This guide will you answer The Care Certificate Standard 9.6a Explain what is meant by the term “capacity”.
Understanding ‘capacity’ is important in health and social care. It relates to whether a person can make their own decisions. This term is essential for ensuring the rights of individuals and providing effective care.
Definition of Capacity
What is Capacity?
Capacity refers to the ability of an individual to understand, retain, and use information to make an informed decision. It determines whether a person can make a specific decision at a particular time.
Legal Context in the UK
The Mental Capacity Act 2005 provides the framework for assessing capacity in England and Wales. This law ensures that care providers respect and protect the rights of individuals who may lack capacity.
Key Elements of Capacity
To have capacity, a person must be able to:
- Understand the information relevant to the decision.
- Retain that information long enough to make the decision.
- Use or weigh that information to make the decision.
- Communicate their decision by any means, including speech, gestures, or other methods.
Importance of Capacity in Health and Social Care
Ethical Considerations
Respecting capacity is about respecting autonomy. Autonomy means the right of an individual to make their own choices. This right is fundamental in health and social care.
Legal Requirements
Healthcare providers must assess capacity as part of their duty of care. They must also document this assessment. Failing to assess or mismanaging an assessment can lead to legal consequences.
Impact on Care Plans
A care plan should reflect the wishes of the person receiving care. Assessing capacity ensures that care plans are person-centred. It also ensures they align with the individual’s preferences and needs.
Assessing Capacity
The Two-Stage Test
The Mental Capacity Act suggests a two-stage test for assessing capacity:
- Diagnostic Test: Determine if the person has an impairment of the mind or brain, whether temporary or permanent. Conditions like dementia, learning disabilities, mental health issues, or brain injuries can affect capacity.
- Functional Test: Assess if the impairment means the person cannot make a specific decision when required. The functional test includes understanding, retaining, weighing up information, and communicating decisions.
Principles of Assessing Capacity
- Presumption of Capacity: Assume the person has capacity unless proven otherwise.
- Supported Decision-Making: Provide assistance to help the person make their own decision.
- Unwise Decisions: Recognise that making an unwise decision does not necessarily mean a person lacks capacity.
- Best Interests: Any decision made on behalf of someone lacking capacity must be in their best interests.
- Less Restriction: Choose the least restrictive option when acting on behalf of someone lacking capacity.
Practical Steps
- Communicate Clearly: Use simple language and visual aids. Avoid jargon.
- Choose the Right Time and Place: Assess capacity in a calm environment. Ensure the person is comfortable.
- Involve Others: Family, friends, or advocates may provide valuable insights.
- Document Findings: Keep detailed records of the assessment and conclusions.
Situations Affecting Capacity
Temporary vs. Permanent Issues
Capacity can be temporarily affected by conditions like infections, medications, or stress. It can also be permanently impacted by conditions like dementia or severe brain injury.
Fluctuating Capacity
Some individuals might have fluctuating capacity. For example, someone with a mental health condition might have good days and bad days. Assess capacity at the time of the decision.
Specific Decision Focused
Capacity is decision-specific. An individual might lack capacity to manage finances but still have the capacity to make personal care decisions.
Best Interests and Capacity
Making Decisions for Others
When a person lacks capacity, caregivers should make decisions in their best interests. This involves considering:
- The person’s past and present wishes and feelings.
- The beliefs and values that would influence the decision.
- Views of family members, friends, or other concerned parties.
Least Restrictive Option
Care providers should opt for the least restrictive intervention. This means promoting the individual’s freedom as much as possible, even when they lack capacity.
Legal Safeguards and Protections
Lasting Power of Attorney (LPA)
An LPA is a legal document where a person appoints someone to make decisions on their behalf if they lose capacity. There are two types:
- Health and Welfare LPA
- Property and Financial Affairs LPA
Court of Protection
The Court of Protection handles issues related to people who lack capacity. They can make decisions or appoint deputies to manage the person’s affairs.
Independent Mental Capacity Advocate (IMCA)
An IMCA supports individuals who lack capacity and have no one to represent them. IMCAs help ensure decisions are made in the person’s best interests.
Example answers for activity 9.6a Explain what is meant by the term “capacity”
Here are example answers that a care worker might provide when completing the unit on “capacity,” with slightly longer responses and without the questions included.
Example Answer 1
Capacity is about a person’s ability to make their own decisions. For instance, I work with an elderly resident named Mrs Smith. One day, she wanted to decide about her medication change. I sat down with her and explained the information about the new medication in a way she could understand. I checked to make sure she could retain the information by asking her to repeat back what she had understood. Finally, I asked her to weigh the pros and cons, and she made an informed decision. In this situation, Mrs Smith demonstrated she had the capacity to make her own decision about her medication.
Example Answer 2
Capacity means someone can make a decision for themselves by understanding, retaining, and thinking about the information given to them. For example, Mr Jones, a person with early-stage dementia, often needs support when deciding whether to participate in certain activities. One day, he was uncertain about going on an outing. I explained all the details of the outing, including the schedule and what he might need. I then made sure he could remember these details and asked him to consider whether he wanted to go. After thinking about it, he told me he wanted to join the outing. This showed he had the capacity to make that decision.
Example Answer 3
Capacity is a person’s ability to make informed choices, which included understanding, remembering, and using the information provided. For example, I once had to help a resident decide on a new dietary plan. I explained the benefits and disadvantages of different diet options in a way that was easy to comprehend. I also used visual aids to help explain the information. The resident was able to remember the key points and asked relevant questions. After considering all the information, they made an informed choice about their diet plan, demonstrating their capacity in this decision-making process.
Example Answer 4
Capacity refers to whether an individual can understand and think about information to make a choice and communicate their decision. A recent situation involving Ms Turner featureed this. She needed to decide on her daily activities in the care home. I presented her with several options and explained each one clearly. After ensuring she understood and could remember the information, I asked her to think about what she wanted to do. Ms Turner was able to communicate her preference for a particular activity, which showed she had the capacity to make that decision.
Example Answer 5
Capacity involves being able to make one’s own decisions after understanding and considering the information given. For example, when Mr Green needed to decide about undergoing a medical procedure, I took time to explain what the procedure would involve, including the risks and benefits. He listened carefully, asked insightful questions, and repeated back the important points to show he understood. After weighing the information, Mr Green made a decision to proceed with the procedure. This clearly demonstrated his capacity to make an informed decision about his healthcare.
Example Answer 6
Capacity means someone can independently make decisions by understanding important information, retaining it, and using it to make an informed choice. A case with Mrs Baker comes to mind. She wanted to know whether she should update her will. I provided her with detailed yet simple information about the implications of updating her will. She took time to think it over, asked questions to clarify her doubts, and considered her personal circumstances. Finally, she made the decision to update her will, showing she had the capacity to manage her own affairs in this context.
Conclusion
Understanding ‘capacity’ is essential in health and social care. It respects individual autonomy and ensures that care is tailored to the person’s needs. Always assess capacity carefully and document your findings. Use support systems like LPAs, the Court of Protection, and IMCAs to safeguard individuals who may lack capacity. Following these guidelines helps provide ethical, legal, and compassionate care.
