Dols

[independent98]

My Mum is in a care home on a interim basis due to leg ulcers and bed sores. They have approached me for a dols assessment as they said my mum seems confused but she seems quite sharp with myself and the family. I am extremely wary of thier agenda and want someone to explain to me in laymans terms what a dols is and its implications

Hi my Mum is just coming to the end of 6 weeks NHS funded respite care. Her CH also contacted me and said that they needed to complete a DOL's as the home has a locked door policy. I queried it and I was told that it was literally just until she left and then it ends. I did not see or have to sign any paperwork. It is a Deprivation of Liberty order and basically means that legally they can keep you mum safe as she can't leave without it being lifted.

Mum was very confused and trying to leave every day for the first week so this is why it has to be put in place, otherwise they could not stop her leaving.

Have a look on the Alzheimer's Association website for more info, they have some fact sheets which will explain the legalities.

OP

I don't think I'd sign that for my mum unless there were more extreme circumstances than in your OP. Mum has discharged herself from hospital twice and that was the right choice for her.

I had to sign for my mum, basically without it they couldn't stop her for leaving if she asked to. It wouldn't have stopped family members taking her out if they'd wished to or anything more - just let the staff do what was needed to keep her safe

The home doesn't just apply a DOLs and that's that, they are granted by mental health assessors and best interests assessors (together) appointed by the local authority, they do this by speaking to the person involved (they may require a separate mental health assessment too) their families or representative and the home where they're being cared for, weigh up all the information and come to a decision from that. You can agree or oppose the decision as her nok.
They are granted usually to stop a person leaving the place of care alone as the risk to their safety by doing so are outweighed by the risks posed of losing the freedom to do it.

Without a DOLs in place, legally, the home cannot prevent your mum leaving at 3am in her underwear (I'm not saying she's trying to, just an example) if she wanted to, things you may take for granted that they wouldn't let her do for her safety, to care for her, can't legally be done without a DOLs in place.
They are always given a date for review, and that review makes the decision again.
I'd speak to the home and ask what behaviour she's exhibiting to make them think a DOLs is needed to keep her safe, and to your mum too, to find out if there's a reason she's trying to leave (for example).
And why do you think the home has an agenda behind asking? Or what that agenda is?
Unfortunately the terminology used such as depravation, liberty, control etc are harsh terms (imo) for a reason - they remind the people granting them exactly what they're taking away and safeguard against it being done as a matter of course just because someone is in a home or has a diagnosis of dementia.

Has she had a capacity assessment, I think they can only apply for a DOLS if she lacks capacity then all her care will have to be given in her best interests. Has a doctor assessed her and looked for the reason for her confusion.

DMIL was properly assessed before the DOL was granted. Before going into the CH she started wondering at night and it was clear that she didn't recognise the town she'd lived in for 50 years anymore. I think if it hadn't been granted she would have been killed in the road by now.

@DogsSausages

Has she had a capacity assessment, I think they can only apply for a DOLS if she lacks capacity then all her care will have to be given in her best interests. Has a doctor assessed her and looked for the reason for her confusion.

Yes - and have they checked for UTI as this causes confusion and is often missed.

I queried why they thought a dols was neccesary and they are contradicting themselves by first saying that my mum is very coherent and can tell them what she wants and needs but in another sentence saying that she is not expressing her needs about where she wants to be upon being discharged from the home( they asked her after 4 days in the care home which was her decision to go to a home temporarily until her leg ulcers and bed sores heal). I pressed them for an example of my mothers so called confusion and they said that they gave my mum supper ( a sandwich) and later my mum asked for fruit forgetting that she had eaten which i found hilarious because a sandwich hasnt ever been supper at home so i understand why my mother would not think that she had eaten and i told them this and explained that my mum has a large appetite and that a sandwich would not fill her up. The final point they said is that my mother isnt talking to them and I told them that she is in a new environment and she has told me that she has made requests but they are not listening to her so she doesent want to talk to them. I truly dont understand how from the above that they deem it neccesary to apply a dols.

@independent98

I queried why they thought a dols was neccesary and they are contradicting themselves by first saying that my mum is very coherent and can tell them what she wants and needs but in another sentence saying that she is not expressing her needs about where she wants to be upon being discharged from the home( they asked her after 4 days in the care home which was her decision to go to a home temporarily until her leg ulcers and bed sores heal). I pressed them for an example of my mothers so called confusion and they said that they gave my mum supper ( a sandwich) and later my mum asked for fruit forgetting that she had eaten which i found hilarious because a sandwich hasnt ever been supper at home so i understand why my mother would not think that she had eaten and i told them this and explained that my mum has a large appetite and that a sandwich would not fill her up. The final point they said is that my mother isnt talking to them and I told them that she is in a new environment and she has told me that she has made requests but they are not listening to her so she doesent want to talk to them. I truly dont understand how from the above that they deem it neccesary to apply a dols.

