A Patient Person is a Person First

A Patient Person is a Person FIRST

The person-centered care movement appears to have started in January of 1990 (Kogan et al, 2016). Person-centered care, or PCC, is a principle or approach to healthcare that has been embraced by The Center for Medicare Services. The approach considers an individual’s unique qualities and circumstances as well as the entire milieu in which the person lives. The focus is on the patient being a person first and needing care second. It should be noted that these criteria of PCC extend to nursing homes, related service providers, and all those administering aspects of healthcare. According to the American Geriatrics Society (2016), no standard or agreed upon definition exists for PCC

In an extensive review of the PCC literature, two themes emerged in almost every study. These are an emphasis on the whole person, or a holistic approach, and feeling respected and valued in the patient care process. (Kogan et al, 2016). Let us examine these first. The holistic approach of PCC views the person and his/her functioning and abilities, not just treatment, labeling, or limiting aspects of the disease itself. Physical (and medical) needs are considered part of the entire persona – emotional, spiritual, social, and cognitive/intellectual functioning. The needs, values, and preferences for care are considered as well as the abilities, interests, hobbies, and qualities of the individual (Alzheimer’s Society of the UK, 2016).

The second most referenced component of PCC in the literature is respect and value as a person. The physician alone does not make decisions for care. The client is spoken to as a person and their opinions are not ignored. Background and cultural sensitivity are communicated by the physician, and this includes language, differences in clothing, diet, hygiene, and religious preferences. Choice was also mentioned as a theme of PCC. In residential settings, this would include choice of foods at mealtimes, where dining will take place, and whether eating assistance is necessary. Rather than forced attendance, an individual self-selects participation in activities. Dignity was frequently mentioned in the literature describing person-centered care. It includes encouragement to do things independently if capable, a willingness of the healthcare system to respond to individual needs, and managing behavior without medication whenever possible.

The remaining two themes are self-determination and purposeful living. The person receiving care is involved in plans and decisions about their own care. The care plan is reviewed and changed regularly with family consulted if necessary. Purposeful living includes encouragement to continue participation and involvement in social roles.

How is the quality of PCC determined? Westphal et al (2016) and the American Geriatric Society agree on the following three indicators (with the author’s rephrasing as explanation):

Life is lived at the highest functional level possible with least amount of intervention.
Service providers are competent, and additional education and training are provided for any team member(s) –care provider, person, and/or family – if needed.
Needs are met in a timely, organized, convenient manner based on integrated communication through a primary or lead point of contact on the healthcare team.

The patient has self-confidence in navigating the care system (alone or with support). The individualized, goal-oriented care plan is regularly reviewed for performance measurement and quality improvement.

The above principles are similar to those in special education – such as developing an individualized education plan focusing on specific goals, taking into account the interests and strengths of the individual, and implementing objectives and decisions to include accommodations, adaptations and related services. All components are necessary to improve quality of life and make progress toward goals. A case manager coordinates services and is the contact person for communication and measurement of desired progress toward goals.

The PCC approach can lead to a safer, more enjoyable journey for the person. It can also result in much less expense. In fact, 15% of individuals who are on Medicare with functional impairments account for 32% of Medicare costs (Westphal et al, 2016). Perhaps by taking into consideration the entire individual – and not just the disease and its treatment—we can improve quality of life and help maintain the integrity of the patient and their loved ones.

Sources:

Kogan AC, Wilber K, Mosqueda L. Person-centered care for older adults with chronic conditions and functional impairment: A systematic literature review. Journal of the American Geriatrics Society, January 2016;64(1):e1-e7.

Selecting a Care Home. (n.d.) Alzheimer’s Society of United Kingdom. Retrieved October 5, 2016 from www.alzheimers.org.uk. )

Westphal E, Alekema G, Seidel R, Chernof B. How to get better care with lower costs? See the person, not the patient. Journal of the American Geriatrics Society, January 2016;64(1):19-21.