It Ain’t Necessarily So – 6: Does every resident need a care plan?
Caring Times, June 2013
By JOHN BURTON
First let’s consider the basics. When someone comes to live in your care home, you are obliged to match the care and accommodation to the resident’s needs. If you can’t meet their needs, you shouldn’t accept them. However, needs change – they usually increase – and you have to adjust and adapt the service to suit the resident.
There is a substantive contract (the care home receives fees in payment for a specified service), and a moral contract or commitment embedded in the caring relationship(s) essential to “care” and “home”. The former is easy enough to put into words and test against “delivery”, but the latter – the relationship part – is much more difficult to define. As people’s needs change and particularly as they approach the end of their lives, committed, caring relationships will eclipse all other aspects of the contract.
The point of “It ain’t necessarily so” is to question assumptions and standardised practice. So-called “person centred care plans” seem to have become compulsory whether the resident wants one or not. Not only must they be “person centred” (what else could they be?) but they are increasingly written in the first person. To quote a real example, under the heading of mental capacity (memory and cognition): “I am orientated to person and time of day.” Or, Dressing – level of assistance: “Sometimes it takes two carers to attend to me due to my aggressive outbursts.”
Although this particular plan is not as long as some, it runs to nine closely printed pages with more than 30 sections to be completed. It’s not designed for use by the resident or their family, or by the care staff.
I suggest documents like this are a sham: they’re not the wishes or words of the resident, and those who have to write them know that they are simply filling in a form to comply with the widespread misconception that such care plans are compulsory.
To meet a resident’s needs (why they came to the home) of course the staff must know about the person’s background and specific care needs, and must establish an authentic relationship with them. The care has to be planned and a record kept of how they are, and what works best for them. You can call this a care plan if you like, and while a check list may be useful, there is no need to complete a long, standardised form. Truly “personalised” plans will all be different.
It would make sense for many residents to keep their notes and plan in their own rooms as a simple document that they really do “own”. When a member of staff has worked with a resident, they might sit and chat with them and bring the notes up to date, or indeed the resident may do that for themselves. While some residents may not want a plan and record, the home will need both but it would be dishonest to present them as if the resident took ownership and had participated in creating them.
So, design the plan to suit the resident and do consider the possibilities of using handheld computers rather than pen and paper forms, especially to record routine tasks including medication (see IANS 1).
Like so much paperwork in care homes, over complicated and standardised care planning has grown in response to the demands of inspection. Meeting residents’ needs takes careful planning and record keeping, but there is nothing in the regulations to say what form the plan should take or even that there must be something called a “care plan”.
We found a different way: Caring Times readers tell their stories
Brian Murray, Glasgow:
I think every resident should have a care plan but the amount of information required for it will vary. I have spent the last 10 years devising care plans and my newest one is the best yet.
Essential information such as contact details, a current photo and preferences don’t take much time to record and are very helpful when orientating new staff, to use as a transfer document when sending to hospital, or (God forbid) to give the police if they ever go missing.
We should have a comprehensive pen picture of each resident so we can monitor their progress or decline, but where I draw the line is writing for writing’s sake. If a resident has no issues with communication then you can guarantee there will not be screeds of writing in this section.
There are areas where a lot of writing is beneficial, such as life story work. I incorporate this into the care plan as I believe the resident’s past plays a key role in deciding their future with us. Other essential work is the dreaded “What do you want to happen when you die?” section, although for clarity we officially call it preferred priorities in end of life care.
Having this information is vital to ensuring that the resident’s and family’s wishes are prepared for and planned to facilitate a good death. It’s good practice to obtain this information early on to reduce doubts later.
Anything can be requested from having favourite flowers or music in the room to arranging for families to stay with them in a comfortable bed rather than a chair.
Involving the resident and their carers in the care plan is a great way of getting to know them and letting them know that you have a good basis for planning out their care in the months or years ahead.
J.D., South East:
Over the years, we’ve had more trouble with inspectors over care plans than anything else. One inspector tells you that your care plans are rubbish, so you change them all and spend weeks updating them.
Then, two years later another inspector tells you to change them all again. Two years ago we got into trouble for the new “improved” version with a different inspector and so I redesigned them and began re-writing them all.
Halfway through the job we had an inspection, and lo and behold I got told off for having two different sorts of care plans. Care plans should be for the residents’ benefit, not to please the inspector! And the simpler the better because if they’re too long and complicated they’re never used.