More than 250,000 older adults live in English care homes, yet staff often lack clear guidance on how to develop the care plans that shape residents' daily lives. Training is frequently described as "haphazard" and practices vary widely between homes, leaving many struggling to deliver the person-centred approach that regulations require.
Now, a collaborative effort between five NIHR Applied Research Collaborations has produced the first comprehensive set of principles to guide care planning for older adults in residential settings. This collaborative work, just published in Health Expectations, from researchers across ARC Oxford and Thames Valley, ARC Kent, Surrey and Sussex, ARC West, ARC North Thames, and ARC North West Coast, addresses a notable gap in available guidance.
While resources exist for advance care planning – which focuses on end-of-life preferences – there has been little support for the broader, day-to-day care planning that determines whether someone can celebrate their birthday as they wish, maintain their morning routine, or receive care in the way that matters to them.
"Care planning should concern a person's whole life, including their goals, skills, abilities and how they prefer to manage their health," explains ARC OxTV’s Dr Jonathan Taylor, based at the University of Oxford, who led the research. "Yet we found that staff often lack the training and resources to deliver this consistently."
The research team used a modified Delphi survey – a method designed to build consensus among experts – to develop 81 agreed principles across seven key areas. One hundred health and social care professionals from across England took part in the first survey round, with 80 continuing to the second round. The panel included care home managers, nurses, care assistants, and other professionals directly involved in care planning. Crucially, two relatives of care home residents also contributed throughout, helping shape the principles from a family perspective.
The final document emphasises three interconnected themes. First, promoting autonomy by recording not just what support someone needs, but how they prefer to receive it – from which member of staff helps them dress, to what time they like breakfast – and what they can still do independently. Second, strengthening relationships between residents, staff, families and external professionals through meaningful involvement in care planning. Third, maintaining responsive care plans that are regularly updated to reflect changing needs and preferences.
Earlier research by the team revealed significant challenges in current practice. Residents – particularly those with cognitive impairment – are often excluded from care planning discussions. Family involvement can be inconsistent, and staff working under pressure may struggle to make person-centred approaches a reality. Interestingly, survey participants were divided on practical details such as how often plans should be reviewed, with suggestions ranging from weekly to every eight weeks.
The principles have already been translated into three free, practical resources launched during Care Home Open Week 2025: a quick-reference guide for care planning essentials, a detailed step-by-step guide with real-world examples, and a visual poster for use in care homes. All three were co-designed with the same panel of care professionals and family members who shaped the underlying principles.
ARC Kent, Surrey and Sussex, who led the development of these tools as part of their work as national priority lead on care homes, are seeking feedback from users to refine the resources further. The team also plans to develop a companion resource specifically for residents' families and friends, and to pilot the principles in care homes to identify any implementation barriers.
By providing clear, evidence-based guidance in formats designed for busy staff, the collaboration aims to ensure that every older person in residential care has a plan that truly reflects their individual needs, preferences and goals.
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The practical resources are available from ARC Kent, Surrey and Sussex's website