To ask about DOL?

[TaraR2020]

Apologies, posting for traffic as deeply concerned.

Had a call from social worker about grandparent in care home - the care home want to have a Deprivation of Liberty Order (DOL). Very little info online except that it's in the person's best interest(!)

Please can someone with knowledge of it fill me in? What does it mean legally?
What rights will they be stripped of?

They are already in a locked home so what is the point of introducing it? Why would they be doing so?

What does it mean for us as my grandparent's next of kin and advocates? It's already proven near impossible this year to know whats going on in the home with covid lockdowns, will this prevent us from speaking and acting on their behalf?

What is the process that happens to introduce it and if we disagree what can we do?

Why is it in their best interest??

For context, grandparent has had a couple of aggressive outbursts so far this month due to the stress of ongoing lockdown so will this be why they're introducing it? Does it give them powers or restrain them or lock them in their room?

Don't get me started on why the care home didn't contact us before the social team..!

P.s should have mentioned grandparent has dementia

www.gov.uk/guidance/deprivation-of-liberty-orders

We're looking into this at the moment too as care home have told us they're doing this for MIL.
I think it's a safeguard for both the staff and the parent/resident as it allows certain treatment without their permission but if it's in their best interest - but this has to be registered so not exercised without scrutiny.
With MIL we think it may be around her refusing to take medication but we're asking for more details.

DOLS orders are linked to the Mental Capacity Act and, from a legal standpoint, are what is required to make the decision to keep someone in a home with a locked door (that they can't open if they choose to) without this being kidnapping.

The DOLS will state that your gp has had her capacity assessed and isn't able to make a decision about certain aspects of her care, and then will specify in what ways it is agreed that it is necessary to deprive her of liberty in order to keep her safe (often things like not allowing her to leave and keeping the door locked, sometimes things like carers washing her clothing when she doesn't want them to, stuff like that). It can include powers to restraint people (by appropriately trained staff) if it is needed.

My ma has a DoLs in place at her care home as she doesn’t have mental capacity to keep herself safe.

All people who lack capacity, are under constant supervision and cannot leave the place they are living (even if they are not actively stating a wish to leave) should have a DOLs in place. It’s very normal practice and if your GP has been there for a while it may be the case the home/council is playing catch up. It shouldn’t change anything about how you interact with your GP or how decisions are made. You (or your GP’s representative/next of kin) should be consulted as part of the process.

They have to do it because of the locked door.

Essentially it's a safeguard because if your grandparent tried to leave, they would stop her - and I am sure you would be glad of that, rather than just them let her wander off.

What is the point? many of us filling them in have wondered this

Because this situation was not fully covered in the legislation of the Mental Capacity Act so DOLS was brought in as a very messy and non-satisfactory fix.

It's a legal protection to make sure that people who are in care homes aren't being unlawfully deprived of their liberty.

The only other people who are deprived of their liberty are prisoners and a court has decided that it is necessary to deprive them of their liberty.

The DoLs is a legal process to check that any restraints or restrictions that are in place are necessary and proportionate.

So for example most care homes where people live will have locked doors so that residents can't just walk outside and put themselves at risk. This would form part of a DoLs order as it is a necessary deprivation of their liberty and proportionate to their needs.

However, if the care home were strapping a resident into a chair because they kept wandering and the staff couldn't be bothered to keep tabs on them that would be an unlawful deprivation of their liberty, they have been restrained because it is easier for the staff and not because it's in their best interests to do so.

In some circumstances it would be appropriate to use a wheel chair strap if the person was at high risk of falling onto the floor without it. This would be a lawful restriction.

The DoLs basically 'signs off' which restrictions a care home (or hospital) can use for each individual who lacks capacity to agree to any restrictions they are subjected to as part of their care.

Should be nothing to worry about, was brought into place to safeguard adults where capacity may be limited. The home is required to have it if for example they have any restrictive practice or any practice in place that may deprive someone of liberty for example front door lock, or key pad and code not given to everyone or not everyone would be able to retain it. The means which they want to restrict ( door locked or keep medication away from residents etc) are outline in the DOL report and scrutinised and only approved if the panel agrees this is the least restrictive practice to keep the person safe. All homes with those who may lack capacity have these in place and are required to have as a safeguard to ensure staff do not to something that will restrict someone’s freedoms without it being approved by a panel . Hope the responses here reassure you !

Really good answers above 👍

I'd suggest calling back the social worker and car home and asking specifically what this means for your grandparent - they'll be able to speak through it in relation to them.

The Deprivation of Liberties Safeguards are in place to protect those in hospital or care homes. Even if a care home/hospital was locked, if someone wants to go out you have to let them, or it's a violation of their human rights.

If they lack capacity (which is assessed by the SW) to make decisions about whether it's safe to leave the care home, those around the person (family, care home, social worker, best interests assessor etc) must decide whether in the person's best interests to have this restriction (locked door) on them.

Thank you so much for your responses, it is reassuring to read them.

Its so difficult because the care home aren't great at communicating with us in the first place and we worry about them so much- especially when I've hugged her once in the last year and have only had 2 face to face meetings with her in the last year.

Not being allowed in to see her means we can't monitor her well being and pick up on any issues such as a rude staff member or ensuring she remains clean and with her own clothes (which she was not wearing last time I saw her through the window).

I agree that she lack capacity to understand why she needs to be there, which is why she's there in the first place, but how they use it is a different matter and from what I've read part of the authorisation process.

I can't say how much I appreciate you coming back to me so quickly, thank you!

It's highly likely by the way that the care home applied for the DoLs authorisation the week she moved in - it's a legal requirement for them to do it for anyone who lacks capacity.

It's completely out of their hands how quickly the local authority responds to their request though. Most local authorities are running really behind (and were even pre-covid) so that's why it's probably only just happening now.

It really does just legalise the arrangements that are already in place and check they are the least restrictive option for your relative. It isn't being done to try and cut next of kin or advocates out of the decision making process (although in some very very rare circumstances the court will agree to restrictions on visits from family e.g. if there is a concern they may be a risk to the person).