Autonomy and Control for Long-term Care Residents

Patient-Centered Long-term Care

Patient-centered care (PCC) can lead to a higher quality of life for the long-term care resident. PCC is seen as the "gold standard," although there is no universal definition of PCC. In 2016, the American Geriatric Society defined "person-centered care as a model in which an individual's values and preferences guide all aspects of his or her care."^[1]

Calkins and Brush^[2] outline an approach to PCC in the long-term care setting that stresses individual choice and a focus on quality of life. They acknowledge the challenges of implementing PCC, particularly when the patient's preferences are viewed by others as risky in terms of patient safety and opening the door to allegations of negligence or unsafe care. Facilities are apprehensive about legal and regulatory liabilities if residents experience untoward events. These facilities place too much emphasis on the risks of honoring a patient's wishes and fail to weigh the positive outcomes of respecting patient wishes that may enhance quality of life.

The Centers for Medicare & Medicaid Services (CMS) recognize the importance of the individual's right to self-determination,^[3] viewing this right as being just as important as any safety concerns. The Rothschild Person-Centered Care Planning Task Force created A Process for Care Planning for Resident Choice, designed to aid caregivers in working with individuals, families, or representatives to both understand and respect choices to the greatest possible extent within CMS regulations. The steps in the process are:

1. Identify and clarify the individual's choice;

2. Discuss the choice and options with the individual;

3. Determine how to honor the individual's choice and which choices are impossible to honor;

4. Care planning the individual's choice;

5. Monitoring and making revisions to the plan; and

6. Quality assurance and performance improvement.

This tool was sent to various health communities to pilot test the process with their residents. All of these care communities found the tool helpful and worthwhile, and they plan to continue using it.

It is easy to become weighed down in trying to meet all mandates in long-term care. For too long, what is in the best interest of the patient has been based on the medical model, assuming the patient to be passive and compliant. PCC allows patients or residents to have an active voice in directing their own care, and it encourages their participation on the healthcare team, even when their decisions are viewed as posing risk.

Medscape Nurses © 2016  WebMD, LLC

Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.

Cite this: Autonomy and Control for Long-term Care Residents - Medscape - Oct 05, 2016.