Person-Centered Care: What It Means to Experts and Families

By Erin Harris | Posted on 01.09.2017 | 0 comments
Person-Centered Care
When my friend Kendra’s sister suddenly suffered a hemorrhagic stroke, she required emergency brain surgery. Karen spent 10 days intubated and sedated in the ICU—in a strange place and a frightening situation.

In her sleep and when she was awake, she appeared to pull at her breathing tube and IVs—which could jeopardize her health or even her life as much as the stroke.

To protect Karen, the nurses put her in soft restraints. This way she couldn’t tear away the life supports that were meant to help her.

But Kendra knew something the staff didn’t know.

Kendra knew that Karen has severely sensitive skin.

“As I watched my sister’s behaviors,” Kendra wrote, “I realized she was not really pulling at her breathing tube or IVs. What she was doing was trying to scratch her skin and remove items that were causing itches.”

Each day as Karen’s condition brought progress and setbacks, setbacks and progress, Kendra persuaded staff to treat the cause of Karen’s itching with antihistamine cream, and to protect her with a one-to-one nurse rather than restraints.

By the time Karen made her way out of the ICU and into the neuro unit, she was able to shower, use her own soap, and wear her own clothes to reduce the itching.
 

This is person-centered care.


Recognizing the cause of Karen’s scratching is person-centered care.

Using an individualized intervention is person-centered care.

Advocating for someone you love is person-centered care.

Honoring a patient’s preferences is person-centered care.
 

A definition of person-centered care


Person-centered care can be defined as a philosophy of service provision where services are maximally responsive to each individual’s unique needs, values, and preferences.

Like every person, Karen was not just a patient.

Like every person, Karen is an individual.

She’s Karen.
 

PCC in different settings


Whether you work in a hospital, dementia care, a residential treatment facility, with people on the autism spectrum, in education, social services, outpatient behavioral health—in any capacity with people who need your help—you’re likely using person centered approaches more and more every day.

Across fields, care professionals have been moving away from an institutional, task-oriented approach and toward a more holistic approach that honors the individual in care—as well as the caregiver.

A study in the American Journal of Alzheimer’s Disease and Other Dementias reached findings that we at CPI see every day through our customers who use a person-centered, strength-based approach in a wide range of fields.

The study measured the reactions that people living with dementia had to being cared for with person-centered communication.

It found that person-centered communication resulted in people with dementia:
  • Cooperating with staff
  • Revealing personal information about themselves (showing trust and security)
  • Contributing to conversations
  • Asking for clarification
  • Increasing politeness toward staff

The study also revealed that with person-centered communication, staff were more likely to regard their clients in a positive light.

That is:
 

PCC creates a positive feedback loop among staff and clients.


Person-centered communication begets positive client behavior and responses, which begets a positive view of clients for staff, which further elicits positive client behavior and responses.

In CPI training, this is what we call the Integrated Experience. We define the Integrated Experience as the concept that the behaviors and attitudes of staff impact the behaviors and attitudes of those in their care, and vice versa.

In any field, in any part of life, how I treat you has a direct effect on how you treat me.
 

The evolution of person-centeredness


Tom Kitwood, who was a senior lecturer in psychology at the University of Bradford, is considered the originator of the person centered approach in dementia care. His groundbreaking 1997 work, Dementia Reconsidered: The Person Comes First, explores the concept of personhood and remains the authority on the topic, guiding policy makers, service planners, and thought leaders on best practices in dementia care. His work is central to best practices for many fields, and informs CPI’s Dementia Capable Care and Nonviolent Crisis Intervention® training.

In 2001, person-centred planning (PCP) became part of government policy in the UK as part of the Putting People First initiative in social care. The Department of Health’s white paper on Valuing People [PDF] outlines a strategy for using person-centred care with people who have learning disabilities.

Today, as Hazel Watson of NHS England notes, “person centred care at its best” applies to people of all ages and all abilities—especially when they’re vulnerable.
 


