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Elderly parents

Capacity Assessments

21 replies

limetrees32 · 04/09/2026 17:15

My sil tells me that the visit from an OT to my brother was part of a capacity assessment.
This is from adult social care
I am confused, I thought capacity was decision dependent and I'm wondering what decision he might be asked to make .
And I don't really understand how occupational therapists are involved.
He is unsteady and at risk of falling but that doesn't affect his brain or capacity to make decisions
Can someone help.me understand?
TIA

OP posts:
hatgirl · 04/09/2026 21:59

Need a bit more context to answer really but the OTs I work with often have to make sure that someone understands how to use the equipment they are putting in if there are risks in using it.

What is it you are worried about?

Budgiedrama · 04/09/2026 22:24

You’re right, they’re decision dependent. Could it be something to do with his care, like a care act assessment? OTs, nurses, social workers, doctors, can all do capacity assessments. It has to be a registered profession. We have to do capacity assessments as standard for all care act assessments, just because you can’t presume.
OTs have to do them even to apply for pretty basic adaptions.

limetrees32 · 04/09/2026 22:26

Thank you so much for responding .
It's not so much that I'm worried but I want to understand.
My sil said that the OT report was "intended to add to their thoughts about capacity"
And that
"The capacity stuff adds ,I think ,to their eventual diagnosis re dementia "

It doesn't make sense to me,to dx dementia would surely involve a doctor .
Capacity to make what decision?

I dont want to question my sil 's understanding as she is under a lot of pressure and is someone who would see this as criticising .
My brother is elderly and has severe depression which has recently been dx and is treated with medication .
Scans have shown brain damage ( following trauma 7 years ago,)
He is waiting for a memory clinic appointment.

OP posts:
yelrac · 04/09/2026 22:31

I’m an OT, and OT can be involved in diagnostic assessment to provide evidence to support diagnosis. There are certain standardised assessments (such as LACLS) that provide a diagnosing doctor with further information that can aid their decision making.

Budgiedrama · 04/09/2026 22:46

Well if it’s something to do with medical issues (medication, consent to treatment) then a doctor would complete the capacity assessment, if it is more around care, care homes, adaptions, finances then it’s more likely to be a social worker or OT. They are not diagnosing them, they are checking their understanding of doing or not doing something. So if you assess someone as needing a care package of a certain amount of hours, but they don’t want to have it as they don’t want to pay for it, that does not mean they necessarily lack capacity. If they could explain that they are going to get a private cleaner, or ask a neighbour or family member to help out, or they are going to try new medication to improve their health or energy levels, that shows they can weigh up and make that decision. If they seem to need the care package but say no because they’re coping fine and there’s no problems, but there’s evidence which contradicts that, it looks less likely that they have capacity. But as you can imagine there’s lots of variables. It’s good to ask the OT what decision the capacity assessment was needed for, and what her or his findings were. You should be involved.

limetrees32 · 05/09/2026 09:55

@Budgiedrama and @yelrac that's so helpful thank you , especially for taking the time to give details.
Consideration is being given to increase my brother's care package.
He's very compliant and I don't think there is an expectation that he would refuse.
He has no financial concerns.
His partner may have expressed doubts about the need and purpose of additional care visits.
They are long term partners but have always lived separately during the week.
Both my sil.and self have power of attorney/s.

OP posts:
limetrees32 · 05/09/2026 09:58

@yelrac I googled LACLS and it described certain simple sewing/ whipping tests.

OP posts:
yelrac · 05/09/2026 10:16

@limetrees32yes that’s one of the diagnostic tests. It’s about following instructions, problem solving and it’s got a standardised scoring linked to it so can be used as part of diagnosing cognitive impairments. I haven’t done that with anyone for years as I’ve predominantly worked in social services so can’t remember the full ins and outs of it.

In terms of generally assessing capacity, it is time and decision specific and the professional who would take forward the outcome of that decision would be best placed to do the capacity assessment.

limetrees32 · 05/09/2026 10:41

Thank you so much.
The OT has said that my brother must not go out alone .
I think this is mainly because he is so unsteady on his feet .
But speaking of assessments being time specific he had been discharged from a short emergency stay( he had taken too many of his prescription and the PRN. anti histamine phenergan )in hospital the evening before the morning of the assessment and was certainly not fit to be going out.

