Person Centred Care Planning Explained

What is person centred care planning

Providing care that is person centred is a recognised requirement by all of the UK’s national regulators. We have covered what person centred care is elsewhere. This blog gives us the chance to dig into exactly what person centred care planning is, what a person centred care plan could look like, with some examples of a personalised care plan.

Person centred care values and care planning

Person centred care means putting the person who is in receipt of care services at the centre, making them the most important part of the process, not doing things easily, or standardisation, or efficiency.

This means that care should be personalised and tailored to each person’s individual needs and preferences. It also means that each person is involved as much as possible with the creation of their care plan and any decisions taken about their care. Family, friends or other advocates should be involved where appropriate.

Likewise, the person’s cultural, ethnic, sexual and other areas that matter to them should be taken into account. We should avoid taking a one size fits all approach, while at the same time not applying stereotypes or putting people into unhelpful buckets. That is not treating a person as an individual!

We should also help people to recognise and build on their strengths as part of care provision, instead of simply focusing on what they need help and support with.

As people’s needs or preferences should change, their care and care plans should be flexible and responsive to these changes.

Person centred care planning process

Following the values of person centred care we can think about how the care plan creation process also works in a person centred way.

The care plan should be a shared document, but the direction of ownership should be firmly in the hands of the person receiving care, not the care agency. The way a care plan is put together can have a big influence on how much the person receiving care feels a sense of ownership.

In turn this can impact how effective care is. If the person realises they own their care plan, they may be more likely to ask for changes, or raise concerns. This can help improve the quality of care, satisfaction, empowerment and overall better outcomes for the person and the care service.

The process of writing care plans can be made more person focused by:

Using people’s own words and phrases

Incorporating the words they use and recognise. Avoid translating and replacing their terminology and interpretations into jargon and abbreviations.

These might make sense to your colleagues but they then become detached from what the person being cared for was trying to communicate. They can become detached from and lose a sense of ownership over their own care plan.

Using goals, aims and outcomes that the person has identified

Setting goals and objectives is a crucial part of person centred care planning. While we may have our own ideas about what a person should want, it is up to them. We can help them with examples and ideas but should not force them and certainly not dismiss any of their aims if we feel they are not important, it is not our life after all!

Consider what people may have enjoyed doing in the past, but do less of now. This is usually a good place to start, restore independence and improve quality of life. Again, without imposing, only suggesting.

Similarly, we should not have a cookie cutter set of goals for the people we support - that is not a person centred approach.

If we feel a goal is not realistic now, we might work with the person to put some intermediary goals in place to build towards the larger objective.

It’s important to adopt the same focus to using people’s own words and phrases when setting goals and outcomes.

Involvement and ownership

People should realise a sense of ownership over their care plan. We need to help them understand we are not prescribing care to them, they have control in how care is delivered and what they want us to help them with, as much as is possible.

This should extend to reviews of the care plan and any changes that are made. Creating person centred care plans is not a tick box exercise, it’s a way of helping us implement a way of providing care that is unique and personalised for everyone we support.

Make every reasonable effort – strive to be person centred

There may be times when a person’s preferences about care cannot be met. We should always strive to make this the exception, not the norm. In cases where we cannot meet those preferences or desires, we must firstly explain, discuss and agree with the person and try and find the next best alternative.

The person should understand clearly why a certain preference cannot be met, so they can make informed decisions about alternatives and retain that sense of ownership over their care.

Personalised care plan example

An example of a personalised care plan could include (but not be limited to) the following areas:

• Detailed personal information
• Mental health details and history
• Medical history
• Communication (preferences, difficulties, needs)
• Social support
• Environmental risks
• Nutritional preferences and requirements
• Interests and activities

Each of these areas will usually act as groupings, under which there are a number of sub-topics, and not all will be applicable for everyone.

Each of these areas should include:

• What the situation now and how the person is experiencing it
• The persons goals, aims and desired outcomes are in this area
• How we will support them with their outcomes based on how they would like to be supported
• How aspects of this area might link to other areas of the care plan

Auditing for person centred care planning

Care plans will likely form part of your auditing processes. When auditing be sure to build in criteria to assess whether your service has a person centred approach in place, and whether the care plans used are person centred. Here are some examples of the lines of auditing you may want to follow:

• Does the person understand the care plan and how care will be delivered? Has this understanding been affirmed and recorded?
• Has the person been involved, and continue to be involved in meaningful ways, in designing their care?
• Is the care plan written in language familiar and personal to the person?
• Are there any sections duplicated from another person’s care plans (there shouldn’t be!)
• Are care plans made available to the person receiving care, in a format they can easily use/access and understand (language and ease of use)
• Has the care plan been reviewed and changed according to changing needs/preferences?
• Have family, friends or other advocates been involved with the production of the care plan where appropriate?
• Does the care plan adjust to promote people’s independence?
• Does the care plan have personalised goals and outcomes and how we will try to achieve those together?
• Is there clear evidence of the person’s involvement, input, control and ownership over their care plan?

Next steps in person centred care planning

This blog gives you more information on the fundamentals and what is care planning. You can find more of the underlying guidance of what the CQC looks for in person centred care planning here.

If you are providing care for elderly people one of the most frequent challenges you might face in person centred care planning is maintaining person centred care planning for people that have dementia. Dementia Partnerships have put together this guide to help in that very scenario.

As you are probably aware, most providers of social care have transitioned or are transitioning to electronic care planning. This is being pushed for by regulators, government, clients and providers themselves for good reason.

Using this technology makes care planning less labour intensive, more efficient, easier to evidence, link to other relevant processes, more secure and easier to report on. It can also make person centred care planning easier to implement and maintain. To find out more view our care planning software or contact us here.