The shift toward person-centeredness is indeed continuing in many environments, from long-term care facilities to schools, EDs, and psych units. Particularly in behavioral health, the focus is shifting to a recovery-model framework that’s trauma-sensitive and trauma-informed. In dementia care, CMS recently added new final rules for long-term care facilities that include a section on Comprehensive Person-Centered Care Planning. PCC is also making its way into hospital security, as security staff move away from an authoritative approach and work with clinical staff to balance care and welfare with safety and security.
 

With PCC, a holistic view of the person in care evolves into:
  • Checking assumptions
  • Choosing language and vocabulary carefully
  • Leveling the hierarchy within the organization
  • Changing expectations and beliefs about people
  • Adjusting attitudes
  • Building support networks to wrap around those in care
 

Person-centered strategies


Want some strategies to make your approach more person-centered than ever? See the expert roundup below, and try these 12 tips:
  1. Help the person manage their own care.
    When someone needs your help, make sure they have input. Listen to their preferences. Empower them to be and feel involved with your team. Make them full partners in their own care. Put the person in the center, with all other players (family, clinicians, caregivers, teachers, administrators, therapists, etc.) comprising a customized circle of support. Show the person that their individual needs, interests, passions, likes, and dreams are always the core focus of every effort. Let them know that to the best of your ability, you will minimize what they don’t like and maximize what they do like.
  2. Ask the person about their preferences.
    Offer choices and let the person know you aim to meet their needs. Our Life Story Questionnaire is great for this if you work with people who have dementia. And no matter where you work, our new Trauma-Informed Care Resources Guide includes a De-Escalation Preferences Form that can be a huge help to both you and the person in your care.
  3. Get to know the person.
    • What’s their background?
    • What are their interests?
    • What are they good at?
    • What makes them feel supported?
    • What makes them feel happy?
    • What makes them feel scared?

    To find this out, talk to the person. Greet them by name in a friendly tone. Use supportive body language. Be calm and rational, and treat them like they’re calm and rational—even if they’re being anything but. Build their trust. Also talk to others: Ask your colleagues, other professionals, the person’s family, etc.
  4. Do tasks with the person.
    Minimize doing things for them. Maximize their abilities. Focus on success, de-emphasize errors, and provide support where needed.

    To do that . . .
  5. Be strength-based.
    Working hand in hand with PCC is being abilities-focused and strength-based. Instead of focusing on deficits and disabilities, look for the person’s potential and recognize what they CAN do with your belief in them and your support of their abilities. Help them feel purpose, skill, accomplishment, and self-respect—and this will improve how they feel and act toward you.
  6. Offer comfort.
    This could be a pat on the back, a hand on the shoulder, a wink, holding hands, a thumbs-up, or just being present with the person in a difficult moment.
     
    I Like These 12 Tips for Providing #PersonCenteredCare
  7. Celebrate.
    Honor things the person likes. Sing along with them to their favorite song. And let them know when they’re doing a good job. As they achieve benchmarks—even small steps toward their ultimate goals—celebrate. People are more likely to stick with something when they feel that they’re supported and rewarded for their hard work. Be prepared for small steps backward or unanticipated barriers, but work through them and keep moving forward.
  8. Avoid physical intervention.
    If the person you’re working with sometimes poses a physical danger to self or others, there may be times when you need to physically intervene. However, in many situations, there are ways to minimize the need for any physical intervention—and to reduce the risk of injury to you and the person. The very best way to avoid going hands-on is to avoid the need to restrain in the first place. Be aware of changes in the person’s behavior that can be warning signs of anxiety. Intervene early. Focus on proxemics and verbal de-escalation. Learn how to set limits effectively. Get training in how to assess risk. Avoid being drawn into power struggles. Choose the least-restrictive option possible in every situation.

