As our society ages, the care of our elderly loved ones becomes an increasingly important and pressing matter. Providing quality care for the elderly is not just a duty; it’s an expression of love, respect, and gratitude for the wisdom and experience they bring to our lives. In this blog, we will explore practical ways to ensure they live their golden years with dignity and comfort.
Fall Prevention
Falls are a common cause of injuries among the elderly. Ensure their living space is free from hazards, such as loose rugs or clutter, and consider installing handrails and grab bars as needed.
Safety Modifications
Adapting the home environment to their needs is essential. Consider installing ramps, non-slip flooring, and making doorways wider for easy access.
Accessibility
Make sure that the home is wheelchair or walker-friendly. This includes widening hallways and doorways and ensuring that countertops and appliances are at accessible heights.
Personal Space
Respect their need for personal space and independence whilst assisting when necessary. Discuss with them how they want their living space to be arranged and accessible.
Dementia can have a profound impact on a person’s cognitive abilities, making it difficult to determine their capacity to make decisions. In this article, we explore the challenges of assessing mental capacity in people with dementia and offer helpful tips for navigating this complex process.
Mental capacity refers to an individual’s ability to make informed decisions. It is crucial to assess mental capacity, especially when a person’s decision-making ability is in question due to cognitive impairments such as dementia. The assessment process involves evaluating various factors to ensure that the person has the necessary capacity to make a particular decision.
Factors to Consider in Assessing Mental Capacity
When evaluating mental capacity in people with dementia, several factors must be taken into account:
The person’s age and overall health: The individual’s age and health can influence their cognitive abilities.
The stage of their dementia: The severity of dementia can impact the person’s capacity to make decisions.
The nature of the decision that needs to be made: Different decisions require different levels of cognitive abilities.
The person’s ability to understand the information relevant to the decision: Can they comprehend the necessary information?
The person’s ability to weigh the pros and cons of the decision: Are they able to analyze the consequences of their choices?
The person’s ability to communicate their decision: Can they effectively convey their preferences?
Tips for Working with People with Dementia
Here are some practical tips to keep in mind when working with people with dementia during the mental capacity assessment process:
Be patient: Dementia can slow down information processing, so give them time.
Use clear and simple language: Avoid technical terms and jargon that may be confusing.
Repeat yourself as needed: People with dementia may forget what you have said.
Use visual aids: Pictures, diagrams, and other visual aids can help convey information.
Encourage participation: Involve the person in the decision-making process as much as possible.
Get input from family and friends: Consult with those close to the person for insights on their abilities and preferences.
Seeking Professional Help
If you have concerns about a person’s mental capacity or need guidance on how to proceed, it’s essential to seek professional help. You can contact Victoria at 07734393918 for assistance and to have your questions answered. Remember, seeking expert advice is the best way to ensure a thorough and accurate assessment of mental capacity in people with dementia.
How to assess mental capacity and what to do if someone does not want to engage with the assessment
I attended a webinar withNelson’sSolicitors this week. We decided that I would comment on the following questions
When capacity to make a specific decision is in issue, how do you test P?
When P is unwilling to communicate, what strategies do you have to try and break the deadlock?
As you can see in the image (see link here Scan post it notes ) I had lots of notes and planned my response.
What does P mean?
Firstly let me explain, in legal terms the ‘P’ stands for person in question or person being assessed.
Mental Capacity Assessment process
When doing a mental capacity assessment it is important to establish whether there is an impairment or problem with the brain, which may affect their ability to make decisions, such as dementia or brain injury. We also consider the history of the person and their current circumstances.
With the particular decision (for example financial decisions) we need to establish whether the person can:
UNDERSTAND: We check understanding by asking a number of questions related to the matter. Such as where do you work? Sources of income, details of any debt, what bills do you have? Where do you bank? I also show most people objects to establish is they understand their uses. Such as money, till receipts, or a purse.
RETAIN:
We check whether they can retain information throughout the assessment by providing information and check understanding and memory. I ask questions to check long and short term memory, as well as asking if they have noticed any problems themselves. I sometimes administer specific cognitive testing such as the Addenbrook’s Cognitive Examination (see link here) https://neurovascularmedicine.com/ace.pdf
WEIGH OR USE INFORMATION
This is more tricky to assess as people can often understand but cannot use this information to make an informed decision. I would always check how people use information by asking other people how they manage information in real time. Consider how much support someone requires, whether they are in any debt or have problems managing themselves. This part of the assessment involves establishing whether there is evidence that a person can comprehend and rationalise information to make a decision.
