Factors for Implementing Person Centered Care

Person Centered Care

The Person-Centered Care (PCC) model provides the highest quality of life in how medical care and personal care services are provided to the people who reside in long-term care facilities. This model focuses on the patient’s needs, values and expectations for caregiving and decision making (Nikumb-Haval, 2015). Decision making is shared with the patient.  The system is set up to service the needs of the patients.  It ensures that patients are informed and remain in control of their health delivery as a participant whenever possible.

Long-Term Care

Long-term care involves a variety of services and support designed to meet the health and personal care needs of a person. The level of care depends on the needs of the individual. The services of long-term care help the person live as independently as possible when they can no longer do these tasks on their own. Care includes assistance with basic Activities of Daily Living (ADL), which include everyday personal care tasks such as getting out of bed, bathing, dressing, eating, and toilet use. Other services of support can include instrumental ADL like taking medication, housekeeping, preparing meals, meal cleanup, and shopping (U.S. Department of Health and Human Services, 2019). The current approach to long term care in the United States has slowly evolved.

The era of the nursing home began with the Social Security Act of 1935. It includes the Old Age Assistance program making federal money available to assist with the heath care needs of low-income seniors. Amendments of Medicare and Medicaid were passed as well as payments directly to the institutions. Medicaid was set to provide coverage of LTC in institutions, but not in homes.  Government became the largest payers for LTC by 1965. This was followed by standards, regulations and the new age of home and community-based services (HCBS).     HCBS were now an alternative to institutional nursing homes and covered by Medicaid. The 2010 Affordable Care Act (ACA) came with the Community Living Assistance Services and Supports (CLASS) Act with the intention of offering a voluntary insurance program for long term services and support that is paid by individual premium contributions.  This brings us up to today’s government support for new long-term care infrastructures to support the population of Baby Boomers reaching 65 years old (KFF, 2015). According to Genworth (2018), as soon as a U.S. citizen becomes 65 years old, he/she will have a 70% chance of requiring some type of LTC services and supports in their remaining years.  Currently the majority of LTC is paid for by private individuals unless they qualify for Medicaid or have LTC private insurance (Paul & Schaeffer, 2017).

Models of Care

There are many different models for long term care. The Person-Centered Care (PCC) Model puts people and their families at the center of decisions. The person and family work with professionals to meet individuals’ needs, values, and expectations for caregiving and decision making (Nikumb-Haval, 2015). It ensures that patients are informed and remain in control of their health delivery as a participant whenever possible. PCC is about considering people’s desires, values, family situations, social circumstances and lifestyles; seeing the person as an individual and working together to develop appropriate solutions (Health Innovations Network, 2013). The concepts of compassion, respect and seeing things from the person’s point of view are all necessary for this model to work.  The physician or institution does not make all decisions for the individual.  Person (or patient) centeredness stands in contrast to doctor, hospital, or facility centeredness. In that regard, it represents a shift of power and control from the health care provider or practitioner to the patient (Evans, 2017).

When comparing the current medical model to a PCC model there are quite a few differences. The patient’s role moves from passive to active.  The physician discusses treatment options and the patient is now a partner in the process of his health care.  The care of the patient is centered on quality of life, rather than focused on illness or disease. The health provider listens more to the patient, and the patient is more likely to adhere to the plan due to his involvement (Nikumb-Haval, 2015).

Stakeholders

The stakeholders in long term care are the patients, physicians, organization providers themselves as well as insurance companies and the government. They all want to provide the patient with quality health care as cost effectively as possible. Active participation of the patient as a stakeholder is key in person centered care model and an essential element of patient-centered outcomes research (Jayadevappa, 2017). All stakeholders gain from a person-centered care model. Research shows that person centered care can have a huge impact on quality of care in patient outcomes (Source?). The level of customer satisfaction increase, a big impact on the quality of care. It can improve the patients experience, encourage people to lead a healthier lifestyle, impact health outcomes, such as blood pressure, and reduce patients use of services. All of this reduces overall health care costs and gives the provider satisfaction and confidence (Health Innovations Network, 2013).

Cost

There is a gap in available information on PCC cost effectiveness and cost benefit. In order to look at cost effectiveness we can look at care services, which are provided by assisted living facilities and personal care options. According to testimony submitted to the U.S. Senate Special committee on Aging, “person-centered long-term care can be found in assisted living communities” (Black, 2018). The results from Genworth’s 15^th Annual Cost of Care Survey shows PCC cost is much less than institutional nursing home care (Genworth, 2018).

Source of image?

