Question

Why are dedicated PCC based care facilities such as Eden Homes, Green Houses and Wellspring Model Homes or comparable facilities limited in Canada? What is needed to allow for establishment of such facilities?

Answer 1

Person-centered care is essential to good dementia care and the underlying philosophy of the 2018 Alzheimer’s Association Dementia Care Practice Recommendations. Person-centered care is a philosophy of care built around the needs of the individual and contingent upon knowing the person through an interpersonal relationship. It challenges the traditional medical model of care that tends to focus on processes, schedules, and staff and organizational needs. It requires commitment from everyone within the organization, especially leadership. Whether referred to as “person-directed,” “resident-focused” or something similar, the core principles are essentially the same.

Elements of person-centered care can be seen in the Federal 1987 Nursing Home Reform Act (OBRA ‘87). OBRA ‘87 states that each person receives the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, in accordance with the comprehensive assessment and plan of care. Additionally the culture change movement, consisting of models like the Eden Alternative, Wellspring, and Greenhouse/Small House, implemented various elements of what we now call person-centered care. One of the best known of these models is The Eden Alternative, founded by Bill Thomas. Its central mission is to eliminate the three ‘‘intolerable plagues’’ of nursing home life—loneliness, helplessness, and boredom—by following ten Eden principles, thereby improving elders’ quality of life (Thomas, 1996). One important strategy in this approach is to transform the physical institutional environment to be more homelike. Plants, animals, and intergenerational programs are included in the homelike environment to enhance the elder’s social engagement. The Green House or Small House model aims to provide a good quality of life for residents by transforming physical environments, radically revising staff configurations, and emphasizing companionship under normal rather than therapeutic circumstances (Li & Porock, 2014). Person-centered care is also an important component of the 2016 Centers for Medicare and Medicaid Service (CMS) Quality Strategy as noted in “Goal 2: Strengthen person and family engagement as partners in their care.” The objectives of Goal 2 are to ensure all care delivery incorporates person and family preferences, improve experience of care for persons and families and promote self-management.

The "culture change" movement represents a fundamental shift in thinking about nursing homes. Facilities are viewed not as health care institutions, but as person-centered homes offering long-term care services. Culture-change principles and practices have been shaped by shared concerns among consumers, policy makers, and providers regarding the value and quality of care offered in traditional nursing homes. They have shown promise in improving quality of life as well as quality of care, while alleviating such problems as high staff turnover. Policy makers can encourage culture change and capitalize on its transformational power through regulation, reimbursement, public reporting, and other mechanisms.