I was recently reading an article on person-centered dementia care posted last fall by Sonya Barsness. Barsness helped develop the Hand In Hand toolkit now distributed by CMS to train nursing home direct care workers in the principles and strategies of person-centered care.
Barsness points out that true person-centered care means more than just “non-pharmacological interventions” for dementia patients. While I am not going to argue the pros and cons of using medications to help manage the cognitive and behavioral problems associated with dementia, I will heartily agree that caring for someone with dementia involves much more than refraining from psychotropic meds and trying to “fix” problems through other interventions.
Barsness notes five critical differences between non-pharmacological treatment and person-centered care, which I will summarize as follows:
The term “non-pharmacological intervention” perpetuates the notion that dementia behaviors are simply medical problems. Doing so may keep people from looking more closely to find the reasons behind the particular behavior. (For example, if an individual is agitated, it is not enough to say that the person is agitated because he or she has dementia. The more important question is: what is triggering the agitation—and what can we do to help?)
Person-centered care focuses on behaviors of individuals with dementia as being an expression of need and a form of communication. Research in this area supports the belief that so-called acting out behaviors can be due to the environment failing to meet an individual’s specific needs. Rather than just trying to stop a behavior, we need to first determine what it is telling us.
Non-pharmacological interventions tend to measure their success by how well they curb a symptom or behavior. Person-centered care emphasizes other outcomes as well, such as whether the needs of the person were met or their quality of life enhanced.
While non-pharmacological intervention do have value, the do not necessarily improve the individual’s environment or overall experience.
A focus on “interventions” can lead to seeing a disease and symptoms, rather than the total person. (I believe that person-centered care offers the most holistic approach to caregiving.)
For a better understanding of Barsness’ position, you can read the full article here.
A person-centered approach to care emphasizes the value of seeing someone as an individual and not just a patient – or a cluster of symptoms. It stresses the value of understanding and the power of the relationship between the caregiver and care recipient. At Homecare California, we certainly stress the importance of these principles. But it is always worth reminding ourselves of how the language and philosophy of caregiving can influence the nature of the care we provide.
I don’t believe it’s necessarily and either/or situation. Being able to manage a symptom, as clinical as it may sound, can be the difference between an individual being able to remain in the home or requiring institutional care, for example. There is value in focusing on such tools as nutritional modifications, exercise programs, or music therapy.
But the most meaningful approach to care harnesses not only technology and medicine, but looks at the individuals within his or her environment and network or relationships. It is an approach that attempts to solve problems by listening closely to what the individual is trying to tell us is needed. May we all have the patience, the clarity, and the compassion to truly listen.