What is a care plan?

A care plan is a personalised working document that outlines how a resident's care, support and daily life will be safely met within a care home. It contains information about a person's health, routines, preferences and wishes, to ensure that team members who support them understand what great care looks like for that individual. 

Rather than a one-size-fits-all checklist, it’s built around the individual, not just their condition. It covers everything from medical needs and mobility to the small details that make someone feel at home, such as how they like their coffee or what routines they like.

In this article, we’ll explain what is the purpose of a care plan, what it includes and how one is created.

What does a care plan include?

A care plan consists of a range of information about a resident so that carers, nurses and health professionals can deliver consistent, high-quality care. While layouts can differ between care providers, most care plans cover who the person is, what their health and care needs are, how they like to live their daily life, their wellbeing, and how they communicate and make decisions. These give team members a better idea of the individual they’re supporting. 

Personal and background information

Every care plan starts with the basics needed to identify the resident and keep them safe. Typically, this includes: 

- Full name and preferred name

- Date of birth

- Next of kin and emergency contact details

- GP details and any other key healthcare contacts

- Preferred language, and any communication or translation needs

Medical history and care needs

This section is essential as it helps keep a resident safe and it tells team members exactly what support someone needs and why, including:

- Current health conditions and diagnoses

- Medications, dosages and administration times

- Known allergies or sensitivities

- Mobility levels and any equipment used, such as walking frames or hoists

- Fall risk and any related precautions

- Nutritional needs, including any special diets or swallowing difficulties

- Continence care needs

Having this information recorded helps staff predict needs, spot changes early, and respond quickly if something goes wrong.

Daily routines and personal preferences

Good care isn't only about meeting medical needs, it's about helping individuals live a meaningful life. This part of the plan captures the details that make everyday life feel fulfilling and comfortable, such as:

- Waking and sleeping times

- Washing, bathing and dressing preferences

- Food and drink, preferences, likes and dislikes

- Hobbies, interests and favourite activities

- Preferred routines, such as reading before bed 

The small details are often what make a big difference to how settled and content a resident feels. 

Emotional and mental wellbeing

This section outlines a resident's emotional and mental wellbeing, including their mood, mental health needs and social preferences. It may also cover cultural or religious considerations, and any support that helps someone feel comfortable and respected, such as support to continue practising their faith.

Communication and decision-making

This part of the plan consists of how a resident prefers to communicate, whether that's verbally, through gestures, using hearing or visual aids. It also has information about whether a Lasting Power of Attorney (LPA) or similar legal document is in place, which is when a resident's capacity reduces, and they may make decisions about their health, welfare or finances. 

How is a care plan created?

Creating a care plan is a collaborative process – it's created together with the resident, their family, and the professionals who know them best, so that the plan best reflects who that person is and what matters the most. 

The initial assessment

At Barchester, care planning begins with an assessment, usually carried out before or on the day a resident moves in. This is typically led by a senior member of the care team, such as a nurse or care home manager, who meets with the resident and their family to gather information about health needs, daily routines, personal history and preferences.

A key part of this process is Barchester's 'Getting to Know Me' booklet, completed together with residents and their loved ones. It captures details such as hobbies, likes and dislikes, life stories and religious beliefs, helping staff to better understand residents. 

Why family and resident input is important

No one knows a resident better than they know themselves, and their family often hold a great knowledge of their habits, preferences and life story. Involving them both in the care planning journey helps staff create a more accurate picture of what good care looks like for that resident, and strengthening bonds between the resident and their family. It also gives them a sense of security and belonging, knowing they have a say in decisions about their care.

Families are encouraged to take an active role in their care from the very beginning to help design a more meaningful life for that individual. 

Input from medical and care professionals

As well as the resident and their family, professionals also contribute to creating a care plan. GPs and other healthcare providers share relevant medical history and guidance on how to manage existing conditions. Nurses and carers look at ways to best support a resident's physical and emotional needs, while other specialists, such as physiotherapists or dietitians may be involved if a resident has higher level needs. 

Agreeing to a care plan and signing off

Once all the relevant information has been collected, the care plan is drafted, and the resident and their family can check it reflects their needs and wishes. Changes can be made before the plan is agreed and signed off, usually by the resident (or their representative, if they lack capacity) and a member of the care team. 

How often a care plan is reviewed and updated

Regular reviews are crucial to make sure a care plan reflects a resident's needs, as these can sometimes change gradually, or sometimes suddenly. We review care plans regularly with extra reviews carried out when their needs change.  

What can trigger an unscheduled review

Certain events can trigger an unscheduled review of a resident's care plan. These can include:

- A change in the resident's physical or mental health

- A fall or other safety incident

- A hospital admission or discharge

- A request from the resident or their family

- A concern raised by a family member, carer or healthcare professional

Who is involved in a review

A care plan review at Barchester typically involves:

- The resident, wherever possible

- Family members or the resident's representative

- The home's nursing and care team

- The resident's GP or other relevant healthcare professionals

- Specialist practitioners, where applicable, such as physiotherapists or dietitians

How changes are recorded and information shared

Once a review is complete, changes are recorded in the resident's care plan and communicated clearly to the wider team. This means, updated information is captured within our electronic planning system, Enable, so that care needs are met consistently. Families are also kept informed of any significant changes, as we know how important open and ongoing communication is.

Barchester Healthcare's approach to care planning

At Barchester, care planning is anchored in a people-first philosophy. We’re always committed to understanding what makes each resident who they are. From the 'Getting to Know Me' booklet, to regular review, regular meetings with residents, their families and friends, we continuously get to know our residents so we can care for and support them in the best way we can.