Abstract
Loneliness, social isolation, and depression are prevalent among nursing home residents worldwide, causing mortality risks that rival those of major chronic diseases. Over the past three decades, the person-centered care movement has sought to replace the institutional medical model with care prioritizing residents’ individuality, dignity, and meaningful relationships. This review and commentary traces the evolution of person-centered care models and evaluates the evidence regarding whether person-centered care improves resident mental health. As part of our review, we consider evidence gathered from nursing home residents and staff during the COVID-19 pandemic, which led to the removal of major elements of person-centered care from daily life.
Older, pre-pandemic studies yielded mixed but increasingly positive results, with higher-quality designs showing that thorough person-centered care adoption improves quality of life and reduces depressive and neuropsychiatric symptoms. Our own research has clarified mechanisms by which person-centered care improves residents’ mental wellbeing. In a comparative observational study of homes differing in levels of person-centered care adoption, residents in high- person-centered care settings displayed greater positive affect, engagement, and social connection. In a follow-up longitudinal study, higher person-centered care scores predicted significant Patient Health Questionnaire-9 (PHQ-9) reductions and increased expressions of pleasure, mediated by stronger aide-resident relationships and timely depression treatment. Statewide analyses of Kansas’s Medicaid program to incentivize person-centered care adoption (the Promoting Excellent Alternatives in Kansas 2.0, or PEAK 2.0, program) showed that residents whose facilities were strong person-centered care adopters had strikingly lower odds of depression and better clinical outcomes overall.
Pandemic disruptions provided a stress test for person-centered care. When social contact and autonomy were curtailed, resident mental health declined sharply, underscoring the protective mechanisms person-centered care fosters. Emerging post-pandemic evidence reaffirms that comprehensive person-centered care improves psychological wellbeing and stabilizes the workforce through enhanced job satisfaction and lower turnover. Yet under 15% of U.S. facilities have fully implemented person-centered care, hindered by workforce instability and structural financial disincentives. Facilities should pursue thoroughly person-centered care adoption to transform themselves into communities where elders can live with dignity, purpose, and connection.