Agree

How long is she meant to be in? Are you allowed to visit? I'd want to keep a close eye on this.

have you seen or discussed her care plan.
pressure sores need careful and consistent treatment and monitoring by skilled practitioners.
thy can become very serious.
in what circumstances did the pressure sores develop.
did she choose this care home. do thy have nursing staff, or does she have visits from community nurses or TVN.
are you able to visit her. and discuss with them properly face to face.
all the best.

@independent98

I queried why they thought a dols was neccesary and they are contradicting themselves by first saying that my mum is very coherent and can tell them what she wants and needs but in another sentence saying that she is not expressing her needs about where she wants to be upon being discharged from the home( they asked her after 4 days in the care home which was her decision to go to a home temporarily until her leg ulcers and bed sores heal). I pressed them for an example of my mothers so called confusion and they said that they gave my mum supper ( a sandwich) and later my mum asked for fruit forgetting that she had eaten which i found hilarious because a sandwich hasnt ever been supper at home so i understand why my mother would not think that she had eaten and i told them this and explained that my mum has a large appetite and that a sandwich would not fill her up. The final point they said is that my mother isnt talking to them and I told them that she is in a new environment and she has told me that she has made requests but they are not listening to her so she doesent want to talk to them. I truly dont understand how from the above that they deem it neccesary to apply a dols.

Second all the questions that Alex asked above, and querying about an MSU for urine infection too, that can cause quite sudden and severe confusion that usually vanishes when it gets treated. The examples you gave I wouldn't consider even thinking about applying for a DOLs tbh, the person needs to be a significant risk to themselves or others and wanting a piece of fruit isn't really that. Not speaking to the staff is something I'd flag, and monitor in a new resident, as you say, new environment/people etc and they don't know what is normal for your mum yet, to say it's out of the ordinary. How was she placed/referred? Was there social worker or GP/Nurse input into arranging it?

The examples you gave I wouldn't consider even thinking about applying for a DOLs tbh, the person needs to be a significant risk to themselves or others and wanting a piece of fruit isn't really that.

This just isn't true.

In simple terms the Deprivation of Liberty Safeguards (DoLs) are a mechanism to ensure that anyone who lacks capacity to agree to be in the care home/hospital etc isn't being deprived unlawfully of their liberty .

It's a safeguard to ensure that the restrictions being placed on someone are necessary and proportionate. If you or I were visiting and they refused to let us leave when we wanted to then they would be holding us hostage, it wouldn't be proportionate (or lawful) for them to stop us from leaving as we don't need to be in a care home. We can make that choice based on our capacity to do so but people who lack capacity (even temporarily) can't so the law has to be involved to ensure that they aren't being 'held' unlawfully.

Anyone who is in a care home and has any capacity issues around agreeing to be there should have a DoLs in place, regardless of 'risk' or happiness. Even if they quite happily sit in their chair all day singing along to songs and drinking tea, if they don't have capacity to agree to continue to be there then the placement needs to be authorised by a DoLs.

It's a safeguard of a persons human rights not a punishment or anything to do with risk...

Hat "It's a safeguard of a persons human rights"

Pull the other one.

@AcornAutumn

Hat "It's a safeguard of a persons human rights"

Pull the other one.

That's exactly what it is

It's a very very standard authorisation that anyone in a care home who lacks capacity should have.

If the OP feels it's not required then she /her mum can challenge it, and that's also fine.

However, the care home are probably just erring on the side of caution if they feel she has some confusion as they have a legal requirement to apply for a DoLs if someone lacks capacity to agree to any restrictions that they may be under living in a care home.

What are you insinuating the care home intends to do with the DoLs if it's not to ensure someone they are caring for has their human rights not to be 'detained' without a legal process occurring?

The thing is my mum has mental capacity and I'm failing to understand what has happened based on the things i mentioned as why they want to do a dols. They havent defined a time frame for my mum to be there due to the complexities of her pressure sores and leg ulcer. She decided to go to a home because her care needs have become greater than it waa before and local authority carw in the home wouldn't provide enough time that she requires at present.

It's a hassle for the care home to apply for a DoLs and there isn't really anything in it for them to apply for one if it's not needed. It doesn't gain them anything financially or anything like that and even if they did apply for one it's essentially meaningless until it's authorised by the local authority which no one would do without first speaking to your mum to ascertain her capacity for themselves and also approaching you/family for your views.