    Here are some tools to help:
  9. Debrief.
    Be sure to debrief after any crisis. This will help you find patterns and triggers—and prevent the situation from reoccurring. It will also help you help the person foster resilience and develop effective coping skills.
  10. Join hands.
    A person-centered, strength-based approach is about self-determination, treating people with respect and dignity, and working together to enhance the person’s quality of life. Throughout your organization, collaborate as a team to adopt a consistent approach. Work to gain buy-in, not only from all staff departments and all organizational leaders, but from clients and their families as well. This allows everyone to take an active role in promoting their own personal safety, thereby enhancing the safety of others.
  11. Start immediately.
    In many environments, you can get your person centered approach off the ground before the person even comes into your care: During the discovery process, prior to admission, during intake, etc. Being person-centered at every step of a person’s journey furthers their inclusion and engagement in their education, care, treatment, recovery, family, community, peer groups, growth, etc.
  12. Lead the way.
    Model these strategies for your colleagues. Help staff shift from a deficit-based mindset to a strength-based mindset. Show them the results you achieve when you focus on a person’s abilities. Teach them how instead of looking at a person as “damaged,” they can view the person as a survivor.
 
 

What person-centeredness means to the professionals who use it


Below you’ll find insight into how pros like you use person centered approaches in their work.

As you browse, think about:
  • What does “person-centered” mean to you?
  • What does “strength-based” mean to you?
  • What do these approaches mean to each person in your care?
  • How do you practice these values in your day-to-day work?

And share your thoughts, expertise, struggles, and success in the comments. We want to hear how you honor every person as a person!


Rania Ghobrial, ASD Resource Team

Rania Ghobrial, ASD Resource Team

Nonviolent Crisis Intervention® Certified Instructor
Peel District School Board

Haptics and Students With Special Needs
De-Escalation Tale [Certified Instructors, log in to listen]

We all have something in common. We all want to be treated compassionately and empathically when we experience agitation or frustration. When we’re feeling heated or in high-alert mode, we’d rather not experience embarrassment, further frustration, or be berated or have our concerns shelved by others. The guarantee is that responding in an adversarial fashion to someone who isn’t themselves is only going to elicit an unwelcome response.

With this in mind, person-centeredness is especially meaningful in my work with students with an Autism Spectrum Disorder. It’s extremely important because it focuses on the relationship—and in the heat of the moment, when things have derailed, we want to treat an upset student in a genuinely caring and proactive fashion, similar to how a wise and judicious parent would.

Whether they’re calm or in cognitive arousal, there are times when we have to re-examine our responses (particularly the words we use) to our clients, students, and families. Tapping and working with outside resources (families, caregivers, community agencies), building trust and confidence, and developing a culture of collegiality is imperative. All this is ultimately the genesis to enhancing relationships with our clients.
D.C. Foster, Behavioral Health Intervention Specialist

D.C. Foster, Behavioral Health Intervention Specialist

Master Level Nonviolent Crisis Intervention® Certified Instructor
Arizona State Hospital

18 Ways to Build Rapport With Patients
A Pound of Prevention
How Names and Labels Affect Patient Care

With all the well-thought-out and different programs, therapies, interventions, and wellness approaches, if you take away the fads, the glitz, the shine, and the newness of it all, and it’s still successful, you will find at its core a commitment to person-centeredness. No matter the label of the technique, if it succeeds, it’s because of its person-centered foundation. In contrast, a one-size-fits-all approach to treatment is inherently limited and cannot apply in every instance. This is because people change, and time—as well as the natural evolution of things—influences and changes along with us. 
 
The inclusive concept of person-centeredness brings with it a unique look into an individual’s life experiences, as it examines the small pieces and parts of a person that may often be missed or taken for granted. Past and present wants, feelings, needs, experiences, and relationships are just a few of the character constructs it’s necessary to build a care plan around. Their value in a person-centered approach can be priceless when constructing and developing that person’s strength-based wellness plan. 
 
