A Story
Marie Davis
recently had a medication change that made her dizzy, which caused her to fall
and break her hip. After her hospital stay, Mrs. Davis agreed to go to a rehab
facility until she could gain her strength. Two weeks into her stay, her ability
to conduct basic activities of daily living and her ability to live
independently (ADLs and IADLS) were assessed. As a result, her doctor completed
a form recommending long-term skilled nursing services instead of returning
home and her daughter began looking for a nursing facility for her.
Mrs. Davis did
not want to go to a nursing facility and felt that no one is listening to her
or believed in her capacity to return to her home. She lived in her home for
forty years, had a garden to tend and was the president of the local garden
club. Her vision was to stay in her home for the remainder of her life. She
knew she didn’t have the strength that she used to have, and she sometimes
forgot things, but she had some ideas about friends who could help her. She feared
her way of life was threatened and couldn’t imagine leaving her home. Besides,
what would happen to her cat?
This is a
common scenario for many older adults. As changes occur in health status, sometimes
abruptly, older adults find their sense of choice and control diminishing. The older
person, who has had a lifetime history of making decisions, working, raising
families and participating in community activities finds this pattern disrupted.
Professionals begin talking “around” the person to family members, and family
members begin to make more and more decisions. Assessments focus on the ability
to carry out activities of daily living, and less on remaining capacities and
meanings
What is Person-centered Assessment
and Discovery?
Person-centered
Assessment and Discovery is about continuing to listen to the older adult,
respecting the person’s ideas and opinions and responding to them.
The older
adult is treated with dignity and respect in the assessment process. People are
the experts when it comes to their own lives. They know their strengths and
what they need. While aging naturally brings changes in functioning, it may
also bring new depths of experience and understanding to a person’s life. Throughout
the lifespan, people are growing, discovering, developing new capacities and
contributing to their families and communities. Person-centered Assessment and Discovery
demands an ongoing process of discovery as changes occur in the person’s life. Staff
and organizations who use this approach understand that the older adult’s
viewpoint continues to change, and does not make assumptions or pre-judge. They
believe that the older adult maintains authority for controlling his or her
life, and the older person is fully engaged in this process.
The
assessment process discovers what is important to the older person currently
and what has been important in the past. If the person experiences confusion or
memory losses, it is useful to determine whether there are times of day or
situations when the person remembers better and have conversations with the
person at those times. Even with significant memory loss, older adults can
express preferences and can make large and small decisions about their lives. This
process begins with the assumption that the person is competent and then, if
necessary, validate information through family and friends who know the person
well. For the person who is significantly confused or without capacity to communicate
verbally, the assessment and discovery process includes taking the time to discover
the person’s history, lifestyle, achievements, traditions and preferences as
they existed before the confusion or lessened capacity. This history and
background can often lend perspective on what might be important to the person
now.
Staff and
organizations who use a person-centered approach to assessment and discovery
evaluate the older person’s strengths, resilience and capacity as well as what
supports might be needed for the person to function optimally. The assessment
is conducted without preconceptions about particular services or providers that
would meet the person’s needs, available funding streams, or the choices that
the person might make. For some people, remaining in their own homes is
paramount; others might be interested in exploring a new life in congregate
living. Many needs can be met in many different ways and it is important for
the assessment to fairly and accurately assess what is needed so the older
adult will have maximum choices.
In Person-centered
Assessment and Discovery, the older adult feels fully heard, remains in
authority of his or her life, receives a fair assessment of strengths and
needs, and provides the definition for a personal quality of life.
Resources
The service
system for older adults is being transformed by more person-directed values and
practices within congregate and health care settings and in services at home.
The following websites provide more information about some of these culture
change activities:
Pioneer
Network--www.pioneernetwork.net
Eden
Alternative--www.edenalt.org
The Learning
Community for Person-Centered Practices--http://www.learningcommunity.us/aging.htm
Quality Long
Term Care Commission--http://www.qualitylongtermcarecommission.org/
American
Health Care Association’s Quality First Initiative--http://www.ahcancal.org/quality_improvement/quality_first_initiative/Pages/default.aspx
Person-Centered
initiatives in Medicaid--http://www.cms.gov/CommunityServices/30_RCSC.asp
Recommendations
for Reauthorization of the Older Americans Act by the National Association of
Area Agencies on Aging
http://www.n4a.org/advocacy/campaigns/OAAreauth2011/