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.

Keywords

person-centered care chronic conditions barriers and facilitators complementary and alternative approaches nursing homes

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References

Arcury

T. A.

Nguyen

H. T.

Sandberg

J. C.

Neiberg

R. H.

Altizer

K. P.

Bell

R. A.

Grzywacz

J. G.

Lang

Quandt

S. A.

(2015). Use of complementary therapies for health promotion among older adults. Journal of Applied Gerontology, 34(5), 552–572. https://doi.org/10.1177/0733464813495109

Arora

Bhattacharjee

(2008). Modulation of immune responses in stress by Yoga. International Journal of Yoga, 1(2), 45–55. https://doi.org/10.4103/0973-6131.43541

Bergman-Evans

(2004). Beyond the basics. Effects of the Eden Alternative model on quality of life issues. Journal of Gerontological Nursing, 30(6), 27–34. https://doi.org/10.3928/0098-9134-20040601-07

Bernabei

De Ronchi

La Ferla

Moretti

Tonelli

Ferrari

Forlani

Atti

A. R.

(2013). Animal-assisted interventions for elderly patients affected by dementia or psychiatric disorders: A review. Journal of Psychiatric Research, 47(6), 762–773. https://doi.org/10.1016/j.jpsychires.2012.12.014

Best

Greenhalgh

Lewis

Saul

J. E.

Carroll

Bitz

(2012). Large-system transformation in health care: A realist review. The Milbank Quarterly, 90(3), 421–456. https://doi.org/10.1111/j.1468-0009.2012.00670.x

Bhatti

G. K.

Reddy

A. P.

Reddy

P. H.

Bhatti

J. S.

(2020). Lifestyle modifications and nutritional interventions in aging-associated cognitive decline and Alzheimer’s disease. Frontiers in Aging Neuroscience, 11, Article 369. https://doi.org/10.3389/fnagi.2019.00369

Bowblis

J. R.

(2011). Staffing ratios and quality: An analysis of minimum direct care staffing requirements for nursing homes. Health Services Research, 46(5), 1495–1516. https://doi.org/10.1111/j.1475-6773.2011.01274.x

Calcagni

Gana

Quintard

(2019). A systematic review of complementary and alternative medicine in oncology: Psychological and physical effects of manipulative and body-based practices. PLoS ONE, 14(10), Article e0223564. https://doi.org/10.1371/journal.pone.0223564

Chuang

Jason

Morgan

J. C.

(2011). Implementing complex innovations: Factors influencing middle manager support. Health Care Management Review, 36(4), 369–379. https://doi.org/10.1097/HMR.0b013e3182100cc2

10.

Cohen

G. D.

(2006). Research on creativity and aging: The positive impact of the arts on health and illness. The American Society on Aging, 30(1), 7–15. https://www.jstor.org/stable/26555432

11.

Desai

A. K.

Grossberg

G. T.

(2001). Recognition and management of behavioral disturbances in dementia. Primary Care Companion to the Journal of Clinical Psychiatry, 3(3), 93–109. https://doi.org/10.4088/pcc.v03n0301

12.

Desai

A. K.

Wharton

Struble

Blazek

(2017). Person-centered primary care strategies for assessment and intervention for aggressive behaviors in dementia. Journal of Gerontological Nursing, 43(2), 9–17. https://doi.org/10.3928/00989134-20170111-07

13.

Dill

J. S.

Morgan

J. C.

Marshall

V. W.

(2013). Contingency, employment intentions, and retention of vulnerable low-wage workers: An examination of nursing assistants in nursing homes. The Gerontologist, 53(2), 222–234. https://doi.org/10.1093/geront/gns085

14.

Fazio

Pace

Flinner

Kallmyer

(2018). The fundamentals of person-centered care for individuals with dementia. The Gerontologist, 58(Suppl. 1), S10–S19. https://doi.org/10.1093/geront/gnx122

15.

Hays

(2005). Well-being in later life through music. Australian Journal on Ageing, 24(1), 28–32. https://doi.org/10.1111/j.1741-6612.2005.00059.x

16.

Hegde

(2017). Music therapy for mental disorder and mental health: The untapped potential of Indian classical music. Bjpsych International, 14(2), 31–33. https://doi.org/10.1192/s2056474000001732

17.

Huang

S. S.

Bowblis

J. R.

(2019). Is the quality of nursing homes countercyclical? Evidence from 2001 through 2015. The Gerontologist, 59(6), 1044–1054. https://doi.org/10.1093/geront/gny148

18.

Hyer

Temple

Johnson

C. E.

(2009). Florida’s efforts to improve quality of nursing home care through nurse staffing standards, regulation, and Medicaid reimbursement. Journal of Aging & Social Policy, 21(4), 318–337. https://doi.org/10.1080/08959420903166910

19.

