What are person-centred care interventions supporting autonomy and choice?
Person-centred care (PCC) requires understanding and respecting an individual’s life story, circumstances, abilities, needs and preferences, and places the older person at the centre of decisions related to their care. [1]. A PCC approach is central to supporting autonomy and choice of older people receiving aged care services.
Why does this matter for rights-based care?
The strengthened Aged Care Quality Standards mandate the provision of person-centred care (See Standard 1: The Individual). Human-Rights Based Approaches (HRBA) to care aim to embed human rights into decision-making for both care workers and care recipients. [3] Enabling autonomy, dignity and choice through PCC approaches strongly aligns with a rights-based care approach. [4] The practical interventions required to apply a PCC approach must be understood to achieve these desirable outcomes.
PCC interventions that support autonomy and choice for the older person receiving care include:
- Collaborative care planning
- Flexible care settings and routines
- Meaningful communication strategies
- Strength-based care approaches to support dignity and autonomy [4-10]
Collaborative care planning
Collaborative care planning includes the perspectives of all of an older person’s care providers with the person receiving care at the centre. Care planning should inspire confidence for the older person that a good quality of life will be achieved through the care they will receive. [11] Understanding the individual holistically through PCC approaches is required for both developing relevant, individualised care plans and to help care givers meaningfully connect with people receiving care. [7]
Shifting the approach of developing care plans from process-driven to care recipient and family-led helps to fundamentally shift care relationships among care staff, care recipients and families. [4] Reciprocal partnerships in care planning between individuals receiving care, their families and care staff are required for promoting dignity in care planning. [10]
Ideally, all staff who provide care should be involved in PCC planning. Several studies argue, for example, that care assistants in residential care facilities should be more involved in care decisions because they often have the most in-depth knowledge about the individuals receiving care. [7, 8] Providers should collaborate more closely with each other in collaborative care planning. For example,; one study found the extent of communication between nurses and GPs was an important influence on whether pharmacological approaches were used in behaviour management for people living with dementia. [8]
Care plans must be monitored and evaluated collaboratively at specified time points or when changes in circumstances or behaviour occur, to ensure they remain relevant. [11, 12] This allows for adjustments if care plans are not meeting needs, preferences or expectations, and ensures all people involved in caring for the individual have access to accurate information so appropriate and timely care decisions can be made. [12]
Flexible care settings and routines
Providing PCC includes offering adaptable routines and personalised settings for care delivery. For example, care workers can allow for flexible timing of care visits or routines to better meet the older person’s needs. [5, 7] It is also important to consider how residential care spaces are linked to personal identity of the individual, and where possible, resist creating a clinical setting. [13] The RBC personalised environments theme describes how care settings can be personalised.
Examples of flexible care settings and routines include:
- Honouring preferences related to personal appearance and clothing
- Providing meaningful activities based on abilities and interests
- Designing routines that maximise privacy
- In residential care settings, making the setting as ‘homelike’ and peaceful as possible by personalising rooms with photos and other meaningful décor. [8-11]
Meaningful communication strategies
Meaningful communication strategies such as active listening, using respectful, clear and affirming language and having effective tools to help structure conversations about an individual’s priorities are important to enabling the delivery of PCC. [5, 10, 11]
Studies note that one of the barriers to PCC can be ineffective communication strategies used by care staff when developing care plans with older people. An overuse of medical jargon, ineffective care planning templates, and a perception that care professionals are the expert can make the older person reluctant to meaningfully engage. [4] Well-designed and implemented, person-centred tools for care planning can be effective in supporting visioning for PCC. [11]
People receiving care should be addressed by their given or preferred name. [7] If an older person has a hearing impairment or is in a shared space, care should be taken to keep conversations that include personal information private. [10]
The tone of interactions between aged care staff and residents is closely tied to the resident’s sense of dignity. Respectful PCC communication practices include knocking before entering rooms, preserving privacy where possible and offering reassurance while assisting with intimate tasks. [9]
Meaningful relationships between care providers and those receiving care can facilitate provision of PCC. For example, getting to know the older person’s history, what is important to them and even what their movements or noises mean evolve through spending time together, good communication, and feeling connected. [7]
Strength-based approaches to support dignity and autonomy
Good PCC approaches involve care recipients in decision making and apply an individualised approach, supporting autonomy and choice. One study found that autonomy of people in residential aged care depends fundamentally on interactions with, and attitudes of, care staff. Supportive staff who foster a sense of acceptance, rather than shame around needs for assistance, encourage people to ask for help when required, leading to a greater sense of autonomy. [6] Another study found freedom to make complaints without fear of repercussions supports dignity and a sense of autonomy. [10]