It sounds like for whatever reason the home are getting a different impression of your mum than people who know her better.

What is it you are you worried about?

I personally don't understand why they are reccomending a dols as from my understanding it is a safeguard to preserve life and for cases where people are lacking mental capacity. The phone call from the assessor came as a complete surprise to me and also to my mum who is now nervous about what thier agenda could be. She has a distrust of the health and social care industry due to past experiences and this process of my mum entering a nursing home is also new for me too. I have a meeting with them and want to know what key questions i should ask to ascertain the rationale for thier decision.

from my understanding it is a safeguard to preserve life and for cases where people are lacking mental capacity

It isn't anything to do with preserving life.

It's only for people who lack capacity to continue to consent to their placement in a care home or hospital because in this country we can't detain people of their liberty without their consent or without a legal process.

People who can consent to being placed there don't need a DoLs, people who can't consent to being placed there do need a DoLs. The DoLs is part of the Mental Capacity Act.

There is a very clear process to follow if the person or their relatives object to the DoLs being put in place which will be explained to you as part of the process if it even gets that far.

The fact that someone is doing an assessment doesn't mean she will automatically put under a DoLs, the assessment is fulfilling the local authority's legal duty to determine if she needs to have her placement authorised as a DoL.

There are different legal process for people who can consent to being detained, but don't consent, but still need to be detained against their will (e.g in prison or hospital) and these are through the criminal courts and the mental health act.

Their only agenda will be to determine if she requires a DoLs authorisation or not.

@independent98

I personally don't understand why they are reccomending a dols as from my understanding it is a safeguard to preserve life and for cases where people are lacking mental capacity. The phone call from the assessor came as a complete surprise to me and also to my mum who is now nervous about what thier agenda could be. She has a distrust of the health and social care industry due to past experiences and this process of my mum entering a nursing home is also new for me too. I have a meeting with them and want to know what key questions i should ask to ascertain the rationale for thier decision.

I completely understand

Especially under current circumstances, what if they decide to move her somewhere else?

If she has mental capacity, there's no history of her wanting to run out and cause an accident as per a pp concern, I cannot see why they want this, based on the info given.

I think the flip side is they may try to discharge her. I am also coming from a place of distrust with the systems.

Especially under current circumstances, what if they decide to move her somewhere else?

The DoLs doesn't give them the ability to move her and would have zero impact or influence on any decision making around a move. It literally just authorises a placement in that care home. A new one would have to be applied for in any new setting if needed.

If she has mental capacity, there's no history of her wanting to run out and cause an accident as per a pp concern, I cannot see why they want this, based on the info given

Because it doesn't matter if she's trying to escape every 5 minutes or sitting happily in her chair saying how wonderful it is there, if someone lacks capacity it's unlawful to keep them in a care home without a DoLs.
The care home has a legal duty to apply to the local authority if they suspect someone lacks capacity to continue to consent to the placement.

I think the flip side is they may try to discharge her. again The DoLs would have absolutely no bearing on this decision and no impact on it. It literally just makes the placement lawful if someone lacks capacity to consent to be there.

It's legislation that the care home has to abide by, because it's the law. It's not a conspiracy!

Hat thank you

I think that the OP is describing someone with capacity though.

OP you might get more info if you post in the main Elderly Parent thread.
There are so many procedures in place that don't get followed or respected, I would only sign this if I thought mum had lost mental capacity to a very large extent.

The fruit example is just bonkers.

I've done plenty of DoLs assessments for people with capacity that care homes have made DoLs application for on the basis that at a particular point in time they had reason to doubt capacity.

If once I've done the assessment and feel they do have capacity to consent to the placement they then don't get/need a DoLs.

That's the system. Care homes apply for a DoLs authorisation, the local authority receives the application from the care home and do an assessment to determine if a DoLs authorisation is needed or not.

If the local authority agrees the DoLs is needed and the op and her mum object to this decision the can appeal under section 21a of the mental capacity act and they will be supported to do so.

Just a quite update, the dols assessment was today and they deemed my mum to have full capacity. I spoke with the independent assessor and he was perplexed as to the reasons the care home stated for a dols in comparison of how he met my mum today. Thank you guys for your advice

If I were you I would be very reassured that the care home is so thorough. For whatever reason they obviously did have concerns which proves that they had her best interests at heart . Can assure you applying for DOLS is very time consuming.
Care homes often get a lot of criticism so the home has to protect its own interests and reputation.
There is absolutely nothing sinister about applying for DOLS ,quite the opposite.

Really pleased to hear that independent98