Person Centered Care

There is much talk about "person centered care" and the term sounds self explanatory. If only the process of developing a care environment around person centered care was as simple as the phrase appears initially, Actually, the process involves many aspect of the care setting. Let us examine the components that formalize this simple yet complex process that is at the very heart of dementia care mapping. 

There are eight essential characteristics of true person centered care. The core belief is that person centered care maintains and upholds the value of the person regardless of level of dementia. It is the person and his individuality that matters most, not his cognitive deficits. 

The second characteristic of person centered care considers and attempts to provide for the basic social needs of the person. It is felt that everyone shares these basic needs whether cognitively impaired or not. These basic needs are: love, attachment, comfort, identity, occupation and inclusion. If asked, most caregivers would say, "Of course I consider those basic needs." But how often do we consciously stop and think of designing our programs for our participants with dementia to meet these needs? It is so easy to focus care plans on physical symptoms or behaviors that we often overlook these other core needs.

A better understanding can be gained from taking a closer look at these concepts. Love is so basic but we, as professional caregivers, have usually left this need for families or personal caregivers to meet. Often it is difficult to think of love as we attend to the physical needs, especially if the participant is particularly "unattractive." She drools, repeats everything you say, smears her food on the table, and is incontinent of stool and urine. As a caregiver that embraces person centered care, the first step to developing this "universal love" or unconditional acceptance, is to explore what the uniqueness of this person is. We need to know in detail the participant's life history and help them maintain their sense of self by using our care to reinforce the dignity of their life. We must be able to pick up ant tell the pieces of their life story as they begin to lose those pieces. Do they have a title? Children? Where did they live? Grow up? What was important to this person? What name do they choose to be called? Most important of all, be empathetic to help you respond to this person's uniqueness.

Identity is in some part conferred by others. Humans give messages with body language, tone of voice, the words chosen and the level of respect given. We, as care partners, must assure that we affirm the identity of those individuals encounter in our care.

The next two core needs are inclusion and attachment. We are a social species and bonding with others is almost instinctive. Our survival instincts have led us to be group beings for eons. For the person with dementia to function well within a group, both inclusion and attachment are key. It is the responsibility of the caregiver to assure these needs are met. How? As anxieties, fears and loss of memory of strong attachments undermine a person's sense of security, their needs intensify. If needs are not met, challenging behaviors may be exacerbated. Total acceptance of the person and your efforts to make them feel included and attached to other members of the group will represent person centered care and make care easier to deliver. A person cannot thrive with out inclusion or attachment.

Comfort is the next component and denotes a soothing of anxieties and sorrow. Folks with dementia have a special need for our warmth and compassion. Last but not least is occupation. A term we do not often use except when we have a paid position. In this context, it means for the person with dementia to be involved in a significant way in the process of life using their remaining abilities. If a person is deprived of meaningful, rewarding "work", their abilities atrophy and their self-esteem becomes damaged. Meeting this need creates a challenge for care givers to design social environments and programs to encourage the care receivers to participate to the maximum of their abilities in their own care. 

Person centered care is not complete unless we promote positive physical health. We started with promoting positive mental and spiritual health as we attended the aforementioned needs of love, inclusion, occupation, identity, comfort and attachment. Physical health equally impacts quality of life. Paying attention to range of motion, weight bearing exercise, medication monitoring, weight loss, nutritional status, etc., is a given and usually well accomplished in formal care settings but bears mentioning as we discuss the whole person. Unfortunately, in the past, as formal caregivers meeting the physical needs have often taken precedence over the more esoteric emotional and social needs. In dementia care, emotional needs often exceed the physical and practical needs of a participant. Caregivers must be emotionally available to persons with dementia. There can be no "us" and "them", as all persons (staff and participants) need to be part of positive person work and partners in care. We enter into a partnership in the life process of our participants with dementia. 

It was eye opening to us how the concepts of person centered care changed the way we looked at "problem behaviors". In the past, we often taught sessions on how to "manage" these behaviors. Using the Alzheimer's Association problem solving approach was a good first step to sensitize caregivers to viewing the behavior as a message. Dementia care mapping and person centered care takes this concept a step further. Person centered care sees problem behaviors as "an attempt or desire for communication on the part of the person with dementia and the care giver sees these behaviors as an opportunity for them to communicate in return."

To fully understand the value of dementia care mapping, it is important to understand the key elements of person centered care and positive person work. Both are wonderful models of care but too vague without dementia care mapping. Dementia care mapping is too empirical and cold without person centered care and positive person work. As we all struggle to enhance our dementia care practice, we need to make a full commitment to person centered care.

In summary, the list of the eight key components of person centered care:

1. Maintains and upholds value of person, regardless of level of dementia
2. Considers and attempts to provide for the core psychological needs of the person (love, attachment, comfort, identity, occupation and inclusion)
3. Promotes positive health (body, mind, spirit)
4. Sees "problem" behaviors as the desire for communication on the part of the person with dementia
5. Sees "problem" behaviors as an opportunity for communication on the part of care givers.
6. Sees all action as meaningful
7. Employs staff that is emotionally available to the person with dementia
8. Contains elements of positive person work.