Person-Centered Care and Elder Choice: A Look at Implementation and Sustainability

A 5-year longitudinal study was conducted to monitor and guide a nursing home system's transformation from a traditional hospital-type model of care to a culture change model with the central principle of person-centered care. Elders on 13 long-term care (LTC) communities participated in the study. At T1 (baseline) all 13 communities followed the traditional model of care. By T2, seven communities had become culture change communities while six remained traditional (comparison) communities. The comparison communities phased into culture change soon after T2. At each time point, elders (n = 69 at T1, n = 79 at T2 [2-year follow-up], n = 68 at T3 [5-year follow-up]) completed a quality of life interview including the Duncan Choice Index. Results showed a significant interaction effect for total choice scores, and the individual item "what leisure activities you do." Three of the remaining 12 individual items (how you bathe, what you eat, when you perform leisure activities) were identified as promising for practice and further research, with groups being most different from each other at T2. Overall, total choice scores increased from T1 to T2 for the elders in the pilot condition, and from T2 to T3 for elders in the comparison condition. Contrary to expectations, total choice scores reported among elders in the pilot communities showed significant decrease from T2 to T3. Study findings provide support for an initial positive impact of person-centered care on choice, as well as the challenge of long term sustainability.