Many professionals consider their practice is person centred but I often struggle to find evidence to support their claim. So what does being person centred mean and what does it look like?
What Being Person-Centred Means
There is no universally accepted definition. The key principle for being person centred is to support and empower people to make choices and have control about how they want to live their life. Person centred planning encourages people to be more involved in decisions about their care so they get the support and services that are appropriate for their needs and preferences. It’s about seeing the person as an individual before their age and disabilities, focusing on their preferences, expectations, needs and circumstances and trying to see things from their perspective.
Being person-centred also means being aware of a person’s emotional and spiritual well-being. Spiritual care is not just about religious beliefs and practices: it also reflects the person’s values, relationships and need for self-expression.
We need to be aware that people are sometimes unable to tell us what they want. There are many reasons for this; they may be living with dementia, have a physical disability, severe hearing loss or a mental health condition, which makes communication difficult. We may therefore have to use appropriate communication aids to find out what they want and actively encourage them to participate in their care planning so they can be real partners in making decisions about their care choices.
Getting To Know The Person
When planning in a person-centred way with someone, we need to think about the effect of what we’re doing on the person as a whole. We therefore need to know the person and find out as much information as possible. Before you begin care planning, ask the person (or the person/people who know them well) about themselves and the things that are important to them. Listen carefully to what they are saying (sometimes what they are not saying can be as important) and ask probing questions to check your understanding is accurate.
All too often I am asked to undertake an independent care review and find the Manager and carers know very little about the person, especially if they have dementia and don’t have a family. What did they do for a living? Where did they live when they were younger and what did they enjoy doing? What made them happy? What made them sad? What are their likes and dislikes? and one of the most important questions of all, what is important to them?
Don’t only focus on what keeps people healthy and safe. See the person as well and what matters to them- not just what the matter is with them.
A case study
Being person-centred sometimes requires me to think outside the box to achieve my client’s chosen outcome. The following is a good example.
Mrs M lived with her husband who was her primary carer. She had a number of coexisting mental and physical health conditions, including dementia and severe anxiety. She had a suprapubic catheter tube inserted into her bladder through a small hole in her stomach, which she used to empty her bladder. She was encouraged to empty the bag herself to maintain her independence and this required undoing the tap and bending over the toilet pan.
As she progressed along her dementia journey, Mrs M began forgetting to turn the tap off and her clothes became soaked in urine. She always wore tight trousers and would become hysterical when this happened thinking she had wet herself. Her husband’s health was deteriorating, he was losing his sight and found changing her clothes increasingly challenging.
Mrs M’s GP and District Nurse advised that the time had come for her to move into a care home.
I was asked look at care options with the couple.
When I asked Mrs M what was important to her she told me it was remaining in her own home with her husband. They had been happily married for 64 years and didn’t want to live apart.
The solution I recommended was a small gadget produced by the Bath Institute of Medical Engineering department called a Wander Reminder costing £50. I advised this needed to be fixed to the cloakroom wall at the height where she bent over the toilet pan to empty her catheter.
When Mrs M bent over to empty the bag, a motion sensor would trigger a recorded message to remind her to turn the tap off. I advised the message needed to be changed regularly so she didn’t get used to it and ignore it.
Person centred planning and this £50 gadget enabled Mrs M to remain at home with her husband for a further year.
- Get to know the individual and recognise their individuality. Decisions should always be made from their perspective
- People have a variety of different preferences, history, circumstances and lifestyles, so the planning process needs to adopt a personalised approach
- Find out what is important TO the person as well as what is important FOR them
- Think outside the box to find solutions for the person to consider
- Person centred planning needs to focus on achieving meaningful improvements in the person’s life and make a difference to it
- Look at how the person’s identity and independence can be strengthened
- The person’s needs are likely to change over time so make sure you review the care plan regularly.
“We cannot care for people unless we care about them and we cannot care about them if we don’t know who they are”