Table of Contents
Type: Case Study Report | Subject: Health and Social Care | Level: Undergraduate | Word Count: ~2,900 words
This model Case Study Report was produced by an Essays UK specialist as reference material for learning purposes only. For support in this field, see our health and social care writing service.
Overview: This model case study report examines person-centred care planning for a fictional older adult, “Joan Mercer”, receiving domiciliary support after a hospital discharge. It demonstrates how the Care Act 2014 wellbeing principle, the Mental Capacity Act 2005 and a strengths-based approach can be applied to assessment, co-production and risk enablement, and offers evidence-informed recommendations for practice.
This report presents a single-case study of person-centred care planning within an English adult social care setting. The case concerns “Joan Mercer” (a pseudonym), a 79-year-old woman discharged home following a fall and an early diagnosis of vascular dementia. The report traces the assessment, planning and review process undertaken by a community social work team, using the Care Act 2014 wellbeing principle and the Mental Capacity Act 2005 as its statutory frame. Drawing on documentary analysis of an anonymised care record and reflective observation, the study finds that outcomes improved most where support was co-produced with Joan rather than designed for her, where a strengths-based conversation replaced a purely deficit-led needs assessment, and where positive risk-taking was negotiated openly with her and her family. Barriers included time-pressured assessment, fragmented information-sharing between health and social care, and a tendency for standardised documentation to crowd out the service user’s own voice. The report recommends routine use of outcome-focused conversation tools, structured capacity assessment at each material decision, a formalised carer’s assessment for Joan’s daughter, and supervision that protects reflective space for practitioners. The case illustrates that person-centred planning is less a document than a continuing relationship, and that small procedural choices can meaningfully shift the balance of control toward the person being supported.
Person-centred care planning has become the organising principle of adult social care in England. Successive policy reforms, from the personalisation agenda set out in Putting People First (Department of Health, 2007) to the statutory footing provided by the Care Act 2014, have reframed the person receiving support as an active partner rather than a passive recipient of services. In practice, however, the gap between this policy aspiration and day-to-day delivery remains considerable. Assessments can default to a deficit model that catalogues what a person can no longer do, care plans can be written in the language of services rather than outcomes, and the pressures of high caseloads can reduce co-production to a tick-box exercise. Understanding how person-centred principles translate into real planning decisions therefore has clear practical value for student social workers and support practitioners.
This report uses a single, anonymised case study to explore that translation. Case study method is well suited to social care because it preserves the complexity and particularity of an individual situation, allowing the interaction of statute, professional judgement and personal preference to be examined in context. The aim of the report is to analyse how person-centred care planning was applied in the case of “Joan Mercer” and to evaluate the factors that supported or hindered genuinely personalised outcomes.
The specific objectives are: first, to describe the legislative and theoretical framework underpinning person-centred planning; second, to set out the assessment and planning process followed in the case; third, to analyse the findings against that framework; and fourth, to derive recommendations for practice. Throughout, the report treats person-centredness not as a fixed quality of a document but as a property of the ongoing relationship between the person, their informal network and the professionals involved.
All identifying details in this case have been altered and a pseudonym used, consistent with the data protection expectations and ethical standards set out in the BASW Code of Ethics (British Association of Social Workers, 2021). “Joan Mercer” is a 79-year-old widow who lives alone in a two-bedroom terraced house in a northern English town. She owns her home and has lived there for more than forty years; the neighbourhood, her local church and a weekly bingo group are central to her sense of identity. Joan has one daughter, “Susan”, who lives approximately forty miles away, works full time and visits at weekends.
Joan was referred to the community adult social care team following an unplanned hospital admission. She had fallen at home, fracturing her wrist, and during the admission was assessed by the memory service and given an early diagnosis of vascular dementia. On discharge she presented with reduced mobility, mild hearing loss, low confidence following the fall, and some short-term memory difficulties, particularly around medication timing. The hospital discharge summary recommended a package of domiciliary care, and there was initial pressure from ward staff to arrange a residential placement on the grounds of risk.
Joan’s own position was unambiguous and consistently expressed: she wished to return to and remain in her own home. She described the prospect of a care home as “giving up” and placed a high value on independence, routine and her connection to her local community. Susan was supportive of her mother’s wishes but anxious about the risk of further falls and about managing the situation from a distance. This tension, between a strongly held preference to remain at home and a legitimate concern about risk, forms the central planning challenge of the case and is precisely the kind of situation in which person-centred principles are tested.
This is a qualitative, interpretive single-case study. The approach is appropriate because the research interest lies in understanding a process, person-centred care planning, within its real-life context, rather than in measuring a defined variable or generalising to a population. The case was selected purposively as a typical, information-rich example of community care planning for an older adult with emerging cognitive impairment.
