Person-Centered Care in Nursing Homes: Potential of Complementary and Alternative Approaches and Their Challenges

Abstract

A person-centered approach to care shifts the mind-set of care partners from a traditional medical model to a social model in managing chronic conditions. Using a qualitative descriptive approach, this study examines the barriers and facilitators to the implementation of person-centered care (PCC) and how the integration of complementary and alternative approaches (CAA) has the potential to improve residents’ quality of life in nursing homes (NHs). Findings indicate that NHs offer a wide range of engagement activities, but these activities are not purposefully integrated into a person-centered plan of care. Factors such as turnover, “working short,” supervisor support, and rising resident care needs make it challenging to implement PCC in NHs. This knowledge of the landscape of activities will help us identify and improve strategies for supporting residents at a deeper, more meaningful level. CAA has the potential to be therapeutic for residents if integrated into collaborative approaches to care.

The Impact of COVID-19 on the Person-Centered Care Practices in Nursing Homes

“…It is important to note that data were collected from March to July 2021, by that time, nursing homes may have overcome problems with supply and training experienced early on in the pandemic and began to develop practices to support teams of staff. COVID-19-related precautions influenced the relationships and interaction between staff, family, and residents and made it more difficult to provide choice and autonomy in terms of in-person contact for residents with their families which is key to implementing PCC (Bhattacharyya et al, 2022). However, we found that the staff discovered a viable substitute for in-person interaction.…”

“…COVID-19–related precautions influenced the relationships and interaction between staff, family, and residents and made it more difficult to provide choice and autonomy in terms of in-person contact for residents with their families which is key to implementing PCC ( Bhattacharyya et al, 2022 ). However, we found that the staff discovered a viable substitute for in-person interaction.…”

“…Developed on a medical model, nursing homes often function as mini-hospitals with overhead paging systems, minimal privacy, and inflexible eating, sleeping, bathing, and even toileting routines ( Roberts & Pulay, 2018 ) which inhibits the adoption of PCC practices. Barriers to increasing the primacy of resident preferences for autonomy, dignity, simple pleasures, and meaningful engagement abound in nursing homes ( Bangerter et al, 2016 ; Bhattacharyya et al, 2022 ). Furthermore, the COVID pandemic exacerbated staffing challenges within nursing homes making implementing person-centered care more challenging ( Shen et al, 2022 ).…”

Understanding Capacity and Optimizing Meaningful Engagement among Persons Living with Dementia

“…Care partners and convoys need supportive social environments that value time spent with care recipients on meaningful engagement during, before, after and between care activities (Bhattacharyya et al, 2022; Morgan & Ahmad, 2022). Further, stigma, or “collective cultural representation of persons living with dementia as being incapable of purposeful and meaningful communication and interaction” is a persistent barrier to social engagement, meaningful activities and social inclusion (Kontos et al, 2021, p. 714).…”

Exploring the Relationship Between Extent of Person-Centered Care Implementation and Staffing Levels in Ohio Nursing Homes

“…A recent report by the American Health Care Association (AHCA, 2022) found that since 2022, 60% of US NHs reported experiencing worse staffing situations and 87% are facing moderate or high staffing shortages. Given the importance of staffing levels on PCC delivery (Dys et al, 2022) coupled with these recent trends, it is unsurprising that inadequate staff time (Kolanowski et al, 2015; Van Haitsma et al, 2014) and staff turnover (Bhattacharyya et al, 2021) are often cited as barriers to implementing PCC in NHs. As NHs are mandated to provide PCC by the Centers for Medicare and Medicaid Services (CMS, 2016), it is imperative to understand how NHs can do so effectively and efficiently.…”