IMCA involvement in accommodation decisions and care reviews
Which accommodation decisions require an IMCA to be instructed?
There is a duty for local authorities or NHS bodies to instruct IMCAs for the following accommodation decisions where a person lacks capacity to make the decision themselves, and they are without family or friends who can represent them:
- admissions to any hospital that are likely to last for over 28 days
- moves to care homes that are likely to be longer than eight weeks
- moves to any other accommodation, funded by the local authority or Primary Care Trust (PCT), that are likely to be longer than eight weeks.
IMCAs are not required for short-term or urgent moves. An example of this would be a planned respite stay lasting two weeks.
Where it appears that a short-term or urgent move could last for more than four weeks in hospital, or eight weeks for any other setting, an IMCA must be instructed. The IMCA's role here is to represent the person for the decision as to whether staying in the current accommodation represents their best interests.
The MCA Code of Practice says that IMCAs should be instructed where a person may remain living in accommodation which is deregistering as a care home (10.54). Similarly there should be IMCA instruction if the place where the person is living is registering as a care home.
It is good practice is to instruct IMCAs for accommodation decisions in the following situations:
- The local authority is making or changing support arrangements which may allow a person to remain in their own home, when a move to a care home is a serious consideration.
- Moving a person to a different service on the same site. For example, a different building on an NHS campus or a different unit within an older people's care service. This is because such a move could have a similar impact for the person as a move to a different location.s
Practice example
Mr Malik was admitted to hospital in an emergency admission after a brain injury caused by a road accident. After urgent treatment his condition stabilised. He was then assessed as lacking capacity to make decisions about his treatment, including whether or not to stay in hospital. Without family or friends to represent him, the ward manager instructed an IMCA. There were two separate instructions. The first was in relation to Mr Malik's ongoing treatment. The second was for an accommodation decision as it was expected that his stay in hospital would be longer than 28 days. It was recognised that Mr Malik could regain capacity to make some decisions for himself about his treatment.
