IMCA involvement in accommodation decisions and care reviews
The mental capacity assessment
For an IMCA to be instructed, either for an accommodation decision or care review, the person must be assessed as lacking capacity to decide about their accommodation arrangements.
Under the two-part mental capacity test, there first needs to be evidence of an impairment of, or a disturbance in, the functioning of the mind or brain. Examples of these include dementia, significant learning disabilities, brain injury and conditions associated with some forms of mental illness.
The second stage investigates whether the person is able:
- to understand information relevant to the decision
- to retain that information
- to use or weigh that information as part of the process of making the decision
- to communicate the decision.
Information relevant to decisions about accommodation arrangements is likely, at a minimum, to include having some knowledge of:
- At least one alternative to the proposed or current placement (e.g. staying in their own home, or knowing about another service which could be suitable).
- The support that is, or would be, provided in the accommodation – including why it may benefit them personally. For example: help with personal care to avoid pressure sores; support with medication to make sure it is taken regularly; or having 24-hour supervision because of a risk of harm.
For decisions to move to hospital, or reviews taking place in hospital, there needs to be some understanding of:
- the treatment being provided and why this could be of benefit
- the risks of an extended stay in hospital – for example, loss of daily living skills or increased risk of infection
- what could happen if they stayed at, or returned, home.
The MCA requires people to be given all possible support to make their own decisions. This includes making sure there is time to talk through the positives and negatives of different accommodation options.
In most cases the mental capacity assessment will be undertaken by a care manager, social worker or nurse responsible for making, or reviewing, the accommodation arrangements.
Where there are concerns about the outcome of a mental capacity assessment, good practice is to seek a more specialist assessment (e.g. from a senior practitioner or an MCA Deprivation of Liberty Safeguards best interests assessor).
Extra care needs to be taken where there are differences of opinion as to whether a person has capacity to make what might be considered an unwise decision (e.g. wanting to stay in their own home when there are concerns about self-neglect or abuse). In such situations an application may need to be made by the local authority or NHS trust for the Court of Protection to make a decision about the person’s capacity.
While capacity assessments should be undertaken before instructing an IMCA, the MCA does not require IMCAs to be provided with a written copy of a mental capacity assessment before working with an individual. If an IMCA does have concerns about the person’s capacity after they have started their work, it is then appropriate to seek information about the mental capacity assessment.