Person Centred Care: Breaking the Boxes from Childhood

Being person‑centred isn’t necessarily about doing more. It’s about noticing more.

If I were to ask you who you are, what would your response be? Really pause and think about it. If we were both to map just 24 hours of our lives – our thoughts, routines, health, relationships, preferences, fears, joys, environments, work, family histories and past experiences – how different would those maps look? Even over the course of a single hour, what makes you you, and me me?

A simple, recent example comes to mind. A friend and I were on a woodland walk with the kids. I noticed she was filling almost every silence with conversation. Not because anything was wrong – it’s just how she is, plus we hadn't seen each other for a while. She likes to talk as she walks, to process, to connect. At one point we laughed about it, because I’m the opposite. I’m very comfortable with long stretches of quiet. In fact, I quite enjoy them. I don’t feel the need to fill the space but to some, that can feel uncomfortable. Neither of us is right or wrong – we’re just different. But that small difference matters. If we were ever receiving care, and a care assistant accompanied us on a walk, the support we needed would look very different. One of us might want conversation throughout; the other might want periods of shared silence. Person-centred care lives in those details.

This is the premise of person‑centred care. A term that has gained traction in the UK over the last couple of decades, yet in my opinion, based on years of working in and alongside care services, is still not fully embodied. I sometimes wonder if it ever truly will be – and why that might be.

Put simply, person-centred care recognises that every individual receiving care and support is uniquely and wonderfully different. They always have been. That individuality does not disappear when someone moves into a care setting, hospital, or receives support at home. To provide the best possible care, we need to truly know who someone is, what matters to them, and adapt support accordingly, rather than expecting the person to mould themselves to fit the service.

Conceptually, this makes sense to most people. In training, assignments and professional discussions, staff can often confidently list the person‑centred values: individuality, choice, rights, respect, privacy, dignity, independence and partnership. The idea is that we ‘embed’ these values into everything we do and staff can usually give examples of how these values show up during their shift. And yet, despite this understanding, the values are not always lived in practice. Having worked for many years as a frontline worker, trainer and assessor, and like most people, having personal experiences of loved ones receiving care or treatment, I believe this gap is worth exploring and of course, I have my own opinions on the matter.

The idea of being person‑centred did not appear overnight. Carl Rogers was one of the first to formally introduce the term through his Person‑Centred Therapy, which I loved learning about in my psychology studies. Rogers believed that for growth and healing to occur, three core conditions were essential: empathy (therapist understanding the client’s perspective), unconditional positive regard (non-judgmental acceptance from the therapist towards the client), and congruence (genuineness and authenticity from the therapist). Unlike earlier psychoanalytic models, Rogers positioned the client as the expert in their own life (as opposed to the therapist being the ‘expert’ in the client’s life), creating a space where people could explore, understand themselves more deeply, and move toward their own potential.

Around the same time, Abraham Maslow introduced his Hierarchy of Needs. While I don’t believe the hierarchy is as linear as it’s often presented, it remains a useful reflective tool, both in care services and as a personal development tool. An easy example to demonstrate Maslow’s message is that you can’t reach your full potential (self-actualise), or at least, you’d find it very difficult, if you’re worrying every day about whether you will find somewhere safe to sleep tonight. The basics, like food and shelter and feeling safe are fundamental. However, the Hierarchy reminds us that people need more than food, shelter and safety to thrive in life. Meaning, connection, purpose and growth matter deeply to our wellbeing. No matter our age, disability, or care status.

Later, Tom Kitwood expanded this thinking within dementia care through his Flower of Psychological Needs. While applicable to all humans, his work was aimed at looking beyond dementia to the personhood of the individual. It reminds us that even when cognition changes, human needs for comfort, attachment, identity, occupation, inclusion and (most importantly) love, remain.

Across all these models, and the many others that exist, the message is consistent: being human is about far more than survival. While we may, in essence, share universal needs, the ways we meet those needs are deeply individual.

For me, that individuality looks like (just a few examples here) loving learning, nurturing and guiding my son, teaching, writing, planning for the future and compiling to do lists (then writing another list because I didn’t tick off everything from the last list and there is now more to add 😊), walking in the woods, meditation, long drives, music, celebrating birthdays with loved ones, herbal tea, books, candles, random fun things like Ninja Warrior Adult Only sessions, coffee, movies, dressing up occasionally to go out somewhere nice (but not too often, I like chilling at home more 😊) and enjoying a pint or two. And, if I live with dementia at any point in my life, and regress back to my pre ‘responsible mum’ era, I will probably want several cigarettes with those pints, please! These things matter to my wellbeing. Take some of them away, and you’ll start to see distress behaviours – not because something is ‘wrong’ with me, but because something important is missing.

This is why assumptions in care settings can be so damaging. Many services still operate communal routines that suit systems more than people. Sometimes they must; there are a lot of people to support, all of the time, and I get that. But low staffing and limited resources are not always the reason behind a lack of person-centred care. Sometimes it is an individual’s choice not to be person centred, not to take the time someone deserves, not to get to know them properly.

Social inclusion is an important consideration too, but it should never be assumed that it looks the same for everyone. Many care staff try to encourage daily group activities, or shared mealtimes in the dining room, for example. This is inclusive; however, person-centred care doesn’t mean that everyone has to be continuously monitored or needs constant attention. Contentment in solitude should never be mistaken for withdrawal or depression. For example, I’m very ‘selectively social’, and that’s healthy for me. I wouldn’t want to eat in a busy dining room every day. Perhaps I’d join once a week. Yet I know many people who would happily eat in the dining room for breakfast, lunch and dinner, every single day. Neither preference is better or worse, they’re just different.

So why is it still so difficult to embed person‑centred values consistently? Beyond the obvious staffing and funding pressures, challenges include a lack of cohesive multi-disciplinary working, the individual worker’s choice to adopt, or not adopt, a person‑centred approach, and differing organisational or cultural values. But perhaps the issue runs deeper. Perhaps it’s because we are placed into boxes from the very start of life. From infancy, all through school, we are taught to conform, adapt, and suppress difference. We are measured against milestones: is my baby walking too early or too late compared to all the others? Is my child struggling with maths compared to everyone else in the class or are they where they ‘should be’? And we often ask these questions without taking into account the child’s temperament, inner world, or the stresses of their environment. Even routines as an adult – work by day, sleep by night, send your child to school, eat breakfast, lunch and dinner within ‘these’ hours – are considered universal. All through life. So, in a care setting, when someone’s behaviour falls outside these invisible norms, we automatically see it as ‘wrong.’ Eating at a different time and not with everyone else, awake during the night for a couple of hours, just pottering around or watching TV, taking a 9pm walk in the garden – suddenly, it’s a problem. But why? Why is being different, or doing things differently treated as a fault? We are different! Society says that certain behaviours are deemed acceptable, others not (rightly so for some behaviours). That often doesn't allow us to be 'person-centred'. Are we ever truly allowed to be ourselves? Does society ever let us be?

Perhaps person‑centred care does not begin in care homes at all. Perhaps it begins in childhood, in how we listen, respond and allow children to be who they are.

So here are a few gentle reflections for you. What would be on your list of ‘things that truly matter to me’ if you were ever to receive care? And if you support others, how well do you know what matters to them? And if you have children, do you find yourself guiding them according to who they truly are, or more according to what you or society expect you to do?

Even with the wider issues of staff shortages and funding pressures, and without undermining the impact of those things, you don’t need hours to see someone for who they are. Sometimes five minutes of genuine noticing is enough to change someone’s day.

Maybe the place to start is simply here: what does it feel like to be seen as a person?

Image Sources: Simply Psychology and Dementia Hub