As dementia progresses, many people need help making decisions about their health, care, finances and living arrangements. We explain what mental capacity is and how to support someone who has lost capacity.
If there is doubt about a person’s capacity, a trained health or social care professional can carry out a Mental Capacity Assessment. They must follow the Mental Capacity Act Code of Practice and consider:
Does the person have an impairment of their mind or brain?
Does the impairment mean they cannot make a specific decision when they need to?
A Mental Capacity Assessment only extends to the particular decision being made at that time – for instance, whether a person should move into a care home.
If another decision then has to be made, for example about managing their finances, another Mental Capacity Assessment will be needed.
There are two types of document which can help with planning for the future in the event that someone loses capacity.
An Advance Care Plan: a document in which the person sets out their wishes for their future medical and social care
A lasting power of attorney (LPA): a document that appoints an ‘attorney’ – that is, a person who can make decisions on someone’s behalf when they have lost capacity. There are two types: a health and welfare LPA and a property and financial affairs LPA
See Sources of Support, below, for information on ACPs and LPA.
If possible, it is very important to establish an Advance Care Plan (ACP) and LPA soon after diagnosis while the person with dementia has capacity.
This will ensure they can make their future wishes known, and make the process of managing their care and finances less complicated for family and friends.
When a person with dementia can no longer make informed decisions for themselves, their family and health and social care staff may have to make a ‘best interest decision’.
This is especially important for big decisions, such as selling the person’s home or considering a move into residential care.
A Best Interests Meeting should be arranged to establish what is in the person’s best interests. This should involve:
the person with dementia (as far as possible)
health and social care professionals
anyone else who is actively involved in the person’s life
Ideally, you should all discuss the decision together, and aim to come to a consensus about the person’s best interests.
When making a best interest decision, you should consider:
the person’s current wishes and views, or wishes and views they have expressed previously
their culture and beliefs
whether they have an Advance Care Plan and/or LPA, and what these say
Any decisions made should be the least restrictive option possible.
For example, if the person wishes to go for regular walks but are too vulnerable to go out alone, the best interest decision would be for someone to accompany them, rather than deciding they cannot go out.
Deprivation of liberty is when someone’s freedom is taken away, for example if:
they are under continuous supervision/control
they lack the capacity to consent to their care arrangements
there are limitations on where they can go eg they cannot leave a hospital or care home
Deprivation of Liberty Safeguards (DoLS) are a set of six checks that are used to ensure that if a person is deprived of liberty, it is done in the least restrictive way possible and in their best interests.
A Mental Capacity Assessment would first need to be done to establish whether the person has capacity, followed by a Best Interests Meeting.
DoLS apply in England and Wales only.
For more information, see Sources of Support, below.
To speak to a dementia specialist Admiral Nurse about capacity, decision-making or any other aspect of dementia, please call our free Helpline on 0800 888 6678 (Monday-Friday 9am-9pm, Saturday and Sunday 9am-5pm) or email firstname.lastname@example.org.