Person-centred care in a Scottish care home: what it really means

What person-centred care actually means

The idea came out of dementia care, largely through the work of Tom Kitwood in the 1990s, and it was a reaction against care that treated people as a set of tasks to be completed. Kitwood's argument was that personhood survives the diagnosis, and that much of the distress we see in care settings comes from the way people are treated rather than from the condition itself.

Stripped of the jargon, it comes down to four things happening consistently:

• The person is treated as an individual with a history, preferences, relationships and beliefs, not as a room number or a diagnosis.
• Their rights are respected, including the right to make choices other people would not make, and the right to take reasonable risks.
• They have real influence over their own day, and where they cannot express that directly, the people who know them best are involved.
• Staff are supported to build genuine relationships, because none of the above survives constant turnover and rushed rotas.

The last point is the one families most often miss when comparing homes. Person-centred care is not a document. It depends almost entirely on whether the same faces are there week after week, and whether those people have the time to notice things.

The five principles Scotland holds homes to

The Health and Social Care Standards, introduced in 2018, replaced the older National Care Standards. They apply across health and social care in Scotland and are built on five principles. Every one of the detailed standards underneath flows from these.

The Care Inspectorate grades services on a six-point scale, from 1 (unsatisfactory) to 6 (excellent), across key questions such as how well the service supports people's wellbeing and how good the leadership is. Those grades and the full inspection reports are published for every registered home, and you can read them before you visit. Our guide to choosing a care home explains how to read a report properly rather than just looking at the numbers.

Staff are separately regulated. Care workers in Scotland must register with the Scottish Social Services Council and work to its Codes of Practice, which carry the same expectations about dignity, choice and respect down to individual practice.

What it looks like on an ordinary Tuesday

Principles are easy to write and hard to live. These are the ordinary, unglamorous things that tell you whether a home has actually built its day around the people in it.

• Getting up and going to bed when you want to, not when the rota says. A home where everyone is up, dressed and in the lounge by half past nine has organised the morning around the staff.
• Food you actually like, at a time that suits you, with an alternative available and something to eat outside mealtimes.
• Your own furniture, photographs and things in your room.
• Keeping your own GP where geography allows, and keeping the routines that mattered to you at home - a bath rather than a shower, the radio on, the paper in the morning.
• Being able to close your door, be alone, and have visitors without an audience.
• Activity that reflects what you were interested in before you moved in, including doing nothing if that is your preference.
• Continuing to do things for yourself where you can, even when it would be quicker for someone else to do them.

The personal plan: what it must contain

In Scotland every person in a care home has a personal plan. It is a regulatory requirement, not an optional extra: the service must prepare it in consultation with the person, keep it under review, and record how their health, welfare and safety needs will be met. Regulation requires review at least every six months, and in practice any significant change should trigger a review straight away.

A plan that only lists clinical tasks is not a personal plan, whatever it is called. A good one reads like a description of a person and contains:

• A life history - work, family, places, faith, what the person is proud of
• What matters to them now, in their own words wherever possible
• Daily routines and preferences: waking, washing, dressing, eating, sleeping
• How they communicate, and what it looks like when they are unhappy or in pain
• What helps when they are distressed, and what makes it worse
• Health needs, medication and who is involved in their care outside the home
• Any legal arrangements, such as power of attorney or a guardianship order, and any advance decisions
• Who should be contacted, about what, and how often
• Agreed outcomes - what good would look like over the next few months
• A date for the next review, and a record of what changed at the last one

You are entitled to see the plan and to be involved in it. If someone lacks capacity to take part in decisions, the Adults with Incapacity (Scotland) Act 2000 governs how those decisions are made, and anyone acting under a welfare power of attorney or guardianship should be involved directly. Even then, the duty to find out and follow the person's own wishes does not disappear - it becomes harder work.

What it means for someone living with dementia

Person-centred care matters most, and is hardest, when someone cannot easily tell you what they want. The work shifts from asking to noticing: what time of day is difficult, which member of staff they settle with, which song, which chair, which words.

Behaviour that services once labelled as challenging is usually communication - pain, boredom, fear, needing the toilet, too much noise, an unfamiliar face doing something intimate. Homes that work this way go looking for the cause before reaching for a response. Alzheimer Scotland publishes good, plain guidance for families on this.

Familiar music is one of the most reliable practical tools, and we cover it properly in the guide to music therapy for dementia. Life-history work is another: a home that knows someone was a fisherman, or taught primary one for thirty years, has far more to work with on a difficult afternoon.

Questions that reveal whether a home means it

Every home will say it is person-centred. These questions are hard to answer well unless it is true. Take them with you on your visit.

• Can you tell me about one resident's routine and how it differs from everyone else's?
• What time do people get up? What if someone wants a long lie?
• What happens if someone does not want what is on the menu, or wants to eat at three in the afternoon?
• Who writes the personal plan, who is in the room, and how often is it genuinely reviewed?
• What is your staff turnover, and how much agency staffing did you use last month?
• How do you find out what matters to someone who cannot tell you?
• Tell me about a time you changed something because a resident or a family asked.
• Can my relative keep their own GP, bring their own furniture, have a drink, go out?
• How do you raise a concern here, and what happened to the last one?

Visit twice, at different times, and pay attention to late afternoon. Watch whether staff speak to residents while doing things with them, whether people are called by their names, and whether anyone is sitting in the same chair facing the same wall on both of your visits.

How this works across our homes

We run 30 care homes across Scotland, and they are deliberately not identical. Each has its own manager, its own team and its own character, because a home in the Highlands and a home in Glasgow's West End are serving different lives.

The most honest thing we can tell you is to come and look. Read our inspection reports, then visit unannounced if you would rather, and use the questions above. If you would like to talk it through first, our contact page has the details, or you can find the home nearest you on our care homes page.