OP posts:
hatgirl · 05/09/2026 13:00

Budgiedrama · 04/09/2026 22:24

You’re right, they’re decision dependent. Could it be something to do with his care, like a care act assessment? OTs, nurses, social workers, doctors, can all do capacity assessments. It has to be a registered profession. We have to do capacity assessments as standard for all care act assessments, just because you can’t presume.
OTs have to do them even to apply for pretty basic adaptions.

Are you sure about that?

Presumption of capacity is literally the first principle of the mental capacity act and you absolutely shouldn't be assessing someone's capacity unless you have a reason to.

You might want to go and check your organisations training on that...

Cheese55 · 05/09/2026 13:06

Budgiedrama · 04/09/2026 22:24

You’re right, they’re decision dependent. Could it be something to do with his care, like a care act assessment? OTs, nurses, social workers, doctors, can all do capacity assessments. It has to be a registered profession. We have to do capacity assessments as standard for all care act assessments, just because you can’t presume.
OTs have to do them even to apply for pretty basic adaptions.

OTs and nurses can't do capacity assessments for social care decisions. OT can do capacity assessments about OT equipment, nurses can do capacity assessments for heath decisions.

limetrees32 · 05/09/2026 17:54

Presumption of capacity is literally the first principle of the mental capacity act and you absolutely shouldn't be assessing someone's capacity unless you have a reason to.

This is very much where I'm coming from.
And the more I think about it , if the OT visit was to assess my brother's attitude to extra carer visits or to see how he managed daily living tasks then I think that the visit should have been postponed.
He'd just spent 4 days in hospital inactive sitting and lying down .

OP posts:
Budgiedrama · 05/09/2026 22:53

@hatgirlwhat I mean is that we the care act assessment, if done in a person centred way, will naturally be a form of capacity assessment. Most LA’s are pulled up on assuming capacity when they should have assessed, rather than the other way around.

BeaTwix · 05/09/2026 23:37

As someone who has battled through the system assuming capacity without assessment is downright dangerous for people in the early - med stages of demebtia

The person I care for was discharged in an unsafe manner countless times as they present well and it’s much easier for the hospital to assume capacity and discharge than actually do an assessment, liaise with the PoA and put a safe discharge plan in place.

It also cost a lot in terms of nhs resources bouncing in and out of hospital every 2-3months keeping a social care package open during each admission when I was all but screaming that home was no longer the right /safe place.

Trying to keep them safe at home when the professionals kept ignoring/sidelining me brought me close to burnout.

(I’m a professional myself and cannot believe how differently adults with incapacity are treated vis children. In a paediatric hospital parents are involved in every decision. If they aren’t there we wait until they are or phone them. In adult services unless I jump up and down and make a nuisance of myself no one makes contact about even really important things. It took 36hours on the last admissions from a nursing home, with dementia for anyone to phone me back to give them the collateral history I was desperate to give and which changed the management). And I talk the talk and know the hospital involved . Fuck knows how other families navigate the system.

it is incredibly frustrating.-

NoctuaAthene · 06/09/2026 00:09

Other posters have explained well but to add from my simplistic/layperson viewpoint - yes every decision is an individual decision, but particularly relevant decisions for elderly frail people, where in practice the people who hold POA for the person and/or health and social care professionals tend to feel it might be necessary for them to intervene if the person has lost capacity (as opposed to allowing a capacious person to make their own unwise decisions) is whether they should continue living at home in their own home (supported by carers and equipment etc as necessary) or should move to residential care. It's also common in deciding whether/to what extent external help should be accepted/imposed on the person, but you say that isn't an issue for your brother, or for financial/property type decisions but that doesn't sound super relevant here.

