Advice on capacity issues

A friend’s elderly uncle is in hospital as he has been physically unwell. He has had learning difficulties since he was born. He has lived independently for many years without help. The doctor at the hospital said that he is well enough to leave hospital but that he will need so much help he might need to go into a care home. The family agree that he needs lots of help now.

The hospital doctor said that he does not have capacity to make big decisions for himself, like where he will live, because the doctor thinks the uncle has early signs of dementia. BUT the family believe that mentally he is the same as he always was. So the family don’t agree with the doctor because they think that he does have capacity. The family think that the doctor didn’t properly understand his learning difficulties and that is why he thought he had dementia.

The family is very worried that the hospital don’t think he can make big decisions when they believe he can. They have tried to explain this to the hospital staff but it hasn’t changed anything.

What do you think they should do?

I think there are several things this family could do. Has this gentleman been asked what he would like to do; has the situation been explained carefully to him and by whom?

Is there a good advocacy organisation in the area? If so, they should be able to offer both advice about his rights and support to this gentleman and his family. If not, then organisations such as Mencap would advise the family about this gentleman’s rights.

Social services should now be involved. Whilst this gentleman has enjoyed many years of independence, he may still be known to them. There is now a requirement for a comprehensive care assessment, because of his changing needs. This would hopefully lead to a multi-disciplinary meeting, which should include both him, if he is well enough, and most certainly his family. A hospital doctor cannot make a judgement about this gentleman’s capacity, or needs…there are options to be explored.

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The starting point should be a formal capacity assessment to establish whether he is able to decide where he lives and how he is supported. If you share this guide from Hft with the family it should tell them all they need to know:

I agree that a social services assessment would be the next step - the family can call the local adults social services team, but the hospital might do too. As previous reply said, a multi-disciplinary meeting should be arranged.

It would be helpful to involve the local community learning disability team (NHS service, sometimes joint with socal services). They should be able to advise on a specialist learning disability assessment for dementia.

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Thank you - ss are involved. Unfortunately they have accepted the medical view about his capacity and haven’t liaised effectively with the family really.

They are looking into an independent capacity assessment for him

It is not clear how suitably his views have been ascertained. I am trying to get the hospital LD specialist nurse alerted so she can support the staff to give him the best possible care and, if her remit allows, to support the family too as they have been left out of the loop (not sure there has been enough of anything yet to describe it as a loop) :-/

The video is excellent, thank you. It’s real and relevant. I have shared the link.