« The Dual Agenda: February 4, 2015 Issue

Eldercare Voices

Moving Toward Person- and Family-Centered Care

Lynn Friss Feinberg, MSW

Person- and family-centered care (PFCC) generally refers to an orientation to the delivery of health care and supportive services that considers an older adult’s needs, goals, preferences, cultural traditions, family situation and values. It includes the person and, when appropriate, the family, at the center of the care team, along with health and social service professionals and direct care workers. This approach recognizes the role of family caregivers, who often are critical sources of support for older adults with chronic or disabling conditions. The demonstrations underway to integrate care for those eligible for both Medicare and Medicaid require participating health plans and provider groups to conduct a person-centered care plan that allows the enrollee to determine who can participate on his or her care team.

Person versus Patient

PFCC builds upon the concept of “person-centered care.” Traditionally, the term “person” is used in Long-Term Services and Supports (LTSS) settings, while the term “patient” is commonly used in a medical context. The term “person” rather than “patient” is preferred in that it connotes consideration of the “whole person,” including family relationships, when appropriate, and emphasizes continuity of care and support, and quality of life. In contrast, the conventional medical model is organized around providers, episodes of care, and specific diseases. Person-centeredness includes, but also looks beyond, the medical and physical health needs of the older adult.

The concept of person-centeredness and person-centered planning can be traced to changes that took place in the early 1970s as part of the independent living movement, led by people with disabilities. It is focused on the development of a social system in which all people with disabilities have the opportunity to lead productive, meaningful lives as integrated and valued members of their communities. The concept is equally applicable to older adults dealing with chronic and complex conditions.

Importance of the Family

We embrace the term “person- and family-centered care” because the term “person-centered care” alone may not adequately capture the importance of family in the lives of older people.

In 2009, family caregivers of adults with chronic or disabling conditions provided an estimated 40.3 billion hours of unpaid care at an estimated value of $450 billion. Without family caregivers, the health care and LTSS systems would be unable to meet the needs of older adults.

Family-centered care amplifies person-centered care by recognizing and supporting the vital role of family caregivers, building on the strengths of family connections. Some key facts:

The interests and decisions made by older adults and their family caregivers may not always be the same. Differences in the wishes, preferences, and capacity of older adults and family caregivers can present ethical challenges to health care and social service professionals. Conflicts may also arise among family members of an individual older adult. Providers can use skills in listening, empathy, conflict resolution, and mediation to help families cope and plan effectively. Holding a family meeting with a neutral facilitator or professional can mitigate disagreements, for example.

Key Elements of Person- and Family-Centered Care in Practice

The following are key elements of the PFCC model:


In recent years, PFCC has gained increased attention, but it is not yet commonplace in the delivery of health care and LTSS. To promote greater adoption of PFCC in everyday practice, public policies should support adherence to the key elements of PFCC; sufficient resources and supportive technology to address coordination and continuity of care; a trained interdisciplinary care team with the older adult and family at the center; and the provision of services and supports that matter most to older adults and to their families.

Lynn Friss Feinberg, MSW, is a senior strategic policy advisor with AARP’s Public Policy Institute. Her work focuses on family caregiving and long-term care issues. Prior to joining AARP in February 2011, Ms. Feinberg was the first director of the Campaign for Better Care, an initiative of the National Partnership for Women and Families. Previously, she held leadership positions at the San-Francisco based Family Caregiver Alliance, where she led the first 50-state study on publicly funded caregiving programs in the United States. Ms. Feinberg is a leading national expert on family caregiving and long-term care. She currently serves on the Institute of Medicine’s Committee on Family Caregiving for Older Adults, and is the Chair of the American Society on Aging.

Portions of this column reprinted with permission from the AARP Public Policy Institute. The original paper, with citations, is available here.

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