Person-centered confusion — and the value of a milkshake

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Emily Mongan
Emily Mongan

Talk about the concept of person-centered care has been ramping up in recent years, through new federal rules and in presentations at conferences. Last week's Pioneer Network annual meeting was no different, with sessions — and even the conference's theme — revolving around this resident centered philosophy.

The official motto of the conference was “Be the Future” with the subheadline “Person-directed culture is happening, be part of it.” That culture change is a journey, the event's organizers promoted in the conference materials. And that journey isn't an easy one, as evidenced by the dozens of guest articles, columns and blogs McKnight's has published on the topic.

Still, it was a bit disheartening to read some of the comments we received on a story covering a resident-focused care session at Pioneer. The commenters seemed to immediately pole vault over the advice the speaker was trying to share, into a place of negativity and sarcasm.

It's not that the concerns shared in the comments aren't valid — there's no denying that the philosophies of culture change and person-centered care will clash at times with the paperwork and compliance expected from long-term care providers.

But when one's knee-jerk reaction to hearing the words person-centered care is to begin weaving wild scenarios of where we draw the line — Steak?! Jazz music?! Bringing the alligator who lives in the pond behind my house who I've fed faithfully for 20 years with me as a comfort animal?! — it tells me that some facilities may have a ways to go in this culture change journey.

Dig a little deeper into that Pioneer story and you'll see that nobody is asking you to let the residents run wild and insist that every wish that pops into their heads be granted. While speaker Kathryn Anderson's shared decision-making model involves letting residents know they have a choice, it also includes sitting down and having a talk about options — options that you as a provider may have to put limits on if a resident's request isn't achievable or even advisable in their current setting.

And there's a good chance that the requests you'll receive from residents won't be as wild as you might be fearing. Take, for example, this story published last week in the Washington Post about a woman dying of pancreatic cancer. While in hospice care in Virginia, she had two wishes: a Cleveland Indians baseball hat, and a mocha milkshake from a restaurant in Ohio.

A friend ended up helping grant her wish (the milkshake was frozen solid and packed in dry ice, for those wondering about the logistics), and she was able to enjoy the shake about a month before she passed.

The lesson here isn't necessarily about the lengths that might have to be taken to fulfill a resident's wish. It's about how simple a resident's choices may turn out to be. So while there might be some requests that may have to be stepped back (“No, Larry, the alligator cannot be admitted with you, or even stay in our beautiful pond just on weekends …”), it's worth listening to residents to find out their preferences.

They might be as simple as a baseball hat or a milkshake. And that can make all the difference in the world.

Follow Staff Writer Emily Mongan @emmongan.

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Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Emily Mongan.

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