19 May 2026By Salwan Inayat9 min readCare planning

James Clear has a useful way of thinking about decisions: hats, haircuts and tattoos.

A hat is easy to try. Put it on. See how it feels. Take it off if it does not work.

A haircut is more serious. It changes things for a while. It will grow back, but not straight away. You should think before doing it, but it is not permanent.

A tattoo is different. It leaves a lasting mark. It may be the right choice, but it deserves more care, more discussion and more certainty.

Clear's original idea is about decision-making generally, but it works surprisingly well in care. Care providers make changes every day: to routines, visit times, care plans, staff allocation, risk controls, family communication and support levels. Some of those changes are small trials. Some affect the person for weeks. Some change the direction of their life.

The mistake is treating all changes the same.

Sometimes we treat hats like tattoos, becoming so cautious that we do not try simple improvements.

Sometimes we treat tattoos like hats, making serious changes too quickly because the rota, the risk assessment, the incident log or the pressure of the day pushes us forward.

Better care starts with knowing the difference.

Care changes should be judged by their effect on the person

A change that looks small to a care provider may feel big to the person receiving care.

Moving a morning visit from 8am to 10am may look like a scheduling adjustment. To the person, it may mean sitting in night clothes for two extra hours, missing breakfast at their usual time, or starting the day feeling forgotten.

Introducing a new carer may look routine on the rota. To someone receiving intimate personal care, it may feel deeply uncomfortable.

Adding a falls prevention measure may be sensible. But if it is explained poorly, the person may experience it as a loss of independence rather than support.

This is why the useful question is not only:

Can we make this change?

It is:

What kind of mark will this change leave on the person?

That way of thinking fits well with good care practice. NHS personalised care guidance is built around what matters to the person, not only what is the matter with them. CQC guidance expects care to be person-centred, respectful and based on consent. NICE guidance around home care and older people points towards planning, review, continuity and support that protects independence.

The hats, haircuts and tattoos idea does not replace any of that. It simply gives care teams a plain-English way to pause before acting.

Hat changes: try them properly

A hat change is low-risk, easy to reverse and worth trying when there is a clear reason.

In care, hat changes might include:

trying a later wash time because early mornings cause distress
changing the order of care tasks so the person feels less rushed
offering breakfast before personal care instead of after
using a different chair at mealtimes
trying a quieter room for someone who becomes anxious
changing the words used when someone refuses support
testing a short extra check-in after a fall
offering a different prompt before stepping in to help

These changes should not need a committee. If they are safe, respectful and reversible, it may be better to test them than talk around the problem for weeks.

But a trial still needs discipline.

A good hat change should answer four questions:

What are we trying?
Why are we trying it?
What would success look like for this person?
When will we review it?

Without review, a trial can quietly become permanent. That is how services drift.

The best providers are not the ones that never change anything. They are the ones that change small things thoughtfully, observe the result, and learn.

Haircut changes: reversible, but not casual

A haircut change is reversible, but not immediately. The person may have to live with the effect for a while.

In care, haircut changes might include:

changing the regular care team
moving visit times for a few weeks
increasing support after a fall
reducing support because someone seems more independent
introducing new equipment into the home
changing a long-standing bedtime or morning routine
moving from one carer to double-up care
changing how family members receive updates

These changes may be sensible. They may even be necessary. But they should not be treated as casual.

A haircut change needs a clear reason, a proper explanation, and a review date. The person should understand whether the change is temporary, under review, or expected to continue.

This matters because older people can lose confidence quickly when routines change without explanation.

A provider may think:

"We have only changed the visit time."

The person may feel:

"My day no longer starts properly. I am left waiting. I do not know what is happening."

That difference is exactly why the framing helps.

The operational change may be small. The emotional effect may not be.

Tattoo changes: slow down before leaving a mark

A tattoo change is a serious decision with a lasting effect.

In care, tattoo changes might include:

deciding someone can no longer live safely at home
moving from home care to a care home
permanently removing a familiar carer from intimate care
labelling someone as "non-compliant" or "refusing care"
stopping an activity that gives the person confidence or identity
introducing major restrictions because of risk
making a permanent care decision during a temporary crisis
changing medication support arrangements without proper discussion
reducing independence because it is easier to manage

Tattoo changes are not wrong. Sometimes they are exactly what good care requires.

