A paradigm shift is occurring in healthcare and long-term services and supports movement away from a clinician-disease ethos to a person-centered one. In 2001, the Institute on Medicine (IOM) issued a seminal report, Crossing the Quality Chasm, in which healthcare in the United States was described as impersonal and fragmented. The report called for a healthcare redesign shifting away from the traditional medical-disease model of care to a patient-centered one. However, healthcare is only one aspect of well-being since humans are bio-psycho-social-spiritual beings. To achieve optimal health and well-being, care needs to address this holistic condition. Since the term 'patient-centered' speaks only to the medical/clinical dimension, the term 'person-centered' has evolved to better describe and encompass the holistic nature of health and well-being. Person-centered care has become accepted as the gold standard.
Person-centered values and practices emerged from humanistic psychology and the influential work of Carl Rogers and Abraham Maslow. Person-centeredness
Nursing home residents who have dementia are one of the most vulnerable populations. As their cognitive condition diminishes, their ability to communicate and to assert clearly their own choices, preferences, and needs diminishes, too. Ninety percent of people who have dementia experience some form of behavioral disturbance such as agitation, restlessness, and anxiety during the course of the illness (Corbett, 2012). We refer to these behaviors as Behavioral and Psychological Symptoms of Distress (BPSD).
A medical model of care supports responding to these behaviors by using antipsychotic medications which further diminishes the person's life-affirming experience. In contrast, a person-centered model of care identifies the root causes of the behavior expression. People trained in person-centered care recognize that behaviors expressed by people who have dementia often communicate unmet needs.
BPSD may occur when the person is over stimulated (for example, an unfamiliar or noisy environment, multiple complicated requests, a room that is too hot or too cold). Other causes may include fatigue, pain, and boredom. Psychosocial-factors such as noise disturbance and feeling lost are not resolved by medications. The medication only serves to “quiet “ the person, which is not humane because the person’s feelings and needs are not addressed. In fact, the effect of “quieting” may promote functional decline and depression.
Someone whose dementia has progressed to the stage where they cannot communicate their needs is unable to provide articulated insights about the experience of person-centered care. The following quote from someone with a mental health disorder makes the critical point: "Nothing they did cost extra money or required intensive training, but the fact that they saw me as a person - and treated me like one - helped transform my life" (Clayton, 2013). Person-centered care affirms life and meaning.