1.1 – Person-centred care is a way of thinking and doing things. It means putting the individual and their families at the centre of decisions and seeing them as experts, working alongside professionals to get the best outcome. Person-centred practise is all about having a focus upon individual’s needs. Every individual has different needs, wishes, choices, likes and dislikes. We must treat everyone fairly and respect their dignity and privacy at all times. We cannot stereo-type or tarnish everyone with the same brush even if they have the same religion, disability or alike in any other way. Despite what they may have in common, every single person is an individual and should be treated like one.

1.2 – All approaches to person-centred practice work well and personally I don’t think there is a particular ‘best approach’. When used correctly, every approach will have the same benefits and outcomes. Also different approaches would work better in some work placements than others the same as work better with some individual’s than others.
Below I have compared just a few different types of approaches:

Essential Lifestyle Planning. (ELP).
This plan looks at:

- what people like and admire about the individual
- what is most important to the individual
- the communication
- how to provide the support
- identification of successful methods
- how to solve problems and/or overcome any barriers

ELP is a good for a day to day basis. It’s a good way to start to get to know an individual and work out their individual needs.

Personal Future Planning.
This is similar to ELP but it also includes access to all other professional services and community resources. It looks at life now and what the individual wants in the future. It’s quite a brief over view.
Compared to the other approaches I have chosen it isn’t as detailed as some of the others.

Planning Alternate Tomorrows with Hope. (PATH).
This is a fast moving tool and can be very powerful. PATH works really well when an individual has a group of people around them who are committed to making things happen. It works in 6 stages:

1 Step 1 – The Dream.
The individual and/or key people describe their personal goals for the future. It will cover their wishes, preferences and choices and how they want to live on a day to day basis.
2 Step 2 – Sensing the goal.
This is where the individual imagines how it would be and feel to live how they have chosen in stage one. This is important as everyone involved can sense the importance to the individual to live this chosen way and everyone can see the potential benefits this would have.
3 Step 3 – Now.
This stage looks at how life is now and where they want to be. It helps recognise what needs to be done and what changes need to be made and what needs to be put in place to enable the goal to be met.
4 Step 4 – Who’s on board?
This is about recognising all the people needed to achieve the goal. This could be professionals, community resources, family and friends. It’s good to gather all the people that are there to support the individual.
5 Step 5 – How?
This is a very important stage as it identifies what steps need to be taken to maintain the goal’s progress. This can be done via regular meetings.
6 Step 6 – Three/Six month goals.
Setting particular goals between 3-6 months of the original meeting will ensure they maintain on track to achieving the goals. Doing it this way will also help if the goal has gone off-track slightly.

I do like PATH as it’s very detailed and personally I would like to use this approach in my workplace now.
1.3 – There’s so much legislation and law regarding health and social care. I have chosen to talk about 2 main legislations that have had impact on person-centred practice.

Part of CQC’s Health & Social Care Act 2008.
Regulation 9.

This regulation is bases around person-centred practice. The intention behind this is to make sure all individual’s using or receiving care and treatment should do in a personalised specific manner for each individual.

It describes the action that providers should take to ensure each individual does receive appropriate person-centred care and treatment.

Providers must:
- take into account people’s capacity and ability to consent
- themselves or a person lawfully acting on their behalf must be involved in the planning, management and review if the individuals care and treatment
- make any reasonable adjustments
- provide support to help individuals to make informed decisions
- provide all staff with up to date and current training to enable them to give the best person-centred care and treatment

The effect that this piece of legislation has is huge as it’s a main regulation that CQC will be inspecting when they inspect any organisations.

Mental Capacity Act 2005.

MCA is designed to protect and restore power to those who are vulnerable and lack capacity. It’s vital to ensuring that person-centred care and practises are being used and that organisations are respecting people’s rights.
Its main message around person-centred care is:

- the MCA promotes people’s human rights to make their own decisions, or to have their best interests adhered to where decisions have to be made on their behalf
- care planning should highlight that all support is in the individuals’ best interest and is the least restrictive way of meeting their needs – particularly if DOL’s are involved.
- Advanced care planning and decision making can help people retain control over their lives when they lose the capacity to make some decisions

The overall effect of legislation has been to promote person-centred care as the highest standard in health and social care and an approach that all individuals and families can expect.

1.4 – Consent means an informed agreement to an action or decision. We use person-centred practise when establishing consent with individuals.

How an individual can give consent will depend entirely on their individual needs. The person centred values that we use to establish consent from an individual includes:

- ensuring individuals can express thoughts and ask questions
- ensuring the individual has personal values and beliefs
- ensuring the individual is treated with respect and has dignity
- ensuring the individual has the necessary information in order to make an informed decision

When establishing consent from individuals, we need to be fully aware of all the factors involved, these could be:

- mental impairments
- communication barriers
- language barriers
- physical illness

When taking these factors into account, there are a range of ways to overcome any barriers and establish consent. These could be things such as:
- flash cards, picture cards
- translation cards (I have recently looked after a Spanish lady who couldn’t speak English and I created translation cards of all the main activities, foods and drinks etc.)
- use of different staff, sometimes individuals have a better relationship with other staff and respond better
- use of families and friends.
- The use of aids, (hearing, sight etc.)
- Using short sentences or just key words

1.5 – There are many benefits to receiving person-centred care and treatment. It’s very important to know the positive effects it has on individuals as it ensures that you do provide this practice as you know the effects.