Implication

For PCC to be effective, it must be supported from the top of the organization to the lowest level.  A review of 12 studies shows when PCC operates at the organizational level, with the full support of organizational leaders, it can increase quality of life in people living with dementia, and it can potentially improve their well-being and reduce neuropsychiatric symptoms (Chenoweth et al., 2019). Research finds the success in implementation of PCC has determinants at three levels: the individual level (personality, skills and attitudes), the organizational level (leadership and training, resources, infrastructure and culture) and the health care system level (regulations and government policies). The organizational level is a mediator between the individual and the system level and combined with the individual level it plays a major role here, since at these levels specific activities for implementing PCC need to be carried out to fulfil patient needs (Hower et al., 2019).  The diagram below defines the steps necessary to successfully implement this model (Santana et al., 2018):

Barriers

The lack of emphasis on PCC in medical education remains a barrier to its implementation, resulting in practices gaps, there is no practical guidance, no strictly defined process, procedures or interviewing styles. Many medical treatment decisions can have multiple paths for treatment. Communication and trust between patient and providers are essential (Santana et al.,2018).  Changing the interaction of patient and physician is a challenge due to the current culture in health care.

Cultural change must shift from task-oriented care to supporting person center care. PCC changes the environment to a home-like setting from an institution setting. The ethical framework in the medical field has always been to work in the best interest of the patient.   A societal shift has taken place with regards to health care, manifest in part by an ethical shift from paternalism to autonomy. Autonomy — the right to self-determination, to do what you want — has come to take precedence over all other guiding ethical principles, particularly “paternalism” and “best interest”  (Evans, 2017).

Future Directions

The future direction in the application of the PCC model is in the development of tools to support organization in the delivery of PCC. All areas of the medical industry are going towards a person-centered delivery system.  It will be essential in assisting in government guidelines in providing quality service to patients in all areas. This can be applied to all industries, which provide care services.

References

• Black, C. (2018). ASSISTED LIVING: The Model for Person-Centered Long-Term Care. Retrieved from https://www.argentum.org/press-releases/assisted-living-the-model-for-person-centered-long-term-care/
• Chenoweth, L., Stein-Parbury, J., Lapkin, S., Wang, A., Liu, Z., & Williams, A. (2019). Effects of person-centered care at the organisational-level for people with dementia. A systematic review. PloS one, 14(2), e0212686. doi:10.1371/journal.pone.0212686
• Evans, J. (2017). Person-Centered Care and Cultural Change. Caring for the Ages, 18(8), 6.
  doi: 10.1016/j.carage.2017.07.007
• Genworth. (2018). Genworth’s 15th Annual Cost of Care Survey Shows Continuing Rise in Long Term Care Costs.Retrieved from http://newsroom.genworth.com/2018-10-16-Genworths-15th-Annual-Cost-of-Care-Survey-Shows-Continuing-Rise-in-Long-Term-Care-Costs
• Health Innovation Network. (2013). What is person-centered care and why is it important? Retrieved from https://healthinnovationnetwork.com/system/ckeditor_assets/attachments/41/what_is_person-centred_care_and_why_is_it_important.pdf/
• Hower, K., Vennedey, V., Hillen, H., Kuntz, L., Stock, S., Pfaff, H., & Ansmann, L. (2019). Implementation of patient-centred care: which organisational determinants matter from decision maker’s perspective? Results from a qualitative interview study across various health and social care organisations. BMJ Open, 9(4), e027591. doi: 10.1136/bmjopen-2018-027591.  
• Jayadevappa R. (2017). Patient-Centered Outcomes Research and Patient-Centered Care for Older Adults: A Perspective. Gerontology & geriatric medicine, 3. doi:10.1177/2333721417700759
• Kaiser Family Foundation. (2015). Long-Term Care in the United States: A Timeline.  Retrieved from https://www.kff.org/medicaid/timeline/long-term-care-in-the-united-states-a-timeline/
• Nikumb-Haval, S. (2015). Patient Centered Care. Retrieved from https://www.slideshare.net/smrutihaval/patient-centred-care
• Paul, D. & Schaeffer, K. (2017). Long-term care policy: What the United States can learn from Denmark, Sweden, and the Netherlands. Business & Health Administration Proceedings.  Retrieved from https://mds.marshall.edu/mgmt_faculty/177/
• Santana, M. J., Manalili, K., Jolley, R. J., Zelinsky, S., Quan, H., & Lu, M. (2018). How to practice person-centred care: A conceptual framework. Health expectations : an international journal of public participation in health care and health policy, 21(2), 429–440. doi:10.1111/hex.12640
• U.S. Department of Health and Human Services. (2019). What is Long-Term Care?from https://longtermcare.acl.gov/the-basics/what-is-long-term-care.html