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Person-centred working

Person-centred working

The guideline has person-centred working (recommendations 1.1.1–1.1.6) at its heart. It states that care should meet the aspirations, goals and priorities of people using home care. The guideline is based on principles of choice, independence and control, and focuses on achieving outcomes rather than completing tasks. This may mean a culture change for some services. True person‑centred working is a process, not a one‑off: the opposite of a 'one size fits all' model of care. Services need to work together to listen to and act on what the person finds important. Seeking regular feedback about the quality and suitability of care and making changes where needed means the person continues to get the care they need.

CQC Regulation 9 relates specifically to person-centred care.

Why is person-centred working a challenge in home care?

Traditionally, home care has been commissioned and delivered on a 'time and task' model. This prioritises procedure and amount of time spent on care over meeting the needs of individual people. Often, home care workers have difficult working conditions and the work can be highly pressured (Social Care Institute for Excellence: Dignity in care – dignity for home care workers). This may compromise communication with the person and, ultimately, outcomes. Cost pressures can lead to commissioning short visits, compounding the issue.

Person-centred working, by definition, has no set of rules. Establishing the aspirations, goals and priorities of each person calls for conversations and time. Although actions can be taken to achieve person‑centred care there is no formula for each individual. For some people (for example, those with cognitive impairments or sensory loss) extra time may be needed for communication. For others, the additional time may be needed for help with eating or drinking.

Key resources

Person-centred care starts with commissioning. The Social Care Institute for Excellence's Commissioning home care for older people: what older people want includes 2 short films. For local authorities in particular, the Association of Directors of Adult Social Services has produced a route map to help organisations commission with best practice in mind, including substantial material on person-centred care.

How can these challenges be addressed?

Establishing person-centred working

The only way to find out what people want or need is to ask them. This sounds obvious, but it may not be easy. Many people who use home care have cognitive impairment, sensory loss, or other communication difficulties. People do want to be listened to, but may be worried about losing a service if they challenge their current support. Their home care workers may also feel they do not have the time to listen, or the influence to bring about change according to the person's wishes. Managers should make sure that frontline staff understand the importance of and feel able to listen to what people say about their care.

Case study

A home care worker explains what person‑centred communication looks like on the frontline. "I support an 89‑year‑old lady who is a football fanatic. I bring her the paper and she goes straight to the back page. She can fully explain the offside rule better than anybody I know."

Why the offside rule is important to the 89-year-old I support: my life as a home care worker Social Care Institute for Excellence.

Time for person-centred working

Without sufficient time, it is unlikely that a person's needs will be met in the way that they prefer. The guideline states that home care visits should only be shorter than half an hour if: (recommendation 1.4.2)

  • the home care worker is known to the person and

  • the visit is part of a wider package of support and

  • it allows enough time to complete specific, time‑limited tasks or to check if someone is safe and well.

Shorter visits should also be agreed with the person. The buying of home care is a powerful tool for making sure that services provide a good quality service that meets person‑centred needs. Commissioners should ensure that workers have time to do their job without being rushed or compromising the dignity or wellbeing of the person who uses services.

Continuity of care

Wherever possible, the person should be supported by the same home care workers (recommendation 1.1.4) so that they can get to know each other. When a person knows their home care workers they develop confidence in the service and feel safe. Home care workers who know the person are better able to understand their needs and preferences. The guideline states that a home care worker should be 'matched' to the person; this too will support a consistent and person‑centred home care service.

Case study

The Raglan Project in Monmouthshire (featured by SCIE) is replacing task‑based care with flexible care. This focuses on the social and emotional (as well as physical) needs of the person being supported. Before the care begins, staff members establish a relationship with the person receiving care. Staff are then given the freedom to decide for themselves how the relationship and care should work – and their decisions are supported rather than controlled by management.

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