Care Principles Made Simple – Part 4 of 10
Person-centred care is a phrase you will hear repeatedly in adult social care. It appears in training, care plans, inspections and workplace policies.
The meaning is simpler than it sounds:
See the person before you see the task.
A care worker may have a list of jobs to complete, but the individual receiving care has their own personality, routines, history, preferences and goals. Good care brings those two things together.
A morning visit with two possible outcomes
Mr Harris receives support at home each morning. His care plan says that he needs help with washing, dressing, breakfast and medication.
His care worker, Sarah, arrives at 8am.
Mr Harris usually likes to drink tea while listening to the radio before getting washed. He prefers a shower, chooses his own clothes and can prepare his toast if the ingredients are placed within reach.
There are two ways Sarah could approach the visit.
The task-centred approach
Sarah enters and immediately says:
“Right, let’s get you washed. I have several more calls this morning.”
She chooses his clothes, makes his breakfast without asking what he wants and completes every task herself because it is faster.
All the required jobs are finished, but Mr Harris has had little control over his morning.
The person-centred approach
Sarah knocks, greets Mr Harris by his preferred name and asks how he is feeling.
She checks whether he would like to wash before or after his tea. She places two suitable shirts where he can see them and asks which he would prefer.
At breakfast, she places the bread, butter and plate within reach so that he can prepare his toast himself. She offers help only when he needs it.
The visit may involve the same care tasks, but the experience is completely different.
Mr Harris remains involved in his own life.
What person-centred care means
Person-centred care means providing support that is built around the individual rather than expecting the individual to fit around a standard routine.
It involves understanding:
- What matters to the person
- What they can do independently
- What support they want
- How they prefer that support to be provided
- Their routines, culture, beliefs and relationships
- Their communication needs
- Their goals and interests
- The risks they are willing and able to manage
The Care Quality Commission’s Regulation 9 on person-centred care requires registered providers to make sure that care is appropriate, meets the person’s needs and reflects their preferences.
The Care Act statutory guidance also emphasises the person’s views, wishes, feelings and beliefs. Decisions should not be based simply on age, appearance, diagnosis or assumptions about what someone’s life should look like.
Person-centred care is therefore not an optional extra. It is a fundamental part of safe, lawful and respectful care.
The person is more than their diagnosis
Imagine two people who both have arthritis.
One may want help preparing breakfast because opening containers is painful. The other may prefer to use adapted equipment and prepare the meal independently.
The diagnosis is the same, but the right support is different.
A care worker should not assume that everyone with dementia, diabetes, limited mobility or another condition will have identical needs.
A person is also shaped by:
- Their life experiences
- Family and relationships
- Culture and faith
- Work and interests
- Daily habits
- Personal identity
- Communication style
- Hopes for the future
- Previous experiences of care
A care plan should describe the individual, not simply list their conditions.
The main values behind person-centred care
The Care Certificate includes working in a person-centred way as one of its core standards. Skills for Care identifies values including individuality, independence, privacy, partnership, choice, dignity and respect.
Individuality
Every person is unique.
Support should be based on the person’s specific needs and preferences rather than a routine used for everyone.
Choice
People should be offered meaningful choices about their care and daily life.
This might include what to wear, what to eat, when to get up, how to spend their time or who is present during a conversation.
Independence
Person-centred care supports people to do as much as they safely can for themselves.
Independence does not mean leaving someone without help. It means providing the right amount of assistance without automatically taking over.
Dignity
The person should feel valued and should not be embarrassed, exposed or spoken down to.
This is particularly important during personal care, continence support and conversations about sensitive matters.
Respect
Respect involves listening, using appropriate language, recognising personal boundaries and taking the person’s opinions seriously.
Privacy
People have a right to personal space and appropriate control over their information.
A care worker should knock before entering, protect the person’s body during personal care and discuss confidential matters privately.
Partnership
Person-centred care is something done with a person, not to them.
The person, care workers, family members and professionals may all contribute, but the individual should remain at the centre.
Skills for Care provides further guidance on person-centred approaches in health and care.
Meaningful choices are better than false choices
A choice is only meaningful when the person’s answer can influence what happens.
A worker should not ask, “Would you like a shower?” if they intend to insist on one regardless of the answer.
More useful questions might include:
- “Would you prefer a shower now or after breakfast?”
- “Would you like the blue shirt or the green one?”
- “Would you like to walk to the dining room or use your wheelchair today?”
- “Would you like help cutting your food, or would you prefer to try first?”
- “Would you like the television on or some quiet time?”
Too many options can sometimes feel overwhelming. Offering two suitable choices may make decision-making easier while preserving control.
Communication should be adapted when necessary. A person may benefit from pictures, objects, gestures, written information, extra time or communication equipment.
The aim is not simply to ask more questions. It is to help the person participate.
Supporting independence without abandoning the person
Doing everything for someone may appear helpful, but it can gradually reduce confidence and ability.
For example, a person may be able to:
- Wash their face while receiving help with their back
- Choose their clothes while needing help with fastenings
- Brush their hair after the brush is placed within reach
- Prepare part of a meal using adapted equipment
- Walk a short distance with the correct mobility aid
- Take medication after an authorised worker has prepared or prompted it according to the care plan
The care worker should allow sufficient time and avoid rushing to complete the task.
There is an important difference between:
“I will do this for you.”
and:
“How can I support you to do this?”
Person-centred care often begins with the second question.
When choice and safety appear to conflict
Person-centred care does not mean agreeing to every request without considering risk.
