A facility or a home. A feeder or a person who needs assistance with eating. A common room or a living room. The words we choose and how we deliver them truly hold significance. This is a belief I’m deeply passionate about, so much so that I authored a book exploring this very concept. However, it was during an Illinois Pioneer Summit, listening to Steve Shields speak, that I embarked on a profound self-reflection regarding my own linguistic choices within the realm of elder care. Steve shared a revelation that resonated deeply: he, like many in the field, had been using “culture change” and “person-centered care” as interchangeable terms. He came to understand that they represent distinct yet interconnected concepts, with culture change being the overarching objective.
This insight sparked a significant “aha” moment for me, a pivotal point in my understanding of elder care.
Similar to Steve and countless others dedicated to improving elder care, I had also blurred the lines between these two phrases. I’d often speak of a “culture change journey” and a “person-centered care journey” almost as synonyms. But what is the fundamental difference? Through careful consideration, I’ve come to realize this: Person-centered care is fundamentally the what – the specific actions and practices we implement. Culture change, however, embodies the how and, more importantly, the why behind our actions. Person-centered care encompasses the practical approaches that champion and respect the individual, practices inherently driven by the elders themselves. Culture change delves deeper, examining the methodologies, the interpersonal dynamics, and the core values that underpin our actions, revealing our fundamental purpose.
Consider this illustration: In the traditional, institutional model of care, residents were often awakened according to a rigid “get up” schedule, prioritizing institutional convenience over individual needs. In contrast, a person-centered care approach prioritizes supporting residents to wake up naturally, respecting their individual rhythms and choices. While we might universally acknowledge the institutional model as driven by directives – perhaps “because the Director of Nursing (DON) told us to” – it’s crucial to examine the underlying motivations even in person-centered practices. If a person-centered wake-up practice is implemented merely “because the DON told us to,” we might have achieved a person-centered practice, but we haven’t necessarily fostered true culture change. Genuine culture change emerges when our support for a resident’s choice stems from a deeply ingrained understanding of individual rights and a profound respect for every elder’s capacity to direct their own life. Only then does the “practice” become sustainable, rooted in shared values rather than mandated compliance.
Historically, the traditional model of elder care often centered on achieving “quality of care.” Even practices now deemed questionable were, in their context, aimed at this goal. For instance, physically restraining residents in chairs was intended to prevent falls, thereby achieving the quality of care metric of safety. Yet, this approach came at a significant cost: diminished quality of life. Today, we recognize that quality of life should be the paramount objective. We’ve learned that achieving quality of care is possible without ensuring quality of life, but I argue that prioritizing quality of life inherently necessitates quality of care. Quality care becomes the indispensable foundation upon which quality of life is built. Our previous focus on merely quality of care represented setting our sights too low.
Drawing upon my past studies in logic, I’ve formulated a logical parallel to further clarify the distinction between person-centered care and culture change:
Quality of Care is to Quality of Life as Person-Centered Care is to Culture Change.
It is possible to implement person-centered care practices without actively pursuing comprehensive culture change. However, if our true aim is to achieve genuine and lasting culture change in elder care, we must build our practices upon the bedrock of person-centered care principles. The journey toward transforming elder care necessitates embracing the spirit of a Pioneer Person, someone who champions these values and drives this essential culture shift, ensuring dignity and quality of life for every elder.
