Person-Centered Care in Nursing Homes: Many Stakeholders, Many Perspectives

Nursing home culture change moves facilities toward person-centered care. The current study examined how people in different roles experienced choice and autonomy in four areas addressed by culture change: consistent assignment, food choice, waking/bedtime routines, and bathing. This descriptive qualitative study included 32 participants from one continuing care retirement community: 10 residents, eight family members, nine direct care workers, and five managers. Interviews were audiotaped, transcribed verbatim, and coded. Codes were grouped around the practice areas and cross-cutting themes. All groups reported choice in all areas. Challenges arose when patient choice and nursing home functions conflicted. Stakeholders disagreed when care needs should supersede choice. Findings suggest that it is difficult to balance resident choices with (a) the diverse needs/wants of other residents and (b) safety. Leaders, such as nurse managers, should provide ongoing education to residents, family, and staff to help negotiate these challenges.