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Resources for the Comprehensive Geriatric Assessment based
Proactive and Personalised Primary Care of the Elderly

Personalised Care Planning

personalised care planning

Personalised care and support planning encourages care professionals and people with long term conditions and their carers

to work together to clarify and understand what is important to that individual. They agree goals, identify support needs, develop and implement action plans, and monitor progress. This is a planned and continuous process, not a one off event.

(Coalition for Collaborative Care, 2014)

My Health Plan - int'l

My Health Plan - international version

Personalised Care Plan template

x min.  variable

Care for people with long term conditions (LTCs) forms a significant part of the health and social care system. There are over 15 million people living with a long term condition in England. This includes both physical and mental health conditions such as arthritis, asthma, COPD, depression, dementia, diabetes and many more. These are conditions which cannot at present be cured but can be managed or improved through person-centred approaches that deliver the right care for that individual no matter what their condition(s) to ensure that they are involved in managing their condition (s), receive the care they need to live and die well, and that both they and their carers feel supported to maintain a good quality of life.

Support might relate to learning new skills, changes in behaviour, access to community support, as well as medication and traditional treatment or therapies (NHS UK, 2015).


Evidence shows that personalised care and support planning can lead to the most appropriate use of limited healthcare resources. People who are engaged in their health and care are more likely to receive care and treatment that is appropriate to them; to take up appropriate prevention services (such as regular screening); and to adopt more healthy behaviour. By sustaining successful self-management, and by anticipating and making explicit provision for possible crises and emergencies,

personalised care and support planning may also help to reduce the use of urgent and emergency care (NHS UK, 2015).

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The responsibilities of a Care Pro

  • Companionship: ensuring a client enjoys regular and meaningful social interaction is an important part of your visit.

  • Home help for everyday activities and tasks such as: planning and preparing a nutritious meal, doing light housework, and accompanying to appointments or shopping, all the things that make up their routine.

  • Personal care: supporting clients with the daily essentials such as bathing, showering, dressing and grooming ensuring they can continue to live independently in their own home.

  • Specialist care: if a clients needs change or progress you will receive the training to deliver the person-centred care they need, with confidence.

Becoming a Professional Care Worker a U.K. perspective


Consider Assisted Living

Go To : Consider Assisted Living

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