Transforming care planning for older adults in English care homes

Nearly 280,000 people live in care homes in England. Every one of them is entitled to a care plan built around who they are – their preferences, their needs, their life. The Care Quality Commission requires it. But between the regulation and the reality lies a gap that affects some of the most vulnerable people in the country.

Care home staff describe the challenge in blunt terms: too little time, too few colleagues, and training that arrives infrequently – if at all. Care planning gets squeezed by competing demands, and residents and their families are often left out of the process entirely. Until recently, almost all research on care planning practices came from other countries, leaving England without a clear picture of what was actually happening in its own care homes.

Our approach and partners

ARC OxTV joined a collaboration led by ARC Kent, Surrey and Sussex, with researchers from ARC West (Bristol), ARC North West Coast (Liverpool), and the London School of Economics. Together, the team set out to understand how care planning really works across the English care home sector – and to build practical tools that could improve it.

The team interviewed 22 social care professionals across England, recruiting through NIHR Local Clinical Research Networks, Health Innovation Networks, and the Enabling Research in Care Homes (ENRICH) network. Two patient, carer and public involvement advisors with lived experience of the care home system shaped every stage – from designing the interview questions to reviewing the findings and final resources.

What the team heard informed the co-design of four free resources, developed with more than 100 care professionals and residents' families and friends. A modified Delphi survey then established a consensus set of principles for person-centred care planning.

What we found – and why it matters

1. Staff commitment runs deep, but the system works against them. Care professionals consistently described person-centred care as their core purpose – yet time pressures, workforce shortages, and patchy training forced them to deprioritise the very planning that underpins good care.
2. Training is a critical weak point. Staff described their preparation for care planning – particularly for sensitive conversations around end-of-life preferences – as infrequent and inconsistent. Confidence gaps are widespread.
3. Digital systems bring risks alongside benefits. Rapid adoption of digital care planning has improved efficiency and information sharing, but staff warned it can reduce care planning to a tick-box exercise if not implemented carefully.
4. Residents and families are too often excluded. Despite broad agreement that involvement matters, mental capacity challenges, logistical barriers, and discomfort with difficult topics mean families are rarely asked to contribute in a structured way.

These findings directly shaped three published resources – a Quick Guide, a Step-by-Step Guide, and a Care Planning Poster – all freely available through ARC KSS. By December 2025, these had been downloaded more than 2,250 times. A fourth resource, a guide to help families and friends understand and engage with care planning, is in development.

What this means

For the first time, care homes in England have evidence-based, co-designed tools that address the gap between what regulations require and what staff can realistically deliver. The resources give practical guidance on capturing what matters to each resident – supporting better care, better communication, and better use of staff time. If adopted widely, they could improve the daily experience of care for hundreds of thousands of older adults and their families.

What needs to happen next

The resources exist. The challenge now is reach. Care home networks and commissioners need to actively promote these tools and embed them in staff induction and training programmes. ARC KSS is leading this dissemination work and will evaluate usability and effectiveness.

Future research must hear directly from residents themselves – this study primarily captured the perspectives of professionals and families. And as digital care planning becomes the norm, work is needed to ensure these systems genuinely support person-centred practice rather than reducing it to data entry.

Workforce challenges remain the fundamental barrier. Without protected time for care planning and sustained investment in staff training – particularly for end-of-life conversations – even the best tools will struggle to achieve their potential.

Lessons for future research

This project reinforced a principle that applied researchers often state but rarely operationalise fully: co-design with end users is not a methodological nicety – it is the mechanism through which research becomes usable.

The team's partnership with more than 100 practitioners and family members produced resources grounded in operational reality, not academic assumptions.

The inter-ARC collaboration also demonstrated how NIHR's infrastructure network can be mobilised to recruit participants and build research capacity across regions that a single centre could not reach alone.