9.6d Describe situations where an assessment of capacity might need to be undertaken and the meaning and significance of “advance statements” regarding future care.
This standard addresses understanding when an assessment of capacity might be needed and the meaning of advance statements regarding future care. Here, we will cover these topics in-depth, ensuring clarity and relevance for care providers.
What is Capacity?
Capacity refers to a person’s ability to make decisions for themselves. This includes understanding the information relevant to a decision, retaining that information, weighing that information as part of the decision-making process, and communicating their decision.
The Mental Capacity Act 2005
The Mental Capacity Act 2005 (MCA) governs capacity in the UK. This act provides a framework to protect and empower people who may lack the capacity to make certain decisions for themselves. It outlines five key principles which must be followed:
- Presume capacity: Every adult has the right to make their own decisions unless it is proven otherwise.
- Support to make decisions: Individuals should be given all practical assistance before anyone concludes they cannot make decisions.
- Unwise decisions: Just because someone makes a decision that others consider unwise, it does not mean they lack capacity.
- Best interests: Any decisions made on behalf of someone who lacks capacity must be in their best interests.
- Less restrictive option: Any action taken must be the least restrictive of their basic rights and freedoms.
Situations Requiring an Assessment of Capacity
Assessing capacity is important when there are doubts about a person’s ability to make certain decisions. These situations include:
Medical Treatment Decisions
- Serious medical treatment: If an individual needs a critical operation or treatment but there’s uncertainty about their capacity to consent, an assessment is necessary.
- End-of-life care: Decisions regarding life-sustaining treatment or palliative care often require a thorough assessment of capacity.
Financial Decisions
- Managing finances: For large financial transactions or if routine handling of finances becomes problematic, assessing capacity ensures protection against financial abuse or mistakes.
- Benefits and entitlements: Ensuring the person understands their financial entitlements and can manage benefit claims effectively.
Daily Living Decisions
- Living arrangements: Choosing where to live—whether remaining in their own home or moving into supported accommodation—requires capacity assessment.
- Personal care: Decisions about daily personal care, such as hygiene or diet, need assessment if there are signs of confusion or forgetfulness.
Legal Decisions
- Legal agreements: Signing contracts, including renting or purchasing property, mandates capacity assessment to avoid nullifying agreements.
- Wills and advance statements: Creating or altering wills and advance care plans requires certain capacity to be deemed valid.
Conducting a Capacity Assessment
A capacity assessment should follow specific guidelines:
- Objective and thorough: Base the assessment on the individual’s specific decision at the specific time, considering their ability to understand, retain, and communicate their decision.
- Involve common assessments: These often include medical evaluations, interviews, and observations in different settings.
- Document findings: Record the assessment process and findings comprehensively to inform future care and legal requirements.
Advance Statements
Definition
An advance statement allows individuals to record their preferences and wishes regarding their future care, should they lack capacity to communicate these later. It’s often broad, covering daily routines, dietary preferences, cultural or religious considerations, and types of treatment or care settings they would prefer.
Significance of Advance Statements
Empowerment and Respect
- Respect for preferences: Ensures the individual’s wishes are respected even if they can no longer voice them themselves.
- Empowerment: Empowers individuals to have a say in their future care. This is particularly significant for those with progressive conditions.
Informing Best Interests Decisions
When a person lacks capacity, care providers and families must act in the individual’s best interests. Advance statements play an important role here, acting as a guide for best-interest decisions that reflect the person’s known wishes and feelings.
Legal Recognition
- Not legally binding: Advance statements are not legally binding but should still be taken into account by care providers and medical professionals when making decisions about an individual’s care.
- Guidance for attorneys and deputies: For individuals with appointed attorneys or deputies, these statements provide clear instructions, reducing uncertainty and conflict.
Practical Implementation of Advance Statements
Discuss Early and Review Regularly
- Discussion with loved ones: Encourage individuals to discuss and document their advance statements early, involving family members.
- Regular updates: Periodically review and update advance statements to reflect any changes in the individual’s preferences or circumstances.
Recording and Accessing Advance Statements
- Proper documentation: Keep advance statements well documented and accessible in the individual’s care records.
- Sharing with care providers: Ensure all relevant care providers are aware of and understand the advance statements, integrating them into care plans.
Training for Staff
- Training: Ensure all care staff receive training on the importance and use of capacity assessments and advance statements.
- Case studies and scenarios: Use practical examples to illustrate the process and significance, improving understanding and application in real-world care settings.
Example answers for activity 9.6d Describe situations where an assessment of capacity might need to be undertaken and the meaning and significance of “advance statements” regarding future care
Example Answer 1
As a care worker, I understand that an assessment of capacity might need to be undertaken if I notice a resident struggling to manage their finances. For example, Mrs Brown, a resident in our care home, has recently shown signs of confusion when dealing with money and has made several mistakes in paying for her groceries. This change in her behaviour prompted me to refer her for a capacity assessment. By doing this, we can ensure Mrs Brown receives the appropriate support and prevent any financial misconduct.
Example Answer 2
In my role, I’ve encountered situations where an individual needs to make a significant medical decision, such as undergoing surgery. Mr Jones had a stroke and required urgent surgery. However, he seemed unsure and unable to fully understand the risks and benefits of the operation. By initiating a capacity assessment, we ensured that Mr Jones’ decision was informed and in his best interest. This also helped to alleviate any concerns his family had regarding his ability to consent to treatment.
Example Answer 3
One of my responsibilities is to support individuals in making everyday decisions. Recently, I noticed that Mrs Patel appeared very confused about her daily hygiene routine. She would often forget whether she had brushed her teeth or taken a shower, leading to concerns about her personal care. By conducting a capacity assessment, we were able to determine how much she understood about her hygiene needs. This allowed us to develop a more tailored and supportive approach to her daily care.
Example Answer 4
As part of my duties, I spoke with Mr Harris about his future care preferences. He was diagnosed with early-stage dementia and wanted to create an advance statement to outline his wishes for future care. Together, we documented his preferences regarding daily routines, dietary needs, and his desire to remain in his home for as long as possible. This advance statement will guide us and his family in making decisions that align with his wishes, should he lose the capacity to communicate these in the future.
Example Answer 5
I recently worked with Mrs Green, who was considering changing her living arrangements due to her declining health. She was finding it increasingly difficult to live independently and was contemplating moving into a care home. However, she seemed very stressed and unsure about this significant decision. A capacity assessment was conducted to determine her ability to understand and weigh the pros and cons of her options. This assessment was crucial in helping her make an informed decision that reflected her best interests and comfort.
Example Answer 6
During a care planning meeting for Mr Wilson, who has a progressive neurological condition, I raised the importance of documenting an advance statement. Mr Wilson expressed specific wishes about his end-of-life care, including his preference for certain palliative treatments and his desire to avoid life-sustaining measures if his condition deteriorated significantly. By formally recording these wishes, we ensured that his care would respect his autonomy and preferences even if he could no longer articulate them in the future. This also provided peace of mind for his family, knowing his wishes were clearly documented.
Concluding Thoughts
Capacity assessments and advance statements are fundamental components of delivering person-centred care in health and social care settings. They ensure respect, empowerment, and tailored care delivery, aligned with the individual’s preferences and best interests. Consistent application and training on these principles will enhance the quality of care and uphold the dignity and rights of those who may lack the capacity to make decisions for themselves.