Each of us has the ability to shine brightly and burn intensely, our hearts lighting our way as we move forward in life. I would offer that the strength of any individual allows for their creative expression to be appropriately nurtured and channeled. Taking a person-centered approach makes these things not only possible, but probable.
LeAnn McCormick, Onboarding Coordinator, Educational Services

LeAnn McCormick, Onboarding Coordinator, Educational Services

Dementia Capable Care and Senior Level
Nonviolent Crisis Intervention® Certified Instructor
Riverside Medical Center

As a healthcare professional, I frame person-centered approaches so that the patient is at the heart of the plan that’s developed by all disciplines. It goes beyond just knowing the patient or the patient’s family’s preferences. Person-centeredness goes beyond fashioning an efficient task list, and expands critical awareness to encompass values, family preferences, life experiences, culture, and social circumstances. The concept actually promotes critically thinking about the patient care, which in turn guides appropriate approaches and involvement of resources. There is freedom in this understanding, helping reach full patient potential.

During daily “huddles” in my organization, patient preferences and care approaches are shared with all disciplines. Examples may include information such as identifying visitors that create anxiety in the patient with interventions on how to change the approaches. 

Our documentation system allows a space for notes to be posted electronically for all disciplines as an FYI. It’s also part of the care plan that’s accessed by all disciplines.

In long-term care, adopting the “Can Do,” “Will Do,” “May Do” terminology across disciplines to communicate in a common language and tactics is also helpful to reach full potential.
Tracy Vail, MS, CCC/SLP, Autism Consultant, Speech/Language Pathologist

Tracy Vail, MS, CCC/SLP, Autism Consultant, Speech/Language Pathologist

Senior Level Nonviolent Crisis Intervention® Certified Instructor
Let’s Talk Speech and Language Services
8 Ways to Help a Child on the Autism Spectrum
Context Blindness and Autism

My understanding of person-centered care is that it involves taking the values and preferences of the person we are serving in every aspect of treatment. In my work with children and adults with autism, it means teaching them to communicate and engage with others within activities that they find valuable and enjoyable. 

With regards to their behavior, it means that once the function of their maladaptive behavior is determined in the Postvention stage, if they are cognitively able, we work with them to develop a plan that allows them to get their exact same need met in a more adaptive or acceptable manner. If the person is a child, we work closely with their parents to make sure we’re all teaching the child to get their needs met in a more functional manner. We also make sure that whenever a behavior change needs to be made, that change is socially significant and is one that will allow the child to be successful in their environment.
Christopher Fernandes, MA, LMHC, CSAC, Clinical Behavioral Psychotherapist

Christopher Fernandes, MA, LMHC, CSAC, Clinical Behavioral Psychotherapist

Nonviolent Crisis Intervention® Certified Instructor
New Bedford Public Schools

Think Behavior blog
Twitter
LinkedIn

PCC really is the understanding that you cannot make a person change, and that change comes from the person.
The power, motivation, and the will to act comes from the person. As therapists, we can set up the conditions that increase the likelihood of change through encouragement, nonjudgment, reflective listening, and unconditional positive regard.

Person-centered approaches understand that resistance doesn’t come from the client but instead from the inability of the therapist to meet the client where they’re at.
Attempting to get someone to change a behavior when they are not aware of the behavior leads to resistance. It’s important to understand that there is no such thing as a resistant client, but only a therapist who attempts an intervention that the client is not ready to attempt. Person-centered approaches meet a client at the stage of change that they are at.

If you want to be a better person-centered therapist, the best tip I can give you is to identify where the client is in terms of their problem. 
  • Are they oblivious to their problem?
  • Are they thinking about their problem? 
  • Have they tried to act on change already? 
  • Have they acted and failed on their intervention? 
 
Identifying where the client is in terms of thinking provides a better roadmap for providing the most appropriate intervention.

Creating ambivalence with a client helps them move from thinking about change to acting on change. 
Ambivalence is when the client holds two conflicting ideas in their mind. For example: “I really don’t want to quit drinking. At the same time, it’s breaking my marriage apart.”

This type of belief drives clients to take the next step.

It is significantly important that clients arrive at their own motivation to change through this ambivalence process, otherwise the likelihood of real change occurring is low and superficial. As a therapist, you can help create ambivalence by reminding your client of both conflicting ideas, never siding with one or the other but always pitching them against one another. Remember that giving advice can make the client dependent on you for good advice and blame you for bad advice.

