Person-Centered Care
Redefining Quality for the New Age of Aging
Imagine.
You’re the CEO of a home care agency and you’re in your office reading letters from clients and their families.
Those letters are brimming with compliments and praise. A daughter writes to thank your team for arranging a special trip for her dad to his boyhood home two towns away, including securing a wheelchair van. “Your team really sees Dad as someone who’s lived an amazing life, which he has,” the daughter writes. You set her note on top of a growing stack of similar letters to share at the next all-agency meeting.
Or imagine you’re a nursing center administrator making your morning rounds, checking in with staff, residents, and family members. And everyone seems fulfilled.
A son pulls you aside. He shares how much it meant that one of your caregivers made sure his mom’s bed was set up so she and her best friend could do crosswords together when the friend visits. That caregiver, by the way, loves her job and just celebrated her 5-year work anniversary.
CEO or administrator, you smile as you head off to your first meeting of the day, where you get to congratulate your department heads on your latest quality ratings—the best in your area. Days like these remind you why you got into long-term care. What if they happened all the time?
Long-term care is at a crossroads. We have a tremendous opportunity before us to change the status quo — quality ratings that can be meaningless, negative public perceptions, high workforce turnover, and a complete lack of a plan to address the coming tsunami of older adults in the next decade.
We must change. Our long-term care system is barely a system. It is hard to navigate and often leaves older adults and their families lost and confused. It creates roadblocks to providing the personcentered care they need and deserve. Fractured and disjointed, our system is hanging by a thread and will surely break when the bulk of baby boomers age into our care.
So let’s start the conversation, because we can’t fix what we’re not talking about. At CareScout we’re charting a bold new path for long-term care, but we can’t do it alone. Real change can only occur if we discuss our challenges openly and individual providers take up the cause and lead the way.
We’re building a curated group of likeminded providers in assisted living, nursing centers, adult day care, and home care called the CareScout Quality Network. This network is redefining the concept of person-centered care to help simplify and dignify the aging experience, from making it easier to find quality providers, to making it possible for more older adults to be cared for at home and age in place.
Intrigued?
What follows is a conversation starter: how CareScout views person-centered care and how our unique approach can benefit everyone in the long-term care ecosystem, including providers.
Person-Centered Care
One name, many interpretations
The Concept of Person-Centered Care
The concept of person-centered care has begun to appear more frequently in healthcare in recent years. And with good reason: Compared to care that focuses mainly on illness or health conditions, person-centered care has proven to offer more complete, more effective care that results in improved outcomes and higher patient and provider satisfaction.
More frequent use, however, has made it clear that what is meant by “person-centered care” can be in the eye of the beholder. It is often thought to be the same as patient-centered care, but there are important differences. Patient-centered care was introduced by psychologists in the 1950s and began to emerge in primary care in the late 1960s, still later in the acute care hospital setting. It continues to evolve to this day.
Both patient-centered and person-centered care emphasize seeing the patient as a unique human being and treating the whole person. Here, for example, is how the Institute for Healthcare Improvement has defined patient-centered care:
Care that is truly patient-centered considers patients’ cultural traditions, their personal preferences and values, their family situations, and their lifestyles.
It makes the patient and their loved ones an integral part of the care team who collaborate with healthcare professionals in making clinical decisions …
When care is patient-centered … unneeded and unwanted services can be reduced.1
All of this is true for person-centered care as well. Person-centered care takes this concept further, however, to emphasize addressing physical, mental, social, and spiritual health for long-term well-being, all based on who the person is rather than what health issue or condition they present. It is, in short, more personal.
Many descriptions of person-centered care exist. Morgan and Yoder (2011) identified four attributes that distinguish personcentered care: holistic, individualized, respectful, and empowering.2 Today, the Centers for Medicare and Medicaid Services (CMS) defines person-centered care as having five elements:3
01 Guided care
Care that’s guided and informed by patients’ goals, preferences, and values
02 Measured success
Success measured by patient-reported outcomes
03 Coordinated care
Integrated and coordinated care across health systems, providers, and care settings
04 Managed conditions
Managing chronic and complex conditions
05 Trusting relationships
Relationships built on trust and a commitment to long-term well-being
Other healthcare-related organizations, both public and private, also offer their own definitions of person-centered care, along with varying models and principles. Still, there is no one prevailing definition or model for person-centered care.
