1. Understand person-centered approaches for care and support

2. Understand how to implement a person-centered approach in an adult social care setting

3. Understand the importance of establishing consent when providing care or support

4. Understand how to encourage active participation

5. Understand how to support an individual’s right to make choices

6. Understand how to promote an individual’s well-being

A Person-centered approach is about providing care and support that is centered or focused on theindividual and their needs.

We are all individuals and just because two people might have the same medical condition, for example; Dementia, it doesn’t mean that they require the same care and support.

Person-centred care is a term used to describe an approach that aims to provide support in a way that fully reflects the individual's views.This involves attempting to meet needs and preferences as each individual sees them.It is often described as a way of working that puts the individual at the centre of everything.

  Person-centred care was first developed by

professionals working in learning disability services. Following on from there,it was adapted and used widely in dementia care. Person-centred care has now been extended to be incorporated into all areas of care.

This is the governments policy which focuses on empowerment and independence for all individuals using care services. It influences how services are provided and monitored. Personalisation is a term used to describe 'putting people first' and enabling people using services to have a lot more control/ choices over service provision and the way in which they are supported.

In your note book, write down and think about the benefits gained when people have a say in how their care is provided.

Person-centered values provide a foundation on which you can base and build your practice.

You need to understand what the values are, how you can promote them and why they are important. A value is simply what is important in the life of the person you are supporting.

There are eight person centered values that support person-centered care and support.

These are:- 1. Individuality 2. Rights 3. Choice 4. Privacy 5. Independence 6. Dignity 7. Respect 8. Partnership

Individuality Assumptions should never be made about an individual. They should never have to fit in with you or your employer. Individuals should be allowed and supported to make their own choices.

Care and support needs should be tailored to suit each individual. This shows respect by preserving the individual’s dignity and individuality. Their personal beliefs should be respected.

IndependenceAllow the individuals you support to do things for themselves, however small they are. Being independent does not necessarily mean being completely alone, but being supported to do things for themselves.

Remember-Independence makes people feel in control of their lives and gives them a sense of self-worth.

PrivacyYou will need to understand each individual’s need for privacy and support this in the way you work. Irrespective of which environment-

> you should always ask permission before entering an individual’s room.

> Always knock on their door. > All visitors must ask permission before entering rooms

irrespective of who they are. > Close doors when performing personal hygiene but

first check the individual is happy with you doing so.

Every individual should have time and spaces to do things in private if they should wish to, for example; meeting friends and family or making phone calls.

The availability of private space will be different in residential care home and home care environments.

PartnershipWorking in partnership with other professionals, with colleagues, families and carers is an essential part of providing care and support.

Person-centered care and support is about a whole range of people working together to improve the lives of individuals.

Partnership is all about the individual you are supporting and all of the partners involved will need good communication, sharing appropriate information putting the individual’s best interests at the centre of everything that everyone does.

Choice

Each individual you are supporting should be allowed and supported to make choices. They should be given thorough information in order to make informed choices themselves and you must acknowledge the benefits of their choices.

Always involve the individual in decisions about their care and support. Sometimes individuals can be overwhelmed with choice, for example; individuals suffering from Dementia, may respond better if you give them two simple choices but this is much better than giving no choice at all.

You will need to be able to communicate and listen well. Never take over because you can do things faster or because you think something should be done a particular way.

DignityDignity is what we feel when we are respected and it is what makes us feel important in society and in our lives.

Whether individuals are eating, sleeping, washing, shopping or dying, care and support workers must help them to feel dignified.Be aware of the importance of preserving an individual’s dignity-

® ask them how they wish to be addressed® try not to rush them and take time to listen® use towels or clothing to cover them up when performing intimate care tasks.

It is important not to be stereotype or make guesses about individuals and their needs.

Respect

Respect is showing individuals that you will support them in what they believe is important whatever their age, culture, disability, gender, belief or sexual orientation are.

When working with other people or professionals, never ignore the individuals you are supporting. Always include them in the conversation, irrespective of the subject.

Never use a term of endearment, for example, calling an individual “love” or “dear”, without asking them what name they would like to be called. Some people dislike terms of endearment, others will approve as it is part of their everyday language. Either way, we can never assume it is acceptable and it is essential to always check when you first meet.

