Person First

by Nancy Tischer, RN

For generations the Nursing Home “Way of Life” has been a strong medical model of care, where elders no longer control such basic pleasures and rights as making their own medical decisions or when they wake up in the morning or what they eat or when they go to sleep at night. It has been acceptable practice within our society’s traditional long term care institutions to expect elders to conform to the caregiver’s efficient routines and schedules. When the elder is left out of his/her life’s equation it eventually leads to loss of spirit, loss of ongoing living of life as one’s activity and loss of will to live.

Saint John’s is working to transform the institutional approach to long term care into one that is person-centered. Megan Hannan, MS, an associate with Action Pact, a consulting group devoted to culture change based in Milwaukee, explains that Person First focuses on cultivating “personhood” instead of merely maintaining the elders’ physical comfort and safety. “Person First” is a set of principles and practices that guide the care and service approaches through knowing and honoring the person before the task. These practices provide the basis for creating a daily life worth living, striving to nurture the mind as well as the spirit and promoting growth and development for all.

In order to grow person-centered culture, it is necessary to transform an organization’s principles, values, systems and practices. The traditional hierarchical structure of most nursing homes today places the decision making power furthest away from the elder at the hands of the leadership staff. Leadership must become aligned and grounded in shifting more control to the residents and the hands-on caregivers who know the residents the best.

One of the richest values we have adopted is that relationships between residents, family and staff are the foundation for the Saint John’s community and that each person living, working or visiting our community can and does make a difference. According to Megan, “Person First” assumes that adults are adults and should be treated as such; a lost art for stressed-out caregivers who may lack the resources and training to help them see the elders they care for as persons rather than as objects.”

Megan is creator of the Person First dementia care model. She has provided train-the trainer sessions in the Person First model for a group of Saint John’s employees. This group trained every employee working within the Saint John’s community to practice person centered principles. They also taught staff how to facilitate community circles. Community circles give residents, their families and other workers an opportunity to share information about their life history, tastes and values. Because of community circles our elders feel a sense of belonging and inclusion. Their voices are being heard once again which means they are more willing to participate in decision making and taking control over their own life choices again. Caregivers who provide hands on care once provided standardized treatments based upon medical diagnosis are entering into care-giving relationships based upon individualized care needs and personal desires. They too are being given a voice and becoming empowered to make decisions for residents with dementia because they know them so well.

The positive outcomes from our passionate efforts to give back to our elders and caregivers the inner spirits that have been taken away from them, far out weigh the trial and tribulations of changing our behaviors. Saint John’s is committed to transforming the culture of long term care by bringing this message to the greater Milwaukee community as a better way of life for all elders.

Hannan, M. (2003). Person First dementia care model elevates resident, workers, morale. Culture Change Now, vol. 2