Person-Centered Care versus personalized medicine
Person-centered care also can be confused with personalized medicine, but they differ. As Ekman, et al. pointed out, personalized medicine prescribes treatment based on what a patient presents, including genetic variations, while a person-centered approach
… [is] based on who the person is: their context, their history, their family and loved ones, their individual strengths and weaknesses… Person-centered care highlights the importance of knowing the person behind the patient — as a human being with reason, will, feelings, and needs — in order to engage the person as an active partner in his/her care and treatment.4
Person-centered care is based on who the person is versus what they present.
The Cost of Confusion
The problems created by this ambiguity are more than just semantics.
At CareScout, we see at least three major issues stemming from failing to place the older adult at the center of care — issues our vision for person-centered care is designed to address:
01 A negative impact on care
Staff of long-term care providers who don’t fully understand what person-centered care truly is or how to deliver it can’t possibly meet a care recipient’s expectations—even if they believe they are providing person-centered care. Especially in long-term care, where older adults can be viewed as without dreams or aspirations and only need to be “maintained”—in other words, less than a whole person—the result can range from substandard care to outright neglect. It is not the aging journey we would wish for our loved ones or for ourselves.
02 A fragile, fragmented system
The long-term care system relies heavily on an informal and nonprofessional network of family, friends, and neighbors trying to navigate the system on behalf of the older adult. These family caregivers are scared for their loved one, confused about what is available to support them, and feel unqualified to decide between in-home care or a residential placement. They are also often in the dark about what the care seeker has paid into insurance or what they can afford moving forward. They either have no support, or they don’t know where to find it.
03 A lack of specific, objective criteria
Current methods for measuring quality in long-term care can result in misleading quality ratings—sometimes very misleading. In March 2021, a New York Times investigative report exposed the contrast between Medicare Five-Star Quality Rating System scores for nursing centers and actual quality. The Times found that one in three nursing centers misreported data about residents’ well-being, including nearly 800 facilities with top ratings. In all, of the more than 3,500 nursing centers rated with five stars, over 2,400 were cited for problems with infection control or patient abuse.5
Current quality measures also tend to equate quality with safety and don’t go far enough in measuring what can bring true satisfaction in long-term care beyond physical health: having choices, feeling respected and empowered, having confidence in one’s caregivers, receiving responsive attention, feeling happy, liked, and even loved. Quality means more than safety — much more.
Quality means more than safety.
The result of these failures is perpetuation of the status quo in which care seekers and care recipients have little choice but to endure a fragmented, intimidating, and unfair long-term care experience. The burden is on them to find what they need.
The good news?
It doesn’t have to be this way.
Quality means more than safety.
The result of these failures is perpetuation of the status quo in which care seekers and care recipients have little choice but to endure a fragmented, intimidating, and unfair long-term care experience. The burden is on them to find what they need.
The good news?
It doesn’t have to be this way.
The CareScout Approach
Dignifying the aging experience
One definition
CareScout is addressing these challenges by making it easier to evaluate, identify, and support the delivery of person-centered care in long-term care settings. It begins with a simple definition:
Person-centered care looks beyond safety to integrate a person’s values, preferences, and goals into the care they receive. It creates a partnership between caregiver and care recipient that encompasses the physical, mental, spiritual, and social elements of a person’s health.
That’s the what, the who, and the how of person-centered care. Here’s the why:
To support an aging experience that is dignified, connected, and fulfilling.
This goal recognizes that older adults have aspirations just like anyone else. It’s an attitudinal shift that requires a radical rethinking of the aging care experience for a reimagining of how excellent long-term care can be.
A New Mindset
Words are powerful, even in our minds. Whether we’re discussing care recipients with colleagues or just thinking about the people we serve, framing our thoughts in a more person-centered language can help reshape how aging and long-term care are viewed:
Think:
“journey continuation”
“care experience”
“person with aspirations”
“life story”
“goals, preferences, and values”
“with” and “for”
Instead of:
“life stage”
“care delivery”
“person with a problem”
“medical history”
“health goals”
“at” and “to”
The CareScout Quality Network
Identifying and supporting person-centered care
Providers who embrace person-centered care as foundational to safe, quality care are invited to join the CareScout Quality Network. The CareScout Quality Network will reframe how care seekers find, choose, and feel confident about their care. Some of the innovations we’re introducing to the market include:
Objective evaluations
CareScout will be launching a Person-Centered Care (PCC) rating program whose goals are to educate and evaluate providers and to work with those providers to elevate their person-centered methods. The program includes surveying care recipients and provider staff directly to gain objective insight from the people most affected by the care experience. (See Table 1 for sample questions.)
