workforce
Details matter
How can we put the person
into person-centred care?
Lynn Chenoweth interviewed
by Conor Burke
P
erson-centred care was at the heart of
the recent Perth hearing of the royal
commission. Derived from the ideas of
Carl Rogers and Thomas Kitwood, person-
centred care can be defined as care that is
unique to the patient – their preferences are
the key, not the disease.
Rogers, an American psychologist,
originally developed his idea in relation to
therapy situations. The idea was to move
away from the maxim that the therapist
knows best, and towards a process that
trusted the innate ability of the individual
to find fulfilment.
Originally coined “non-directive therapy”
and then “client-centred”, the term “person-
centred” came to be with the realisation that
these principles could be applied to other
areas where there is a relationship, such as
childcare, patient care and management.
Kitwood applied the theory to dementia
care in the early 1990s with the foundation
of the Bradford Dementia Group, and he
went on to develop many educational tools
aimed at facilitating person-centred care.
38 agedcareinsite.com.au
“Personhood is a standing or status that
is bestowed upon one human being, by
others, in the context of relationship and
social being,” he said.
Bryan Lipmann, chief executive of
Wintringham, and the manager of one of its
homes, Kate Rice, spoke about the very niche
type of person-centred care they deliver.
Wintringham is a service for elderly
homeless people and people at risk of
becoming homeless, and part of the care
model includes giving these people lots
of choice.
“It’s interesting in the context of this
person-centred care discussion because
someone’s right or wish to, say, drink
or smoke or participate in gambling
or any of those other activities, to us is
no less important in a sense to honour
than someone who might ... want to do
gardening,” Rice told the royal commission.
A panel made up of two nurses, a personal
carer and a physio also spoke to the
commission about some of the challenges
they face trying to deliver care in this way.
Registered nurse Gaye Whitford said
that not enough is being done despite an
emphasis on person-centred care.
“I feel that ‘person-centred care’ is a term
that’s overused,” she told the commission.
“I think we are not fulfilling that term
adequately enough. We need to be looking at
a holistic view of the person, their emotional
and spiritual needs, not just their chronic
conditions.
“I feel that we don’t provide enough time
in order to achieve this with these people …
When you do provide this time, [it’s] very
rewarding.”
Personal care worker Patti Houston
has seen the effects of person-centred
care at her workplace, where they have
implemented the Butterfly Model.
“It’s just a wonderful program that really
gets to the heart of people, and their slogan
is ‘Feelings Matter Most’, so that’s where the
care comes from. And we’re in the process
at the moment, a transition of change
starting with our memory support area, so
we’re changing the environment,” she said.
“We’re not wearing uniforms anymore –
we come in colourful clothing. We’re using
music. There’s a whole process of about 70
different things that we need to do to actually
achieve the Butterfly Model status and we’re
working towards doing that.”
Aged Care Insite spoke with Professor
Lynn Chenoweth from the University of
NSW to delve further into the ideas behind
person-centred care.
ACI: Person-centred care is a very buzzy
term, but how do you define it?
Person-centred care is, as Professor Tom
Kitwood said, about making sure that all the
services are really focused on the need of
the person, while also taking into account
their personal history, their life story, the
things that make them feel supported and
loved and cared for.
The most important outcome that
we’re hoping to achieve is the support of
someone’s personhood. Personhood is
comprised of those things that make all of
us feel that we matter: that people recognise
that we’re human, and that we have
inalienable rights that must be supported
whether we have dementia or not.
These are the main principles. Within that,
we have to ensure that the person is able to
live the life that they would have chosen for
themselves if they had been able to express
those feelings.
At the start of the royal commission,
there was a comparison between
relationship-centred versus consumer-
centred care. The way we view people
in aged care as consumers can be a
problem because of the transactional
nature. How do we get around that?
All social experiences are relational, so
the whole idea of person-centred care
is that we focus on creating, developing
and maintaining a relationship with the
person, their family and their loved ones in
negotiating all of the things that we do to
help the person have a quality of life.
Many of these people are coming into
residential care or they’re receiving care
at home or in other services at the end
of life. So all we need to do is to focus on