Introduction to person-centred care for older people in care homes

This resource covers the implications of the personalisation agenda for owners and managers of care homes. It summarises information, advice and guidance which will support care home owners and managers as they develop a person-centred (or personalised) approach to care in their homes.

Introduction to personalisation

Personalisation means putting the person who is using your service at the centre of everything you do in the care home. Person-centred care starts with the identity of the individual. It focuses on their personal history and strengths, their hopes and ambitions. It means you respect their past, support their present, and help them plan for their future.

Personalisation involves understanding the rights of each individual who lives in the home. The human rights approach to healthcare is based on the FREDA principles from the Human Rights Act: fairness, respect, equality, dignity and autonomy. The Care Quality Commission (CQC), has built on these developments to identify a human rights approach to regulation.

In the past, some ‘care’ institutions offered the opposite of individualised care: a regimented and depersonalised approach which destroyed self-esteem, identity, and resilience. Traditional, service-led care offers little choice or variety, and treats everyone in the same way. Such models mean that people are not able to shape their own care to fit their personal needs, and access to information about what could be available is often limited.

Over many years, the personalised approach, pioneered by disabled people and third sector organisations, has become embedded in social care policy.

Personalisation is about providing services which are varied, and innovative, and meet the needs of individuals. It requires good communication, so that people can take control of their futures, and make informed choices about their own care from a range of options. It means that people can continue to live their own lives, and follow their own interests. This approach should be the basis of care, treatment and support in all residential care home services, with or without nursing provision.

That is the essence of personalisation – tailoring care and support to what individuals choose as a means of helping them to live their normal life. People don’t want to be defined by their condition – they are not “suffering from dementia” or “autistic” or “subject to multiple co-morbidities”. They are, first and foremost, individuals with very personal hopes, fears, aspirations and relationships.

Department of Health 2015: Voice, Choice and Control, p.4

What the law, policy and guidance say about person-centred services

A number of principles of good care have been highlighted in the last few years by policy and research, regulation and guidance. They include respect and ordinary courtesy; compassion and kindness; responsive care and treatment; openness and honesty when something goes wrong. The principles should underpin practice to ensure the kind of treatment which we would all want for our families and ourselves.

The Care Act 2014 set the terms for the development of social care for the foreseeable future. It brings together and amends legislation and guidance which has developed over years, and places it all in one framework, underpinned by the principle of individual wellbeing.

The Act puts personalisation on a legal footing for the first time. It defines rights to choice, personalised care plans and personal budgets. It also requires local authorities to ensure that a range of high-quality services are available in their area. The principles of personalised care are now central to social care law and policy.

The Act shifts the meaning of ‘care’ away from a traditional focus on meeting needs. In the care home, working towards wellbeing means collaborating with individual residents on a personal range of services which will preserve their identity and promote their independence.

Care home owners and managers should know about the local authorities’ duties for supporting wellbeing, and the opportunities which these offer to providers.

Regulation

The Care Quality Commission (CQC) regulates all care homes, and provides guidance on meeting the regulations it is enforcing. It also spells out what the fundamental standards are, and exactly what inspectors are looking for when they visit a care home.

The Key Lines of Enquiry (KLOES) are set out under the five key questions the CQC asks about your service: is it safe, effective, caring, responsive and well-led. The person-centred focus of any inspection is clearest from the lines of enquiry included under ‘Responsive’. But each of the five questions is clearly relevant to the development of a service which supports the individual.

The KLOES for social care (which cover all care homes, with or without nursing), are likely to be under revision in 2017.

Personalisation for owners and managers

• Leadership - Strong leadership is critical to developing a culture inside the home which supports personalisation.
• Person-centred - Owners and managers need to ensure that all staff are fully committed to personalisation. Ask the residents whether you are getting it right.
• The individual - In a care home, ‘quality’ is about ensuring that the individual’s hopes, goals and needs are met.
• Families and carers - Encourage families to be active partners in the care you offer to residents.
• Better services - Owners and managers should support the development of new local services which respond to the demands of the people in their care homes.
• Local partners - Managers and staff need to work jointly with health and social care partners, as well as third sector and community organisations, in transforming local care.
• Good health in the care home - Most care home residents are in their 80s or older, and many need care and support for a range of conditions.
• Care home ‘is’ a community - Your aim is to make the home ‘home-like’: it should look, sound and smell as much as possible like an ordinary home anyone might live in.
• Care home ‘in’ the community - The life of the home should not stop at the front door: it should become part of the local community.
• Information for care homes - At every stage, people in your home will need information to choose between and take up the opportunities available to them.
• Safety and safeguarding - People in care homes are entitled to live without fear or harm, abuse or neglect. They should be supported to manage any risk arising from the independence they seek.
• End of life care - About a fifth of all people who die in any one year in England die in a care home. This means that training for all staff in end of life care planning, and for some in palliative care is a priority.