Principle 1

Summary

Constantly remembering that the needs and preferences of individuals are placed at the heart of their care and support, helps keep our focus where it should always be. It’s about listening, understanding, honouring and implementing the individual’s personal perspectives and preferences, thereby giving choice and control. Person-centred care and support is not something extraordinary, but is part of everyday life and should be something everybody practises.

Good practice scenario

Situation

A gentleman supported by a domiciliary care agency.

He required a high level of specialist care and had culturally sensitive support needs. At the point of initial assessment the care manager from the agency recognised that the organisation would not be in a position to deliver all elements of his required support package. Following discussion with the gentleman, it was agreed that:

  • The care manager would undertake some research to find other organisations and community groups in the area that could fill in the gaps and would be willing to work in partnership in order to create a complete package of support to meet all his needs. Once this research had been completed, the care manager would present the gentleman with a range of options for him to consider.

  • From these, he would be able to identify a shortlist and see what may be right for him.

  • He would then be supported to conduct interviews with the other organisations and make a decision as to who he would like to use.

  • He would be supported to visit any community groups or voluntary organisations in his local area that may meet other requirements.

  • The care manager would then take responsibility for the ongoing monitoring of the care package, with the effect that the individual’s experience would be of a seamless and personal service with built-in contingences in case of emergency.

Dilemma

You are supporting an Asian man in his late 50s who has been diagnosed with terminal cancer. He has told you that his doctor had informed him that he was rapidly deteriorating and may not live much longer. During your conversation it becomes evident that he has a very clear idea about what he wants during his last days, especially if he is not able to express his wishes at a later time. He asks you to write these wishes down. The two main points were:

  • he wants to stay at home and to be at home to die

  • due to the nature of his cancer he experiences frequently high temperatures to the extent where his clothes are stripped off to make him more comfortable. However he does not want extended family/friends to see him when he is unconscious/asleep/heavily sedated and therefore unaware and possibly half clothed.

You discuss how you can support him to express these wishes to his family. He feels that they would not respect his wishes, as it is a part of their culture that the time of passing is about seeking forgiveness and therefore family and friends are encouraged to visit, pray and seek and grant forgiveness. He knows that to deny friends and family this opportunity would not be understood or accepted.

  • What do you think the challenges are in supporting this gentleman’s wishes at the end of his life?

  • What actions would you take to ensure this man’s dignity is upheld?

“It’s really important that you get to know me. Take time to find out what I like, need and want. Don’t assume. If I can’t tell you myself, ask the people close to me”
Person who uses services

“Providing dignity is the key to helping individuals maintain, improve or adjust to the best independent living, at any age and for any major life event”
Dignity Champion, British Red Cross