As quoted from ‘Valuing People’

‘A person-centred approach helps organisations provide accessible, responsive and flexible services that meet the diverse needs and preferences of people living in our community. Many of these individual’s want to remain independent for as long as possible and they rely on the community care system to help them achieve this’.

Improved quality of life.
- When an individual is encouraged to engage in their past pleasures it will improve their social well-being. It helps create a good relationship between carers and individuals, where a bond is built on trust and respect. All of this maintains a high level of psychological well-being and productive behaviours.
Less agitation.
- There would be less agitation and anxiety, especially in the elderly with dementia, when we respect their freedom of choice regarding daily activities.

Improved self-esteem.
- Individuals, when provided with the opportunity to express themselves and their needs will maintain a positive sense of self. This in turn will significantly reduce feelings of grief, anxiety, anger and feeling like a burden to those around them.

Better sleep patterns.
- Respecting individual’s past interests, treating them as individuals and respect their current capabilities can improve their sleep during the nights and day naps as the individual will feel content and calm and will sleep better.

2.1 – In my current workplace we have ‘memory books’. These are completed in the first week of an individual moving into our home. It’s normally completed by their designated key worker as it’s nice to start to build a bond with their key worker from the get go. This booklet contains lots of questions about:

- past interests, hobbies and past times
- all family and friends
- past jobs
- marriage
- holidays
- places they’ve travelled
- pets
- houses and places they lived
- mother and fathers occupations

If they are unable to answer any questions, or get stuck and can’t remember anything, we tend to give the booklet, with permission (if they have the capacity), to the families and they will add to it.

Every individual has their own care plan. This folders contain all their specific needs and how we can achieve these. It also contains their past medical history. This is put together by either myself or my other senior, using information from the pre-assessment and other assessments that we do when they move in. Also we do encourage the individual, if able to and have the capacity to read the care plan and add anything or change anything. We also involved the family to this process, especially the next of kin’s of the individuals who don’t have the capacity. The more information we can gather, the better we can care for and provide the best person centred practice to the individual.

As I am creating the care plans, I will also go through all other information such as:
- likes and dislikes
- what foods they like and the ones they don’t
- preferences such as male or female carers
- anything in specific they want such as, hairdressers, chiropodists etc.
- where they generally like their meals
- generally prefer baths or showers, mornings or evenings?

In the staff meetings, we go through each individual and discuss them. We will discuss anything new we have found out, if we have found things that worked really well, if things haven’t worked well and if we have any concerns.

As we are gathering information, I do like to try and find out and I normally do this through the individual’s families or next of kins, if there is anything distressing, traumatic or upsetting that has happened in their past. This is extremely important, even more so in individuals with dementia as they could return to that moment at any time and it’s important, all staff have a good understanding of the events so they know how to deal with it and if possible calm the atmosphere.

Case Example.
In my previous workplace, Mr.B was a gentlemen who lived in the home and he had dementia. During a night shift, we had a young Japanese girl who was working. Mr.B took a very strong disliking to her and did grab her arms and wouldn’t let go and just kept shouting and screaming at her. As I had read the care plans, I knew straight away what the problem was. During the war, he was a prisoner of war in Japan. His dementia had put him back to that time and he was clearly distressed, angry and scared due to what he had been through in the past. I explained to Tom and we had to sort of act out an Army scene where I broke the news that the war had ended and he was safe to go home. He did eventually calm down. After this, I asked the Head of Care on that floor how this happened, he hadn’t read the care plan and didn’t know. I then brought this up in a staff meeting and it was made clear that under no circumstances would we allow a Japanese worker to care for him. Mr.B didn’t react this way again after this.

2.2 – Life story work enables care workers to see the individual as the person they are now in relation to who they used to be. Though getting this past information can be complex and sensitive. Supporting the individual to implement person-centred practice in this way can be challenging but there are some things to remember when supporting them to cooperate with us when sharing this information:

- Ensuring that the individual’s rights and dignity are maintained. This is fundamental to good and safe practice. Listen to what they are telling you, and show them that you are interested in what they are saying. Life story work with individuals with dementia gives the families and carers the opportunity to connect with them as people and maintain positive relationships as well as stimulates conversation and meaningful interaction.
- Show them that doing this will enable their independence and identity as far as possible and safe. Remind them that they will continue to be a person in their own right even though they have social or health needs and this does not define them.
- Explain to the individual that they have real choices. This may not be possible in all aspects and areas in life, but in dressing and other personal activities there is a great deal of scope to personalise their care.

