Open Access Open Access  Restricted Access Subscription Access

Realizing person-centred care in residential care facilities for young adults with complex and chronic disabilities: the understanding, perception and beliefs of workers

Lauren Rissanen, Carolyn Ehrlich, Elizabeth Kendall, Heidi Muenchberger


Young people living with complex and chronic disabilities who require assistance with health-related needs are rarely receiving the optimum support and care that will enable their full participation in society, or simply to live as they choose. For young people with complex disabling health conditions, this situation may not only be unpleasant, but may have a detrimental impact on their outcomes. In Australia, considerable attention has been paid to the relocation of people from institutional care into community settings within purpose-built apartments. However, it is the service model and the residential workers who articulate that service model into practice that are crucial to stimulate better outcomes for young people.  In this study, a qualitative design was used to identify the major ways in which residential workers understood and articulated person-centred practice for young people with complex disabilities. Data were thematically analysed using an a priori coding framework. The study identified 4 main themes relevant to person-centred practice in this setting, namely: 1) recognition of the person in time and context; 2) recognition of individuality; 3) recognition of the relationship and 4) promotion of autonomy. Importantly, the themes were connected in a broad and multi-level way through communication. The findings indicate that to enact behaviours congruent with person-centredness, residential care workers may need to reframe their professional role, image and values. However, several barriers hindered this process (i.e., system/organisational constraints, time etc.) and participants clearly needed support, education and/or mentoring to improve their capacity to apply person-centred models and also to create meaningful care partnerships.


Beliefs, complex care needs, nursing, perceptions, person-centred care, residential care facilities, understanding, young adults

Full Text:



Gilmore, V. (2002). Aged care is not the right place for younger people. Australian Nursing Journal 10 (1) 15.

Cameron, C., Pirozzo, S. & Tooth, L. (2001). Long-term care of people below age 65 with severe acquired brain injury: appropriateness of aged care facilities. Australian and New Zealand Journal of Public Health 25 (3) 261-264.

Condeluci, A. (1992). Brain injury rehabilitation: the need to bridge paradigms. Brain Injury 6 (6) 543-551.

O’Reilly, K. & Pryor, J. (2002). Young people with brain injury in nursing homes: not the best option! Australian Health Review 25 (3) 46-51.

Smith, M. (2004). Under the circumstances: The experiences of younger people living in residential aged care facilities. Contemporary Nurse 16 (3) 187-194.

Winkler, D., Farnworth, L. & Sloan, S. (2006). People under 60 living in aged care facilities in Victoria. Australian Health Review 30 (1) 100-108.

Disability Services Queensland. (2006). Younger People in Residential Aged Care Initiative. Service Specifications. Integrated Living Model, 1-17.

Cott, C.A. (2004). Client-centred rehabilitation: client perspectives. Disability and Rehabilitation 26 (24) 1411-1422.

McCormack, B. & McCance, T.V. (2006). Development of a framework for person-centred nursing. Journal of Advanced Nursing 56 (5) 472-479.

Schoot, T., Proot, I., Legius, M., ter Meulen, R. & de Witte, L. (2006). Client-centered home care: Balancing between competing responsibilities. Clinical Nursing Research 15 (4) 231-254.

Wales, L.R., & Bernhardt, J.A. (2000). A case for slow to recover rehabilitation services following severe acquired brain injury. Australian Journal of Physiotherapy 46 (2) 143-146.

Strettles, B., Bush, M., Simpson, G. & Gillet, L. (2005). Accommodation in NSW for adults with high care needs after Traumatic Brain Injury. Sydney, Australia: Motor Accident Authority.

Holburn, S. (2002). How science can evaluate and enhance person-centered planning. Research & Practice for Persons with Severe Disabilities 27 (4) 250-260.

Holburn, S. & Vietze, P. (2002). A better life for Hal: Five years of person-centered planning and applied behaviour analysis. In: Personcentered planning: Research, practice, and future directions (Holburn, S. & Vietze, P.M., eds.), pp. 291-314. Baltimore: Paul H. Brookes.

Brooker, D. (2004). What is person-centred care in dementia? Reviews in Clinical Gerontology 13 (3) 215-222.

Eales, K., Keating, N. & Dasma, A. (2001). Seniors' experiences of client-centred residential care. Ageing and Society 21 (3) 279-296.

Kitwood, T. (1997). Dementia reconsidered: The person comes first. Buckingham: Open University Press.

Kitwood, T. & Bredin. K. (1992). Towards a theory of dementia care: Personhood and well-being. Ageing and Society 12 (3) 269-287.

McCormack, B. (2001). Negotiating Partnerships with Older people: a Person-centred Approach. Aldershot: Ashgate Press.

