Giving Elders a Voice in Their Own Care: Person-Centered Care and Choice

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Giving Elders a Voice in Their Own Care: Person-Centered Care and Choice

choicePerson-Centered Care puts considerable value on an individual’s right to make decisions concerning every aspect of her or his life. Often long-term care providers want to honor resident choice, but are afraid to do so because of fear of injury or risk of liability.  The key is to find the balance between providing good care and keeping elders safe, on the one hand, and allowing choice which may involve risk but enhances quality of life, on the other.

So how does the care community accommodate resident preferences when the choice is seen as having some potential risk for a negative outcome?

The Rothschild Person-Centered Care Planning Task Force, sponsored by the Hulda B. and Maurice L. Rothschild Foundation, worked for over a year to create A Proposed Process for Care Planning for Resident Choice. I was involved as a member of the steering committee that created and guided the work of the task force. I would like to share some information about this process, which is specifically aimed at care planning when the choice carries sufficient risk and the community is considering not honoring the resident’s wishes. Following the process summarized below will help the community work with the elder to understand and respect choices to the greatest extent possible.

Step 1: Identify the Choice

Talk with the elder and gather as much information about the nature of the choice that the person wishes to make. Repeat back to the person your understanding of what she or he desires to choose or refuse, to confirm both parties understand each other.

Step 2: Discuss the Options

Discuss potential positive and negative outcomes of respecting his or her choices, as well as the potential outcomes of preventing the person from acting on the choices. The care team should offer ways in which they can accommodate the choice and also mitigate potential negative consequences.

Step 3: Determine how to Honor the Choice

 While some requests are potentially too harmful to other people to honor, many other requests can and should be honored by creating a plan to mitigate known potential negative consequences or offering a similar activity which has fewer potential adverse consequences. The team should compare the elder’s choice to the person’s condition to deter­mine the nature of potential risks. If the requested action poses significant danger to others, the team should clearly explain why they cannot honor that particular choice.

Step 4: Care Plan the Choice

If a mutual decision is reached as to how the team will accommodate a choice to maximize the elder’s well-being, the team will work out with the person the specific steps the staff will take to support that choice. The elder participates in the care planning process and is made aware of the steps of the plan.

Step 5: Monitor and Make Revisions

Monitor the progress of the plan and its effects on the elder’s well-being and ongoing desire to continue with the choice. The team will work with the person to revise the plan as needed and desired by the resident. Care plans and staff should be flexible, as people have the right to change their minds.

Step 6: Quality Assurance and Performance Improvement

The Quality Improvement team should review trends related to resident choice and safety, particularly when elders are routinely denied requests, or when the team identifies patterns of community care practices that might be improved by performance improvement action plans.


For so long, the focus in long-term care has been on doing what is “in the best interest of the person” as defined by the healthcare professional staff, rather than as defined by the person. In contrast, this care planning process has been developed to help give the person a voice in directing his or her own care.  Rather than viewing a person as non-compliant if he or she does not agree with your recommendations, try viewing the elder as a member of the care team participating in the discussion about options, potential risks and outcomes.

The full Process for Care Planning for Resident Choice, which includes blank forms and case studies can be found at



By | 2017-08-14T14:30:47+00:00 October 28th, 2015|aging, long term care, nursing home, Person-Centered Care|0 Comments

About the Author:

Jennifer Brush
Jennifer A. Brush, M.A., CCC/SLP has been working for over 20 years to change the face of dementia care in hospitals, assisted living communities, nursing homes and home care. Prior to establishing her own practice, Jennifer served for many years as the Executive Director of IDEAS Institute, a nonprofit organization that improves the lives of older adults through the conduct of applied research. She is an international speaker and recognized speech-language pathologist known for her work in the areas of memory, swallowing, and environmental interventions for people with dementia. She has served as the Principal Investigator on applied research grants that have examined issues pertaining to dementia, hearing impairment, dining, dysphagia, and the long-term care environment. Her research and consulting in the area of environmental modifications has resulted in improved functioning for people with dementia. Jennifer offers interactive and educational presentations and coaching that help clients bridge the gap between current research findings and the care needs of people with dementia. Jennifer Brush is the co-author of four books: Creative Connections in Dementia Care™; I Care; Environment and Communication Assessment Toolkit™ (ECAT) and A Therapy Technique for Improving Memory: Spaced Retrieval. She is the author of Meal Time Matters and Meal Time Matters at Home, training programs that build nursing assistants' and home caregivers' skills related to dining, swallowing disorders, and safe feeding assistance. Jennifer has authored over 25 articles in peer-reviewed journals, served as guest editor of the journals Seminars in Speech and Language and Perspectives in Gerontology, volunteered as Chair of Professional Development in Gerontology for the American Speech Language Hearing Association Special Interest Group, and was an editorial reviewer for Jennifer is a member of the American Speech-Language Hearing Association and the Association Montessori Internationale (AMI). Jennifer is honored to be appointed by the Executive Director of AMI to serve as an inaugural member of the Advisory Group for Montessori for Aging and Dementia. This group is responsible for writing the AMI standards for Montessori dementia programs. Jennifer presented her research in the area of dementia at the first international conference for Montessori environments for dementia in Sydney, Australia in 2014, and spoke at the annual AMI meeting in Amsterdam, Netherlands in 2015. She will return to Sydney in November, 2015 to speak about creating supportive environments for the aging.
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