Rights

Individuals you care for and support should continue to have the same rights as when they were living independently. Each individual you support has- the right to say no,

the right to have a relationship, the right to have a say about how they are supported, the right to choose what they eat and when, the right to decide how they dress and when,

the right to choose their friends and the right to do what they want to do with their time.

You may have to-make changes to take an individual’s rights into account. balance an individual’s rights against your

responsibilities and consider if either they or you are at risk or not. If you are concerned or unsure, check with your supervisor or manager.

Person-centered values

It is important to work in a person centered approach and to embed the values in all that you do - to meet the needs of the individual to provide the best possible quality care service to ensure a good quality of life of the individual to treat individual as you would want to be treated

Care workers and individuals' families may feel anxious about 'risk taking' and keeping people safe. They are aware of the responsibilities they have towards individuals and take these responsibilities seriously.

  Positive risk taking is not about leaving individuals

to make choices that could result in harm to themselves or others who may be affected by their actions. Positive risk taking is about taking risks that benefit the individual and can make a positive impact on their life. lt is also about supporting individuals to take control of their lives.

Taking risks is a part of daily life.

Life is full of risks, whether you are crossing the road, driving a car or taking medication. Think about why you are willing to take these risks. This is probably because you feel the benefits of doing what you want to do outweigh the risks involved.

Without taking risks, children would never learn to walk or ride a bike. People would not participate in some sports for fear of injur y. But people take these risks because, overall, they think that the activity will improve their lives.

Although it is true that as a care worker you must act responsibly and in a way that safeguards individuals, you have to balance this with promoting choice.You should also provide evidence of that process. 

Think about a task you cany out every day. This could be cooking a meal or going for a walk. Identify the following in relation to your chosen activity.

Your chosen activity is: a) The potential risks:   b) The benefits:   c) How to reduce the risks:                

 The potential risks are: burns and scalds food poisoning fire :  The likelihood of these risks would increase if you were

forgetful easily lost concentration or if you had a physical disability

and found lifting pans off the cooker difficult.

You would balance the possibility of the risks with the benefits. The benefits are:  enjoyment preparing food in the way you like it own choice of menu

independence. 

When cooking, you will automatically weigh up these risks and take action to avoid them causing harm.

For example, you would wash your hands carefully and ensure the utensils and surfaces for food preparation were clean.

You would keep meat separate from other foods while it is raw. You would check that foods were in date, ensure that they were

cooked for the required time, and that they were cooked right through before serving or eating.

You would use oven gloves to take food out of the oven,or ensure that the oil in the chip pan did not overheat. You would keep young children out of the way of hot pans and dishes, and make sure

you turned off all appliances after use. All these actions you take to reduce risk are a result of a risk

assessment process that you carry out automatically. You do it when you drive or cross a road, assessing distance, the speed of other traffic and the weather conditions, and take measures to reduce risks.

Risk taking is an individual choice, usually to act in a way that the person feels is enhancing their life. Without taking any risks,the individual might be safe,but feel that they are not living their life as they wish. They may also feel that their choices are not being respected,but are being over-ridden by other people.

When an individual uses a care ser vice. their right to take risks does not end. You have a responsibility to support this right. but in a way that is also as safe as possible. Agreeing a risk assessment

with individuals helps to support choice while making sure that the risks are minimised.

You work for a provider of domiciliary care. Annie, who is 88 years old, lives alone in sheltered housing. She has arthritis and is frail, but had been coping. Recently, she has had a few falls, and though she was not injured, she has lost confidence.

  Annie has a niece, Connie, who works full time and

can only visit once a week. Connie is concerned that the flat is becoming dirty and she thinks that Annie is forgetting to eat sometimes as she has lost weight. She insists that Annie should receive more support, and feels that she should go into residential care. Annie insists she doesn't want to leave her home and Jive with strangers.

From the information you have been given, explain the situation from the following points of view: (use your note pad)

a) Annieb) Conniec) You as a care worker

Annie feels that the risk of falling is worth it if it means she can remain in her flat. To her, the risk of falls is a better option than losing her home and her independence. She has got over the falls so far, and is being very careful to avoid them as she walks around the house.