Simpler identification
Survey findings help CareScout identify long-term care providers who embrace person-centered care as integral to the services they provide. Providers who participate in our Person-Centered Care rating program can earn badges highlighting their status as a quality provider on their CareScout.com profile, making it easier for care seekers to find options for quality care.
Continuing education
Building a person-centered care climate requires ongoing support, especially given high workforce turnover in the industry. We support providers with free CE-credit courses aligned with person-centered care through our CareScout Quality Care Academy. These 60-minute, curated courses include modules for administrators, clinicians, caregivers, HHAs, and CNAs. Providers in need of improvement are also supported through our Academy with targeted education to help them improve their results.
Supporting care seekers: Why not home?
CareScout also offers support to family, friends, and neighbors of the older adult, guiding them through the long-term care system and connecting them when appropriate with quality providers of in-home care services. Supporting a safe plan of care for home creates opportunity for dignified aging in place, and often at lower cost than facility-based care.
Table 1.
Sample survey questions for care recipients and provider staff
Care recipients
I feel like:
The care and support I receive from the staff at [company name] follow a plan that is based on my choices, my beliefs, and what’s important to me.
I am listened to and have a voice in my own care and the services I receive.
The staff uses language I can understand when we communicate about my options and my needs.
The staff from [company name] are knowledgeable about my preferences, and they will change how they care for me based on my preferences.
I am valued and respected by the staff at [company name].
Person-centered care staff
My peers and co-workers:
Respect the values and choices of our clients regarding how, when, and where they want to be cared for.
Ensure that care plans reflect our clients’ choices, values, and beliefs.
Respect the different cultures of our clients and engage with them in ways that are appropriate to their background.
Communicate with our clients using language they can understand.
Are effective at communicating with each other and holding each other accountable regarding the needs of our clients.
What makes this centered care different?
If care recipients feel respected, confident, happy, and loved, it’s likely their caregivers will feel that way, too.
We see the aging care experience as part of a journey, so for us person-centered care is not just about outcomes but also about how we get there. The quality of the journey itself is also an outcome.
This is a key difference in what we look for in a provider and how we measure quality, as illustrated by the sample survey questions in Table 1 (above). It’s why we’re making it simpler for care seekers and providers to find each other, because the journey begins long before any care is provided. Seeing care as part of a larger journey is central to creating an aging care experience that is dignified, connected, and fulfilling.
Another key difference is our recognition that the person-centered care experience is made possible by other persons — provider staff. They are on this journey, too, and are also affected by it. The better staff members are supported, the better able they become to provide quality, person-centered care. They too can enjoy an experience that is dignified, connected, and fulfilling.
In fact, if care recipients feel respected, confident, happy, and loved, it’s likely their caregivers will feel that way, too. That’s how human connection works.
A bold new path that benefits everyone
Person-centered care works, plain and simple. Studies have shown it leads to better patient satisfaction and engagement, less stress for the workforce and lower turnover, better clinical outcomes, safety and quality, and better value care through lower costs of care. At CareScout, we strongly believe that person-centered care, lovingly provided, fully supported, and properly evaluated, is the bold new path for long-term care.
Join our movement
We invite you to partner with us to create a new standard and new expectations for long-term care. For providers seeking to lead in the new age of aging, we offer:
01 Connect with care seekers
with our access to 1 million+ long-term care insurance policyholders.
02 Recognition for quality care
as part of a curated group of providers known for their quality and commitment to person-centered care
03 Support for person-centered care practices
through access to free CE-credit courses aligned to person-centered care and inclusion in our person-centered care program.
Footnotes:
1. Cliff, B. The Evolution of Patient-Centered Care. Journal of Healthcare Management. 57(2):p 86-88, March-April 2012.
2. Morgan S. and Yoder L.H. A concept analysis of personcentered care. J Holist Nurs., published online 19 July 2011.
3. CMS.gov. Person-centered care. Accessed 6/15/2023.
4. I. Ekman, et al. Person-centered care — ready for prime time. Eur J Cardiovasc Nurs. 10 (2011) 248–251.
5. Silver-Greenberg, Jessica, and Robert Gebeloff. “Maggots, Rape and Yet Five Stars: How U.S. Ratings of Nursing Homes Mislead the Public.” The New York Times, 13 Mar. 2021. https://www.nytimes.com/2021/03/13/business/nursing-homes-ratings-medicare-covid.html.