2.3 & 2.4 – One way of reviewing and adapting approaches is by supervision. This can be individually, which in my workplaces happens every month. Another way is through staff meetings. During staff meetings we can openly discuss methods that have worked well with individuals, as well as the things that haven’t worked well.
Individual staff meetings is a great way to give constructive feedback on a one to one basis. Hopefully staff will feel comfortable to openly discuss what they don’t feel comfortable with and if they feel they need more support or training in providing person-centred practice.

Between myself and my other senior, we review the care plans 2 monthly but we amend them as and when needed. We also encourage our staff to read the care plan every 2 months, especially when changes or adaptations have been made.

We assess the individual’s daily. This is done naturally when providing personal care to doing daily activities with the individuals. Staff will come and raise any concerns that they have to either myself, other senior or management and we can act upon this concern how we see fit.

Especially during the period when care workers are completing the Care Certificate, as I am the Care Certificate Assessor, I have to complete observations on my staff to go alongside their booklets. Here is a good opportunity for me to observe the staff in practice and give constructive feedback there on the spot. Here I can also tell if they need more training in certain areas.

My manager ensures that all staff are always fully trained and that their training is up to date. My manager also has made it clear to all staff that if you feel like you need a refresher on anything, then to come and speak to her or the seniors and we can arrange this.

3.1 – Without active participation, there is no person-centred values in anything that we do, because individuals are not being fully included in their own care.

Active participation is a way of working that recognises an individual’s right to participate in the activities and relationships of everyday life as independently as possible; the individual is regarded as an active partner in their own care, rather than a passive recipient.

It’s very important to evaluate our practices to ensure that it does enhance an individual’s well-being and quality of life. It can be easy to just assume that it does just that.

The SMART criteria is a good tool to evaluate active participation. Although I don’t use this in my current workplace, I do personally still use the principles of this tool. Below is a table to show how the tool can be used:

|Criteria|Example|
S|Specific|‘How has that made you feel in yourself?’|
M|Measurable|‘You walked the first hundred metres without a stick. Can you go further next time?’|
A|Achievable|‘You said you could do it. I bet you’re pleased?’|
R|Relevant|‘Was it something you wanted to do?’|
T|Timely|‘Would you have preferred to try next week, or was this the right time to have a go?’|
Active participation can address holistic needs for an individual which helps them to live their lives as independently as possible. It’s very important that individuals can be as active in their own care as possible as it helps them to feel empowered and that they still have control over their lives by making decisions and choices for what they want and need. It’s our duty of care towards the individual to make sure this happens.

3.2 & 3.3 – Ways to promote understanding and use of active participation is to help individuals to talk to us so we know what they want and like so we can make it happen for them. We always ask them what they want to do and if they have any ideas to let us know. If individuals don’t understand what we mean we will actually show them so they can see what we are talking about and can then make their own mind up. By individuals participating in activities it makes them happy to be involved and sharing the experience with others around them makes them feel good about them self’s. It’s our duty of care to make the time to spend with the individuals and include them in as much as possible. To support an individual to make informed choices you have to be non-judgemental as it is not your choice to make. You should give them all the information that they need to make the right choice and just be there to support their wishes. My role as a senior health care worker is to make sure the needs and wishes of an individual is respected and you have to support the individuals choices whatever they are as its their right. You cannot let personal views or beliefs influence an individual’s decision as it’s their human right to do this. By support an individual in a way that promotes their sense of identity, self-image and self-esteem you develop a good relationship with them. The individuals learn to trust and respect you. As a carer you need to help support their wishes and choices. You can help them to grow in confidence, feel good about themselves and make them to feel safe and secure as well. To contribute to an environment that promotes wellbeing you need to build up positive relationships with the individuals so they can trust you. You need to make their surroundings as warm, friendly and welcoming as possible to make them feel safe and happy. You need to encourage communication as it is a two way thing. You should have a good attitude towards the individuals as you need to put their needs above anything else as it is your duty of care to do so. Systems and processes to promote active participation include ensuring that there are agreed ways of working that follow policies and procedures, for example:

- a personal history for each individual in your care (if this is not possible from the individual, then other key people can be asked)
- a full assessment on each individual for their potential and current abilities, needs, wishes and preferences on a regular basis, remembering that emergent needs and preferences can alter the care that is appropriate
- asking each individual what they want from services
- respecting cultural and other personal characteristics, whether due to ethnicity, age, gender or other criteria
- evaluating risk assessments against the extent to which they enable the individual to participate actively in their own care (remember, it should never be assumed a person is unable to carry out an activity of daily living without good evidence that this is the case)
- establishing regular supervision sessions

Different types of risk assessments in health and social care are mobility, medication, lifestyle and personal needs. These are all types of assessments that need to be carried out on a regular basis as circumstances can change really quickly. Risk-taking and risk-assessments relate to rights and responsibilities are all about accountability for individuals or our actions. This is why we have to review and monitor their progress in a regular basis. Risk assessments are really important and must be carried out every month when a care plan is updated as with all individual’s changes in health and mobility can happen really quickly. So if we need more equipment to help deal with this changes we can get them in place and make sure the individuals are getting the correct care they need and deserve and are safe at all times.