Connie wants peace of mind in knowing that her aunt is safe. She is worried that she cannot provide more support without reorganising her life and perhaps her job. She is afraid that Annie will have a fall that results in a serious injur y and long-term effects.

You as a care worker would probably share both their concerns, as they are both very real and valid worries. You would also be aware of additional support that could be put in place for Annie to enable her to remain in her home.

You may also have your own views on the situation, and feel that either Annie or Connie is right.

Risk assessment isn't just a tool for removing all possible risk. It is a process to go through to help find the best solution, especially where there are potential areas of disagreement, as in this case.

Informed choices can only be made when an individual has all the information needed, for example the risks and harm that

Could result from the choice they have made. The different options open to them should also be made clear, and you may need help from a professional in relation to the resources available.  

You can support individuals to make choices by providing this information or by organising access to people who can give them the information they need. By using the risk assessment process, you can talk through the different options available, including ways in which the risk can be reduced.

In order to be able to make an informed choice, an individual will need to be aware of:

 • The possibility of different risks. • The likelihood of the risks. • The severity of the risk - what are the potential outcomes? • The benefits to the individual making the choice. • Ways of reducing risk, and the impact this might have on the

individual. You should present this information in a format that the individual

can understand. In most cases, this would be to talk it through, answer any questions they have and check their understanding of what you have said.

Some choices people make may impact on others,or even pose risks to others. This can make the situation more complicated.

  Your responsibilities in relation to risk assessment must

take into account the following:

The degree of risk - the potential of harm or embarrassment to individuals or others. Unacceptable risks

include the distress or annoyance of others expressed towards the individual. It could also include actions leading to law infringement abuse or damage to property or equipment.

 

The likelihood of risk - if the individual has a history or past experiences of harm, or their level of ability relating to their chosen activity. • The people who are at risk - this may include the individual,their supporters, care workers, visitors, members ofthe public and all employees.

The potential intervention - options that may facilitate choice whilst reducing the level of risk and the impact of this on the individual.  

The benefits for the individual - empowerment independence, self-esteem, learning and development opportunities.

The legal implications - what the law says, for example moving and handling regulations.

What you must never do is allow your views to influence an individual's choice. Remember that a person-centred approach is about working in partnership as equals, and not about you advising as an expert. If you have talked it through with them, and as long as the principles of risk assessment have been taken into account,the choice is theirs.

While you may be supporting individuals to make choices about risk taking for everyday activities, it is usually the role of a senior care worker to carry out a formal risk assessment. This is recorded and included as part of the care plan. Formal risk assessments have to be carried out in relation to a number of activities, for example moving and handling, mobility and nutrition.

Sometimes an individual could be unhappy about a decision made that concerns them. Although they are involved in making decisions, the outcome agreed may not be their full choice, or'wish list'.

Individual choice could be compromised for various reasons including:

Limited resources - meaning that support may not meet what the individual would really prefer.

Risk assessment - this may indicate that the preferred options are not considered to be examples of safe practice following assessment, and may pose unacceptable risks to the individual or others affected by their actions.

Decisions that affect individuals can be made between different agencies and professionals, or sometimes by their family or supporters.

There are certain ways to support on individual to question or challenge these decisions.

You may be able to tell that on individual is not entirely happy, or they may tell you. You could know them better than other professionals, or they may tell you that they are feeling pressured to go along with a decision that is not theirs. If you suspect they are unhappy, ask them.

Discuss with them why they are unhappy and perhaps whether they have expressed their view to the people concerned. They may want your support to challenge these decisions. They may ask you to speak to the people responsible. or you might be able to raise the topic in a tactful way, providing on opportunity for the individual to discuss their feelings about the decision.

If you or the individual thinks their rights are not being respected, they may wish to complain or take further action.

  Providing information - some people are not even

aware of what their rights are or how to complain. This may mean providing them with details of the procedure, a contact name or relevant leaflets.

  Report to your line manager if there is a

situation where you think rights are not being respected. You can also encourage those involved to report or complain if they are unhappy.

Provide a positive role model - if others who you work with observe you treating individuals with respect, even in challenging situations, and taking action when rights ore being denied they are likely to follow your example.

DefinitionConsent is an agreement to an action;

i.e. in social care agreeing to a bath or a shower,

to medication, agreement to have details shared with others.

