We don't always get it right and many carers can put their hands up and say 'I got it wrong'. It's okay, we're all human and we all make mistakes. Making mistakes is very often the best experience for us to learn from. Here, Jenni Mack from Craigielea Care Home shares her own experience of 'getting it wrong' with some great reflection on what she learned from it and how we can avoid making the same mistake ourselves.
Person Centred or Person Led?
After a wonderful day working with Scottish Care’s Donald McAskill I’ve been left with this phrase stuck in my head and it has really got me thinking….
Are we getting it ALMOST right but not quite with our current obsession with Person CENTRED care? Should we perhaps be aiming more at Person - LED care?
What is the difference between person centred and person led? If something is person centred we have thought about the person and put them at the centre of the scenario but we have still made the decisions. If we think of things being more person led then the person themselves will have made the decisions. Open ended questions are a good way of achieving this, instead of asking “Would you like to go to the park today?” one should maybe ask “Where would you like to go today?”
With non verbal people this can be harder but body language and symbols can be helpful, to allow independence and power over their own care.
An example of a mistake I made on this very subject was recently during my activities work at Craigielea Care Home. One of the residents in my dementia care unit is a Royal Navy veteran so when I booked a boat trip for my residents I thought of him straight away. In my mind I had “put him at the centre” of my planning and decided it would be a wonderful reminiscence session for him, bringing back memories of being at sea and hopefully sharing stories with us. When the day came for the trip and he was getting ready to go out he asked where we were going. I excitedly told him where we were going and he became aggressive and angry.
He told me “If I ever go on another boat in my life I'll throw myself off!”
This was a shocking reality check for me. I had planned what I thought was a wonderful day out and formed the idea round his “This is Me” document which spoke about his career in the Navy however I had made one glaring error. I had failed to ASK HIM! Therefore my person centred care was in no way person led and had failed miserably.
So as someone who truly wants what’s best for those in my care, I had to stop and reflect back on this practice and realise my error. The phrase “nothing about me without me” is frequently used by people who have dementia and I had sadly (even though with the best intentions) done exactly the opposite of that.
As part of my activities work I try to hold residents meetings every couple of months to assess what they would like to do and also to bounce ideas off them in case like with my Navy veteran I am way off base. I include residents in this who are non verbal and also those who’s dementia is more advanced. Now this may seem absurd to some but when you spend time with residents and get to know them well, learning their body language and facial expressions it helps me to know if what I’m saying pleases them or not. By doing this I am using their feelings to build my activity plans. This is truly person led care.
If we base this on personal care tasks and not activities it is a very similar scenario.
Preferences are so utterly paramount for residents to know that they are cared for and what they want matters.
How do we achieve person led care? Communication, communication, communication!
NEVER make assumptions, especially with those living with dementia where needs, wants and desires can change moment to moment. Whether it is tea or coffee, sugar or no sugar, TV or radio, cereal or toast. Simple choices given add to feeling valued, understood, and listened to.
All person led. How is this different to person centred? Well, person centred would be reading care plans and seeing that Mr A used to have toast with marmalade every morning without fail prior to moving into your care and assuming that this will be his preference now. Person centred care would show that you showed an interest in him and provided (what you thought was) his preference. The one error in this was that you didn’t ASK him. Perhaps his late wife made this breakfast for him in the past and he ate it without a grumble so as not to hurt her feelings and he would actually love some cornflakes. Perhaps he DID love this breakfast but now his taste buds have changed and he finds the marmalade bitter. Perhaps he just fancies a change. So the moral of this is, communication. TALK to people, and NEVER make assumptions, even if you believe you know them well. Perhaps Mr A will continue to eat toast with marmalade for the rest of his days, but maybe just maybe he’ll branch out to new tastes and really enjoy them. We are never too old to try something new!