The term ‘person-centred care’ appears to be everywhere, an absolute buzz-term at the moment in so many different areas. But what does it really mean to the people working with dementia every day?
We have been talking a lot about person-centred care recently. Not so much because it’s something that we do – even though it is, and it is the core of our work – but more so because we are concerned about how its meaning is becoming rather confused. In many ways, I am starting to feel that its real meaning has been lost over the years.
When I interviewed Michael Spellman to find out about his fascinating locksmiths programme, we talked about this too. We both recalled how, when doing degrees in psychology and counselling, the person-centred approach as developed by Carl Rogers, that we had both focused on, was a very clear set of core conditions - congruence, unconditional positive regard, and empathic understanding - specific things that were crucial to working with individuals. We also recalled the impact of this phrase when used by Professor Tom Kitwood, who developed the Enriched Model of Dementia, and was the first person to use the term ‘person-centred’ in regards to understanding dementia. This understanding is something that we have both subsequently carried with us through our years in dementia care, and understanding its historic origins has been very important.
But, more crucially, it’s been most relevant when we’ve seen it in practice. Michael explained: “For me the person-centred theory has a lot of history to it, and something that is palpable when applied to care. You should be able to see when a person is receiving person-centred care because the staff know the person so well that the staff have changed around the person, they have not expected the person to change and ‘fit in’ with them or how they do things.”
It is so true that the way person-centred care most shows itself is in seeing how carers have worked to change and develop themselves around the person they are caring for. And, those people who genuinely practice person-centred care, get an enormous amount of satisfaction, pride and joy from doing what they do and the way that they do it. “Done at an individual level, person-centred care is possible by taking the time to understand the person and committing to following approaches which work for that individual,” agrees Michael.
But – he also has a word of caution. “On a larger, and more complicated scale, person-centred care requires enough funding and resources being made available to be able to deliver this type of care, truly person-centred care which is lives up to the use of the term.” And, this is where we come to the problem. Person-centred care shouldn’t be formulaic – that turns something that should be instinctive and natural into a goal attained by certain prescribed actions without necessarily really seeing the person. Person-centred care as a ‘concept’ is very dangerous – because it becomes something you can add to a list. You can start to say: “We do person-centred care.” But person-centred care is something that you are, not something that you do.
I get very concerned when I see person-centred care being used as a tickbox exercise. It has to be led by your heart, by your real care for a person, and any amount of legislation or directives telling you how to do it, completely undermine the concept in the first place. Person-centred care works by the fact that you’re motivated to care for a person, and that you want to know about them and what makes them tick. You are interested in their likes and dislikes, their backgrounds, their experiences – you want to serve them in the best way, for them.
“I do think that the concept of person-centred care is something that requires a challenge from time to time,” agrees Michael, explaining the extent to which he sees person-centred care reaching. “The tasks in the person’s care plan reflect how and when the person wants/needs support, the approach to completing those tasks works for the person, even if the approach needs to change from one person to the next. The person’s feelings and point of view is validated. The person has activity and occupation in their life which has purpose and authenticity. If you see these components, you are very likely to see a happy, safe, and content person living in the middle of that care.
“So, I think we should challenge descriptions of person-centred care which extends only to knowing a person’s name or preferred name. Yes, those things are a good start, but should that be described as person-centred or basic courtesy?” he asks.
Challenging the understanding of person-centred care is something that Michael is tackling every day, and bringing into the culture as a foundation of his company. It is great to see people as passionate as Michael and organisations as forward-thinking as Extra Care pushing the agenda for what person-centred care really means.
Because the biggest part of achieving person-centred care is about choosing the right people to do that job. Far from being something that offers a chance to tick a box or get a gold star, person-centred care is something which has its own rewards. Anyone can tick a box, but that doesn’t mean they will be really caring. Either you want to go to that level of care, or you don’t. Person-centred care is as much about the person giving it, as the person receiving it. It’s very intimate, and it’s about moving to a different part of your being and connecting with people in a real and heartful way.