1. Models of disability 3
2. Benefits of person-centered care approach 4
3. Barriers for implementing PCC 5
4. Recommendations for PCC caregivers 6
One of the most important problems in social care now is the issue of introducing and implementing person-centered care (PCC). The focus on person-centered care is valuable for all individuals with a need for care services. However, the individuals with disabilities (especially intellectual disabilities) are in greater need for person-center care because their access to care services becomes limited while ageing, and this problem is especially actual for the so-called “young olds” in the age of 60-75 years (Bigby, 2004).
Disabled people were traditionally expected to adjust to the existing set of care services, and the range of services they could receive was limited. Despite the varied needs of these people and resulting social stigmatization of the disabled, care giving institutions could not provide adequate support for these categories of patients. Nowadays, the importance of person-centered planning and care has been widely recognized, but the implementation of this approach leaves much to be desired (Bigby, 2004). The purpose of this paper is to consider the role of social care practitioners in person-centered care, discuss current issues of PCC and possible barriers to implementing such type of services, as well as to provide recommendations for improving the process of PCC for social care practitioners.
1. Models of disability
Traditionally, the medical model of disability was the first one to be developed. The approach of this model is perfectly described in the definitions offered by the World Health Organization in 1980 (World Health Organization, 1980). It is based on two key concepts: impairment and disability. Impairment is defined as abnormality or loss of some psychological, anatomical or physiological structure/function. Disability, according to medical model, is defined as impairment-based restriction or lack of ability to perform activities within the range of human activities considered as normal. The problem of medical model is that within its scope, the disabled individual is left alone with own problems, and the impairment is considered as given. However, such perception automatically deprives the disabled person of fundamental rights and places a social stigma on him or her. The provision of social care services in this model is meant to compensate the impairment rather than to involve disabled people in the society, and inevitably leads to impaired self-perception of these people.
Luckily, in the 1960s another approach originated: social models of disability. According to this model, impairment is considered as lacking some organ or part of it, or having a defective mechanism of the body, and disability is understood as the restriction of activity as a result of current social organization which does not take into account the needs of people with impairment and excludes disabled people from main social activities. According to this model disabled people are a separate social group and their needs should be addressed by the society. According to Americans with Disabilities Act (1990), any disability-based discrimination is prohibited.
Under this model, the concept of person-centered care as the alternative to traditional “one size fits all” set of care services has emerged. The idea of PCC is not a set of rules but a philosophy of providing care centered about the personal needs of a person, and not only focusing on health needs. This approach stresses the fact that disabled people are individual people with different needs and in current society they cannot realize these needs fully without special care and support.
2. Benefits of person-centered care approach
Person-centered approach requires to involve all stakeholders and address individual needs of a disabled person, which requires a lot of efforts and money. However, it is difficult to estimate the effectiveness of PCP without special analysis. A longitudinal research including 93 patients with intellectual disabilities (varying in type of disability, personal characteristics and age) was performed during 2001-2003 period (Robertson et al., 2007). Development of personal care plan took place for 70% of these patients, and the findings after these two years showed the following: participants receiving PCC showed by 2.4 times chances of having active contacts with family, 52% increase of social networks, 2.2 times greater contact with friends, 25% increase of community-based activities participation and 33% increase in scheduled day activities (Robertson et al., 2007). However, these participants showed a SDQ hyperactivity subscale score increase of 37%, 1.5 times higher health risks and 67% increase of health problems reported (Robertson et al., 2007). The latter figure appeared most likely due to better contact of the disabled person with other people, and increased attention of family members and other stakeholders to the participants.
In general, it is possible to see that while health condition of people receiving PCC requires more closer attention and planning, social connections and relations significantly improve. Thus, with person-centered care disabled people become more involved in the society, and in fact live a happier and fuller life than those without PCC.
For intellectually disabled people, person-centered planning and care is more complicated because this process requires informed consent and decision making. Basic requirements for the patient’s ability to participate in planning are: the ability to understand personal authority, the ability to understand information and processes, the ability to formulate decision and explain it and the ability to produce consistent decisions (Gaventa & Coulter, 2005). When some of these components are absent, the major role in decision-making should be the guardian and the people being in close personal relations with the patient.