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Person-Centered vs Person-Led Care

Why Words Matter – What Person-Centered Care Means

The widely accepted model in dementia care — endorsed by leading organizations such as Alzheimer’s Disease International, Dementia Care Matters, and the Center for Applied Research in Dementia (CARD) — is person-centered care.

This model emphasizes:

  • Seeing the individual beyond their diagnosis.

  • Valuing their preferences, history, and dignity.

  • Involving them in decisions to the extent they can participate.

  • Creating care plans around the person’s identity, abilities, and needs rather than the system’s convenience.

At its heart, person-centered care is about partnership. Whenever a person with dementia can direct, choose, or express their will, staff are meant to honor it. In this sense, person-centered care already contains the spirit of “person-led” care — because residents are invited to lead whenever they are able.

The Problem With “Person-Led” Care

Some have suggested that “person-led care” should replace “person-centered care.” At first glance, this may sound like an evolution. But in dementia care, the term is problematic for several reasons:

  • Unrealistic expectations. In both moderate and late-stage dementia, many people cannot consistently make or communicate decisions about their own care. Suggesting that they should “lead” places a burden they cannot carry.

  • Diluted accountability. It risks shifting responsibility away from staff — as though the person with dementia is solely responsible for guiding their care, when in reality the care team has a duty to interpret, support, and advocate.

  • Semantic rebranding. It often comes across as splitting hairs — rebranding a well-established model to sound new, rather than offering meaningful improvement.

Moderate Dementia and Decision-Making

It is not only those in advanced dementia who struggle to lead. Many in the moderate stage already lose the capacity for sustained decision-making, abstract reasoning, or recognizing consequences.

Here’s why:

  • Memory gaps: Choices don’t stick. Someone may answer “tea” when offered a choice, but forget within a minute that they were asked.

  • Language difficulties: They may lack the words to express a preference, leading to silence, frustration, or default “yes” responses.

  • Judgment and sequencing loss: Multi-step options (“Do you want to bathe now or after breakfast?”) overwhelm them.

  • Emotional primacy: Feelings in the moment — comfort, anxiety, fatigue — drive behavior more than rational choice.

Thus, in moderate dementia, the ability to “lead” one’s care is already intermittent at best.

What Person-Centered Care Does Instead

Person-centered care acknowledges this reality:

  • Residents do not need to carry the full burden of leading.

  • Staff provide scaffolding — offering cues, breaking down options, and noticing nonverbal signals.

  • Choice is often about interpretation, not verbal decision-making. Caregivers pay attention to what someone gravitates toward, resists, or emotionally responds to.

The resident still guides care — but often indirectly, through behaviors, rhythms, and comfort levels. Staff, in turn, act like a cognitive ramp, helping the person cross a gap they can no longer bridge alone.

Why “Person-Led” Collapses in Moderate and Advanced Dementia

If care were rigidly framed as “person-led”:

  • Many residents would be set up to fail, appearing “resistant,” “indecisive,” or “difficult” simply because they cannot lead consistently.

  • Staff might hesitate to act, waiting for explicit choices instead of using their professional responsibility to interpret and advocate.

  • Families could feel guilt or frustration when their loved one “isn’t leading” the way the term suggests.

Bottom line: in both moderate and advanced dementia, many people cannot reliably lead or choose. That doesn’t mean they stop guiding care — but it does mean that staff remain responsible for interpreting, scaffolding, and protecting dignity.

In Practice: How Person-Centered Care Already Includes Person-Led

Good person-centered care already behaves as “person-led” whenever possible:

  • If a resident indicates a preference — verbally or nonverbally — staff follow that lead.

  • If they want to choose their clothing, meal, or activity, they are empowered to do so.

  • When they cannot (or do not wish to) lead, staff draw on life history, family input, and close observation to stand in for their voice.

The distinction, then, is more rhetorical than practical.

The danger of “person-led” is that it could be taken literally in settings where residents cannot lead, causing confusion, guilt, or even neglect of professional responsibility.

Addressing the Arguments for Person-Led Care

Advocates of “person-led” care argue that it addresses gaps left by person-centered care. But in reality, these are gaps in implementation, not the model itself.

  • Stronger empowerment?
    Yes, but person-centered care already requires staff to honor verbal and nonverbal signals. Empowerment is its cornerstone.

  • Reduces paternalism?
    Yes, but true person-centered care is already about doing with rather than doing for. Paternalism comes from poor practice, not from the term.

  • Cultural shift?
    Yes, but culture changes when leaders enforce accountability to principles — not when words are swapped. Rebranding risks creating yet another buzzword.

  • Rights-based approach?
    Yes, but person-centered care already rests on human rights: autonomy, dignity, and self-determination. Rights aren’t enhanced by renaming; they’re upheld by consistent practice.

In other words: person-led tries to fix with new language what is already covered under person-centered care.

The Honest Comparison

  • Philosophically: Person-led sounds more radical, rights-driven, and autonomy-focused. On paper, it looks closer to the “pure” ideal of autonomy.

  • Practically: Person-centered is sturdier and more sustainable. It adapts across all dementia stages, acknowledges when residents cannot lead, and keeps staff accountable.

Which is better?

  • For policy and training: Person-centered care is better. It’s clear, internationally recognized, and flexible.

  • For culture change in stagnant organizations: Person-led care might serve as a provocative rallying cry — shaking staff out of autopilot and sparking discussion about power dynamics.

But it must be stressed: if an organization cannot operationalize person-centered care, they absolutely cannot deliver person-led care. In those cases, pushing “person-led” is not progress but regression.

The Risks of Rebranding Without Practice

If “person-led” is simply layered on top of weak person-centered practice, it could:

  • Confuse staff further: If they don’t grasp person-centered care, person-led only muddies the waters.

  • Dilute accountability: Staff may excuse inaction by saying “the resident didn’t lead.”

  • Cause regression: Overwhelmed staff may retreat back into rigid, task-driven routines.

This is why person-centered care — when faithfully practiced — remains the stronger, safer, and more responsible model.

Conclusion: Why Person-Centered Remains the Right Term

Person-centered care means we follow the person’s lead whenever possible — their choices, their signals, their preferences. But when they can’t lead, we don’t step back. We step up, using what we know about their life, identity, and history to guide care.

That’s why person-centered care remains the right term. It already includes person-led moments, without burdening people with expectations they cannot meet. It balances empowerment with responsibility, ensuring that care is always dignified, safe, and meaningful.

In dementia care, person-centered care is not just best practice — it is the practical and ethical standard.

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