Person Centered Care in the Chicago Tribune – 2/16/2011
Person-centered care creates home-like environment for residents
Person-centered care creates home-like environment for residents
The common living room at Lutheran Home in Arlington Heights.
Christine Casey believes that personal care has probably extended the life of her 93-year-old mother, Jane Olson.
Olson lives at Three Crowns Park, a retirement community in Evanston. At first, Olson lived in her own apartment. But Olson moved into the nursing care wing of the building when she became frail. The wing was recently remodeled and the staff uses an approach called person-centered care. The wing has several sections, each with about 17 residents. Each section or neighborhood has private rooms clustered around a common area that seems more like a private home than a nursing facility.
Olson’s room is right across the hall from the neighborhood’s dining area. Going to breakfast doesn’t involve a walk down a long corridor, or an elevator ride. Olson can stop by for a snack when she wants. The comfortable common living room is right outside Olson’s room.
Best of all, the staff knows Olson and what she likes. The same nurses treat Olson day to day. They build relationships together. “It’s a very personal approach,” says Casey. “We feel so fortunate.”
The kind of person-centered care that Olson receives is growing in popularity. Person-centered care is a recognition that resident choice and autonomy should be the primary aim of resident care in nursing homes and assisted living facilities.
Residents should be able to get up when they want, or eat when they want, instead of being tied to a task-oriented nursing schedule. Residents should decide whether they’d prefer a bath or a shower. Consistent staffing lets residents and nurses alike get to know each other.
“Person-centered care is something so simple” says Karen Love, president of the Center for Excellence in Assisted Living, Falls Church, Va. “It’s treating residents with dignity.”
The shift towards person-centered care started in the early ’90s. It is sometimes referred to as “culture change.” The Pioneer movement and the Eden Alternative are both examples of person-centered care models.
The Illinois Pioneer Coalition is a non-profit group that promotes person-centered care through community outreach programs and education. The Coalition also seeks to inform the public that the philosophy of care at a nursing home does matter. “Many Chicago-area buildings practice person-centered care, but the goal is to expand that network,” says Stephanie Buck, executive director of the Illinois Pioneer Coalition.
The staff at person-centered care buildings must be trained in the approach. Employees are taught how to build the daily activities around the individual needs of the residents instead of focusing on a list of tasks that must be completed.
Person-centered care is practiced at the five Chicago area facilities owned by Lutheran Life Communities. “The key is for the staff to build a relationship with the resident and the resident’s family,” says Amy Iacch, corporate director of clinical services at Lutheran Life in Arlington Heights. Forming a personal attachment results in fewer complaints from residents. It also helps to reduce staff turnover because they are personally involved in their work.
One of the most notable examples of person-centered care is the Green House Project. The project creates small, intentional communities for groups of elders and staff. Each Green House is designed for six to 10 elders. The senior has his or her own room. The house has a shared living room, and an open kitchen and dining area.
The Green House encourages elders to make themselves at home. Residents can decorate their private rooms and baths with their own belongings. They have easy access to all areas of the house, including the kitchen, laundry, outdoor garden and patio. They are free from schedules and can eat, sleep and entertain themselves when and where they choose. Meals are prepared in the open kitchen and served at a large dining table where all residents can socialize.
A small staff manages resident care. This helps create a family-like environment and allows residents and staff members to build relationships.
“Activities are very spontaneous,” says Bill Keane, manager of the Green House project, Alexandria, Va.
A growing movement
More than 50 Green Houses currently operate on 18 campuses in 13 states. The project is managed by NCB Capital Impact, with funding from the Robert Wood Johnson Foundation. NCB provides technical assistance to help local organizations build Green House projects.
Green Houses can vary in size, physical design, amenities, and operational structure. But all Green Houses follow the same principles of creating intentional communities with high levels of care.
Several Green House projects are planned for Illinois. One is already under way in downstate Danville on the campus of the veteran’s hospital. The Green House is scheduled to open by the end of the year. Another Green House will be built on the campus of the veteran’s hospital in North Chicago.
The Chicago architecture firm of Perkins Eastman designed the two Illinois Green House projects. The firm also designed the Green House prototype which is used across the country.
The original Green House layout has recently been tweaked to enhance the feeling that the building is a real home. Instead of one large open space, the common area is divided into a living room, dining room and kitchen. Private rooms are situated off a corridor rather than opening on to the common areas.
“This gives residents some places to explore,” says Dan Cinelli, principal and director at Perkins Eastman. The Green House environment works well for those with dementia. It’s a safe place, but not a confusing one, notes Cinelli. Ideally, two residents with dementia would live with eight other residents without memory problems to allow those with dementia to function more normally.
While the building design can help facilitate person-centered care, traditional-looking facilities can also take the approach.
“The idea is catching on,” says Robyn O’Neill, the long-term care ombudsman for suburban Cook County. In her work advocating for nursing home residents, O’Neill says residents of buildings with a person-centered approach tend to be happier than those in other types of homes. Person-centered homes are the subject of fewer complaints too. When seeking nursing care, O’Neill advises: “People should ask about it.”