Incorrect: “You should probably think about stopping drinking. It’s ruining your marriage.” (This is directed by the therapist and unlikely to work.)

Correct: “You want to keep drinking because it’s not that big a deal. At the same time, you’ve noticed that it’s causing an issue in your relationship.” (This reflection/restatement gives the client the power to change and decide.)

Here are some quick reminders about practicing person-centered approaches:
  1. Listen, understand, reflect.
  2. Try not to make a judgment.
  3. Reframe the resistance.
  4. Create ambivalence by restating the two conflicting conditions the client discusses.
  5. Give the client choice and power.
Maria Miller, Occupational Therapist

Maria Miller, Occupational Therapist

Dementia Capable Care Certified Instructor and DCCT
Wilkes Barre VA Medical Center


 

A person-centered care model is based on the unique needs, values, and beliefs of each individual patient rather than the time schedule and/or productivity standards of the therapist.

Working in an outpatient mental health program in addition to a dementia unit, I begin each evaluation with a personal interview where I first learn each individual’s life story. On the dementia unit, I often become the keeper of their stories as they begin to forget the details, and we use these stories to make ongoing connections even as the dementia progresses.

My treatment strategies are developed for each individual patient and I work collaboratively with them to select goals that are meaningful to them in order to assist them in achieving maximum therapeutic outcomes.

D.K. Johnson, Linkage to Care Coordinator

Dementia Capable Care Certified Instructor
University of Cincinnati Medical Center

Being person-centered means focusing on the needs, strengths, and potential barriers of the person I’m working with.
 
I practice person-centeredness with the patients I assist in the emergency department (ED) and when I do volunteering with hospice clients. I work with patients between the ages of 18 and 64 who are HIV positive. I assist patients who are dealing with mental health and drug and alcohol use, and connect them with proper resources.

In almost all interaction with patients, I use a motivational interviewing technique. However, it is so important to focus on the person first. Motivational interviewing can be useless if I don’t understand where the patient is at during their crisis or problem. Building rapport with the person helps me help them obtain the most beneficial resources.

When working with hospice clients, I listen to their needs and to identified activities they can do. I also get a sense of why they may feel depressed and how to help them and their family work through moments like this. It’s very important to be person-centered so I can help individuals get the tools they need to move forward.

Tammy Whitehead, MA, OTR/L, Regional Rehab Director

Dementia Capable Care Certified Instructor
Life Care Centers of America

I’ve had the opportunity to not only teach the person-centered approach, but also to see the wonderful outcomes and tremendous success that occurs when this approach is used. When teaching, I focus on personhood and what that means especially in terms of who the person is or was depending on what stage of dementia they’re in. I stress the importance of knowing your resident so you can use the patient-centered care approach. 

I’d like to share a story. I was teaching a course and my participants were sharing about a resident who’d been a challenge for several weeks when it came to bathing. She would resist any attempt at showering, so the staff initially thought that she wasn’t worried about cleanliness, and they didn’t want to force her. 

In class, we discussed personhood, generational changes, and person-centered approaches. I asked the staff if they had spoken to the lady’s family and if they knew their residents’ bathing preferences: Whether or not their residents liked to take a bath in a bathtub (very typical for the generation), take a sponge bath (also typical), or take a shower. I suggested that they set their client up in front of the sink with basin, soap, and water and that they assist only as needed. I asked them to stand back and observe and let their client direct the activity herself.

When I returned the following week, the staff were elated with their success, as their client was now giving herself a sponge bath daily with minimal assistance.

This to me is what the person-centered approach is all about. Focusing on the person and what is truly important to them, what they know or remember, and what makes them feel in control and safe.