Three sources of evidence were used, allowing a degree of triangulation. The first was documentary analysis of the anonymised care record, including the Care Act assessment, the support plan, the capacity assessment and the first review notes. The second was reflective observation of two planning conversations, recorded as contemporaneous practice notes. The third was the relevant legal and policy framework, which provided the analytical lens against which practice was interpreted. Findings were organised thematically, with themes drawn both from the data and from the person-centred literature.
The analytical framework combined statute, guidance and theory. At its centre is the Care Act 2014, which places a duty on local authorities to promote individual wellbeing and to carry out assessment and planning in a way that involves the person and considers their own view of the outcomes they wish to achieve (Care Act 2014; Department of Health and Social Care, 2014). Decisions touching on Joan’s capacity were framed by the Mental Capacity Act 2005 and its five statutory principles, supported by the NICE guideline on decision-making and mental capacity (National Institute for Health and Care Excellence, 2018). The study also drew on the strengths-based practice framework promoted in national guidance (Department of Health and Social Care, 2019) and on Kitwood’s (1997) concept of personhood, which holds that the person should always be seen before the condition.
Ethical considerations were central. Because the case involves a person with a dementia diagnosis, consent and confidentiality required particular care. The record was fully anonymised before analysis, consent to use the material for learning purposes was obtained through the appropriate channels, and the principles of the BASW Code of Ethics, respect, confidentiality and the promotion of self-determination, guided the handling of the material throughout (British Association of Social Workers, 2021).
The assessment began not with a list of deficits but with a conversation about what a good day looked like for Joan and what she wanted her life to continue to include. This outcome-focused opening, consistent with the “Making it Real” markers of personalised care (Think Local Act Personal, 2011), shifted the tone of the assessment from one of eligibility-testing toward one of shared planning. Joan’s eligible needs under the Care Act were nonetheless clearly identified, but they were recorded alongside, and in the service of, the outcomes she had articulated.
A capacity assessment was carried out in relation to the specific decision about where Joan should live. Applying the functional test under the Mental Capacity Act 2005, the practitioner concluded that Joan was able to understand, retain, weigh and communicate the relevant information for that decision, and therefore had capacity to decide to return home. The starting presumption of capacity was explicitly recorded, and the assessment was decision-specific rather than a global judgement about Joan’s abilities, in line with the NICE guidance (National Institute for Health and Care Excellence, 2018). This finding was pivotal: it meant that the professional role was to support and enable Joan’s decision, not to override it on the basis of risk.
The support that was co-produced reflected Joan’s priorities. A short period of reablement focused on rebuilding her confidence and mobility after the fall; twice-daily domiciliary visits supported medication and personal care while explicitly aiming to reduce over time; a pendant alarm and a medication dispenser addressed specific risks without constraining her routine; and support was arranged to help her continue attending church and the bingo group, which she herself identified as essential to her wellbeing. The following table summarises how assessed needs were linked to Joan’s own desired outcomes and the agreed support.
| Domain | Assessed Need | Desired Outcome (in Joan’s words) | Agreed Support |
|---|---|---|---|
| Mobility and safety | Reduced mobility and falls risk after wrist fracture | “To get about my own house without being frightened of falling” | Six-week reablement; occupational therapy home assessment; grab rails; pendant alarm |
| Medication | Short-term memory difficulties affecting medication timing | “To take my tablets right without a fuss” | Daily dispenser; morning prompt at the first domiciliary visit |
| Personal care | Difficulty washing and dressing while wrist healing | “To stay clean and dressed in my own clothes, my way” | Twice-daily visits, tapering as confidence returns |
| Social and community | Risk of isolation and loss of valued roles | “To keep going to church and my Tuesday bingo” | Community transport link; befriending volunteer; church already offers lifts |
| Carer support | Daughter providing distance care and experiencing strain | “I don’t want to be a worry to our Susan” | Carer’s assessment offered; shared digital care record; respite contingency |
At the first review, six weeks after discharge, outcomes were broadly positive. Joan’s confidence and mobility had improved sufficiently for the domiciliary visits to be reduced from twice to once daily, and she had resumed attending church. However, the review also surfaced two weaknesses in the original plan: information-sharing between the district nursing team and the social care provider had been inconsistent, leading to one missed medication review, and no formal carer’s assessment had yet been completed for Susan despite her growing involvement.
