Mrs F (88): DoLS example from practice

Mrs F (88) had a long history of dementia. She lived alone and very independently in a spotless bungalow, maintaining strict routines, but was neglectful of herself (often forgetting to eat and drink properly). One day, Mrs F left an electric heater on, covered by clothing, then tried to put the resulting flames out with water and by cutting the cable to the plug without turning the electricity off. The fire was serious, and she was admitted to hospital. She was very confused, and left the hospital twice, in her nightclothes, trying to go home. On both occasions the police found her in a distressed state, and returned her to the hospital.
The hospital, as the managing authority, gave itself an urgent authorisation in order to make it legal to deprive Mrs F of her liberty, in her best interests. At the same time, the hospital applied for a standard authorisation under DoLS from the supervisory body.

The best interests assessor agreed that Mrs F was being deprived of her liberty, and that this was in her best interests. He suggested a short period of standard authorisation, with conditions around care planning, and a best interests meeting to ensure that the least restrictive option for Mrs F’s care was identified. This was authorised by the local authority authorising signatory. Due to her lack of family or close friends, an independent mental capacity advocate (IMCA) was part of the assessment process.

When she had recovered from the effects of the fire, Mrs F was admitted to short-term residential care, while her house was being repaired. The care home, the new managing authority, applied in advance of her admission for a standard authorisation, which was approved (authorisations are place-specific, so the hospital authorisation did not 'travel' with Mrs F).

Mrs F’s social worker and the best interests assessor both felt she still did not have the mental capacity to make her own decisions about where she should live, but they acknowledged her strong desire to go home.

The repair of her home following the fire took several weeks, during which time a series of best interests meetings identified a plan for her return. Mrs F agreed that it would help her to have a live-in carer, and visited home several times with her social worker and IMCA to prepare for her return home. She returned and all went well for a few days, but then there was an aggressive incident towards her carer. Mrs F asked to go back to ‘the lovely care home to my friends’. She returned to the care home where she remains, now settled and calling it her home. 

Read more: Putting DoLS into practice