While person-centered care has been around for decades now, it took some time to work its way through senior care communities throughout the United States. Even today, there are some skilled nursing facilities as reported in various studies, that are still not fully engaged in culture change, deinstitutionalization or person-centered care. How can this be and why?
Poor Information Exchange
Some studies report that one of the biggest barriers to person-centered care is not poor communication in general, but a lack of specific information about the resident’s personal and clinical background. The breakdown is between the care staff and residents, staff and families and staff to staff. Added to this barrier is the lack of time that many nursing assistants have during a normal shift and staffing, which sometimes can run on the low side. Poor exchange of information, lack of time and staffing shortages do not lend to positive culture change or person-centered care.
High Acuity Residents
Recently, some skilled nursing centers have made the decision to focus on the care of more acute, complex and high-risk residents, many of whom require intensive rehabilitation. Along with this shift, person-centered care may receive less attention and culture change may come to a halt in many care centers. Finances, among other factors, drive this decision, as skilled care is more profitable than residential care.
Staff Turnover
Developing and implementing person-centered care and culture change take a lot of planning, work, and time. Such development requires strong and steady leaders, who themselves, may leave a care community in the middle of a new stage of culture change implementation. Sometimes, when a high-level manager or supervisor leaves, they are not replaced for some time, leaving a gap in productivity and a greater workload for those remaining.
Lack of Management Engagement
One sure way to stop progress in person-centered care and culture change is to have a management and supervisory staff who don’t buy into the program. They show no enthusiasm for changes and don’t play a significant part in helping changes take place. If managers have their own agenda which is not related to culture change, they can become a major barrier to success.
Lack of Training and Education
Person-centered care and culture change require ongoing training and education for staff in each department. Within nursing, social services, therapy, dietary, and environmental services, nothing will change unless there is good knowledge to share and someone who is able to teach it. Finances might get in the way of ongoing training and education but a general lack of concern for it from the top-down may also hinder it.
Final Thoughts on Barriers to Person-Centered Care and Culture Change
While most senior care centers around the country have engaged in culture change or person-centered care, there are still plenty who have not committed to implementing these care- and life-enhancing models. There are many moving parts in senior care and it is easy for road blocks to stand in the way of progress. Strong leadership, well-trained staff, low turnover, personal information about residents and engaged management can make a huge difference in overcoming barriers to person-centered care and culture change.