The case illustrates several of the defining features of effective person-centred planning, as well as the structural pressures that work against it. The most significant positive finding is the effect of beginning with outcomes rather than deficits. By opening the assessment with a discussion of what Joan valued and wished to retain, the practitioner reframed the entire planning process around her goals. This is consistent with the Care Act’s wellbeing principle, which requires that assessment be built around the outcomes the person wishes to achieve rather than around the services a provider happens to offer (Care Act 2014; Department of Health and Social Care, 2014). It also reflects the strengths-based approach promoted nationally, in which the person’s own assets, relationships and community resources, Joan’s home, her church and her social network, are treated as central resources rather than incidental background (Department of Health and Social Care, 2019). Had the assessment instead begun from the ward’s framing of Joan as a falls risk requiring residential care, the plan would almost certainly have been different and markedly less personalised.
The handling of mental capacity is the analytical heart of the case. The temptation in situations involving dementia and risk is to allow a diagnosis to stand in for a capacity judgement, effectively assuming incapacity and planning accordingly. The practice here avoided that error. By treating capacity as decision-specific, starting from the presumption of capacity, and recording how Joan was able to understand, retain, weigh and communicate the relevant information, the practitioner applied the Mental Capacity Act 2005 correctly and in the spirit of the NICE guidance (National Institute for Health and Care Excellence, 2018). The consequence was decisive for the direction of the plan: because Joan had capacity to decide where to live, the professional duty was to enable her choice and to manage the associated risk collaboratively, not to substitute a professional judgement of her best interests. This demonstrates how a technically correct application of the law is itself an expression of person-centred values, since it protects the person’s right to self-determination.
Closely related is the question of positive risk-taking. A deficit-led, defensive approach would have sought to eliminate the risk of further falls, most reliably by moving Joan into residential care. A person-centred approach instead weighs the risk of harm against the risk to wellbeing of removing a person from the home and community that give their life meaning. Kitwood’s (1997) concept of personhood is useful here: to reduce Joan to her diagnosis and her falls risk would be to practise a form of what he termed malignant social psychology, in which the person disappears behind the condition. The agreed plan, with its grab rails, pendant alarm, reablement and tapering support, represents a negotiated, proportionate acceptance of risk that preserves Joan’s identity and autonomy. Importantly, this risk was shared and documented transparently with Joan and Susan, which both respects the person’s agency and protects the practitioner’s accountability.
Co-production was also evident in the language and ownership of the plan. Recording outcomes in Joan’s own words, as in the summary table, is a small but meaningful practice: it keeps the person’s voice visible in a document that could otherwise be dominated by professional and service terminology. This aligns with the “Making it Real” markers, which describe personalised care from the perspective of the person: “I” statements such as “I am in control of planning my care and support” (Think Local Act Personal, 2011). Where the case fell short of this ideal is instructive. The failure to complete a carer’s assessment for Susan, despite the Care Act 2014 placing carers’ needs on an equal statutory footing with those of the cared-for person, shows how easily a plan can remain person-centred toward the service user while neglecting the wider family system on which the arrangement depends. Distance caring of the kind Susan provides is a recognised source of strain, and leaving her needs unassessed is both a legal gap and a risk to the sustainability of the whole plan.
Finally, the inconsistent information-sharing between health and social care exposes a structural, rather than individual, barrier to person-centredness. Even a well-designed, highly personalised plan can be undermined when the organisations delivering it do not communicate reliably, as the missed medication review demonstrates. This points to the limits of person-centredness as a purely relational or attitudinal quality: it also requires systems, records and inter-agency arrangements that carry the person’s plan faithfully across organisational boundaries (Social Care Institute for Excellence, 2020). The case therefore supports an interpretation of person-centred planning as simultaneously relational and systemic.
Drawing on the analysis above, the following recommendations are offered for practice. They are directed at individual practitioners, at supervisory practice, and at the wider service system, since the case shows that person-centredness depends on all three.
This case study has examined how person-centred care planning was applied in the community support of an older adult following hospital discharge and an early dementia diagnosis. The analysis suggests that the most important determinant of a personalised outcome was not any single document or service but the orientation of the whole process: beginning with the person’s own outcomes, applying mental capacity law in a way that enabled rather than overrode Joan’s choice, and negotiating risk openly instead of eliminating it defensively. Where the plan was less successful, in the neglected carer’s assessment and the unreliable information-sharing, the shortfalls were as much systemic as individual, reinforcing the view that person-centred planning is both a relationship and an organisational achievement. For student practitioners, the central lesson is that person-centredness is enacted in a series of small, deliberate choices, how an assessment opens, whose words appear in the plan, how capacity is framed, and that these choices, taken together, decide whether a person retains authorship of their own life. The case affirms the principle at the heart of the person-centred tradition: the person must always be seen before the condition.
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