Topics - Geriatric Care
Basic Principles of Patient- and Family-Centered Care
The essence of patient-and family-centered care is captured in the following four principles. Each principle is presented here, followed by examples of how it is being put into practice to improve the quality of care for older people and their families.
Principle 1. People are treated with respect and dignity. The expertise, preferences, and culture of each individual and family are valued. These features form the basis for communication and relationships.
Hearthstone Alzheimer Care administers seven long-term care facilities in Massachusetts and New York. The philosophy of the organization embraces families and invites their participation. Each facility has a newsletter, for which families are encouraged to write biographies of the resident family members. At each site, families participate in planning a family meeting once a month that includes a presentation and a period for general discussion. Families are also encouraged to develop projects that benefit the group and the residents. For instance, families recently participated in a project to research music that the residents had enjoyed when they were younger, and they put together a list of music titles for reference when planning events.
Residents often enter the Hearthstone facilities requiring only assisted living. However, the facilities are designed for continuity of care. As individuals progress through the stages of Alzheimer’s and require enhanced levels of care, they continue to be cared for on site. Hospice care is available, and families participate in care to whatever extent they wish.
Principle 2. Health care providers communicate and share complete and unbiased information with patients and families in ways that are useful and affirming.
Beginning as a department of the San Jose Medical Center, the Plane Tree Health Library in San Jose, California is now a freestanding health library that serves the entire community. As one of its first services, a nurse on its staff went bed to bed in the hospital asking patients and families if they wanted information about any health topic. A packet of material was prepared and brought back in response to each request. In addition, a book cart of health information with reference books and wellness literature circulated on the floors. At the same time, patients and families were encouraged to visit the library, and many have continued to return for health information up to several years after discharge. Housed in a renovated Victorian structure, the library offers more than 3000 books, extensive files of articles and clippings, and Internet access. Senior citizens are provided with individual instruction about using the Internet. The community clearly feels the library lives up to its motto: “Walk in with questions. Walk out with confidence.”
Principle 3. Individuals and families build on their strengths by participating in experiences that enhance control and independence.
The wife of a stroke survivor in Des Moines, Iowa found that there was no local stroke support group. She and a speech-language pathologist at the Iowa Health System who worked with her husband initiated the Stroke Club. It is run collaboratively by the speech pathologist, members of the group, and volunteers from the community. Once a year, interested members get together for dinner to plan the programs for the upcoming year. Physical therapy students from a nearby school of osteopathy attend the meetings as part of their curriculum. Occupational therapists, physical therapists, and social workers regularly attend from the Younker Rehabilitation Center.
Principle 4. Collaboration among older people, their families, other community caregivers, and health care providers occurs in policy and program development and professional education, as well as in the delivery of care.
The cultural milieu at the Brandon Wilde Center in Augusta, Georgia, is such that staff and administrators recognize the people who live there as colleagues who have valuable skills and experience. In 1999, the Center underwent the year-long process required to become fully accredited by the Continuing Care Accreditation Committee of the American Association of Homes and Services for the Aged. When asked to help, 75 residents volunteered to form committees with staff members to prepare for the survey. The site visit included a tour for the surveyors by a group of residents.
A Resident Council member recently raised the issue of buying a defibrillator for the center. A special committee of residents was formed to examine this complex issue. After contacting the American Heart Association and other facilities, the committee assisted in the development of a policy governing the defibrillator’s use in response to emergency calls from throughout the campus. The committee was also involved in purchasing the defibrillator unit.