As we are all aware, a Royal Commission into Aged Care Quality and Safety is underway. In the last two weeks the Commission has come to Western Australia, with hearings first in Broome then last week in Perth. In Broome, the focus in the hearings was on the provision of aged care for Indigenous and remote communities. In Perth, the hearings focused on person-centred care, dementia and palliative care.
Planning for aged care is confusing, not the least because of the language and jargon each sector uses. Many providers refer to person-centred care, but what does the term really mean? At the core of this question is something we all should contemplate. How would you like to be treated if you were older or in need of care and support? What is it about your sense of self that is essential to be considered, especially if you didn’t have the capacity to communicate those things?
It could be your role as a matriarch in your family is important to you. Or that you were a champion in your chosen sport. Or a successful clinician, musician, farmer, gardener or club member.
Knowing these things will inform your – or your family’s – choices about care if or when you may need to access it. These features about what is important to you, your identity and your choices are aspects of ‘personhood’. Care that knows and embraces personhood is person-centred care.
Person-centred care is a philosophy developed by Professor Tom Kitwood at Bradford University in the late 1980’s. It challenged the bio-medical model of dementia by seeking to understand the lived experience of dementia from the person’s perspective. Person-centred care seeks to provide care and support in a way that respects the individual and meets not only their physical care needs but equally importantly their emotional and spiritual needs. After all, we are so much more than just our physical being.
As an organisation Alzheimer’s WA has embedded a person-centred approach into the way we view the lived experience and journey of dementia. We provide our services within this philosophical approach and have seen first hand the difference to people’s quality of life this approach can make, regardless of the level of cognitive or physical impairment.
Following a harrowing case study on the failure of care for a gentleman living with dementia in a residential aged care facility in Adelaide, Alzheimer’s WA’s Head of Dementia Practice, Jason Burton, was called to give evidence before the Commission about how person-centred care can be achieved in an aged care setting.
In his evidence, Jason explained that at the core of the philosophy and practice was the need for some critical rethinking of both ageing and living with dementia. This rethinking includes treating people as individuals, respecting people’s right to choice and intrinsic human rights regardless of impairment, valuing a person’s life experiences and identity, a need for meaning and purpose, and the importance of genuine relationships.
Jason emphasised that person-centred care was a philosophical framework for an organisation and had to be intrinsic to the culture of the organisation from the Board down. Relationships matter. Good aged care isn’t hospitality at its best. It relies on creating a human habitat to support the daily experience of someone whose abilities are challenged but who nonetheless has the same human need to belong, have meaningful relationships, and have dignity and purpose just like the rest of us.
Truly person-centred care will ensure people living with dementia feel engaged, purposeful and part of a human eco-system.
It’s aged care, but not as we always know it!
Following Jason’s testimony, a carer described how the services she and her partner had received had been delivered in this person-centred way and the significant difference it had made to their dementia journey. Receiving care that respected them and their needs had made a world of difference to acceptance of the care and the positive outcomes experienced.
At the end of her testimony, the carer graciously asked the Royal Commissioners not to miss the important opportunity they had – to make recommendations that would result in true person-centred care being implemented in services across the sector.