Saturday, December 7, 2013


Don't miss another article about the roots of the person-centered approach: 

When I left you in my last article, we were still on the roller coaster of the “early” phases of a person-centered initiative (click HERE for Part One) We were about to embark on a small pilot program on one of the smaller units of the nursing home, this time explicitly fostering Person-centered Care. The plan was to bring residents and staff together for a constructive experiment in collaboration.

We (the Administrator, Director of Nursing, the Unit Head Nurse, and I) agreed that through the holidays and into January, I would be meeting with staff and residents to build mutual trust and to learn what improvements staff and residents might most want to pursue. As I moved forward, what I unearthed surprised me. 

I merely had to scratch below the surface to see that current circumstances and climate would not support a person-centered initiative at this time. Activities on the unit were limited to two per week. For the generally spirited residents, their mounting boredom had two results: a few residents began venting their frustration and fomenting still more unrest; while others kept more to themselves, either turning inward or decamping elsewhere in the building. There was understandably, a negative amount of community, if such a thing is possible. 

Though the floor nurse had suggested I get to know her staff better, she then let me know that staff didn’t have time to talk to her, let alone me. When I did talk to a couple of them, they smiled and nodded but seemed very nervous and all but one declined to ask questions. 

Both the head nurse and the activities person assigned to that unit declared that they had reached a limit with one of the residents who was openly promoting complaint fests and was emotionally abusive to another resident. The solution mentioned to me was to move the resident to another unit. Hmmm. This was consistent with a pattern I had at times noticed in some residents and staff to smooth over “problems” and to make nice, rather than look creatively for a customized person-specific opportunity. The quiet resident is not necessarily the happy resident, even if they say that they are. But problems can be opportunities if thought of in the right way.

I believe that a person-centered approach can, over time, heal even this degree of distrust and unhappiness. I believe it would have taken at least: a vital and stimulating activities program appropriate to the high abilities of the residents; time to talk with the staff to grow trust and foster curiosity about person-centered principles; support of staff in eliminating obstacles to their work and growing pride; and perhaps most essential, the visible presence, support, and participation by upper level administration.

But I would be remiss if I left you there, thinking that this was a failure. It wasn’t, and this another way in which my understanding of “person-centered” was deepened. My mentor on this project had told me repeatedly, “Person-centered is not about the goals, it is about the journey.” Even in my three years as Ombudsman I modeled the slower person-centered way of listening with eye contact and respect. I routinely directed conversation to inquiring into resident choices. None of us knows the difference we make as we move through our days, but I know my presence mattered to quite a few residents. Perhaps I even broadened the viewpoint of a few of the staff. I didn’t “get the results” that one might look for as a measure of success, but I know that that way of thinking never brings real success because real success isn’t a static end-point of arrival. It is an ever-ending evolving climate change. 

I will continue to support two residents who are now fired up by their participation in a state-wide coalition of nursing home residents. Their fire may be one more spark that will travel to ignite the spirits of others. That’s how culture change happens.

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