Person-Centered Care for People with Dementia: A Theoretical and Conceptual Framework

Providing a framework for person-centered dementia care may allow care practices in the United States to rise to the level of other developed countries.In 2001, the Institute of Medicine (IOM) released a seminal report, Crossing the Qual- ity Chasm: A New Health System for the 21st Century, that described American healthcare as impersonal and fragmented and called for a redesign of the nation's healthcare system (IOM, 2001). The report noted that a critical element necessary to this redesign was a shift to patient-centered practices. Patient-centered practices are rooted in humanistic psychology and in the work of Carl Rogers and Abraham Maslow, among others. Humanism holds that people are unique and multidimensional beings, and psychosocial and spiritual dimensions are as important as physical health for their holistic well-being (Rogers, 1980). Toward a Definition of Person-Centered CareDepending upon the constituency, various terms are used for these practices, such as person- centered, resident-directed, and relationship- centered. We use the term person-centered for its widespread acceptability and to honor its holistic and personalized ethos. Patient-centered is also widely used, but it is not considered as desirable among proponents of the culture change movement, as it connotes a bio-medical orientation to care. Also, because the word patient comes from the Latin word patiens, meaning "one who suffers," patient-centered can obscure the term's spirit and intent.Person-centered care focuses on the indivi- dual needs of a person rather than on efficiencies of the care provider; builds upon the strengths of a person; and honors their values, choices, and preferences (McCance, McCormack, and Dewing, 2011; Edvardsson, Fetherstonhaugh, and Nay, 2010; Brooker, 2007; McCormack and McCance, 2006; McCormack, 2003; Kitwood, 1992). A person-centered model of care reorients the medical disease-dominated model of care that can be impersonal for those oriented to holistic well-being that encompasses all four human dimensions: bio-psycho-social-spiritual.Imagine having a doctor's appointment in an office that is freezing cold, receiving impersonal treatment from the staff, and being made to wait forty-five minutes beyond your appointment time. While the physician may be extremely competent, the physical discomfort and imper- sonal treatment detracts from the overall quality of care. The visit may leave you feeling distrust- ful and lacking confidence in the healthcare received-despite skilled medical care-because of poor psycho-social aspects of the service. In healthcare and long-term services and supports, the interplay between bio-psycho- social-spiritual needs is especially important because the person receiving care is more vulnerable. Person-centered care recognizes the multi-dimensionality dynamic and reorients practices to be delivered in a positive manner, which, in turn, helps support holistic well-being.Toward Person-Centered Care Practices in Dementia CareWhen a person with dementia has progressed to a point where they need significant help and support, they may no longer be able to articu- late insights about their care. However, we can offer here a (published) quote from an individ- ual with a mental health disorder who could articulate personal feelings about person-cen- tered care: "The nurses got to know me and could support me in ways that were personally meaningful . These might sound like little things-a soda, an art project, a few minutes spent talking . nothing they did cost extra money or required intensive training, but the fact that they saw me as a person-and treated me like one-helped restore my dignity and sense of personhood" (Clayton, 2013). Tom Kitwood's influential work in the 1990s at the University of Bradford in England con- nected the beliefs and values of person-centered care specifically to dementia care. His work and research gave voice and credence to the need to realign dementia care practices to a model oriented to the "personhood" of the individual living with dementia. …