Person-centred care planning

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.

Communication Challenges

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 Person45281480

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.

In conclusion

  • 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”

Planning End of Life Care

As its Dying Matters Awareness Week I would like to talk to you about the importance of getting your elderly loved ones to make plans for their end of life care. I have seen what happens when people don’t plan for having an accident, a stroke or an illness such as dementia, which leaves them unable to make decisions such as whether they want life prolonging treatment and how and where they would like to be treated.

This issue is very important to me and although I will be unable to control what happens to me if I find myself in this situation, I want to choose how I live the end of my life and how my funeral is conducted. I have therefore taken out a Lasting Power of Attorney for both my property and affairs and my health and well-being. I am also  one of the 3 in 10 people who have made a will. Why on earth would I want to leave my hard earned dosh to the Government?

Holy spirit dove flies in blue sky, bright light shines from heaven, christian symbol, holy bible story

I would much rather address these matters while I am relatively young and have no intention of dying, although  like everyone else I have no control over that whatsoever. If I leave it too late and am no longer able to make my own decisions, I will not be able to make these plans myself.  Now I can relax, forget about the Lasting Powers of Attorney which will only be able to be used if I am unfortunate enough to loose my marbles so there is no danger of my sons (who are my attorneys)  selling  my home and emigrating with my loot.

Although it is possible to download the LPA forms and will template  from the Internet  and do it yourself I chose not to do this as unintentional mistakes can be made by not considering all eventualities. If you have made your own will and LPAs this only comes to light when it is too late to do anything about it. So find yourself a good solicitor. You will be glad you did.

Here is an example of a situation  I remember from my days of working on night duty at the local hospital. that illustrates my point nicely. I have made up their names for anonymity. To be honest I can’t remember them anyway!

Example of  how failing to plan can cause conflict in a family

Steve lived near his father and they had an especially close relationship. When his father had a stroke Steve was asked whether or not he wanted his father to be resuscitated if his condition deteriorated. Steve told me that his father valued his quality of life and felt that if it was seriously compromised, he would not want his life to be prolonged. However, his brother disagreed and as you can imagine, the situation could have caused a serious conflict within the family. Luckily his father’s condition improved and a decision did not have to be made.

Another example is a personal one. When my father became terminally ill, I knew exactly what his wishes were and had power of attorney to back up decisions I made on his behalf. He died peacefully at home listening to his favourite music, being assured it was OK to let go and reassured that my brother, sister and I would look after our Mother. I cannot stress enough the comfort it gave me to know I was carrying out his wishes just as he would have wanted.

A letter of wishes

I have one last thing to do to ensure my choices are taken into account, I am writing a letter of wishes to be go with my papers, so that my sons know exactly what I want to happen if I have an accident become seriously ill or lose the ability to make decisions for any other reason. Also where and how I want to live if I am unable to make my own choices, how I would like my body disposed of at the end of my life and what I want to happen afterwards.

We are all going to die

As a society we tend to avoid talking about these matters. However, death is a part of life and if they are faced, discussed and planned for we can forget about them, know our wishes will be heeded and acted upon and that we have saved the person or people we have left behind the responsibility of guessing our choices. Don’t leave it too late

Millions leave it too late to discuss end of life wishes. Don’t let an older person you care about be one of them.! The following website offers lots of good information to help you. Dying Matters.Org

Stimulation for people with dementia

This guest post provides information about activities, games and excercises that provide stimulation for people living with dementia

Mental stimulation is important for older people generally and especially so for people living with dementia. This guest post provides  information about activities, games and excercises that provide stimulation. A dementia diagnosis can be overwhelming. People living with dementia sometimes find that the anxiety and depression that often comes with the condition causes them to withdraw from the friends, family, hobbies, and social or physical activities they once loved. Not only does this affect their quality of life, it has also been proven that a lack of mental stimulation can be bad news when it comes to cognitive decline as well. 45281480

In a study published by the Rush University Medical Centre in Chicago, test subjects were given frequent cognitive tests over a number of years as well as being quizzed on how often they took part in mentally stimulating activities. The participants who engaged in mentally stimulating activities more often were found to experience a rate of cognitive decline that was 15% slower than those who didn’t.

As we mentioned before, mental stimulation is also important when it comes to the quality of life of those living with dementia. Encouraging someone to reconnect with a favourite hobby or to join an activity group will help them to maintain their social life, avoid feelings of depression and isolation, and give them a sense of purpose.

The key for friends, family, and carers is to find mentally stimulating activities that are suited to the unique needs of people living with dementia. While a person may have enjoyed a particular hobby before their diagnosis, that hobby may no longer be viable as their condition progresses so it’s important to find similar activities that are both suitable for all stages of dementia and that exercise the same skills.

At Active Minds, we specialise in activities, games, puzzles, and exercises that have been crafted specially for people living with dementia. From art activities to Animal Bingo, our products are designed to allow people with dementia to continue enjoying their favourite hobbies in a way that is both fun and safe. Each product is carefully created to both entertain and stimulate at the same time, providing a crucial boost to cognitive function as well as supplying people with activities that can be enjoyed socially with friends or peacefully at home.

For more information on our huge range of activities, games, reminiscence books and DVDs, and exercise equipment, visit our website at www.active-minds.co.uk