Individualized care (also referred to as person-centered care, consumer-directed care, and self-directed care) takes into account resident individuality, includes resident participation in decision-making processes, and provides a holistic approach to wellness. However, providing individualized care can be a resource- and energy-intensive process for long-term care staff. Such staff’s perceived ability to provide this individualized care might be influenced by both contextual and individual factors. A recent study in The Gerontologist explores the relationship between contextual and individual factors and long-term care staffs’ reported ability to provide individualized care, as well as the role that staff empowerment might play.
The contextual factors examined in this study included for-profit versus nonprofit long-term care facilities, staff-to-resident ratios, consistency of staff assignment to the same groups of residents, and the transition to a model of cultural change in long-term care facilities that encourages individualized care. Individual factors that were assessed included staff demographics and job classifications. The demographic factors considered included gender, racial, ethnic, immigrant, and socioeconomic status. The job classifications examined were RNs, LPNs, and care aides. The empowerment of the employees in this study was assessed by questionnaires and scales designed to measure staff’s support, opportunity, access to resources and information, as well as staff perceptions of having formal or informal power in the workplace.
Staff included in this study did vary significantly in their perceived ability to provide individualized care. Looking first at individual characteristics of the long-term care staff, none of the demographic characteristics examined predicted the differences in staff’s reported ability to provide individualized care. Turning to contextual characteristics, again none of these factors predicted the differences in perceived ability to provide individualized care. Finally, of the empowerment variables, three factors were found that predicted perceived ability to provide individualized care: informal power, support, and access to resources. Informal power reflects the network of alliances a worker has in an organization and has been described as reflecting “the quality of interprofessional relationships.” An example of support would be being thanked for a job well done. Access to resources refers to both access to supplies as well as having sufficient time to accomplish required tasks. Of these three factors that predicted perceived ability to provide individualized care, access to resources was the strongest factor, followed by support, and then informal power.
The authors of this study view the lack of individual and contextual predictors as good news, because these are not easily adaptable or changeable. They write, “For example, it is not possible to systematically change the ownership status or the size of the [long-term care] facilities nor is it feasible to unilaterally increase the education or experience level of all care staff members.” They suggest that the important individual characteristics are those associated with perceived access to structural empowerment.
These findings have a number of managerial implications for administrators. This research suggests that management initiatives aimed at enhancing individualized care should focus on building positive interprofessional relationships. This might include focusing on team building, intershift communication, trust, or conflict resolution. Additionally, management initiatives should also ensure that care staff members have adequate access to resources and be given the time necessary to successfully accomplish their tasks.
Caspar S, Cooke HA, O’Rourke N, et al. Influence of individual and contextual characteristics on the provision of individualized care in long-term care facilities. The Gerontologist (2013); 53: 790–800.