Jeon

Y. H.

Luscombe

Chenoweth

Stein-Pearbury

Brodaty

King

Hass

(2012). Staff outcomes from the caring for aged dementia care resident study (CADRES): A cluster randomized trial. International Journal of Nursing Studies, 49(5), 508–518. https://doi.org/10.1016/j.ijnurstu.2011.10.020

20.

Kemp

C. L.

Ball

M. M.

Morgan

J. C.

Doyle

P. J.

Burgess

E. O.

Perkins

M. M.

(2018). Maneuvering together, apart, and at odds: Residents’ care convoys in assisted living. The Journals of Gerontology: Series B, Psychological Sciences and Social Sciences, 73(4), e13–e23. https://doi.org/10.1093/geronb/gbx184

21.

Koren

M. J.

(2010). Person-centered care for nursing home residents: The culture-change movement. Health Affairs (Project Hope), 29(2), 312–317. https://doi.org/10.1377/hlthaff.2009.0966

22.

Lavretsky

(2009). Complementary and alternative medicine use for treatment and prevention of late-life mood and cognitive disorders. Aging Health, 5(1), 61–78. https://doi.org/10.2217/1745509X.5.1.61

23.

Maslow

(2013). Person centered care for people with dementia: Opportunities and challenges. Generations, 37(3), 8–15.

24.

Miller

S. C.

Lepore

Lima

J. C.

Shield

Tyler

D. A.

(2014). Does the introduction of nursing home culture change practices improve quality? Journal of the American Geriatrics Society, 62(9), 1675–1682. https://doi.org/10.1111/jgs.12987

25.

Molony

S. L.

Kolanowski

Van Haitsma

Rooney

K. E.

(2018). Person-centered assessment and care planning. The Gerontologist, 58(Suppl. 1), S32–S47. https://doi.org/10.1093/geront/gnx173

26.

Morgan

D. L.

(2003). Focus groups. In Hesse-Biber

S.N.

Leavy

(Eds.), Approaches to qualitative research: A reader on theory and practice (pp. 263–285). Oxford University Press.

27.

Morgan

J. C.

Haviland

S. B.

Woodside

M. A.

Konrad

T. R.

(2007). Fostering supportive learning environments in long-term care: The case of WIN A STEP UP. Gerontology & Geriatrics Education, 28(2), 55–75. https://doi.org/10.1300/J021v28n02_05

28.

National Center for Complementary and Integrative Health. (2016). Complimentary, alternative or integrative health: What’s in a name? https://nccih.nih.gov/health/integrative-health#cvsa

29.

Power

G. A.

(2010). Dementia beyond drugs: Changing the culture of care. Baltimore: Health Professional Press. ISBN, 978–971.

30.

Quinton

(2020, May 18). Staffing nursing homes was hard before the pandemic. Now it’s even tougher. Stateline. https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2020/05/18/staffing-nursing-homes-was-hard-before-the-pandemic-now-its-even-tougher

31.

Sandelowski

(2000). Whatever happened to qualitative description? Research in Nursing & Health, 23(4), 334–340. https://doi.org/10.1002/1098-240x(200008)23:4<334::aid-nur9>3.0.co;2-g

32.

Scales

(2020). It’s time to resolve the direct care workforce crisis in long-term care. The Gerontologist. Advance online publication. https://doi.org/10.1093/geront/gnaa116

33.

Scales

Lepore

M. J.

(2020). Always essential: Valuing direct care workers in long-term care. The Public Policy & Aging Report, 30(4), 173–177. https://doi.org/10.1093/ppar/praa022

34.

Scales

Lepore

M. J.

Anderson

R. A.

McConnell

E. S.

Song

Kang

Porter

Thach

Corazzini

K. N.

(2019). Person-directed care planning in nursing homes: Resident, family, and staff perspectives. Journal of Applied Gerontology, 38(2), 183–206. https://doi.org/10.1177/0733464817732519

35.

Takeda

Tanaka

Okochi

Kazui

(2012). Non-pharmacological intervention for dementia patients. Psychiatry & Clinical Neurosciences, 66(1), 1–7. https://doi.org/10.1111/j.1440-1819.2011.02304.x

36.

Thomas

W. H.

(1996). Life worth living: How someone you love can still enjoy life in a nursing home; the Eden alternative in action. https://www.goodreads.com/book/show/1088160.Life_Worth_Living

37.

Vleuten

Visser

Meeuwesen

(2012). The contribution of intimate live music performances to the quality of life for persons with dementia. Patient Education and Counselling, 89(3), 484–488. https://doi.org/10.1016/j.pec.2012.05.012

38.

Wee

S. L.

Yap

(2020). Timely lessons from a pandemic on the benefits of person centric care in long term care facilities. The Journal of Frailty & Aging, 9(3), 132–133. https://doi.org/10.14283/jfa.2020.28

39.

White

E. M.

Aiken

L. H.

McHugh

M. D.

(2019). Registered nurse burnout, job dissatisfaction, and missed care in nursing homes. Journal of the American Geriatrics Society, 67(10), 2065–2071. https://doi.org/10.1111/jgs.16051

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