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Care planning for people is without doubt one of the most challenging elements of being a home care provider. There are many things to consider when care planning, including being inclusive, person-centred, holistic and creating interventions that contain enough detail for carers to understand what is expected of them without being too prescriptive.
In home care, words do more than describe support: they shape expectations, relationships and outcomes. The language used in care plans can either reinforce dependence or promote confidence, choice and control; that is promote and independence. That is why enabling terminology matters. That is also why it is a topic for this blog.
The idea came out of various discussions, and care plan reviews, with providers over the last week or so in which the notion of enabling versus disabling terminology was debated.
Good care planning
The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 9: person-centred care, requires that care plans be appropriate and meet the needs of service users while reflecting their preferences. Within this one section of the legislation, the word enabling or enable is used 5 times.
The Care Quality Commission (CQC), interpret this to mean:
“Providers must do everything reasonably practicable to make sure that people who use the service receive person-centred care and treatment that is appropriate, meets their needs and reflects their personal preferences, whatever they might be.” The CQC also talk about enabling and in their guidance on achieving person-centred care. https://www.cqc.org.uk/guidance-regulation/providers/regulations-service-providers-and-managers/health-social-care-act/regulation-9
In their comparison or traditional and person-centred care planning, the Social Care Institute for Excellence (SCIE) identifies how traditional care plans focus on what people cannot do, while with person-centred care planning:
This insight helps us to understand that good care planning rather than defining people by tasks they cannot do, describes how support will enable a person to do as much as possible for themselves, in ways that are safe, meaningful and respectful.
SCIE further describes a strengths-based approach as one that looks at a person holistically, taking account of their skills, ambitions, priorities and networks, not only their needs or risks. It emphasises supporting independence, resilience, choice and wellbeing, and asks practitioners to consider what support may be available from the person themselves, their family, friends and community where appropriate and agreed.
In practical terms, this means a care plan should not read as a list of deficits but rather it should reflect what the person can do, what they want to achieve, what support helps them remain involved, and how home care can build on existing routines and abilities.
This better aligns closely with the expectations which arise from Regulation 9. It also aligns well with the CQC wider guidance on person-centred care highlights that people should be at the centre of decisions and supported to understand their options, risks and benefits.
So, what does an enabling care plan say?
In inspection terms, the wording of the care plan matters because it gives evidence of whether support is being delivered with the person or being done to them.
A care or support plan that repeatedly says, “carers to do”, “staff will complete” or “service user requires full assistance” without nuance can suggest a task-led model. Task led care diminishes people and personal care to the level of inanimate beings, a recipe, something that lacks sentience or meaning.
Conversely, a plan which uses terms like says “prompt”, “encourage”, “support to participate”, “offer choices” or “enable to complete the parts of the task they prefer and are able to manage” better demonstrates personalised care.
The difference may seem small, but it is powerful. Compare “Mrs Khan needs washing and dressing” with “Mrs Khan likes to wash her face and upper body independently; care workers should prepare items within reach, support with lower body washing as agreed, and offer a choice of clothes she wishes to wear.” The second version reflects preference, participation and dignity.
Or take nutrition: instead of “make lunch for Mr Jones”, an enabling plan might say, “Mr Jones enjoys preparing a simple sandwich when ingredients are set out clearly; support him to make choices, supervise safely around the kitchen, and assist only where needed.” These phrases do not ignore risk or need. They simply place the person’s abilities and wishes alongside those needs, which is at the heart of person-centred home care.
Skills for Care makes this even more practical through its resources on person-centred and community-based working; it’s strengths based approach.
Its guidance encourages care providers to use conversations to assess and plan support, focusing on “what’s strong, not what’s wrong”. That phrase is especially helpful when writing or reviewing care plans. It reminds registered managers to listen for abilities, routines, relationships, interests and goals, then translate those into support instructions that preserve the person’s role in their own life.
Instead of recording only problems, workers are encouraged to ask what helps the person have a good day, what they want to keep doing, and what support from family, neighbours or local community assets is important to them, where this is appropriate and with consent.
What does this change?
For home care providers, enabling terminology is not just about sounding positive; it improves practice. It helps care workers understand the difference between supporting, guiding, helping and taking over. It supports more consistent, respectful delivery because the plan is clearer about the person’s preferences, communication style and level of participation.
It can also improve review conversations, because outcomes are easier to measure when plans describe what the person is aiming to maintain or achieve. For example, “support to walk to the kitchen with reassurance” is more meaningful than “assist with mobility”, and “offer two breakfast options and encourage the person to choose” is more person-centred than “prepare breakfast”. This kind of wording promotes dignity, independence and decision-making while still recognising risk and cognitive challenges.
A useful way to improve care plans is to review them for default task-based wording and rewrite where appropriate in the person’s own voice. “Steve tells me that”, or “Steve states that” is real and lets everyone, CQC included, that a conversation has been had. It is also better than putting “I like” and “I prefer”, because it is rare that the service user actually writes their own care plan!
Replace labels such as “non-compliant”, “refuses” or “challenging” with neutral, descriptive language that explains what happened and what may help. “Amrit may sometime prefer not to bathe”, or “Amrit prefers to be asked than told” is more person-centred and enabling.
Replace passive statements with active ones that show participation, such as “prefers”, “chooses”, “likes”, “can manage”, “benefits from prompts”, or “would like support with”. Managers can build this into audits, supervision and training by asking simple questions:
• Does this care plan show the person’s strengths?
• Does it explain how they are involved?
• Does it reflect what matters to them?
• Does it balance choice, dignity and safety?
Language will not transform a service on its own, but it is a visible sign of culture and often one of the easiest places to start.
Similarly choosing enabling words like continence support, rather than incontinence support sets the tone as it shows respect for the person and what they aim to achieve rather than identifying an issue.
Ultimately, enabling terminology helps home care services put policy into practice. For providers the message is clear: care planning should not reduce people to needs and tasks. It should capture the person’s:
• Strengths
• Preferences
• Voice
• Potential
And then describe support in ways that enable rather than diminish.
If organisations want care plans that are more respectful, more compliant and more useful in practice, reviewing terminology is a smart and immediate place to begin.
Summary
At Bettal, we believe that people should be enabled by those who provide their care and support and that how we approach care and support and the language that we use tells a lot about us. We would encourage care providers to look again at their care and support plans and ask the simple question, “are these enabling or disabling?”
If you have run a domiciliary, homecare, agency and you are looking for ongoing support with policies, procedures, browse our website or get in touch:
Email: info@bettal.co.uk
Telephone: 01697741411
Peter Ellis MA MSc BSc(Hons) RN
Consultant
Bettal Quality Consultancy
Call on 01697 741411 or fill out the form below:
