Person-centered dementia care strategies and facilitators in low-resource long-term care: staff insights

Person-centered care is considered best practice in dementia care, emphasizing autonomy, dignity, and relationship-based individualized care. However, little is known about how person-centered dementia care (PCDC) is implemented in low-resource long-term care (LTC) settings. This study identified PCDC strategies used by staff providing care for residents with dementia in low-resource LTC settings and key facilitators supporting the use of PCDC strategies.

We conducted a qualitative analysis of semi-structured interviews with 27 staff (20 direct care staff and 7 administrators) from four LTC facilities (nursing homes and assisted living) in urban Maryland and rural New Hampshire. Participants were drawn from a larger study in federally designated medically underserved areas. Template analysis was used to analyze data and identify themes related to PCDC strategies and facilitators.

LTC staff described PCDC strategies for residents with dementia across three domains: communication-based interactional approaches, preserving dignity and autonomy, and tailoring care to individual preferences. Key facilitators identified included fostering communication, responsiveness to residents' needs, organizational support, and resource optimization. Despite limited resources, information-sharing systems, teamwork, engagement with care partners, positive attitudes, motivation, empowerment, adaptability, and dementia training facilitated PCDC implementation, highlighting that multilevel facilitators are key to delivering quality dementia care.

Findings emphasize the importance of communication and teamwork, responsiveness to residents' needs, supportive organizational structures, and resource optimization in implementation of PCDC in low-resource settings. Future research should incorporate the perspectives of residents and care partners and examine PCDC implementation across broader contexts.