Lack of consent could be construed as abuse-. . i e forcing an individual to have a shower

. when they have not agreed

Consen t can be in different forms and includes

> verbal> written> . via a representative or advocate

?How Consent is established

Steps to take when consent can not be established include-

> not continuing with the task> reporting to the supervisor or manager> recording the information

Act ive 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 or support rather than a passiverecipient.

Benefits of active participation include- > Sense of well-being > Sense of purpose > Engagement > Achievement > Stimulation – physical and

mental.

Being part of a community is particularly important to individuals who live on their own and do not work. It means they have relationships and make friendships with other people giving them a more fulfilling life. It doesn’t matter what kind of contribution they make or the type of activities they are involved in, just being part of something will give them a sense of belonging, a feeling of self-worth and independence.

When individuals make choices, they have more controland feel valued. It is important that you support empowerment of the individuals you work with. Providing individuals with empowerment to make informed choices enables individuals to maintain their rights of choice, equality and opportunity.

Barriers include- > Lack of opportunity > Lack of events > Lack of staff > Unwillingness of participants > Lack of confidence.

Ways of encouraging participation include-

> discussion and encouragement with the individual

> providing useful information > using friends and family to

encourage > ensuring appropriate activities > peer-group encouragement > persuasion techniques > highlighting the benefits of

the activity

5. Understand how to support an individual’s right to make choices

Your role as a care or support worker is to help individuals to make informed choices about things that happen every day and also in planning for the

longer term.

Each time you work with an individual you should be able to give them choices. Individuals’ choices will

be different depending on the types of tasks you are doing together and their abilities.

Good communication is essential so that you can give

choices and individuals can make them. It doesn’t matter what environment you support an individual in,

there should always be plenty of opportunity to provide choices.

Here are some examples-• When would they like to get up?• What would they like to wear?• What would they like to eat and drink?

• What brands would they like to use, for example, shampoo, toothpaste,

moisturiser?• What activities would they like to take part

in?

You can support individuals to make choices by giving them encouragement and giving praise when they have made a choice. This will give them the confidence to continue to make choices about other aspects of their lives.

Ways of supporting an individual to make informed choices may also include_

> Discussion > Providing relevant information > Guidance from friends or family > Using an advocate or support service

Others who can support an individual to make informed choice may include-

Colleagues Social worker GP Physiotherapist Pharmacist Occupational Therapist Speech and Language

Therapist

Nurse Specialist nurse Psychologist Psychiatrist Advocate Dementia care advisor Family or carers

In order to enable an individual to make an informed choice, both you and the individual first need to think about what all of the available options are. You then need to look at what are good and bad about each option. Health and safety are important factors and must be put first for you, the individual and anyone else involved.

There is a four-step way to test for capacity : A person must be able to_1. Understand the information relevant to a decision2. Retain the information3. Use the information as part of the decision making process4. Communicate their decision

Mental Capacity Act provides the legal framework for capacity and decision making about health and social care and financial decisions.

Applies to everyone aged over 16. You will need to consider whether the person you are supporting has capacity to make informed decisions or whether you need a formal mental capacity review.

It is important to note that a person is It is important to note that a person is assumed to have capacity unless it is proved assumed to have capacity unless it is proved

otherwise.otherwise.

Capacity is assessed specific to each decision and each Capacity is assessed specific to each decision and each occasion. For example, a person may have capacity to occasion. For example, a person may have capacity to make a decision in the morning about what to wear, make a decision in the morning about what to wear, but not later that day in deciding if they want to move but not later that day in deciding if they want to move home.home.

The risk assessment should contain information about the individual andthe type of care and support they need. It will provide the most appropriate options for keeping the individual and anyone else involved as safe as possible.

It will also tell you how to do some tasks where these tasks have been risk assessed and the best option has been established.

Risk-taking means being aware of the potential hazards

but still carrying on with the activity

Each individual should have a formal risk assessment as part of their care and support plan.

FOR EXAMPLEFOR EXAMPLE

A particular way of moving and handling is recommended for Mr. X because he has health issues that mean he or she can only be moved in a particular way. Mr. X doesn’t like being moved this way and asks to be moved another way.

