Long-term care is vitally important in our region: More than eight million older adults are not able to independently carry out at least one basic activity of daily living, such as bathing and feeding themselves, or getting out of bed. So how can we provide them with personalized, quality service? Last Tuesday, April 21, Mayte Sancho, psychologist, gerontologist, and expert in gerontological planning and accommodation models, introduced “Model of Person-Centered Long-Term Care for the Elderly: The Experience of the Basque Country,” as part of a new Panorama of Aging and Long-Term Care webinar. What are the key aspects of this model? Can countries in the region apply it to improve older adult care?
An Example from the Private Sector
Mayte talked about Matia Fundazioa foundation’s experience. The foundation began working in the Basque Country approximately ten years ago to change the traditional care model that was being used in nursing homes. The traditional model, which is characterized by institutional rigidity and impersonal care, often ends up further weakening people’s autonomy. The change of paradigm that the foundation set out to attain was an integrated, coordinated model, focused on people’s quality of life.
A New Model Focused on Quality of Life
But what does this model seek? The answer is clear and simple: It aims to enable older adults to feel “at home” when they receive care at a nursing home. To this end, three key dimensions need to be changed: the physical appearance of the place where they live, the attitude of caregivers and staff (i.e., human resources), and the organizational structure of the nursing home.
Nursing Home’s Physical Appearance
To increase residents’ sense of belonging, rooms (which are usually single or double) come empty, with the exception of a bed, and older adults furnish them as they wish, using their own furniture. The new model also aims at enabling older adults to maintain or regain their autonomy, involving them in activities of daily living, as much as possible. Therefore, people who live in nursing homes that follow this care model feel that they are participating in their own care and they carry out such tasks as shopping, helping to cook, or setting the table. This attempts to dispel the perception that they cannot do things themselves, which is something that often overwhelms older adults in traditional settings.
In addition to nursing homes’ physical environment and involving residents in the home’s daily routine, good treatment by caregivers is fundamental. Great attention to detail and appreciation of the little things are encouraged; this can often make a big difference at a minimal cost. For example, at the foundation, the simple fact that caregivers started wearing “street clothes,” instead of the typical white robes, effected a radical change in the way older adults regard them. They no longer see them as strangers, but as friends who take care of them and are concerned about them. Caregivers are also happier with this new care model because their new work style implies greater involvement, but also a higher level of satisfaction.
Nursing Home Organization
The third dimension that needs to be changed is the organizational aspect. In this sense, switching to the new care model implies a shift from a vertical structure to a horizontal one and includes the creation of interdisciplinary and collaborative teams. In other words, and as a more concrete example, under the new model, instead of doctors and psychologists establishing the guidelines that caregivers must follow, these groups work together to create care plans that are adapted to the specific needs and preferences of each person. There is a shift from control-based management to trust-based management. The emphasis that there is on flexibility, where each person is free to adapt his or her schedule, choose his or her food, or customize the place where he or she lives, means that the environment adapts to the person and not the other way around.
All of the above mainly entails a profound cultural change, which focuses on ensuring older adults’ quality of life in all its dimensions. The results confirm this. In fact, the World Health Organization (2015) underscores the importance of aging in a place that enables older adults to have a sense of belonging and identity as a determining factor in their health status. There is also research that shows the importance of a person’s physical environment on his or her health. In most cases, changes can be carried out without incurring any additional cost (or at a very low cost), for example, avoiding “hospital” lighting or ensuring that nurses do not administer medication at mealtimes. In this sense, a person-centered care model not only is adapted to older adults’ preferences, but also has very positive effects on their physical and mental health.
Long-Term Care in the Region
In Latin America, some nursing homes are gradually beginning to understand the importance of these factors on older adults’ well-being. For example, in Costa Rica, nursing homes encourage residents to use their own furniture and decoration in their rooms. In one nursing home, rooms that house people with cognitive impairment have a picture of the resident in his or her youth hung on the door as a constant reminder to caregivers of the life story of the person they are taking care of. These small interventions can have very positive effects at virtually no cost.
Within the context of this health emergency due to the COVID-19 pandemic, most nursing homes are applying strict protocols and forbidding family visits to protect older adults, who are among the most vulnerable population groups. The fact that residents can still feel “at home,” in a family environment, surrounded by people who take care of them with love and concern, becomes essential, not only to guarantee their emotional well-being, but also to preserve their physical and mental health.
Learn more about this care model by visiting our Panorama of Aging and Long-Term Care website, where the webinar recording and presentation are already available. Would you like to join our next webinars? Please enroll here.
Do you know about any other cases that involve person-centered care models? Please comment below or mention us @BIDgente.