Interpretations of person-centered dementia care: Same rhetoric, different practices? A comparative study of nursing homes in England and Sweden

• A comparative study of the meaning and content of person-centered care in two nursing homes situated in England and Sweden.
• The discourse of a person-centered approach to dementia care is more uniform than the caring practice.
• The differences shown in the environmental modifications and caring practices relates to how the nursing homes accentuate two different symptoms of dementia.
• In the process of realizing person-centered care, new standards of what kind of care it is possible to give is constructed.
• It is central to consider policy, means and the organization to know how person centered care evolves in different contexts.

Using ethnographic data collected from nursing homes in England and Sweden, this article analyzes how a person-centered approach to dementia care has been interpreted in two different contexts. Based on typical elements of person-centered care identified in previous research, the analysis examines environmental changes and the way care is performed. A discourse of person-centered care is articulated at both nursing homes, which aim to create a good environment and care practice for people with dementia. Although we found similarities in how good care was understood at the two homes, we also found important differences. The results point by to two types of care atmospheres, such that cheerfulness and activity are underlined at the English home and calmness at the Swedish home. Differences in the environments and practices of a person-centered approach can be related to how ways of giving care in the two homes accentuate two different symptoms of dementia. In the English home, the problem of a shrinking world was stressed and the solution was stimulation. At the Swedish home, problems of agitation and anxiety were stressed and the solution was calm and quiet. These differences are discussed in the light of the role of national policy, resources and the organization of work, which can partly clarify why some aspects of what is good care for persons with dementia are underscored in a specific context and not in others.