Systematic processes for keeping care plans up to date helps to support autonomy in decision-making, ensuring appropriate and timely care decisions can be made. [12] This provides guidance if conflicts arise when navigating tensions between an older person’s preferences and maintaining safety and duty of care. [7]
Older people may experience sense of humiliation and loss of dignity that comes with the requirement to rely on others for completing intimate tasks. Designing routines that maximise privacy and autonomy help to mitigate negative feelings. [9]
To uphold dignity and autonomy of people receiving care, the underlying assumption of care providers should be that older people are competent, and have the right to make decisions about their lives. [11]
Organisational considerations for implementing PCC interventions
Effectively applying PCC interventions requires alignment with PCC principles at all organisational levels, including strong leadership and governance structures. [4, 5, 14] Some of the barriers to PCC implementation include:
- Time constraints and workload
- Feeling unsupported by managers
- Need for updated documents and processes to guide PCC approaches
- Lack of training in HRBA, PCC approaches
- Focus on task-oriented care
- Lack of involvement direct care staff in care planning meetings [3, 4, 7, 11]
Aged care organisation leaders need to foster a culture that prioritises PCC; this may require shifts in values and attitudes, and in training and practices. [4, 14]
The implementation of PCC practices is time consuming, but in supportive settings, PCC can reduce stress and burnout among aged care staff. [14] Clear shifts in perspective toward rights-based, PCC approaches have been found for care staff that attended human rights-based training. [3]
PCC interventions are more likely to be successful when embedded across an organisation. One study suggests a four-stage quality framework to guide the implementation of PCC that includes: 1) personalising goal setting 2) care planning aligned with goals 3) care delivery according to the plan and 4) evaluation of goal attainment. [10] Read more about embedding multidisciplinary person-centred care pathways within organisations.
Want to learn more?
Explore these ARIIA resources:
- The role of PCC in helping older people to achieve meaningful lifestyle activities
- PCC for people living with dementia
- Organisational level information on the relevance of multidisciplinary and person-centred care pathways to RBC
This resource from the Aged Care Quality and Safety Commission provides practical tips for aged care workers in applying person-centred care approaches.
This resource from palliAGED outlines the benefits of PCC approaches and considerations for applying PCC from different perspectives or for older people with unique needs or identities.
This web resource from Ausmed includes practical examples of how to implement PCC as an aged care worker.
What can be done?
Support a collaborative, positive approach to care planning
Organisations:
- Involve the entire care team, including direct care staff, in development of care routines.
- Update and adapt individuals’ care plans on a regular basis.
Care teams:
- Treat collaborative care planning as a tool to create a good quality of life through the care received.
- Encourage reciprocal partnerships between individuals receiving care, their care teams and family members.
The evidence:
- Care relationships radically shift when care plans are developed collaboratively and led by the individual receiving care and their supporters. [4]
- Direct care staff often have the most intimate knowledge of care recipients needs and preferences, yet they are often not involved in care planning meetings. [7]
- Establishing a process to update care plans iteratively helps to ensure care preferences continue to be met. [4, 12]
Adopt flexible care routines, meaningful communication strategies and strength-based approaches to support dignity and autonomy
Organisations:
- Provide staff training in effective communication strategies for developing PCC plans with older people.
- Develop and implement fit-for-purpose tools and forms to help guide successful PCC planning discussions.
- Support meaningful relationships between staff and care recipients to help with the development of connected relationships that help to support PCC.
Care teams:
- Avoid use of medical, industry or organisation-specific jargon when developing PCC plans with older people.
- Enable flexible, personalised settings and care routines and activities whenever possible.
- Use respectful and affirming language and practices when interacting with older people receiving care.
- Support older people receiving care to ask for assistance and make complaints when required.
The evidence:
- One of the barriers identified in providing PCC is a lack of staff training in communication approaches that effectively elicit care preferences when designing care plans. [4]
- For carers, building a relationship with the people they are providing care for leads to greater understanding and provides tips for caregiving. [7]
- Rigid schedules, task-oriented care, depersonalization of care can compromise dignity of the person receiving care. [10]
- The language care givers use can impact a sense of dignity, for example if using ageist or diminutive terms, or publicly sharing sensitive information. [10]
Create an organisational culture that embraces PCC principles and practices
Policy makers:
- Provide training resources, implementation support, and evaluation standards for PCC.
Organisations:
- Identify and manage barriers to effective PCC practices.
- Create care environments where PCC practices are modelled, supported and encouraged.
- Provide training in HRBA, PCC approaches to care.
The evidence:
- Studies show a lack of mandatory training and limited access to information and resources in providing PCC. [11]
Study findings show care staff are often unclear about how to merge task-oriented practices with PCC, leading to difficulty in integrating PCC concepts into daily care practice. [7] - Training, leadership, and a culture that encourages consistent use of PCC approaches is required for successful outcomes. [14]
- Guidance and modelling by senior caregivers in PCC approaches has been found to be even more valuable than formal training. [7]
- Following aged care staff HRBA training, there was a clear shift towards recognising dignity, empowerment, participation and respect in care decision. [3]