DoLS process - best interests assessment

@FiniteSagacity In my experience carers can accompany family members as long as they have enough notice to rota that, leaving sufficient other carers at the home for the other residents, and if the family cover their wages for that time period. There are also independent care agencies that can support community access if the care home can't free up their staff.

@Louisetopaz21 Yes, the DOLS is being challenged rather than the placement but social services involvement is limited to the DOLS. It can't make decisions about funding 1:1 support for community access for self funding residents but can still allocate social workers to complete Needs Assessments. Sorry that wasn't clear in my post. Ultimately where a person is self funding with a Finance LPA in place, the LPA would need to confirm whether that support could be affordable or not.

In my experience of S21a challenges, the judge will direct the local authority to complete a needs assessment and position statement as the DoLS authorisation is being directly objected to rather than the placement per se so the person is challenging the local authority.

The DOLS team would have appointed an independent RPR as soon they noted his objections and that family weren't in agreement with launching a challenge in court anyway. Hopefully his solicitor and RPR will agree that just making the placement less restrictive by increasing community access will be enough.

You'd be surprised at the number of people in care homes that don't have a formal diagnosis. The s21A challenge may direct proper evidence of that as part of the process.

As LPAs, your views will also be taken into account by the court and given weight. Social services will have a minimal role as he's self-funding. Just to make you aware that if increased 1:1 support is required to enable increased community access, he would also be highly likely to be expected to pay for that himself too.

Just to say that if he's objecting to the placement (even if he doesn't have capacity) the independent representative (RPR) will be obliged to appoint a solicitor to launch a s21A challenge in the Court of Protection. It's non means tested and doesn't mean he will move but can take several months for a final decision.

You are so welcome I share this with families

https://wp.me/pc5lMH-3Ni

A person does not need to have a conformed diagnosis but the section 12 dr can determine a probable diagnosis. In terms of him requesting to leave the home can be seen as a challenge to the authorisation and without wanting to cause you any worries because you don't need to be potentially it can be progressed as a section 21a challenge for a judge to determine if the placement is in his best interests and necessary and proportionate. This does not mean that you will be criticised at all, it just ensures his Article 5 rights under the Human Rights Act is upheld, he will get access automatically to legal aid. https://openjusticecourtofprotection.org/ this explains in simple terms for families but honestly do not worry though but you might find it interesting.

DoLS isn't really to do with medical decisons. It's more about keeping someone somewhere they can't consent to be kept.

Lady Hale's acid test

Is the person free to leave

Is the person subject to continuous supervision and control

That applies whether the person is in a hospital or in a care home and it is the setting they are in that needs to make the application for a DoLS.

If a person lacking capacity meets the 'acid test' within a non regulated setting, e.g. their own home then the deprivation of their liberty still needs to be signed off in what is know as a 'Court of Protection (CoP) DoLS - for example if they have cameras or sensors monitoring their movements within the house, or live in carers, and they can't leave the house without supervision or control.

However things like using covert meds, sedative meds, restraints such as lap belts on wheelchairs, baby gates etc should also be considered as part of a DoLS application.

Thanks hatgirl, I thought dols doesn't apply to medical decisions, I know urgent dols can be applied for and always thought the carehome manager could authorise that, it's good to learn so appreciate your knowledge. If he has capacity I guess he's free to leave.

It's two separate things.

He will have had a capacity assessment at the point of admission by the sound of things.

The OP having LPOA means she can legally make the decision to place him there if he is considered to lack capacity to make the decision himself without having to have a best interests meeting with the local authority.

The care home as the physical place that is 'detaining' him has to apply in its own right to legally detain him there 'against his will' (a lack of capacity means he can't consent to it) and the local authority has to sign off the application.

Everyone in a care home who lacks capacity has to have a DoLS, most are standard DoLS applications and there are huuuge backlogs for these being signed off by local authorities. However in situations where someone is actively objecting and indicating they want to leave, an urgent DoLS can be applied for and will happen quite quickly.

Doesn't he need a capacity assessment first before anyone can submit a dol, what do the care home think he needs a dol for and if he's not got capacity then the health lpa can start, there's no need for a best interest meeting.

Have been thought this with my mother; I’ve found the assessor to be incredibly diligent, compassionate and thoughtful. I think they are well used to dealing with people who for a variety of reasons have no insight into their own care needs. Sometimes they are unintentionally hilarious as they write down verbatim what the conversation was.

Most local authorities have huge DoLS backlogs - it's part of the reason the Liberty Protection Safeguards were being brought in instead but they keep being pushed into the long grass by what is now several governments.

However there are mechanisms in place to apply for an urgent DoLS Authorisation if it's needed.

I wouldn't be surprised if your dad's recent objections haven't pushed him up the list a bit.

I didn't cover everything, I used to write the dols applications for local authority care homes, though it was a while back