Person Centred Support Plan

Person Centred Support Plan

The aim of this tool is to balance what is important for the person with what is important to the person. It is essential to ensure that what is important to the person remains at the centre of any support or care intervention. It is necessary for a person with capacity to give consent to their care and support

There are several domains. It is not necessary to complete all the domains but ones that are relevant to the person. Each area may need to be updated as there are changes in the person. The domain asks what is important for the person. For example, it may be important for a person with diabetes to have a low-sugar, healthy diet. But it may be important to them to eat sweet food. The tool identifies these tensions and helps you to balance these.

Each domain encourages the ‘how’ to support the person. This should include a balance of what is important for and to. For example, the person with diabetes may want to eat sweet foods daily, and this may be achieved by making or purchasing low-sugar desserts for the person to each most days with, perhaps, a once a week option of a sugary dessert. This, of course, would increase risk and should be noted in the column where notes are taken about what the person is good at. Placing an ‘R’ in this box would highlight that there are some concerns and a risk assessment may need to completed.

At the foot of the domains list is an area where the person or others can make note of their fears and concerns, using the ‘R’ from the right hand column. This will ensure that each risk is assessed and managed.

So, the person with diabetes may continue to eat sugary foods one day a week and this may need to be reflected in an appointment with their GP to adjust their medication, or for person, family or staff to be aware that close monitoring of the blood sugars is necessary to adjust insulin. In this way, what is important to the person remains at the centre of any intervention, without ignoring what is important for them.

This tool can be completed over a period and is likely to change as the person changes. This, in turn, will affect the ‘how’ and the risk assessment. A dynamic tool that ensures the person is supported in a way that they want keeps them at the centre of their decision making process, understands their best interests and works with them on ‘how’ to provide such support.

For people with dementia who do not have capacity to make many of the decisions within each domain, it is essential they are as involved as they can be in creating the support plan. For the person unable to give consent to professional care and support, a best interests meeting would be necessary to ensure that the consent can be obtained.

The domains to consider are:

How to use the tool

1. When using the tool make sure that you allow enough time for the person. The information collected will be kept very safe, but you must make sure that the person is happy to share and record this information.

2. When you start the tool it will ask you for some information such as ‘what people appreciate about me’, and if a male or female carer is preferred. This information can be printed on the short (summary plan) and/or long (full plan) copy of the person centred plan.

3. Nest select your domains, this is the area that you want to cover. Click on any that you don't want to include to untick it.

4. When you enter each domain there will be questions to complete. You should tick what is important TO and what is important FOR the person. Under the important TO the person there is a box for the person to SAY themselves what is important for them. If you think that any aspect of the important TO or FOR poses a risk, you should select a red R. This will highlight to you at the end that a risk assessment may be required. This will vary depending on whether you are a service or a family member/ carer.

5. After you have completed the important TO and important FOR complete the HOW box. If you write this as the person is saying it in 'I' it will be more powerful.

6. Once you have completed all the domains you can print a report. You can access a summary plan, or a full plan. The summary plan has all the - HOW to provide care boxes completed.

7. Finally the plans can be updated whenever there is a change.

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