Purpose/Benefit of a Mental Capacity assessment

All about caring
1

Hi all,

MIL is disabled, cannot get out of her chair without a hoist and totally dependant on her 4 daily home care visits, plus us for her shopping, laundry, errands etc.

I went down today to meet with her and GP as MIL has swallowing issues when she eats, and GP wanted to discuss results of Barium Xray and options to improve/resolve going forwards. When GP arrived, she said she was pleased to see me there, as she had previously visited MIL a couple of weeks ago, and felt she didn’t understand the conversation and struggled to answer her questions, so had planned to ring us later today to discuss her situation.

We know MIL is forgetful, muddled, hardly knows what day it is sometimes, ie she rang us on the evening of 28th December as she wanted to wish us Happy New Year … 3 days early … She is showing signs of dementia but we have always felt it is good that she is immobile as she cannot go out alone or get herself in trouble. However, I do wonder if she would now be considered as having Mental Capacity. The GP said to ring her at any time to discuss any concerns. What purpose/benefit comes with her not being mentally capable to make decisions? When GP left today, after a long discussion on her current issues, MIL said good job you were here as I didn’t understand anything she asked me and don’t know what this is all about … having had 3 lifeline calls to her in the last 10 days, surely she should remember she has been choking on her food?

I am sure the GP will arrange a Mental Capacity review if I ask, but not sure what it will gain. We currently have Financial LPA for her, as do her banking etc, but never went down the Health LPA route as felt she had capacity at that time, but doubt she would pass a test now. We don’t want to use it to force her into care etc, but the time will come when this may be needed as she is declining to the point where being home alone is not a safe situation.

Any advice appreciate, thanks.

2

Is she currently receiving Attendance Allowance?
Are you aware that if she has dementia she is exempt from council tax?

3

Yes, she has higher level Attendance allowance.

Had no idea about Council Tax. Obviously this would be a benefit, although financially she is comfortable so wouldn’t be the primary reason to get an MC review.

Thanks :slight_smile:

4

It’s easy to claim the Council Tax Exemption as dementia is a “severe mental impairment”.
In my area, it’s a one page form asking for doctor’s details.

It can be backdated! Highest amount refunded I’ve heard of is £8,000+!

I urge everyone to spread the word about this, it’s a “best kept secret” of many councils!

5

Witch Hazel,

My take on this, is if she is tested and found not to have mental capacity and as you don’t have LPA for health and welfare then social care could hold a best interests meeting to make decisions - that you and she may or may not agree with.

Melly1

6

First of all let me apologise. Witch Hazel reminds me of the cartoon character from the Bugs Bunny cartoons, and it’s not the most flattering of images!

Mental Capacity is a difficult area - some social workers don’t always understand it - but I’ll try to make it clear.

First of all, the law says that mental capacity must be assessed by giving the individual the best possible chance of making their own decisions. So if the time of day for being at their best mentally is 8am, that’s when you do the test. If it helps to use pictures or a different language, the same applies. The aim is to only interfere when there really isn’t any choice.

Most people don’t realise that a Mental Capacity Assessment is for one decision. Because capacity can vary depending on the decision. For example, your Mum might struggle with being able to decide where she ought to live, but may be fine deciding what clothes she wants to wear. Both decisions are equally important - wearing a bikini in -2 degrees is literally life or death - but require different skills to some extent.

This is a lot to take in right now, but mental capacity is determined by four steps about each decision to be made:

  1. Taking in the facts needed to make the decision and understanding them
  2. Retaining the facts long enough to make the decision
  3. Assessing the pros and cons and using the facts to make the decision
  4. Communicating the decision.

Each of those steps has to be successfully carried out if the person has capacity. Missing any one means they do not. From what you’re describing, your Mum will struggle at least with the first two, and this suggests that she might not have mental capacity.

So where does this leave you?

Ok, well you have the Finance LPA. That’s good. You can manage her financial affairs and she’s obviously happy with that.

A Health and Wellbeing LPA would have been ideal: you could have had it but it can’t be used until the person loses capacity. But once they’ve lost capacity you can’t get one in retrospect, so that’s out.

It’s possible to seek a Deputyship for Health and Wellbeing from the Court of Protection. The problem with this is that Deputyships are more expensive than an LPA and take longer. Before the pandemic, LPAs were taking about 6 weeks, and Deputyships 3 months. Now LPAs are taking 6 months at least and Deputyships are taking much longer.

So this leaves you where Melly1 said: you can take a Best Interests decision. This is usually done by the people involved, so social services, the GP perhaps, and yourself, along with anyone else involved. The decision is based on current known facts and also on history. I was involved with a carer who had documentary evidence that their parent had made it clear that they did not wish to go into a care home. The care package they were receiving wasn’t sufficient to prevent that, and it had to be increased until they reached the point where it really wasn’t viable any more.

If such a decision is made that deprives a person of their liberty - e.g. moving to a care home - it has to be the “least restrictive” choice available that will meet their needs. And this is tested by an independent service. That said, I’m still waiting for that to happen over my Mum because out where I live the Deprivation of Liberties Team (DOLS) has an enormous backlog due to covid. It’s now over a year and there should be a review any time.

There’s lots more involved but this is the basics of it. Hope it makes sense!
OIP.jpg

7

Thanks for replies.

Melly, if she was assessed as not having capacity, we would be happy for adult social care to step under a best interests review. She may need higher level of care at home, before we reach the residential care stage, but it would hopefully prompt some advice on what the next steps in her care options would be. We don’t want to push her into residential care too soon, but also feel it would give her a much better quality of life as she is currently stuck at home 24/7 with no social interaction except her 4 care visits per day and whenever we can pop in, which is at least once a week. She was always a very gregarious character, loved a party and a good “chinwag” which she is sadly missing now, and the benefits of having something going on around her would do wonders, but she is adamant she doesn’t want to go in with “old people” … she’s 87!

Charles, thanks for your comprehensive reply. The meeting with the Dr was on Wednesday afternoon. We saw mum this morning and she said that the Dr had been out this week - initially forgot I had actually been there at the time until I reminded her. Then said she wasn’t sure what the Dr said. When I mentioned that Dr advised to drink more water, especially when she is eating to help her swallowing issues, she said she had never been told that … so the lack of understanding and being able to retain information is definitely an issue.

I have dropped the Dr an email, thanking her for her time this week, and raising our concerns over mum’s mental abilities. I have asked that it be noted on her medical records that before any future appointments, visits, assessments etc from any medical professionals are made, that we are asked to also attend, as there is no point expecting mum to understand or remember anything she is being told. I hope this works as we often get told "someone came from the hospital this week but I can’t remember who they are or what they wanted". We could be missing vital details which would help us support her at home, or important information which we need to pass on to her care company, but no one seems to want to keep us in the loop. This is why I thought maybe a Mental Capacity assessment might help flag with the powers-that-be that Mum is not able to understand these things and more likely to involve us in any reviews of her care going forwards.

I will await the GPs reply to see where we go from there. Thanks again :slight_smile:

8

I’m definitely not wanted in the loop if my son’s carers think everything is OK.
However, as soon as the first lockdown was announced, without consulting with SSD, I was sent an email that summarised, said “Can you come and get him as quickly as possible!”
No, I couldn’t, I’m under orders never to care for him ever again because of my health issues.
A night or two is just about manageable now, and that’s all.