Caregiving Collaborative planning Health and wellbeing Manifesto

Evaluating the Quality of Carer Support Plans and Statements

Collaborative planning and effective decision-making are powerful catalysts in the promotion of high-quality, person-centred care. Programs for action should result in a wide array of life-affirming initiatives to meet identified needs.

Frank O’Hagan

“Blessed be the caregivers for they shall save the NHS.”

Introduction: When the quality of personalised carer support plans and statements are being evaluated, it is important that national and authority guidelines are being followed. However, my own experience indicates that the standard of forward planning is generally poor. On occasions, proposed outcomes may be imprecise or even unavailable for voluntary and/or paid caregivers. I would very much like to be proved wrong in making this evaluation.

The principles underlying operational planning for different groups, involved in providing or receiving care, have much in common. This brief article emphasises the value of collaborative work and effective decision-making. It also highlights the importance of examining a number of features relating to the formulation and contents of documents. These include: (1) administration; (2) personal support; (3) health and wellbeing; (4) psychological support; (5) social engagement; and (6) reviewing and forward planning.

Are we all ‘singing from the same hymn sheet’?  Cooperative inputs involving all stakeholders can ensure that, even in the face of difficult circumstances and obstacles, significant progress can be achieved. In particular, a dedicated contact person and other team members – who are knowledgeable about the requirements of caregivers and of those for whom they are caring – have key roles to undertake within this process. Skilful planning guarantees that all are fully cognisant of their duties and are working towards the same positive results. Or to express this enterprise in another way: a pivotal aim is to guarantee that, as far as is possible, everyone is ‘singing from the same hymn sheet’. And, very importantly, that all are singing with gusto and conviction!

Effective decision-making: In best practice, plans and statements should only be signed off after an appropriate and comprehensive assessment of someone’s requirements has been concluded. It is essential that the process of reaching decisions takes due account of the views of caregivers and pertinent members of professional agencies. At all stages of planning and implementation, attention must be paid to matters of confidentiality and the right of access to information. Crucially, decision-making should focus on devising SMART targets; this characteristic requires objectives and benchmarks to be specific, measurable, achievable, relevant and timed. Completed records must avoid the dangers associated with bureaucracy. Schedules for execution and re-evaluation should be wholly understood. When put into operation, programs for action ought to be purposeful, expedient and dynamic, leading to creative and life-affirming initiatives in both care and provision.

The formulation and contents of carers’ plans and statements:

  1. Administration: Planning decisions should make clear as to who have particular responsibilities for specific tasks and activities. This also will indicate those who are acting as designated contact personnel and how they can be reached without unnecessary delays. In best practice, the responsibilities of members of a well-integrated support team will cover: (1) ensuring that planning is based on accurate information about individuals and their needs; (2) assisting others, as necessary, in effectively carrying out their undertakings; and (3) participating in timeous, collective appraisals to keep arrangements up-to-date. Together, these aspects should provide a general overview of which forms of interventions, therapies and social services are to be employed and managed. It is imperative to make sure that everyone is knowledgeable about their respective roles and confident that they are able to complete them successfully.
  2. Personal support:  The value of enabling caregivers to benefit from taking as much control as possible of their lives has to be highlighted at all times. On a cautionary note, carers should be helped to ensure that the stresses and tensions which they may be experiencing do not govern their choices, activities and routines. Aspirations in this domain will focus on the promotion and maintenance of abilities relating to agency, empowerment, resilience and independent living competences. In response to changing situations, attention to immediate or gradual modifications in planning may be necessary. The knowledge and understanding of the wishes of individuals about future resolutions, if circumstances were to deteriorate, ought to be clarified well in advance. Some key judgments, such as those pertaining to wills and power of attorney, should be made as soon as practical and kept under review.
  3. Health and wellbeing: Many professionals have significant assignments to undertake concerning the identification of physical and mental difficulties and the availability of pragmatic solutions. Their contributions can include close surveillance of those being cared for or specialist guidance to carers looking after those with ailments such as pain, obesity, diabetes, blood pressure, cholesterol levels and oral hygiene. Issues relating to mental health may necessitate the involvement or advice of psychiatric services and members of community teams. Directed instructions will be important towards the enhancement of their esteem and self-assurance. Worthwhile health and wellbeing objectives in schedules could concentrate on establishing higher standards in daily living as regards nutrition, physical exercise, relaxation, sleeping routines and the like.
  4. Psychological support: This area links closely with or can overlap topics mentioned in the previous section. Its aims should be to consolidate a line of attack which encompasses the psychological features of ‘good living’ such as feelings of agency, self-worth, composure and safety. The value of shared and community-based interventions, as opposed to individualistic approaches, also should be given serious consideration. Taking part in recreational activities, mindfulness sessions and problem-solving meetings can all contribute to the reinforcement of confidence, calmness and interpersonal skills. Sometimes, it may be helpful to identify specific types of training which carers may have to embark on before carrying out their duties. For instance, this could involve tuition or counselling being made accessible in order for them to foster the emotional wellbeing of those for whom they are caring.
  5. Social engagement: Depending on the situation in which they find themselves, carers can benefit from a wide variety of social and communal activities such as: participation in leisure pursuits and friendship clusters; membership of art, drama, dance and recreational clubs; and attendance at concerts, theatres and sporting events. Some may need assistance in: (1) organising properly-equipped living quarters to extend self-sufficiency; (2) learning about a range of suitable utensils and apparatus to reassure them in caring chores, perhaps with specialist recommendations from occupational therapists; and (3) making good use of gardens, local parks, libraries, disability-enabling cafes and other local facilities. Additionally, targets could relate to enhancing their capabilities in the application of new technologies, for example, to facilitate internet purchasing, participate in relevant distance learning, and keep in touch with support groups.
  6. Review and forward planning: Plans and statements should be regarded as ‘live’ documents with the unambiguous purpose of making sure that there is relevant on-going backing for caregivers. It is vital that all those involved are aware of monitoring and reviewing procedures and kept informed of how well they are being implemented. Good practice will allow for flexibility regarding the most suitable periods and dates for formal reviews and future planning to take place. Collaborative approaches can reach appropriate decisions as to when provision and goals may need to be modified or are no longer applicable.

Summary and concluding remarks: Vague and elusive verbal promises are often expressed on behalf of those seeking vital aid but frequently these nebulous assurances are not recorded, never materialise and leave no trace of accountability. Efficient and competent planning entails a thorough method for outlining worthwhile targets towards maintaining or improving health, wellbeing and resources. Within plans and statements there should be clearly noted roles and responsibilities. They must never be treated as wish lists. On the contrary, they should be regarded as an integral feature within a concerted and practical process which delivers high-quality, person-centred assistance.

Footnote: Please see the related page entitled “Better Planning” for further comments on the use of SMART targets and ways of meeting needs.

By O'Hagan

Dr Frank O'Hagan has formerly worked as a science and mathematics teacher, social welfare officer, teacher education lecturer, university lecturer and inspector of educational establishments. Now retired, he continues to have a keen interest in education and provision for carers.