Person-Centered Care

Two months ago, DOORWAYS employee Taylor McCabe transitioned from his role as a social worker at Cooper House to the newly created position as Manager of Person-Centered Care. Person-centered care is based on the concept stating that the individual receiving care is the primary leader of his or her own care, and is treated with dignity, respect, and compassion. The Department of Health and Senior Services regularly conducts audits and inspections to make sure individuals in care facilities are being treated with dignity and respect and receiving quality care. Cooper House consistently meets those standards and has been working for years to provide care beyond those state guidelines. We recently officially confirmed the person-centered care model through creation of the Manager of Person-Centered Care position, and McCabe’s promotion to launch the effort. “We are working towards a place where residents feel the needs they identify are truly being met. This is their home, so we want them to feel genuine care and compassion in every interaction, knowing they can trust us,” said McCabe. “It’s not ‘client’ or ‘tenant.’  We say ‘resident’ just like you would at any apartment building.”

DOORWAYS was founded in 1988 as a hospice for people with AIDS who were alone and homeless. Since then, life for people living with HIV/AIDs has changed. “Cooper House is no longer a final stop for most residents,” explained McCabe. “The goal is to get our residents back on their feet, help them take control of their health, and encourage them to start living independently.” But that path may be different for each person. Cooper House serves a diverse group of men, women, and transgender adults of various ages and races at different stages of health. For this reason, person-centered care is essential, as it focuses on individualized standards of practice:

  1. Presenting residents with choices regarding their care and livelihood.
  2. Recognizing that residents are the leader of their own treatment plans.
  3. Remembering that residents are human beings and treating each resident respectfully.

The first evidence of a person-centered care model is the use of goals created in consultation with each resident. Upon admission of every new resident, Cooper House social workers evaluate the resident’s health and life status, probing to understand their needs, expectations, and desires. Through that discussion, the residents create for themselves a set of goals. Staff use that as a foundational road map to inform the personalized care and support plan, in order to assist them in achieving positive milestones.

For some a first goal might be to reach a healthy weight, reversing the wasting and illness accompanying HIV/AIDS and homelessness. Others may want to commit to a treatment plan to reach viral suppression. For those with more stable HIV/AIDs symptoms, their goal may be to better manage other life challenges, such as mental health or substance use issues. As goals are met, new goals are established to continue the momentum.  “We have a meeting with each resident every three months at which we discuss their plan and help them assess their progress towards their goals,” noted McCabe. “We offer support and additional resources to keep them moving forward, or help them through hurdles when progress is lacking, keeping the focus on what they hope to achieve.”

One example of embracing the person-centered care model occurred in October 2017, when Cooper House welcomed their first openly transgender resident. To be able to care for her in a manner that would create a feeling of support and safety, it was important to understand her needs and expectations related not only to health care but, also, identity care—such as the use of the preferred pronouns and specific personal needs. Recognizing a need for expanded knowledge, Cooper House staff received education and training addressing best practices for working with transgender residents. Sharing information opened new paths of understanding, further enriching the Cooper House commitment to person-centered care. “I have seen a shift in culture within our staff,” noted McCabe. “Many have gone from a lack of knowledge to full understanding of the unique issues related to diversity. Now they are sitting on committees and working towards furthering education on how to care for transgender people.” In fact, Cooper House has developed a reputation for respectful care of transgender residents within the larger community. Since October 2017, the census has included five transgender residents. Management has been contacted by several organizations unaffiliated with HIV/AIDS seeking advice on best practices when working with transgender individuals.  “This is the result of fully embracing person-centered care,” said McCabe.

Person-centered care even begins before admission to Cooper House, and across service platforms. DOORWAYS provides housing to homeless individuals and families affected by HIV/AIDS through Cooper House as well as more independent living programs plus an emergency housing response and a subsidies service. Recently an individual with HIV/AIDS was released from prison into homelessness. She was referred to DOORWAYS by her Ryan White Medical Case Manager and provided with emergency housing. However, she began having seizures and was taken to the emergency room, where doctors were able to stabilize her. However, with an untreated seizure disorder, no income, no health insurance, and no support network, living alone in DOORWAYS’ emergency housing was no longer safe. Following a person-centered care philosophy, when she was discharged from the hospital, she was immediately admitted to Cooper House even before all Medicaid paperwork had been completed. “Person-centered care sometimes requires that we reorder our steps to assure that the patient’s needs are the primary focus of our efforts,” explained McCabe. Since moving into Cooper House, her life has totally changed. She has received much-needed medical care, medications, and treatments. Her seizures have stopped. “She is a bright light for all the residents and the staff. Her move to Cooper House has allowed her to thrive in a safe environment where she can focus on her health, because that’s what we do,” said McCabe. “We create opportunities for residents to make the changes in their lives that can lead them to a better level of health and hope.”

While it may take years of compassionate person-centered care, some residents do reach a point of health and hope that their goal becomes returning to independent living. A philosophy of person-centered care mandates attention to all needs of the individual at every phase of care, so planning and preparing for a life of independence becomes a goal to be achieved.  “When a resident begins planning to move out on their own, we begin practicing the responsibilities that will be needed when they no longer have 24-hour care. While still in Cooper House, we encourage them to manage their medication schedule and even introduce them to a home-health nurse who will stay connected with them after they transition into independent living,” said McCabe. Using his background in education, he is working to develop an expanded exit program that will include topics such as medical literacy, medical advocacy, and a vast array of resources to support them during their move and future life of independence. “Before they are admitted, during their stay with us—no matter how long—and even when they are preparing to leave Cooper House, our goal is to focus on what each resident needs as a unique individual. We want them to have stable health and stable housing for the rest of their lives. We can’t use a process and relationship of only one shape. We need to create a new mold for each person we serve.”

Through support from generous donors, DOORWAYS now celebrates 30 years of service to people in the City of St. Louis and 117 counties in Missouri and Illinois. Last year we provided a new beginning to 3,100 individuals. For more information, contact Karen Carpentier at 314-328-2704 or kcarpentier@doorwayshousing.org.

 

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