If someone is unsafe at night, repeatedly falling, missing medication or becoming distressed between visits, a bigger change may be needed. If a routine is causing harm, it should not continue just because it is familiar.

But tattoo changes need more care around them.

They need proper assessment, explanation, consent or supported decision-making, family or advocate input where appropriate, clear recording and a review plan. They also need humility.

A good question for the team is:

Are we making this decision because it is genuinely best for the person, or because the current setup is difficult to manage?

That is not an accusation. It is an honesty check.

Example: "She refuses personal care"

A care note says:

"Refused wash."

That sentence can lead to very different decisions.

A rushed service may treat it like a tattoo:

"She refuses washing. Update the care plan. Stop attempting showers."

But a better service first treats it like a hat.

What if the room is cold? What if the person is embarrassed? What if the carer is unfamiliar? What if the person is in pain? What if the visit is too early? What if they prefer to wash their face themselves first? What if the word "shower" makes them anxious because they fear falling?

A reversible trial might be:

"For one week, try personal care 30 minutes later with the familiar female carer where possible. Warm the bathroom first. Offer the person the choice of washing face, hands or upper body first. Review after five visits."

That is not soft care. It is intelligent care.

It avoids turning one moment into a permanent label.

If the trial works, the person keeps more dignity and receives better support. If it does not work, the team has still learned something useful and can think again with better evidence.

Example: after hospital discharge

Hospital discharge is a common moment where haircuts and tattoos get mixed up.

An older person may come home weaker, more confused or more anxious than before. Family members may be worried. Providers may be cautious. Everyone wants a safe answer quickly.

Sometimes a major change is needed.

But sometimes the person is not showing their long-term level of ability. They are showing the effect of illness, hospital, poor sleep, new medication, fear, pain or a sudden disruption to routine.

A useful question is:

Are we seeing the person's new normal, or are we seeing a difficult week?

That question can change the decision.

Instead of immediately making a permanent decision, the team might agree a short-term increase in support, equipment, reablement where available, closer observation and a review date.

That turns a possible tattoo into a haircut first.

It gives the person time to recover, while still taking safety seriously.

How care providers can use this in the workflow

This idea becomes useful when it enters everyday practice.

Before a planned change is made, ask:

Is this a hat, a haircut or a tattoo?

Then match the process to the answer.

For a hat, try it safely, record it and review quickly.

For a haircut, explain it properly, agree a review date and watch the impact.

For a tattoo, slow down. Involve the right people. Record the reasoning. Check consent and capacity where relevant. Think about dignity, identity, independence and long-term effect.

A care provider could add one simple line to care plan reviews:

Change type: hat / haircut / tattoo
Reason for change:
What success looks like:
Review date:

That is not extra paperwork for the sake of it. It is better thinking made visible.

It helps staff avoid two common mistakes: overcomplicating small improvements and underthinking serious changes.

A challenge for carers and care providers

Look at your current workflow.

Where do changes get discussed?

Where do care plans get updated?

Where are refusals recorded?

Where are falls reviewed?

Where are family concerns logged?

Where are hospital discharge changes handled?

Now ask:

Do we already separate small reversible trials from serious lasting decisions?

If not, try adding the hats, haircuts and tattoos question to one part of the process.

Use it in a care plan review. Use it in a team handover. Use it after a fall. Use it when someone refuses care. Use it when the rota changes. Use it before a family meeting.

You do not need to make it complicated.

The value is in the pause.

Some changes should be tried sooner because they are reversible and may improve the person's day.

Some changes should be slowed down because they leave a deeper mark.

The best care providers know the difference.

They do not avoid change. They do not rush it either.

They ask how much the change will affect the person, how easy it is to undo, and whether the decision has been made with the person rather than around them.

So the next time your service updates a routine, changes a support plan, responds to a refusal, reviews a fall, or considers a bigger move, ask the team: