When
I sat down this afternoon to write this article it started out being about the
CQC, how Care Homes could improve their rating from inadequate too Good,
possibly even with our help and support to Outstanding.
However,
the more I researched my article and ensured we had all the facts to provide
the more I realised this article isn’t even about the CQC or how care homes
fail inspections. This article was about
People Not Policy, deliverable Person Centred Care. The actual reason why so many care homes fail
to meet standards and why so many carers are failing to provide a high standard
of care.
Person
Centred Care, also described as ‘patient-centred care’, ‘client-centred care’,
or ‘resident-centred care’. Each of
these options has a very specific context.
‘Resident-centred’
is very specific to people who live, either temporarily or permanently, in care
homes and other long-stay residences.
‘Patient-centred
care’ is about patients as people who are accessing the health system for care
and treatment in, for example, a hospital or GP surgery.
‘Client-centred
care’ often refers to people who access mental health services as clients, and
we might also use this word for those accessing health or care services but who
may not be ill – a young mother speaking to a health visitor about looking
after her baby, perhaps.
So
when we speak of person-centred care, we are trying to bring all those options
into a single definition. But what does
it mean?
Simply
put, being person-centred is about focusing care on the needs of the
person rather than the needs of the service. Most people who need health care
these days aren’t happy just to sit back and let health care staff do what they
think is best. They have their own views on what’s best for them and their own
priorities in life. So as health care workers, we have to be flexible to meet
their needs – we have to make our system suit them, rather than the other way around.
When
was the last time you had to ask to
go to the toilet, when was the last time you
were told it wasn’t time to go to the toilet and when was the last time your body agreed with someone telling
you it wasn’t time?
So what is person-centred care?
It
means that the person is an equal partner in the planning of care and that his
or her opinions are important and are respected. That doesn’t mean that ‘what
the person says, goes’, but it does mean that we have to take into consideration
and act on what people want when we plan and deliver their care.
We
can’t always assume, however, that a person will tell us what he or she thinks
or wants.
There
are many reasons why people may feel awkward about this, or they may live with
a mental health condition, dementia or physical or learning disability that
makes communication challenging.
So
we may have to ask them what they want, using appropriate communication methods
to actively encourage them to participate in their own care and be
real partners in the decisions that are made. To support them with this, we
need to make sure they get information in a format that is acceptable to them
to help them make decisions about their care and treatment and to agree – or
disagree – with the treatment plan that is developing.
We
should always be prepared to negotiate with patients/clients to agree a
plan that’s acceptable to them and the health care team.
Being
person-centred means that when we plan care with the person, we think
about the effect of what we’re doing on the person as a whole. Think, for
example, of a young female health care assistant planning to bathe an older
man. The ‘mechanics’ of the procedure are very straightforward – ensure the
water temperature and depth are appropriate, ensure the bath hoist is working
and is used properly, make sure the person’s dignity is protected, end up with
the person being clean and refreshed. The health care assistant is perfectly
competent to ensure all these issues are addressed.
But
what might the older man feel about being bathed by a young woman who might be
no older than his own daughter, or even granddaughter? Will it make him feel
helpless, humiliated, useless? And does he want a bath in the first
place? When we begin to think of the care we give in this way – of the
effect of what we’re doing on the whole person – we’re giving care in a
person-centred way. And that might mean compromise – the health care
assistant might, for instance, negotiate with the man and agree that
for today, a wash from a basin at the bedside or the bathroom will be
sufficient.
Being
person-centred means that we always have the person’s safety, comfort and
well-being uppermost in our mind. There is much we can do to promote people’s
safety, and we look at this in some detail in promoting patient safety.
Ensuring people are comfortable calls for us to be aware of the things that can
cause discomfort – feeling cold or hot, having a thirst or being hungry, being
in pain or having an itch, needing to go to the toilet or change a sitting
position, for instance – and taking steps to relieve them. Having
people’s well-being uppermost means that nothing we do – or don’t do – causes
the person any physical, emotional or social harm.
And
being person-centred 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 a person’s values, relationships and need for self-expression.
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