COMMUNICATION
Being able to reliably communicate a decision by any means is important. I have known people to use sign language, and writing information down.
What to do if someone does not want to engage in assessment
To answer the question, to describe what I do when someone does not want to be assessed. Firstly I try to gather as much information as I can before the assessment date, I aways try to build rapport as soon as possible by reading body language and ensure they feel listened to. I tend to approach every assessment differently depending on the person’s circumstances, but I always give respect and space, I do not behave or act as an expert.I am always interested in their life and ask inquisitive questions. If the person does not want to engage, I will leave it and arrange to meet another day, and consider the location, environment and time of day.
I have added the link for a previous blog on working with vulnerable and young people
3D or holistic mental capacity assessments are essential. As some people talk the talk but can’t walk the walk! We gather evidence from available documentation and speak to important others (who know the person very well and see them on regular basis). Most importantly triangulate this with information that is gathered from the person themselves. Holistic mental capacity assessments are essential as some people who experienced a traumatic brain injury or have executive function problems ‘can talk the talk but can’t walk the walk’.
But what does this mean?
Someone may be able to say how they will save or spend their money to live safely. But in real terms without appropriate support and those protective measures in place, they are unable to control their spending and may give all their money away, which increases their vulnerability.
It’s important not to take things at face value; analysis and evaluation is important. This is why 3D or holistic mental capacity assessment are essential. Especially when the outcome of the mental capacity assessment can have a direct impact on their freedom to make decisions independently. It’s important to gather the evidence and not offer opinion based on speculation. And the report has to be provide this evidence in way that can understood by the reader. The report has to showcase what we discovered in the assessment, the assessors analysis and offer an expert opinion.
By March 2020 everyone was scared, lots of people were very poorly and we had no protection for our most vulnerable in society. Our older generation suffered the most.
Children have been hit hard too, but they have time to recover and have access to lots of support through school. I have met so many older people who did not get Covid but have suffered through isolation and loneliness, which has created a vacuum for mental and physical health deterioration. People haven’t had access to their usual activities, they haven’t seen their GP, or been to see their Doctor at the memory clinic. They haven’t wanted to bother anyone and just sit at home waiting. I have met so many people who are still scared and no longer go out.
I have met so many families who have experienced so much loss that they want to make sure they have everything in place, in case the worse happens.
Our loved ones in care homes have been looking at faces with masks on for the past 2 years and some haven’t had a cuddle from their loved ones for far too long.
Everyone is an individual with a life story. Let’s value our older people for what they have given us.
Look after your neighbours, love your family and do your best to care.
Our values and guiding principles when working with vulnerable adults and young people:
1. Everyone should be physically and psychologically safe.
2. Decisions are made with transparency, building and maintaining trust.
3. Appreciation of shared experiences and expert by experience.
4. Collaboration between care staff, family & our service users is essential – reducing power struggles.
5. To empower others increases innovation, kindness, safety and cost-effectiveness.
6. Equality and diversity are celebrated.
You may ask how does this relate to completing a mental capacity assessment? Every principle can be applied to working with solicitors, clients, family, other professionals and the wider community. We want people to feel safe and believed. Decisions should be made with transparency, such as when making decisions regarding someone’s care.
Acknowledging that power struggles do exist, but making an effort to reduce the impact of these on vulnerable people is extremely important. Do you know how to empower others? Well, it’s helping people to remain in control of their own lives for as long as possible and respecting differences. Capacious people are allowed to make unwise decisions and as you know mental capacity assessments must be decision specific, capacity must be assumed until proven otherwise. So offering meaningful choices might be something you can do.
Equality and diversity have become a hot topic and unfortunately, it is not widely understood (in my experience). Let’s accept that not everyone is the same and should be treated the same way. I see the person as an individual and try to treat everyone equally, sometimes reasonable adjustments are required to help the person. Everyone is unique and we all have something to offer. Unfortunately, not everyone knows how to implement these principles so training care staff is essential.
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3D or holistic mental capacity assessments are essential. As some people talk the talk but can’t walk the walk! We gather evidence from available documentation and speak to important others (who know the person very well and see them on regular basis). Most importantly triangulate this with information that is gathered from the person themselves. Holistic mental capacity assessments are essential as some people who experienced a traumatic brain injury or have executive function problems ‘can talk the talk but can’t walk the walk’.
