4.3 Describe how older people can be in control of decision making about their care and support needs

This guide will help you answer 4.3 Describe how older people can be in control of decision making about their care and support needs.

Older people can take an active role in deciding their care and support needs. This means they take part in discussions, express preferences, and choose options that meet their individual situations. A person-centred approach is used so that their views remain central. Respecting these choices supports dignity and independence.

Care workers and professionals must support older people to understand their options. This may involve explaining information in plain language, using visual aids, or repeating details if needed. Sometimes family members or advocates are involved, but the older person’s voice should remain the main influence.

What are Rights and Choices?

Older people have the legal right to make decisions about their care. The Care Act 2014 and the Human Rights Act protect these rights. They include being able to:

Decide where to live and receive care
Choose the type of support they want
Accept or refuse treatments
Request changes to care plans

Knowing about these rights helps older people speak up and remain in control. Workers should encourage them to ask questions and give feedback.

Person-Centred Care

Person-centred care means planning and delivering services from the viewpoint of the person receiving them. For older people, this approach recognises life history, cultural background, beliefs, health needs and personal tastes.

Workers can support this by:

Listening closely to the person’s wishes
Allowing time for them to express themselves
Offering a range of choices
Respecting decisions, even if they are different from professional opinions

This approach values individuality and helps older people feel respected.

Communication Support

Clear communication is a key part of involving older people in decision making. Some may have hearing difficulties, sight problems, memory loss or speech challenges. Workers need to adapt communication so the person can understand and respond.

Ways to help include:

Using simple, plain language without jargon
Speaking slowly and giving time for responses
Checking understanding by asking the person to repeat information
Providing written details in large font
Using pictures or diagrams

If the person speaks another language, interpreters may be used so they can take part fully.

Involving Advocacy

An advocate is someone who speaks on behalf of a person when they find it hard to express their views. Advocates can be family members, friends, or trained volunteers. Independent advocates follow the person’s wishes without adding their own opinions.

For older people who lack confidence or have cognitive challenges, an advocate ensures their needs and preferences influence care plans. This increases the older person’s control and prevents others from making decisions for them without consent.

Shared Decision Making

Shared decision making happens when the person and professionals discuss options together. The professional explains risks, benefits and practical factors. The older person describes their priorities, lifestyle, and comfort levels. Together, they choose the option that suits best.

For example:

Choosing between home care visits or moving to a supported living setting
Selecting the timing and length of visits from care workers
Deciding what daily tasks they want help with

This approach recognises the person’s knowledge of their own life.

Involving Family and Friends

Sometimes family and friends can support the older person’s decision making. They can help by reminding them of previous choices, explaining information, and attending meetings. It is important to make sure their influence does not replace the older person’s voice. The care worker should check that the final decision reflects what the older person wants.

Respecting Autonomy

Autonomy means self-rule and control over personal choices. In health and social care, respecting autonomy means avoiding making decisions for someone without their input. Workers should not assume that an older person cannot decide for themselves unless there is clear evidence that they lack capacity.

This respect can be shown by:

Asking permission before any action
Offering options and letting the person choose
Supporting them to live by their values and preferences

Use of Care Plans

A care plan is a written record of the person’s needs, wishes, schedules, and agreed actions. Involving older people in creating and reviewing this plan gives them direct control over their support.

They can:

Approve or change the care plan before it begins
Request new services or remove ones they do not want
Choose the order tasks are done
Review the plan regularly and update it

By keeping the plan flexible, older people remain in control even as their needs change.

Supporting Capacity

The Mental Capacity Act 2005 explains how to support someone to make decisions and when decisions can be made on their behalf. It says people should be assumed capable unless proven otherwise. Workers must try all reasonable steps to help them understand and choose.

Support steps include:

Giving information in more than one form
Holding meetings in quiet, comfortable places
Choosing times when the person is more alert
Allowing breaks during discussions

If the person is found to lack capacity, decisions must be made in their best interests, often involving family or advocates.

Use of Technology

Some older people use technology to help manage their care. Examples include video calls with health professionals, setting reminders for medication, and using online portals to review care plans. Workers can teach them how to use these tools to keep oversight of their support.

It is important to offer training at a comfortable pace and ensure devices are set up in accessible ways.

Choice in Daily Living

Control over daily living helps older people maintain independence. Workers should encourage them to decide on details of their day-to-day care.

Examples include:

Choosing meal times and food preferences
Selecting clothes for comfort or personal style
Deciding on activities or hobbies
Choosing whether visits happen in morning or evening

These small decisions make a large difference in feeling respected and valued.

Cultural and Religious Preferences

Older people may want care that respects their culture or religion. This can include food preparation, clothing, personal routines, or attending religious services. Workers must ask and record these preferences and make sure they are followed.

This keeps care personal and meaningful while giving them control over important aspects of their life.

Managing Risks

Sometimes older people choose options with higher risk, such as living alone despite mobility issues. Workers need to balance safety with the person’s right to decide. This means explaining risks and discussing ways to manage them without removing independence.

For example, adding grab rails, emergency alarms, or regular phone check-ins can reduce risk while allowing the person to live as they wish.

Feedback and Reviews

Regular reviews give older people opportunities to adjust their care and support. Workers should make sure these meetings are held in a way that is comfortable and accessible. Feedback can be gathered through conversation, forms, or anonymous suggestions.

Changes based on feedback should be recorded in the care plan and acted on promptly.

Preparing for Changes

Older people may face changes in health, home environment, or family support. Involving them early in planning for these changes helps them stay in control. Discussions can cover different care settings, how to keep contact with loved ones, and preferred routines.

This approach reduces anxiety and keeps their voice at the centre during transitions.

Building Trust

For older people to take control, they must trust workers and organisations. Trust grows when workers follow through on promises, respect confidentiality, and treat the person consistently with kindness. A good relationship makes it easier for the person to speak openly about their needs and preferences.

Training for Workers

Workers can improve skills for involving older people in decision making through training in communication, empathy, and legal responsibilities. Understanding how to support capacity and use a person-centred approach is key.

A trained worker can balance professional knowledge with respect for the person’s right to choose.

Supporting Emotional Wellbeing

Taking control of decisions helps emotional wellbeing. It reduces feelings of helplessness and increases confidence. Workers can encourage older people to state preferences openly and reassure them that their opinions matter.

When people feel heard, they are more likely to engage positively with care.

Final Thoughts

Older people should have clear, informed, and active involvement in deciding their care and support. This means treating their views as central, respecting their rights, and providing the assistance they need to understand options. Workers must remember that even when health challenges arise, many older people retain the ability to make decisions about their lives. Communication, flexibility, and respect help keep decision making in their hands.

Giving older people control is not just about meeting legal requirements. It is about recognising their lifetime of experience and individuality. By placing them at the centre of planning and support, care becomes meaningful, respectful, and empowering. This approach benefits both the person and those providing care, leading to better outcomes and stronger relationships.