The Standard of Quality in Assisted Living
“Where did you eat breakfast?” Derean Thornley asked. “Did you get a Bloody Mary while you were at it? I hear their Bloody Marys are really great.”
This wasn’t a conversation between two young adults on a lazy Sunday afternoon. It took place at Warm Valley Lodge, the assisted living community in Dubois, where Derean was working her shift as a certified nurse assistant (CNA). Her friend had just returned from breakfast in town with some visitors, and they were chatting in his apartment. While there, she took his blood pressure.
Some nurses would “just go in and out,” she observed later. “They do what they have to do and then leave.” But for Derean, hanging out and conversing is one of the best parts of the job.
There is a name for this kind of nursing practice: Person-centered care (PCC).
The Center for Excellence in Assisted Living describes PCC as a pivot away from the traditional mentality of the health-care industry, which is focused on the providers’ tasks and efficiency, and toward a custom based on the dignity and self-determination of the individuals in the community. The emphasis is on the individual residents’ preferences and needs–not those of the staff or the organization.
It’s not just a set of rules or a practice standard. For some senior living communities, it’s culture shift, a change of paradigm.
For some others, like Warm Valley Lodge, this philosophy has been embedded in the community from the outset. The term person-centered care was new to Warm Valley Lodge staff members last spring, when they heard about it at a conference–but not the concept. Talking afterwards, Marcy Leseberg and Melissa Miller agreed, “we already do that.”
What does PCC mean in practical terms?
- There’s usually no need to invade another resident’s personal space, for instance, just to collect a sample for urinalysis. A CNA can simply hand a resident a sterile plastic cup with a lid, and pick up the urine sample later. Most people at Warm Valley Lodge are perfectly able to complete that small task for themselves.
- An aging man wants to take care of his own clean laundry, but that’s too cumbersome with his walker, and all that moving about would tire him out. To make him feel less needy, the nurses ask him to tell them where everything goes, and they chat while putting his clothes away.
- To refill a prescription for medication, staff members never drive to the pharmacy for the man who needs it. He has his own car, and he picks it up for himself. The object is not efficiency for the staff; it’s one of many ways to reinforce his autonomy.
- A woman with early-onset Alzheimer’s disease was constantly fretting about the disorder in her apartment (far too many clothing choices and “books flung from hell to breakfast,” as Darean put it). So after asking permission, the staff worked to help the woman organize her belongings. The task isn’t ordinarily in a CNA’s job description, but they knew she no longer had the resources to de-clutter for herself. The result was reduced distress and an increased ability to care for herself.
This kind of effort can have a significant benefit for dementia patients, according to an analysis published in the journal “Clinical Interventions in Aging,” which combined the results of 17 studies. PCC reduces the prevalence of depression particularly for individuals in the early stages of dementia, the authors wrote, probably because they are fully aware of their situation and are grateful to be given choices and opportunities that affirm their individuality.
How can you recognize a senior living community that embraces these practices?
There’s no official checklist, but research shows the features of assisted living that are most important to residents’ quality of life: their level of control, how much they feel themselves to be at home, what they do all day, and their relationships with staff and other residents.
To optimize these, a residence must offer as much privacy and autonomy as possible, learn what each resident enjoys doing and provide those opportunities, and do everything possible to enable close friendships.
An assisted living residence may fulfill all of the regulatory requirements, ensuring proper hygiene, nutrition, and housekeeping, while missing out on opportunities for person-centered care. However clean, bright, and inviting the physical facility may look, the daily routines and schedules that go on behind the scenes could be revealing.
If someone needs help with a shower, for instance, does the schedule require staff to assist in the morning when the resident prefers to have a shower at bedtime? Does housekeeping staff routinely vacuum at night when there’s no traffic in the corridor, although that may disturb someone’s sleep? Is there only one set of options at meals, because that’s simpler for the kitchen staff
The nature and environment of the facility may also be a factor, judging from experience with nursing homes (not assisted living facilities) in Ohio. After that state began to mandate steps toward providing PCC in skilled-nursing facilities in 2015, studies showed that the ones most likely to fulfill the requirements were those located either in large cities or in rural areas, not in mid-sized cities.
Contrary to previous research, they were also more likely to be for-profit entities, rather than nonprofit. The researchers speculated that the for-profit facilities in the study had more resources and a greater ability to change practices quickly in the face of a government mandate. Perhaps nonprofit facilities, being more “mission-oriented,” have been doing this all along, they wrote, and were simply less motivated to spend time documenting their results.
“Most large businesses do not want to run a place like this because it’s too small. There’s not enough profit margin in it,” said Warm Valley Lodge resident Dick Hodge, “But I think it ends up with some very positive aspects because of the personalized relationships between the people that work here and the residents.
“It’s a very powerful thing,” he went on. “You’ve got to talk to each resident and find out what each resident is like,-wise, health-wise, all of the different aspects of a human being, and try to adjust to that. You can watch the people working here and they will treat people differently. But that’s what they need.”
So CNA Chandra Baughn measures vital signs, serves meals, and helps people change clothes if they need it, but she said most of her job is “just to sit and listen to their concerns. A lot of these people don’t have family nearby, so I feel like I’m their family.”
Ultimately that kind of person-centered care works in more than one direction. “The residents embrace each other,” she went on. “They’re concerned for each other. It’s just a big family.”
