what does it mean to have capacity in this scenario?

[MissJeanBrodiesmother]

I am new to this and could do with some advice from those with more experience.

My mother has a diagnosis of alzheimers and vascular dementia. She is up and down but can at times be very fixated on some things, finds any changes very difficult and can be argumentative. The fact that she cannot remember anything means that she does not know or accept that she had alzheimers or that she is difficult to look after for her husband. She sometimes needs reminders to eat and would not remember medication alone. She can do all her own personal care and can make herself simple meals/drinks. She can have superficial conversations but cannot remember what has been discussed just ten minutes later. She spends lots of time cleaning things that don't really need it.

Her husband seems to be saying he needs help as she is so argumentative at times and seems to get fixated on things. She won't accept help. I am not sure whether he is hinting she needs a care home. I would like to know the legal situation.

1. Can she be forced to go into a care home? What is the test for capacity in this scenario?
2. How could we go about getting in carers when she refuses them or gets angry if they are suggested?

So first of all he needs a carers assessment, this is normally done by a social worker but in some areas the local branch of age uk or family carers organisations might do it. Best to try and refer the husband for carer support to as many different places as possible, local dementia charity, carers charity's, age uk and social services to cover all bases.
Also contact GP as they will need to check that there is nothing underlying or exacerbating issue such as a uti.
Dont under play things, he needs to use the words carer burn out and explain how hard it is and also if she is showing distressing or behaviours that he is struggling to manage.

Do they have funds to pay for a care home and does anyone have POA. A social worker would normally do the capacity assessment but they normally try the least restrictive thing first which might be some respite for husband or carers or home help.
If its at crisis point tempory care home respite can be arranged.

So The capacity assessment would be dependent on what help she needed at home. Husband can say he doesn't want to provide all the care and needs help.
The question would then be if can show that she understands that she can't care for herself and the risks of that. And then what options there are to help with this. She would have to show that she can understand, retain and weigh up these discussions. So if she didn't want carers at home or a care home she would need to be able to explain that she knows this would be needed but be able to explain why she doesn't want this amd how she will meet her care needs instead ( this is probably unlikely given what you have said). But she, husband and you all need to know what the options are first if that makes sense?

Hi OP,

I don’t know the procedure but, and I truly mean this with kindness/experience, you will not be able to hold back the tide of your mother’s decline. There will be phases of relative stability, but it is only going to get worse. Try not to wait until you are all in a crisis to make the move.
If her husband dropped dead/walked away it does sound like you would all be - not to put too fine a point on it- screwed.

It will already be unsafe for her to be alone, and if you can think about what the future reality will be that would be sensible.

Organise POA if you can.
It may need to be presented to her along the lines of " if you became unable to look after yourself after Dad dies (or invent another suitable scenario), signing this means I can help you and the council couldn't force you into a care home against your will".

Having POA isn't a magic wand, but it opens a lot of doors.
Get a care assessment too.
Think about how well she copes on her "worst" days and describe that to the assessor in advance.

Mental Capacity is question specific and not just an overall term that can be applied. A person may have difficulties with their cognition, but that does not mean they lack the capacity to make an informed choice or decision.
A Mental Capacity assessment is made up of three parts.
1- Is the person able to understand the question and have insight to understand the risks of any decision?
2- Is the person able to retain the information long enough to be able to weigh it up and reason it out in order to make an informed decision?
3- Is the person able to communicate that decision by any means?
So if you think of the care that your mum needs on a day to day basis, would she understand the implications and risks associated with not eating, or not drinking enough and would she be able to make a reasoned decision about this?
A social worker or other professional such as an OT can complete a MCA.