The role of the OT in this scenario is largely around risk assessing for things like falls or how other injuries/issues might arise for someone in your brother's position living at home, and seeing what equipment or other aids and assistance can help him to remain living safely at home. I would expect the reason capacity is being discussed by your SIL in the context of the OT is not that there's a suggestion necessarily that they or the carers would physically intervene to force the use of the equipment, because your brother lacks capacity to decide whether to use or not use something, but more so that the OT's professional opinion and insight is relevant to the broader question of (a) whether or not your brother can live at home safely at all and (b) if your brother thinks he can live at home safely against professional advice, or would refuse alternative options I.e. hospital admission or residential care, is that simply an unwise decision that has to be respected and given his autonomy as someone with capacity or is that actually not something he has the capacity to decide, and therefore you and she as attorneys are responsible for now.

An example of how that conversation might go, an elderly person with a history of falls refuses to use a walker in the house. The OT would discuss with them why that is and explore options. If the elderly person demonstrates an understanding of their illnesses, can relate the history of the falls, understands that if they don't use the walker they are at high risk of further falls and the consequences of that i.e. serious injury, death, and still says they don't want to use it, or will choose to use it when they want to, or will use an alternative, less good aid instead, that might point in the direction of capacity - whereas if they don't seem to understand or deny they have any illnesses, can't point to the risks or acknowledge the consequences of not using the walker or suggest magical or delusional thinking, then that would suggest lack of capacity. Highly unlikely someone would be taken into residential care on the single assessment of an OT alone against their wishes, but as your SIL has suggested the opinion of the OT will be informative and relevant.

Not saying your SIL necessarily is planning or thinking your brother necessarily has already lost capacity on these key issues, or that residential care is imminently needed, but I'm guessing she's anxious as he's clearly frail and at high risk, perhaps there's a suggestion of somewhat unhelpful influence from the partner (interesting that s/he not an attorney?) and she probably wants to understand how close you are to needing to take over this kind of decision making for him and ideally to have professional endorsement/diagnosis around this rather than guessing and risk either overstepping or under stepping, if that makes sense. It's often only when there's a crisis that this sort of thing becomes abundantly clear but of course you'd like to avoid the crisis if possible while giving your brother maximum independence as well...

avilsdedvocate · 06/09/2026 00:17

Budgiedrama · 05/09/2026 22:53

@hatgirlwhat I mean is that we the care act assessment, if done in a person centred way, will naturally be a form of capacity assessment. Most LA’s are pulled up on assuming capacity when they should have assessed, rather than the other way around.

Nonsense.
Also doesnt change the law...

limetrees32 · 06/09/2026 09:01

@avilsdedvocate I'm not sure what is nonsense about Budgies post .

But I do get a sort of brain freeze when I consider the issues of capacity .

One thing I've learned is that the assessment of the capacity of someone to decide X or y will be led by whoever is involved in delivering X or y.

This thread is so interesting and helpful to me .
Particularly as a friend with Alzheimer's that I support presents v well indeed to strangers and professionals who only see a snap shot of her.
My brother is the opposite.

OP posts:
limetrees32 · 06/09/2026 09:09

What I'm getting , hopefully correctly and I see there is nuance ,is that the OT report will be a factor in considering how realistic my brother is being about staying in his home and whether a more robust care package will help avoid residential care .
At least for now.
. Most LA’s are pulled up on assuming capacity when they should have assessed, rather than the other way around. @Budgiedrama
I take your point.
Anf that of @BeaTwix who said
assuming capacity without assessment is downright dangerous for people in the early - med stages of demebtia

OP posts:
limetrees32 · 06/09/2026 09:12

@NoctuaAthene thank you for taking the time to write giving detail.
Both my.Sil. and my self are attorneys on the Poa for my brother.

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AndSoFinally · 06/09/2026 09:23

You also need to remember that capacity (or lack of) doesn’t necessarily override a persons wishes

If whatever he wants can be safely delivered, then that’s what professionals should aim for. Lack of capacity isn’t carte Blanche to carry someone off to a nursing home

limetrees32 · 06/09/2026 09:42

@AndSoFinally thanks for adding that.
The person's long standing wishes also have to be considered.
It's seems impossible to balance respect for the vulnerable person's wishes and the carer who is on their knees , knows the situation and will have to deal with an upcoming crisis.
But I guess that's because not all carers are decent and honest.

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