T.D. Loftus, MS, LMHC, Quality Management and Compliance Officer

Senior Level Nonviolent Crisis Intervention® Certified Instructor
3 Keys to Help Staff Cope With Secondary Trauma
How to Stay Safe During Home Visits

What is person-centeredness?
A person-centered approach includes looking at all major facets of the person in front of you. Coming from a high-fidelity, evidenced-based approach of Wraparound, one looks for the strengths and needs of their client. In the past, the major focus was on psychosocial needs. That doesn’t help when someone is hungry, doesn’t have a stable living situation, has troubling medical conditions, or when any other factors that may affect their quality of life are at play.

The focus on integrated care is beyond theory now. Certified Community Behavioral Health Clinics (CCBHCs) are a major initiative at the federal level driven by the Excellence in Mental Health Act. This model is designed to provide for a comprehensive range of services for vulnerable individuals with complex psychosocial, mental health, and substance use conditions. Eight states will receive a grant and within those states, participating behavioral health agencies will need to become CCBHC entities. My agency is fortunate to be one.

How can it be effectuated?
In Wraparound, one valuable tool is the Strengths, Needs, and Cultural Discovery assessment. This process is prepared with the client. Identifying strengths prevents a deficit-based approach and helps enlist the client’s involvement in their own recovery. Rather than culture being defined by race, ethnicity, socioeconomic status, where one lives and so on, it focuses on the individual or the family. 

What is important to the person might not be the same as broad brush strokes ascribed to an identified population.
 
Another factor that’s important to take into consideration is the learning style of the client.
There are many models. One of the simple ones is using an Auditory, Visual, and Kinesthetic paradigm. Does the client learn by hearing, do they need to see something to learn, or do they learn by doing? While people can tap into more than one learning style, many of us tend to prefer one or the other.

Pamela Atwood, MA, CDP, CADDCT, CLL Director, Dementia Services

Dementia Capable Care Certified Instructor
Hebrew HealthCare

Person-centeredness to me is an evolution of care. It starts with basic training of people who really want to provide care to others—teaching critical thinking skills, how to adapt care, and how to transform practices.

It then evolves beyond task-orientation to the WHY of care. The why is to provide compassion, improve quality of life, relieve suffering, and/or enhance meaning and joy to a person in need. 

Because the WHY differs from individual to individual, PCC is not a singularly defined action.
No single strategy will work. How to deliver PCC will change depending on who the person is, and what the goal is. 

The PERSON is the focus, not the task, not the practice. 
Tasks and procedures are just steps to facilitate person-centered care. 

PCC adapts to the preferences and needs of the individual receiving the care. 
A client who is afraid of a carer and resists being helped will need the carer to know what makes him or her relax. For truly PCC, the carer needs to implement those strategies BEFORE the client resists. We may all feel better with music, but which specific kind of music or piece makes the client relax? Which excites? Which stresses? 

For me, PCC starts before the individual is a client.
Our staff is skilled at helping people feel at home and engendering trust in their caring; however, to cut their learning curve, I evaluate the client in their living environment BEFORE they come to us. I interview the individual; I speak with the primary family. And then I share my knowledge with the team so they have something to discuss beyond medical diagnoses and medication reconciliation.
  • We try to have favorite comfort foods on hand the first day of admission.
  • We ask them to tell us about their work if they were proud of that, or the art studio they used to sponsor, or the recipe they use for matzo balls. 
 
PCC is about honoring the personhood of those in our care.
It’s about recognizing their unique vulnerabilities and cherishing the opportunity to be a part of their journey.

We do this so that they do not fear the ills of aging: loneliness, suffering, and despair. 

Karen Barnash, RN, Training Coordinator

Dementia Capable Care Certified Instructor
Friendship Senior Option

In my care community, we offer the friendship spirit in everything we do.

Since we are a continuing care retirement community, we serve senior residents who are at any level of need along life’s journey. We are fortunate to have a leadership team that recognizes the impact and the essentialness of viewing each resident as the individual that they are.

We look for those unique qualities in personhood that help us gain insight into a life, so that we can relate at a more intimate level.

Therefore, our strategic plan is not only to identify, but to anticipate needs and offer solutions, providing a more comfortable and nourishing environment.


 

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