A Story
Ralph
Waddell’s wife recently died suddenly after 45 years of marriage. He has
numerous health problems including diabetes and high blood pressure, and he
always relied on his wife to help him. She knew how to test his blood sugars
and adjust his insulin, cooked healthy meals and fussed when she saw him
sneaking sweets. She also walked in the neighborhood with him, which helped him
keep his weight and blood pressure under control and gave them opportunities to
visit neighbors. Since his wife’s death, Mr. Waddell’s health has deteriorated.
He feels depressed, has gained ten pounds, and went to the emergency room twice
when he became sick due to blood sugar fluctuations. He has recently had
trouble walking due to a sore on his foot which won’t heal.
A doctor at
the emergency room referred him to a home health case manager, who came to see
him and plan for his needs. Based on the medical information in his chart and
her assessment, the case manager planned for him to receive in-home services
from a nurse and a home health aide for health evaluation, nutritious meals and
basic home-making services. However, Mr. Waddell is becoming increasingly
depressed. He hates eating meals alone and misses his neighborhood walks. His
friends are all married and do not stop by as often as they used to. He knows
that there is a Senior Center near where he lives and his neighbor told him it
was a great place to go and meet people. He has heard that they will teach seniors
how to use computers, and he wants to learn how to email his daughter who lives
in another state. However, he doesn’t know what other services they provide or
how he would get there.
Mr. Waddell
has been the recipient of planning that was not person-centered. The case manager
arranged for his medical needs to be attended, apparently without asking him
what he wants and without taking into account his social and psychological
needs. Attention was paid to his health
and safety without understanding his life goals or his need to connect to other
people in his community. A plan was developed without a larger context of
meaning for Mr. Waddell.
What is Person-centered Planning?
Person-centered
planning is comprehensive life-planning, taking into account not only what the
person needs for health and safety, but also personal goals and lifestyle
preferences. It occurs from the person’s point of view, with his direct
involvement and decision-making authority. Each person is different and has
different life goals and preferences, so there is no previously held assumption
that a particular service or program will be the right one. Services and
supports are planned after hearing the person’s story—his strengths, his
struggles, his wishes for life and how he believes his needs can be met.
The Person-centered
planning process proceeds with an understanding of the importance of the
person’s community connections and personal relationships. Planning includes
and enhances natural supports from family, friends and community that already
exist and looks for opportunities to expand relationships. This is particularly
important as older adults’ social networks diminish and they must rely more and
more on family and close friends to support their needs. Formal services do not
take the place of naturally occurring supports but rather fill in the gaps and
reinforce them. The plan also addresses how to support family caregivers as
they try to fulfill this sometimes demanding role.
For older
adults, it is also important that planning include future contingencies. With
sometimes rapid changes occurring in bodily functioning and health, finances, and
deaths of friends and family, it is important to plan for “what if” something
happens. This includes advance directives, health care and financial powers of
attorney, and planning for finances. It also includes the daily “what ifs” such
as the service provider not showing up, a family caregiver getting sick, an ice
storm breaking a power line, running out of medicine, etc. Planning is ongoing
and responsive to changes that are occurring in the older adult’s life.
In the
example above, a Person-centered planning process would have been focused on
Mr. Waddell’s goals and how he wanted to live his life. Planning would have
taken into account his recent loss and how that affected not only his health
but his psychological and emotional well-being. The plan would have included
how he wanted to address his new needs for companionship, stimulation and
social interaction as well as his health care needs. With his permission, the
process would have included other important people in his life, such as his
friends and his daughter. The plan would have included formal services as well
as informal supports provided by family, friends, neighbors and other community
resources. Finally, the team would have addressed contingency plans and a way
to respond to Mr. Waddell’s changing needs.
Resources
While many
of the earlier person-centered planning processes have their roots in
supporting people with developmental disabilities, the processes have spread
and been modified to accommodate many other populations including older adults
and adults at the end of life. In
addition, parallel processes have been developing through providers of services
and advocates for older adults, moving away from more medically oriented care
models to individualized person-centered models embracing choice and autonomy.
The
following websites provide more information about some of the person-centered
processes and principles that are being used to support older adults:
The Council
on Quality and Leadership--http://www.thecouncil.org/base.aspx?id=1170
The Learning
Community for Person-Centered Practices--http://www.learningcommunity.us/aging.htm
Helen
Sanderson Associates--http://www.helensandersonassociates.co.uk/reading-room/who-/older-people.aspx
University
of New Hampshire Institute on Disability--http://iod.unh.edu/Services/eventdetail/10-10-11/Person-Centered_Planning_for_Older_Adults.aspx
http://www.dhh.louisiana.gov/offices/publications/pubs-105/PCP%20Presentation%202-09.pdf
Inclusive
Solutions—http://www.inclusive-solutions.com/pcplanning.asp
Person-Centered
initiatives in Medicaid--http://www.cms.gov/CommunityServices/30_RCSC.asp
Pioneer
Network--www.pioneernetwork.net
Eden
Alternative--www.edenalt.org
Quality Long
Term Care Commission--http://www.qualitylongtermcarecommission.org/
American
Health Care Association’s Quality First Initiative--http://www.ahcancal.org/quality_improvement/quality_first_initiative/Pages/default.aspx