Abstract

Background and Objectives: Personalisation of care services is a key policy objective in England(1). In residential care settings the interpretation, approach and level of implementation of personalisation - or person-centred care (PCC) - varies considerably. Our study examines the different conceptualisations of - and approaches to - personalised care and reviews the effects of, and facilitators to, improving personalisation in care homes.
Methods: This research, conducted by the Policy Innovation Research Unit, consists of a comprehensive review of the international literature on personalisation in residential settings, UK Government policy documents, guidance from professional organisations, and in-depth interviews with care home owners and managers in England.

Results: Studies have found that prevalent conceptualisations of PCC support resident-led choice (e.g. timings of meals, activities) in home-like residences. Equally, several care home modernisation initiatives are based on concepts founded by Kitwood(2) and Brooker(3), advocating the creation of empathetic care environments which respond to residents’ personal histories and aspirations.

Reported implementation strategies include adopting principles of the “culture change” movement: a whole systems redesign of homes’ physical layout, service delivery, and staff skills-set. Other approaches include focused government policy and financial incentives, drama programmes, purpose-built care facilities, skills training and the use of tools such as Dementia Care MappingTM(4).

Some care homes observant of PCC report positive effects on residents’ health and wellbeing including a reduction in boredom, aggressive behaviour and use of antipsychotic medication, and more meaningful connections with front-line carers. Furthermore, by embracing “partnership” models of care delivery, homes implementing personalisation often engender flat management structures, resulting in improved cooperation across all levels of staff, enhanced awareness of residents’ needs and heightened carer self-worth and job satisfaction.

Some studies suggest that successful implementation is more likely in small scale home-like care environments. Other studies found that personalisation was enabled in care homes with more resources, such as high staff-to-resident ratios and residents with more financial resources and relatively less disabilities. Other facilitating factors to developing personalised care practices include effective and motivated leadership, open and reciprocal communication between management and staff, and continued support for front-line carers.

Conclusion: Initial findings indicate that a range of factors are important in improving personalisation in care homes. Further parts of the project will explore the response of residential care providers – and representatives of stakeholder organisations - in England to national personalisation policy.

1. Department of Health and Social Care (2018) Care Act statutory guidance, available at https://www.gov.uk/government/publications/care-act-statutory-guidance/care-and-support-statutory-guidance, accessed on March 2, 2018.

2. Kitwood, T. (1997) The experience of dementia, Aging and Mental Health, 1, 13-22.

3. Brooker, D. (2003) What is person-centred care in dementia? Reviews in Clinical Gerontology, 13, 215-222.

4. University of Bradford (2018) Dementia Care Mapping, available at: https://www.bradford.ac.uk/health/dementia/dementia-care-mapping/, accessed on March 6, 2018.