Is It Time to Move Beyond Person-Centered Care?

By Brooke DeNisco

For years, person-centered care has been the gold standard. Expressing anything other than a total commitment to person-centered care is practically heresy. Of course, I think everyone would agree that all care should be centered around people. But person-centered care goes further, claiming that, for a good quality of life in, say, a nursing home or assisted living community, each person must receive the utmost in individualized care.

This involves understanding their preferences, favorite meals, favorite songs and activities, personal history, and preferred daily routine. This is an admirable goal, but, especially when it comes to activities, it is not always possible to achieve it in a community setting.

I worked in a residential care facility with approximately 100 residents. As the sole life enrichment coordinator, I conducted and documented interviews and life histories with each resident. My goal was to respect each person’s personal preferences, but the 100:1 ratio made that very challenging.

There was also an inherent unfairness. Because I couldn’t provide one-on-one activities of choice for every person, I had to pick and choose. And honestly, the people I got along with and felt aligned with, interest-wise, got more time with me.

One woman wanted to write a children’s book, a project that excited me. I helped her achieve that goal. But at what cost to the person who wants to play poker every day?

I did find many creative ways to merge people’s interests. For example, I hosted a weekly coffee house with music, where I made espresso drinks and the kitchen served cookies. It offered something for people who liked socializing, drinking coffee, and listening to music. There were also usually one or two games played, along with some interesting discussions.

Sometimes one person’s choice clashes strongly with most of the community. What if one person wants to watch Jeopardy! on the big television, but 60 people would prefer to watch football? Person-centered care does not favor the majority. So, 60 people clamoring for sports should not automatically take precedence over one person watching Jeopardy! Of course, there are solutions, like multiple televisions, but in this community, that was not possible, and the Jeopardy! fan could not afford to purchase their own TV.

Even when simple solutions exist, the process becomes much harder when only one or two activity professionals are responsible for figuring them out. Living in a community, by definition, requires people to consider others, not just their own preferences. If your personal choice is the opposite of someone else’s, there will be a clash. And there are many clashes.

Treating every person with dignity, respect, and autonomy is crucial. These are essential elements of all care and interaction. But the expectation that each person in a community will have their specific preferences met most of the time is unattainable.

When executives and marketing managers tell prospective residents and their families about person-centered care, they are saying the right words, but they are likely making a promise they can’t keep. It probably won’t be their direct responsibility to implement it, which may make it easier to promise.

When senior living executives aren’t talking about person-centered care, they are probably mentioning the very real importance of “connection” and “engagement.” These are also very good concepts, but they are usually realized in the context of a group, not specifically because of person-centered care.

The idea of community-centered care, which involves learning to connect with different people, respect their preferences, and have your own preferences heard, is a more reasonable and realistic approach. It could also be a more rewarding way to live.

Brooke DeNisco is the Lead Content Writer at Activity Connection. After earning a B.A. in English literature from Colorado College, she worked for Outside magazine and several newspapers.

While living in Portland, Oregon, Brooke got hooked on yoga and eventually moved to Los Angeles to become a certified instructor. Her interest in teaching yoga to older adults led her to study recreation therapy at San Francisco State University. She went on to spend 12 years working in residential care, memory care, and assisted living communities.

In her spare time, Brooke enjoys hanging out with her daughter, a student at Reed College, foraging for mushrooms, and rooting for her local NBA team, the Portland Trail Blazers.

Fun fact: Brooke was once a loyal Activity Connection subscriber. She first contacted the company about working there in 2007 and was hired 11 years later, in 2018.