What is fluctuating capacity?
Fluctuating capacity is when a person’s ability to make a specific decision varies over time. This is usually due to a health condition that disturbs…
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What is executive dysfunction?
In healthcare, executive functioning is an umbrella term that refers to the cognitive functions of the brain that support complex thought processes and processing skills,…
How many stages are there in a Mental Capacity Assessment?
According to the Mental Capacity Act (2005), a Mental Capacity Assessment is made up of two stages, functional and diagnostic. It has therefore been referred to as the ‘two-stage’ test. However, a quick browse online, alongside discussion with different professionals, reveals quite a bit of misunderstanding around how many stages there are and when these stages apply. This is perhaps due to the inconsistent way that assessments are referred to by certain institutions and professional bodies. There also seems to be some confusion between the four steps of the functional stage of an assessment, and the two stages of the overall assessment.
Clearly, terminology is important, and we should make efforts to ensure we are always using the correct terms.
Retrospective Mental Capacity Assessments
A standard mental capacity assessment (also known as the two-stage test) is usually carried out for a specific decision at a specific time. It is completed prior to the decision being made if there is either a ‘reasonable belief’ that an individual may lack capacity, or to reduce the risk of someone challenging the person’s capacity to make the decision at some point in the future.
Meanwhile, a retrospective mental capacity assessment refers to a traditional assessment of capacity for a specific decision, but for a decision made historically. Examples might include a Lasting Power of Attorney submission signed and submitted the previous month, or a financial gift made to a family member or friend several years in the past.
Case study: What do we mean by ‘decision specific’?
We all make many thousands of micro-decisions on a daily basis, from the way we make a cup of tea to what we watch on TV. However, when it comes to decision making, the Mental Capacity Act (2005) is ‘decision specific’. This means that it relates to a specific decision made at a specific time. It does not refer to decision-making more broadly. This raises the question: how specific do we need to be when we assess capacity?
What is an appointee?
An appointee is someone who has been appointed to act on behalf of a person claiming benefits who cannot manage independently due to being ‘mentally incapable or severely impaired’.
DoLS in focus: The role of the Best Interest Assessor (BIA)
The primary role of a Best Interest Assessor (BIA) is to complete the Mental Capacity Assessment and Best Interest Assessment steps within the DoLS process. These are recorded as part of Form 3.
They can also be commissioned by the Supervisory Body to complete ‘Age’ and ‘No Refusals’ steps if required.
The six key assessments for DoLS
The Code of Practice for DoLS (2008) directs that wherever possible, DoLS authorisations should be applied for in advance of a hospital or care home admission, in order to ensure that appropriate safeguards are in place from day one. As such, a DoLS application should really be made at the point where the individual is assessed prior to admittance, in order that the application be processed in time.
DoLS in focus: The role of the Supervisory Body (SB)
The role and responsibilities of the Supervisory Body are outlined in the Code of Practice for DoLS (2008). In England the SB is most commonly the Local Authority, but could also be the Primary Care Trust. Meanwhile in Wales the SB will be either the Local Health Board or Welsh Ministers.
DoLS in focus: The role of the Managing Authority (MA)
Under DoLS, the Managing Authority (MA) is the nursing/care home or hospital providing (or going to provide) care and treatment for the relevant person. The responsibilities of the MA are outlined within the Code of Practice for DoLS (2008) and expanded on through Court of Protection (CoP) case law.
These documents require that the Managing Authority carry out its responsibilities with due care and diligence, with appropriate consultation. All decisions and actions taken should be fully documented as part of professional best practice.