Social work under the Mental Capacity Act

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    Is your practice compliant with the Mental Capacity Act when supporting people with dementia and their families to decide whether to move into a care home? Replay our online chat, discussing the case study below, for helpful tips and insights from fellow practitioners and experts.

    Case study

    An 87-year-old lady with dementia is admitted to a psychiatric ward from the home of her son after carers became concerned over pressure sores and her general physical health. She is in the later stages of dementia. She can’t eat, drink or mobilise without full assistance and she is doubly incontinent. She also can’t communicate anymore and is fully reliant on others to pre-empt her every need and ensure that all her needs are met. After two weeks on the ward her physical health improves dramatically and most of the pressure sores are healing well.

    The son is starting to ask about discharge back home to him. The community social workers are concerned over this and raise a safeguarding alert as they feel it was because he was neglecting her at home that she came to be in such a poor physical state. There was even an incident where the son left her on her own in a chair overnight. The son works full-time and was paying for carers to visit three times a day. He blames her poor physical state on the carers and says that they were not doing their job properly. He says that they insisted that she should stay in bed in order for them to provide physical care and this is why she developed pressure sores. He admits that he did go away overnight, but insists that he arranged for another carer to come and stay with his mum overnight.

    This carer however never turned up and he regrets not waiting to make sure that the carer was there before he left. He has raised complaints about all of this in writing, but he has had no response from anyone. He insists that he wants his mum back home and feels he will be able to manage if he had a better care package at home. He is paying for all of his mother’s care and will continue to do so even at an increased cost.

    She was in a care home up until three years ago, but the family took her out to live with her son after they repeatedly found her in a poor state and then realised that she was being sedated without a prescription. The son does not want her to go back into a care home because of this experience.

    The social work team insists that she should go into a care home and they tell the ward not to let the son take her back home. The ward now feel that she is being deprived of her liberty and they request authorisation under the Deprivation of Liberty Safeguards (Dols).

    Care home or care at home?

    People with dementia are being placed in care homes prematurely because professionals are not complying with the Mental Capacity Act, says consultant social worker Elmari Bishop.

     

    The panellists

     

    Elmari Bishop

    Elmari Bishop, consultant social worker and lecturer practitioner for statutory practice, development and training at South Essex Partnership NHS Trust, and College of Social Work spokesperson on the Mental Capacity Act and Deprivation of Liberty Safeguards (Dols).

    Rachel Griffiths

    Rachel Griffiths, Mental Capacity Act development manager at the Social Care Institute for Excellence

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    Mr and Mrs E, the carers of HL, an autistic man whose detention in Bournewood Hospital in 1997, in breach of his human rights, led to the introduction of Dols, to protect people who lack capacity and are deprived of their liberty. They now provide training on Dols and support for families in dispute with professionals’ decisions

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