You should always follow the risk assessment. You should report Mr. X’s request to your supervisor / manager. If you are appropriately trained in risk assessment and moving and handling and the change Mr. X requires is minor, you may be able to make this change.

You should never make changes unless you are trained or your supervisor or manager confirms you can make the change. You should always record any changes in Mr. X’s wishes and in the way you perform tasks.

Every effort should be made to support Mr. X to be moved in the way hewants to be moved. He has the right to make this choice but an appropriately trained person will need to review the risk assessment first and work out if it is safe for all involved for Mr. X to be moved in the way he wishes.

When an individual has made a decision which you feel is risky, you need to make the individual aware of any consequences involved in the decision; however you should not try to influence the individual with your views and opinions.

Personal views include- > Expressed opinions > Ways of carrying out actions

In case of Mr. X, you might not approve of or like the choice he hasmade. You might need more moving and handling training, perhaps for a specialist piece of equipment. However, the choice is not yours and

you are not allowed to influence Mr X.

In supporting Mr X to make his decision, you need to listen to him and put his wishes and best interests first. He is the customer and you are

providing a service. This means the service must be provided in the way Mr. X would like, as long as it is safe and approved through care and

support plans and risk assessments. This is because the choices belong to Mr X, not to you. He needs to make his own decisions in order to feel he is in control of what happens to him. This leads to positive feelings around

dignity, pride and satisfaction.

If a relative or friend has made a decision about an individual’s care, support or life that the individual is not happy or comfortable with, you may need to support the individual to question or challenge the decision.

Support an individual to question or challenge decisions includes-

> encourage questions and comments > be prepared to listen

> assist the individual to ask for a second opinion > speak/refer the individual to a senior member

of staff > use the complaints procedure

You should never make changes unless you are You should never make changes unless you are trained to do so or your supervisor or manager trained to do so or your supervisor or manager confirms you can make the change. You should confirms you can make the change. You should

always record any changes in individual’s wishes always record any changes in individual’s wishes and in the way you perform tasks.and in the way you perform tasks.

It is essential that you understand the Mental It is essential that you understand the Mental Capacity Act and how to work within it’s Capacity Act and how to work within it’s

requirements every day with every individualrequirements every day with every individual

Any changes that are made as a Any changes that are made as a result of this challenge must be result of this challenge must be safe for you, the individual and safe for you, the individual and

anyone else involved. anyone else involved.

6. Understand how to promote an individual’s well-being

Well-being may include aspects that are: > Spiritual > Emotional > Cultural > Religious > Social > Political > Sexual > Physical > Mental

Spiritual well-being is an integral part of mental, emotional and physical health. It can be associated with a specific religion but does not have to be. It is about an individual’s own journey to discover things of importance in their lives and enabling them to find purpose and meaning in life. A few of the numerous benefits of spiritual well-being include-

• Feeling content with your life’s situation• Making time to spend alone and find inner peace• Taking time to reflect and resolve life’s issues• Finding satisfaction in a job well done• Taking part in an active lifestyle rather than merely standing

by and watching life as it passes• Maintaining balance and control of life• Building relationships• Feeling purpose and meaning in life• Accepting and growing from the challenges of life

Emotional well-being is based on how individuals feel about themselves.

Someone who is emotionally healthy-• Understands and adapts to change• Copes with stress• Has a positive outlook on life and themselves• Has the ability to love and care for others• Can act independently to meet his or her own

needs

Sometimes an individual’s self-esteem (the way they feel about themselves) can become so low that everything seems a lot

harder to cope with compared with when they are feeling confident.

Your role is to support individuals to feel spiritual well-being and to feel emotional wellbeing. Approaches should ensure that individuals feel-

• Appreciated, cared about and loved• Safe and secure• Extra supported when they feel sad, depressed

or lonely• That they are not a burden but an important

priority• Listened to and respected• Satisfied with relationships• Independent and in control of their lives• That they have a purpose and meaning to their

lives

Environment that can contribute to promote well being may include -

> Physical environment - bedroom, handbag, personal belongings

> Social environment - personal boundaries, subjective feelings

etc.

Think about the individuals you work with and how your attitudes and approaches affect an individual’s emotional well-being

By providing emotional support, understanding and good quality care, you can improve an individual’s confidence, promoting spiritual and emotional well-being.