McCormack, B. (2003). A conceptual framework for person-centred practice with older people. International Journal of Nursing Practice 9 (3) 202-209.

Mead, N. & Bower, P. (2000). Patient-centredness: a conceptual framework and review of the empirical literature. Social Science & Medicine 51 (7) 1087-1110.

Williams B. & Grant, G. (1998). Defining ‘people-centredness’: making the implicit explicit. Health and Social Care in the Community 6 (2) 84-94.

Lyle O'Brien, C., O'Brien, J. & Mount, B. (1997). Person-centered planning has arrived… or has it?. Mental Retardation 35 (6) 480-484.

Mount, B. (1994). Benefits and limitations of personal futures planning. In: Creating individual supports for people with developmental disabilities: A mandate for change at many levels. (Bradley, V.J., Ashbaugh, J.W & Blaney, B.C., eds.), pp. 97-108. Baltimore: Paul H. Brookes.

Sanderson, H. (2002). A plan is not enough: Exploring the development of person-centered teams. In: Person-centered planning: Research, practice, and future directions. (Holburn, S. & Vietze, P., eds.), pp. 97-126. Baltimore: Paul H. Brookes.

Marrone, J., Hoff, D. & Helm, D.T. (1997). Person-centered planning for the millennium: We’re old enough to remember when PCP was just a drug. Journal of Vocational Rehabilitation 8, 285-297.

Sumsion T. (1999). Client-centred practice in occupational therapy. A guide to implementation. Edinburgh: Churchill Livingstone.

Ritchie, P. (2002). A turn for the better. In: Implementing person-centered planning: Voices of experience, 2nd edn. (O’Brien, J. & Lyle O’Brien, C., eds.). Toronto, Canada: Inclusion Press.

Miller, S. (1986). Relationships in long-term care facilities. Generations 70, 65-68.

Jewel, S.E. (1994). Patient participation: what does it mean to nurses? Journal of Advanced Nursing 19 (3) 433-438.

Braun, V. & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology 3 (2) 77-101.

Dempsey, P. & Dempsey, A. (1996). Nursing research text and workbook. Boston: Little, Brown.

DeSantis, L. & Ugarriza, D.N. (2000). The Concept of Theme as Used in Qualitative Nursing Research. Western Journal of Nursing Research 22 (3) 351-372.

Morse, J.M. & Field, P.A. (1995). Qualitative research methods for health professionals. Thousand Oaks, CA: Sage.

Hughes, J.C., Bamford, C. & May, C. (2008). Types of centredness in health care: Themes and concepts. Medicine, Health Care and Philosophy 11 (4) 455-463.

Spencer, L., Ritchie, J. & O’Connor, W. (2003). Analysis: Practices, principles and processes. In: Qualitative Research Practice A Guide for Social Science Students and Researchers. (Ritchie, J. & Lewis, J., eds.), pp. 199-218. London: Sage Publications.

Lewis, J. & Ritchie, J. (2003). Generalising from Qualitative Research. In: Qualitative Research Practice A Guide for Social Science Students and Researchers. (Lewis, J. & Ritchie, J., eds.), pp. 263-286. London: Sage Publications.

Ryan, G.W. & Bernard, H.R. (2003). Techniques to identify themes. Field Methods 15 (1) 85-109.

Holburn, C.S. & Vietze, P. (1999). Acknowledging barriers in adopting person-centered planning. Mental Retardation 37 (2) 117-124.

Smull, M.W. & Lakin, K.C. (2002). Public policy and Personcentered planning. In: Person-centered planning: Research, practice, and future directions. (Holburn, S. Vietze, P.M., eds.), pp. 379-397. Baltimore: Paul H. Brookes.

Wellard, S., Lillibridge, J., Beanland, C. & Lewis, M. (2003). Consumer participation in acute care settings: An Australian experience. International Journal of Nursing Practice 9 (4) 255-260.

Brown, D., McWilliam, C. & Ward-Griffin, C. (2006). Client-centred empowering partnering in nursing. Journal of Advanced Nursing 53 (2) 160-168.

McWilliam, C., Ward-Griffin, C., Sweetland, D., Sutherland, C. & O’Halloran, L. (2001). The experience of empowerment in in-home services delivery. Home Health Services Quarterly 20 (4) 49-71.

Dieppe P., Rafferty A.M. & Kitson A. (2002). The clinical encounter– the focal point of patient-centred care. Health Expectation 5 (4) 279-281.

Rogers, C.R. (1967). On becoming a person a therapist’s view of psychotherapy. London: Constable.

Schon, D.A. (1987). Educating the reflective practitioner: Toward a new design for teaching and learning in the



  • There are currently no refbacks.