By Dr Alison Charles, Social Care Themed Project Fellow, ARC KSS
In the UK, around 400,000 older adults live in care homes. These homes must provide not only physical, medical and emotional support to residents but should also nurture and protect their individual dignity and respond to their personal preferences and needs. Given the diverse nature of residents’ requirements and backgrounds, tailored, person-centred care is essential. But how is this achieved in practice?
A recent qualitative study in the International Journal of Care and Caring offers insights from 22 interviews with care staff across England. Led by Nick Smith and colleagues from five universities, the study explores both the potential and the challenges of care planning in a pressured sector.
Understanding the purpose of care planning
Care planning is more than a bureaucratic task. Staff identified three main goals: assessing needs, delivering person-centred care, and ensuring appropriate support. This includes understanding personal preferences—like whether someone prefers showers to baths or two pillows or one. As one nurse said, “We’re not all the same… every care plan should be individualised.”
This focus on personalisation aligns with broader social care policy. However, achieving it consistently remains difficult.
When and how planning happens
Care planning typically occurs at three points: on admission, during regular reviews, and after significant changes like illness or hospitalisation. Initial plans are often rushed, but ongoing reviews allow for refinement.
The process is time intensive. Staff must collect detailed information, from dietary needs to end-of-life wishes. Many homes now use digital care planning systems, which are generally seen as more efficient and accessible than paper records. These tools enable real-time updates and easier information sharing, even offering analytics to monitor health trends.
Yet, some staff worry that digital systems risk turning care planning into a 'tickbox' exercise, undermining the person-centred ethos they aim to support.
Who’s involved—and who’s left out
Ideally, care planning involves residents, families, and professionals. In practice, participation is often limited. Residents with cognitive impairments may be excluded, especially from sensitive discussions. Family involvement, while valued, can be inconsistent or complicated by differing opinions and logistical issues.
Senior staff usually lead the process, but input from junior staff and external professionals— such as GPs, social workers, and speech and language therapists - is vital. Some homes have introduced 'care plan coordinator' roles to streamline efforts.
Barriers to better planning
Time, staff shortages, heavy workloads, and limited funding often push care planning down the priority list. Training is another issue. Many staff feel unprepared to write care plans or discuss complex topics like end-of-life care. Available training is often ad hoc and poorly integrated into daily routines.
Participants also called for better tools and systems—such as short online training modules, standardised templates, and improved integration with external health services.
A systems approach to improvement
The study’s authors advocate for a systems perspective. Care homes are part of a broader ecosystem involving families, healthcare providers, regulators, and society. For instance, societal discomfort with discussing death can hinder end-of-life planning.
Understanding care homes as interconnected systems helps reveal how staffing shortages, policy shifts, and cultural norms all affect care planning. It also underscores the need to involve all stakeholders—especially residents and families—in shaping plans that reflect individual needs and values.
Looking ahead
The study calls for more research, particularly involving residents and families. While digital tools are reshaping the logistics of care planning, human elements—communication, empathy, collaboration—remain essential.
Support for care home staff
To support care homes during Care Home Open Week 2025 (16–22 June), three, new, free resources have been developed and launched to help staff deliver high-quality, person-centred care planning.
Developed with input from over 100 health and social care professionals, residents’ family and friends, and funded by the National Institute for Health and Care Research (NIHR) these resources aim to enhance person-centred care planning in older adult care homes. They outline key principles that promote more meaningful and inclusive planning processes for residents.
Download your copies today and share them with your team to help improve care planning for everyone involved.
- Quick guide to effective care planning with older care home residents – a concise tool to help create meaningful, quality-of-life-enhancing care plans.
- Steps to effective care planning in older adult care homes – a detailed guide offering practical guidance and examples.
- Care Planning Poster – a handy care planning poster offers top tips to help make a difference - suitable for staff rooms or spaces where care home staff, residents and family members will see it.
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