Suppose Mr Harris wants to make tea independently, but his hands have recently become less steady. Simply taking the kettle away may protect him from one risk while removing independence and confidence.
A better response would be to discuss the concern and consider safer options, such as:
- A lightweight kettle
- A kettle tipper
- Filling the kettle with a smaller amount of water
- Supervision while he pours
- An occupational-therapy assessment
- A review of the care plan and risk assessment
This approach connects person-centred care with duty of care. The goal is to support choice while taking reasonable steps to reduce avoidable harm.
Care workers should explain concerns clearly, avoid unnecessary restrictions and follow the person’s care plan, risk assessment and agreed ways of working.
If there are questions about consent or mental capacity, workers must follow the appropriate legal and workplace procedures rather than making assumptions.
Person-centred care when someone has dementia
A person living with dementia is still an individual with preferences, relationships and a personal history.
Communication difficulties do not remove the person’s right to be involved.
A care worker can support involvement by:
- Using simple language
- Asking one question at a time
- Allowing extra time for a response
- Showing objects or pictures
- Watching facial expressions and body language
- Maintaining familiar routines
- Learning about the person’s life history
- Avoiding unnecessary correction or confrontation
- Recording successful communication approaches
Families may provide helpful information, particularly when a person has difficulty explaining their preferences. However, relatives should not automatically replace the person’s voice or make every decision.
The worker should continue communicating directly with the person and involve them as fully as possible.
The care plan should tell a human story
A good person-centred care plan contains more than a list of physical needs.
Compare these two examples:
Task-focused:
“Assist with breakfast.”
Person-centred:
“Mr Harris prefers tea with a small amount of milk and no sugar. He usually has toast after listening to the 8am news. Place the bread and butter within reach so that he can prepare his toast independently. Offer help if he appears tired or experiences pain in his hands.”
The second version helps a new worker understand what matters to Mr Harris and how to support his independence.
Useful person-centred information may include:
- The person’s preferred name
- Important routines
- Food and drink preferences
- Communication methods
- Cultural or religious practices
- Personal-care preferences
- Interests and meaningful activities
- Relationships that matter to them
- What causes anxiety or distress
- What helps them feel calm
- Tasks they can complete independently
- Personal goals and desired outcomes
Care plans should be reviewed when needs, preferences or circumstances change.
Families are partners, not automatic decision-makers
Families and friends can be an important source of emotional and practical support. They may know the person’s history, habits and communication methods.
However, person-centred care requires workers to understand who has authority to make particular decisions.
A relative does not automatically have the right to:
- Control the person’s money
- Access confidential information
- Override the person’s choices
- Consent to care on the person’s behalf
- Instruct workers to ignore the care plan
Workers should follow consent, confidentiality and mental-capacity procedures and seek guidance whenever authority is unclear.
If a family member’s actions create concern about abuse, neglect or coercion, the worker should follow the safeguarding procedure.
Everyday examples of person-centred care
Personal care
Ask how the person prefers to be supported. Explain each step, seek consent and protect privacy.
Food and drink
Consider preferences, cultural needs, allergies, medical guidance and the person’s usual routine. Do not assume everyone wants the same meal at the same time.
Clothing
Support the person to choose what they wear. Make sure the options are suitable for the weather and activity without treating the person like a child.
Activities
Choose activities based on genuine interests rather than what is easiest to organise.
Someone who dislikes group games may prefer gardening, music, reading, cooking or a quiet conversation.
Communication
Speak directly to the person, even when a relative or professional is present. Use their preferred communication method and give them time to respond.
Bedtime and waking
Respect personal routines where reasonably possible. A service routine should not automatically override a person’s lifelong habits.
Record-keeping
Record the person’s choices, outcomes and changes in needs. Avoid descriptions that reduce them to tasks or labels.
Signs that care may not be person-centred
Care may have become task-focused when:
- Everyone is expected to follow the same routine
- Staff talk over people rather than with them
- Choices are offered but ignored
- Workers complete tasks people could do themselves
- Activities are based only on staff convenience
- Personal history and culture are overlooked
- Risk assessments are used to stop every activity
- Care plans contain only diagnoses and tasks
- A relative’s wishes automatically replace the person’s wishes
- Workers describe people mainly as difficult or non-compliant
- Changes in preferences are not recorded or reported
Some routines are necessary for safety and organisation, but they should not erase individuality.
Questions care workers can ask themselves
Before providing support, ask:
- What matters to this person?
- What can they do independently?
- Have I explained what I am doing?
- Have I asked for consent?
- Is the choice I offered genuine?
- Am I following their current care plan?
- Am I making an assumption based on age or diagnosis?
- Could I support this activity instead of taking over?
- Has anything changed that should be recorded or reported?
These questions turn person-centred values into everyday practice.
Return to Mr Harris’s morning
Sarah still completes the important parts of the visit.
Mr Harris receives appropriate support with washing, dressing, breakfast and medication. The difference is that he is involved throughout.
He chooses when to wash. He selects his clothes. He prepares part of his breakfast. His routine is respected, and Sarah observes whether his needs have changed.
The tasks are completed, but Mr Harris has not been treated like a task.
That is person-centred care.
The simplest way to remember it
Person-centred care means asking:
“What matters to you?”
rather than only:
“What is the matter with you?”
Good care protects safety, but it also supports identity, choice, independence and meaningful participation.
The care plan provides guidance. The worker provides support. The individual remains at the centre.
This article provides general information about person-centred adult social care in England. Care workers should follow the individual’s current care plan, risk assessment, employer procedures and the limits of their training and role.
