Person-Centred Decision-Making for Older People: Capacity, Consent and Everyday Choices
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Person-centred planning for older people is fundamentally about decision-making. While Mental Capacity Act processes are well understood at a formal level, many services struggle to embed person-centred decision-making into everyday support. As a result, decisions drift from the person to the service, often unintentionally.
This article complements your capacity and consent work (see Mental Capacity Act) and your strengths-based practice guidance (see Strengths-Based Approaches). Its focus is the practical, day-to-day decisions that define whether support is genuinely person centred.
Why everyday decisions matter
Older people make dozens of decisions each day: when to get up, what to wear, what to eat, whether to go out, and how to spend their time. When staff routinely make these decisions “for efficiency” or “to reduce risk,” autonomy erodes and dependency increases.
Embedding person-centred decision-making in daily support
Presume capacity and support decision-making
Capacity should be presumed unless there is evidence otherwise. Support may include simplifying choices, using visual prompts, allowing time, or revisiting decisions later in the day when fatigue is lower.
Differentiate unwise decisions from unsafe practice
Older people have the right to make unwise decisions. Plans should clearly state how staff support choice while managing risk proportionately.
Document “how we support decisions”
Care plans should explain:
- How choices are offered
- What support helps understanding
- When staff escalate concerns
- How best interests decisions are recorded
Operational examples
Example 1: Clothing and personal identity
Context: Staff choose clothing to save time. Support approach: The plan requires offering two clear options aligned with the person’s style. Day-to-day delivery detail: Staff lay out choices and wait for indication. Evidence: Reduced refusals and improved mood recorded in daily notes.
Example 2: Food choices and nutrition
Context: Concerns about nutrition lead staff to override preferences. Support approach: The plan balances choice with monitoring. Day-to-day delivery detail: Staff offer preferred foods alongside fortified options and record intake. Evidence: Weight stabilises without removing choice.
Example 3: Going out and managed risk
Context: Staff discourage going out due to falls risk. Support approach: Positive risk-taking is agreed. Day-to-day delivery detail: Staff check footwear, weather, and mobility aids before supporting short outings. Evidence: Confidence improves and isolation reduces.
Commissioner and regulator expectations
Commissioner expectation: Services must show how capacity, consent and best interests are applied proportionately in daily decisions, not only at assessment points.
Regulator / Inspector expectation (CQC): Inspectors will test whether people are supported to make choices and whether staff understand capacity principles in everyday practice.
Governance and assurance
- Audits checking decision-making guidance in care plans
- Supervision discussions on supporting choice
- Incident reviews assessing whether autonomy was unnecessarily restricted
Person-centred decision-making is the practical test of values in older people’s services. When embedded into daily routines, it protects rights, improves wellbeing, and provides strong evidence of lawful, ethical care.
💼 Rapid Support Products (fast turnaround options)
- ⚡ 48-Hour Tender Triage
- 🆘 Bid Rescue Session – 60 minutes
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- 🧩 Tender Answer Blueprint
- 📝 Tender Proofreading & Light Editing
- 🔍 Pre-Tender Readiness Audit
- 📁 Tender Document Review
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