We Need a Commitment to Person-Centered Long-Term Care - Lenard Kaye, Director, University of Maine Center on Aging
by Lenard W. Kaye, Director, University of Maine Center on Aging
Printed with permission from the author. Originally appeared in the Bangor Daily News Opinion Section on December 14, 2021
Lenard W. Kaye is a professor at the University of Maine School of Social Work and director of the University of Maine Center on Aging. He is a member of the Maine chapter of the national Scholars Strategy Network, which brings together scholars across the country to address public challenges and their policy implications. Members’ columns appear in the BDN every other week.
Nursing home staff and residents across the nation have faced extraordinarily difficult times over the past two years. During the first year of the pandemic, nursing home residents accounted for 31 percent of all COVID-19 deaths in the U.S. As of the end of November, the Centers for Medicare and Medicaid Services reported approximately 735,000 confirmed COVID-19 cases and 141,000 deaths among nursing home residents. The numbers rise to over 1.4 million cases and 180,000 resident deaths for all long-term care settings (nursing homes, assisted living and other types of congregate care) or roughly one-third of the cases and fatalities reported in the U.S. in the first year of the pandemic alone.
A number of factors appear to have contributed to these devastating statistics, including the communal nature of life in long-term care settings, the compromised health of long-term care residents, the initial lack of personal protective equipment, unsafe organizational health care practices, and both under-staffing and inadequate training of staff.
Have public perceptions of long-term care been affected by the impact of the pandemic on nursing home resident safety and well-being? The answer is a resounding “yes.” A recent poll by the John A. Hartford Foundation of persons 50 or older, found that 71 percent of those surveyed are unwilling to live in a nursing home in the future with 57 percent saying that the COVID-19 pandemic has negatively influenced how they feel about those settings. And, 90 percent said that changes are needed in order to make nursing homes more appealing with Black and Hispanic older adults more likely to say that nursing homes are unsafe.
Increasingly, calls to fix America’s long-term care system are being heard including the need for greater national investment in that system, increased worker salaries, improved oversight, and reassessment of the federal system for evaluating nursing homes. The pandemic has resulted in the increased volume of advocates’ voices heard in this regard. No doubt, these policy-level actions are well advised and urgently needed but, it is argued, not adequate in and of themselves.
At the service delivery level, a more consistent and broad-based change in long-term care philosophy needs to be adopted as well. Now, more than ever, health care in nursing homes and other long-term care settings needs to be person-centered, meaning that success in care delivery and patient outcomes should be measured from the perspective of the patient, including how well staff communicate, coordinate, and share decision-making with residents and their families. The National Quality Forum (NQF) Leadership Consortium, a national not-for-profit organization that gives all healthcare stakeholders a voice in advancing quality measures and improvement strategies leading to better health care outcomes, has set this as one of its three 2022 Priorities for Action. Their decision is to be applauded.
Nursing homes, regardless of auspice, size, location or resident profile, need, once and for all, to make a commitment to embracing person-centeredness. Simply put, person-centered care is highly personalized care that is underpinned by strong communication and a team approach. It focuses on moving care from a model that is medically or task-driven, to one that is driven largely by resident preferences for care and social connectedness.
Thoughtful person-centered long-term care also gives strong consideration for racial and socioeconomic equity and health emergency preparedness. It values holistic resident preferences for care, creating homelike physical spaces, responding to emotional need, and maximizing quality of life. The continuous input and buy-in from frontline staff, residents and family members is vital to genuine and successful person-centered care implementation. Robert Mayer, a leader and visionary of the person-centered care movement, may have said it best in reminding us of the “power of the built environment” and the critical importance of “listening to the voice of those receiving care.” Those residing in long-term care settings deserve nothing less.