Academic journal article Generations

The Right Person at the Right Time: Ensuring Person-Centered Care

Academic journal article Generations

The Right Person at the Right Time: Ensuring Person-Centered Care

Article excerpt

Scope of practice and other systems-level factors weigh into providing high value and high-quality care for older adults.

The Institute of Medicine's report, Retooling for an Aging America, envisioned care that is responsive to an aging society, with an adequate supply of competent workers and improved delivery systems, including healthcare teams that work together (IOM, 2008). Steven Dawson and Christopher Langston opened this issue of Generations with a critical reflection on the incremental and inadequate progress made in meeting the growing demand for eldercare (see page 6) They call for "systems that are designed from the very beginning around the core, central relationship between the elder and the caregiver."

The triple aim of healthcare improves the care experience, advances population health, and reduces per capita cost for care (Berwick, Nolan, and Whittington, 2008). We conceptualize every healthcare encounter as being personcentered (i.e., responsive to the needs, preferences, and goals of the person seeking care) and adding quality and value (see Figure 1, page 48). Healthcare encounters, in this article, mean any time an older adult engages with the healthcare system, whether in a hospitalization involving a large and complex healthcare team, or in a home visit by a community health worker from a clinicbased primary care team.

Encounters between older adults and healthcare providers are dynamic, change over time, and must reflect, in the most cost-effective way, a match between what older adults and their families value and need, and healthcare providers' (professional and direct care workers) capabilities. Each encounter involves considerations on the part of the older adult and the healthcare provider(s) that respond to and bring the greatest value. This article examines the question of scope of practice from a broad perspective of what is needed and what is possible, with the goal of identifying the right person at the right time to provide high-value, high-quality, person-centered care for older adults.

Parsing Optimal Healthcare for Older Adults

The diversity of healthcare needs and goals among older adults is increasing with demographic shifts. There can be up to three generations older than age 65, each reflecting the full spectrum of capacity. At one end of the continuum, active, independent older adults may have two chronic conditions requiring adjustments in diet, activity, and medication management. At the other end, older adults with profound functional or cognitive challenges require constant supervision, support, and care.

As older adults experience their health, it is not compartmentalized by specialty or setting, nor organized by body system or payer. At the core, older adults and their families want compassionate, respectful, high-quality care, and expect clear and appropriate communication as they navigate the system and their health-including the physical, psychosocial, functional, and spiritual aspects. Personand family-centered care emphasizes the older adult's social context and highlights the complexity and diversity of preferences regarding decision making and perspectives of treatment burden (Wolff and Boyd, 2015). Achieving quality and value in healthcare necessitates aligning older adult's personal values and preferences with what the health system is able to provide (Sikma and Young, 2001).

With older adults at the center of care, the delivery system should flex to provide the optimal mix of providers. Yet various systems-level barriers challenge the extent to which older adults receive person-centered care, with environmental context playing a large role. For example, while many older adults prefer aging in place, family and friends' availability to assist with activities of daily living, as well as financial resources (i.e., private funds or medicalfinancial eligibility for Medicaid services) can determine living situations and drive options for long-term care. …

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