The idea of “person-centered care” – putting the patient in the driver’s seat – is easier said than done. Time constraints, institutional procedures, and regulations are just a few of the reasons that skilled nursing staff find it hard to remain empathic and focused on residents’ choices. It seems more efficient to make decisions for the resident rather than supporting him in making decisions for himself.
You might ask, if nursing home staff are experienced, trained, and licensed, why shouldn’t they be the ones to decide what’s best for the resident? Here are six good reasons:
1. Elders are not children
Despite disabilities and cognitive declines, nursing home residents remain adult persons who have lived entire lives. They come to nursing homes with lifelong habits, foods they eat and don’t eat, activities they like and don’t like. They have years of experience in behaving particular ways that affirm their identities. When they enter the facility, they should not be asked to leave their self-image at the door. Respecting the elder’s right to make choices is a clear communication that you honor him as an adult person.
2. Familiar routines define us
Imagine in your own life that you are prohibited from taking your usual morning shower, from staying up to watch movies on Friday nights, or from cooking dinner for family on Sundays. Imagine that your books, personal files, stereo and music collection are taken away. Now people who don’t know you are making decisions about what songs you can hear and what you’ll eat for dinner. Is it surprising that nursing home residents become forgetful and confused? It is reality that long-term care is not home, and there is no economically feasible way to change that fact. But insofar as it is possible, residents should be permitted to maintain some semblance of themselves and some pieces of their former lives.
3. Elders can exercise personal responsibility
Many medical providers cling to a “playing God” approach to healthcare decisions but are shocked when they’re held liable for bad outcomes. But doctors and nurses are not God, and risks are inherent in life. Moving towards a person-centered approach to healthcare permits elders and their families to decide which risks they will take in their care and in their lives. This can relieve the staff from bearing all responsibility for treatment decisions. In time, the change may permit residents and families to make choices important to the person’s independence and spirit rather than merely those that comply with safety rules.
4. Person-centered care can neutralize complaints
There’s no doubt that nursing homes operate under pressure from regulators, residents, families, ombudsmen, and lawyers, and it is easy to develop a defensive mindset that closes off lines of communication. But, ignoring criticism is a short-sighted answer. Do you know the #1 reason plaintiffs sue nursing homes? Because no one listened to their grievances. Find ways to remain open-minded about complaints and seek shared solutions to problems. Focusing with humanity and compassion on your residents’ concerns will improve not just their well-being but that of your staff and your company.
5. It’s the law
Effective November 28, 2016, new federal regulations shift the surveyors’ focus to “person centered care”, with mandated attempts to involve family and residents in medical decisions, life choices, and care plans. These changes will be a nightmare for SNF’s that do not prioritize empathy and open communication. If the facility leadership and staff do not genuinely respect the residents’ autonomy, the result will be complaints to ombudsmen and state regulators, poor survey results, and repeat deficiencies.
6. Greater empathy will benefit us all
You can’t mandate empathy, but you can teach it. Empathy is recognized by psychologists as a sensitivity to others’ emotions because we recognize the feeling in ourselves. Empathy training should start from a recognition of the value of long life and an acceptance that we, too, may one day grow old. Many of the best SNF caretakers – CNA’s, nurses, and administrators, hold horrible age assumptions. Out of self-defense, they come to believe that old age is merely a collection of chronic diseases and uncontrolled behavior. They have become institutionalized to such an extent that they can no longer see the meaning and purpose in residents’ lives. Undertaking this social change inside nursing homes will be a gift to the residents, the staff, providers, and to society.
For more information on meeting the new requirements for person-centered care, download the Quick Guide here.