which categorizes individuals into four levels. Understanding these levels helps caregivers tailor their support effectively.

1. Level 1: Disengaged and Overwhelmed. Residents at this level may not understand their role in their health and feel overwhelmed or helpless. They tend to be passive recipients of care.
2. Level 2: Becoming Aware, But Struggling. These individuals have some knowledge but lack the confidence to take action. They may require structured guidance to start participating.
3. Level 3: Taking Action. At this level, residents have the knowledge and are beginning to take action, but may lack consistency. They can benefit from coaching and a supportive environment.
4. Level 4: Maintaining Behaviors and Pushing Further. Highly activated residents have the confidence, skills, and knowledge to self-manage their health consistently. They are proactive and often seek new ways to maintain or improve their well-being.

Strategies to Boost Activation in Long-Term Care

Long-term care facilities and caregivers can implement various strategies to promote and increase resident activation. These strategies are personalized to meet residents at their current level of activation and help them progress.

Personalization and Tailored Support

• Individualized Care Plans: Moving away from a one-size-fits-all approach, personalized care plans should reflect a resident’s personal history, preferences, and goals.
• Personalized Content: For residents with cognitive impairments, tailored content like biographical photos, music, and videos can trigger positive memories and social interaction. The I-CARE system mentioned in the journal MDPI is a prime example of this.

Communication and Shared Decision-Making

• Engaging Conversations: Training caregivers to have collaborative conversations, rather than just giving instructions, helps foster a resident's confidence and involvement.
• Resident and Family Councils: Establishing forums for residents and their families to have a voice in decisions affecting their care and daily life is a powerful way to promote activation.

Using Technology to Empower

• Digital Outreach: Secure digital tools can help facilities communicate important health information and reminders to residents and their families, especially concerning preventative care and follow-ups.
• Assistive Technology: Technology that supports independence, such as cognitive or memory aids, can give residents the confidence to manage daily tasks.

Activation vs. Compliance

It is vital to recognize that activation is not the same as compliance. The concept of patient compliance, where a resident passively follows a doctor's orders, is outdated. Activation is about a willing partnership. A key difference lies in the motivations:

Feature	Activation	Compliance
Motivation	Intrinsic desire for well-being	External pressure from authority
Role	Proactive partner in care	Passive recipient of instructions
Decision-Making	Informed and shared	Directed by the provider
Outcome	Long-term healthy behaviors	Short-term adherence to rules

The Long-Term Benefits of Activation

When successfully implemented, activation offers a cascade of benefits that improve outcomes for residents, families, and long-term care facilities.

For the Resident

• Improved Health Outcomes: Activated residents are more likely to engage in preventative care and self-management behaviors, leading to better management of chronic conditions and fewer emergency visits.
• Enhanced Well-being: Active participation fosters a greater sense of purpose, self-worth, and emotional stability, combating feelings of helplessness.
• Lower Healthcare Costs: Higher activation levels have been linked to reduced healthcare costs, including fewer hospital readmissions.

For Care Facilities and Staff

• Reduced Burden on Staff: Activated residents who can self-manage aspects of their care allow staff to focus on more complex needs.
• Increased Job Satisfaction: When staff see residents thriving and engaging, it reinforces their purpose and boosts morale.
• Improved Quality of Care: A focus on activation pushes facilities toward a truly person-centered model, resulting in higher overall care quality and better reputation.

The Role of Family Activation

Family activation is also a crucial component, as engaged family members can significantly support the resident's activation journey. A study in BMC Health Services Research explored a tool to measure family activation, highlighting its importance. By empowering families with knowledge and skills, facilities can create a stronger support system for residents.

Conclusion: The Future of Care is Active

The concept of activation in long-term care is more than a buzzword; it's a foundational shift toward respecting and empowering residents. By providing the right support and tools, caregivers can help seniors move from a passive role to an active one, resulting in better health, higher satisfaction, and a more vibrant community. This person-centered approach is not only beneficial for the individual but also creates a more sustainable and successful model for the entire long-term care industry.

Frequently Asked Questions

What is activation in long-term care specifically for a resident with dementia?

For a resident with dementia, activation focuses on using remaining cognitive and social resources through stimulating activities. This can include using personalized music, photos, and sensory items to evoke positive memories and promote engagement. The goal is to stimulate and maintain skills for as long as possible, rather than only focusing on decline.

How can caregivers measure a resident's level of activation?

Professional caregivers may use standardized tools like the Patient Activation Measure (PAM), which uses a survey to score a resident's knowledge, skills, and confidence. On a daily basis, caregivers can observe a resident's willingness to participate in activities, express preferences, and engage in self-care tasks.

Is activation only for physically healthy seniors in long-term care?

No, activation is for all seniors, regardless of their physical or cognitive health. While the methods may differ significantly, the principle remains the same: empowering the individual to participate to the best of their abilities. For those with significant physical limitations, activation might focus on mental engagement, shared decision-making, and social connection.

What role do family members play in a resident's activation?

Family members are key partners. By becoming more activated themselves—that is, knowledgeable and confident in how to best support their loved one—they can encourage independence, reinforce positive behaviors, and act as advocates in the care planning process. They can provide valuable insights into the resident’s personal history and preferences.

How does activation help reduce healthcare costs in long-term care?

Activated residents are more likely to engage in preventative care, manage their chronic conditions effectively, and avoid preventable health crises. This proactive approach reduces the need for costly hospital readmissions and emergency room visits, leading to overall lower healthcare costs for both the resident and the system.

What are the common challenges in implementing activation in long-term care?

Common challenges include resistance from residents accustomed to passive care, lack of adequate staff training on person-centered techniques, insufficient resources for personalized activities, and a need for consistent communication among all members of the care team.

Can activation improve a resident's mood and emotional well-being?

Yes. By fostering a sense of purpose, control, and social connection, activation can significantly improve a resident's emotional well-being. Active participation and successful engagement in activities can boost self-esteem and combat feelings of loneliness and helplessness often associated with institutional living.