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Knowledge of mental capacity issues in residential services for people with intellectual disabilities
- Authors:
- WILLNER Paul, et al
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 6(1), 2012, pp.33-40.
- Publisher:
- Emerald
An earlier study of health and social services professionals in community teams for people with intellectual disabilities (CTIDs) identified a number of significant gaps in their knowledge of mental capacity issues. This study aims to judge the knowledge of staff working in residential services for people with intellectual disabilities. Participants worked in three specialist residential settings for people with intellectual disabilities; qualified nurses working in the NHS and in the independent-sector and senior staff in residential houses. All took part in the same structured survey that was used in the earlier work which was designed around three scenarios concerning a financial/legal issue, a health issue, and a relationships issue, as well as a set of ten “true/false” statements. There were no differences in interview performance between the three groups of residential carers, who performed better than generic NHS staff but worse than CTID professionals. However, the three residential groups did differ in their self-ratings of how well-informed and confident they felt in relation to mental capacity issues. The authors suggest that the confidence of staff in their own knowledge may not be a good guide to their ability to deal with these issues when they arise in practice.
Managing older people's money: assisted and substitute decision making in residential aged-care
- Authors:
- TILSE Cheryl, et al
- Journal article citation:
- Ageing and Society, 31(1), January 2011, pp.93-109.
- Publisher:
- Cambridge University Press
For many older people, decision making about their financial matters is extremely difficult because of competing interests in their assets, and concerns about risk, misuse and abuse. In residential-care settings, older people are often characterised as dependent and vulnerable, especially in relation to decisions about financial assets. Also, older people are often assisted to make decisions where possible, rather than using substitute decision makers. This article reports on an Australian study of the factors that facilitate and constrain residents' involvement in financial decision making in residential settings. Case studies of four facilities explored how staff interpreted the legislative and policy requirements for assisted and substitute decision making, and the factors that facilitated and constrained residents' inclusion in decisions about their finances. Findings revealed substantial variation in the ways that current legislation is understood and implemented, and there are limited resources for this area of practice. The article concludes that policies and practices prioritise managing risk and protecting assets rather than promoting assisted decision making for older people.
The first legal right to advocacy
- Author:
- GORCZYNSKA Teresa
- Journal article citation:
- Working with Older People, 11(1), March 2007, pp.17-20.
- Publisher:
- Emerald
The Mental Capacity Act places a duty on local authorities and the NHS to refer people who may lack capacity to make decisions about serious medical treatment or about a change in accommodation to an Independent Mental Capacity Advocate (IMCA) service. This article describes the experiences and lessons learnt in Croydon, where one of the seven IMCA pilots has taken place.
Supporting autonomy of nursing home residents with dementia in the informed consent process
- Authors:
- BEATTIE Elizabeth, et al
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 18(7-8), 2019, pp.2821-2835.
- Publisher:
- Sage
Background: In studies involving people with dementia, researchers have historically defaulted to seeking consent from a proxy, the assumption being that people with dementia are unable to provide their own informed consent. This choice denies people with dementia a voice in the consent process, thus disregarding their autonomy and agency. Recently, other options for improving the consent process have been explored. Objective: This study aimed to determine whether nursing home residents with dementia could demonstrate an ability to provide their own informed consent as determined by the Evaluation to Sign Consent instrument. Methods: As part of a larger study on the quality of life of nursing home residents, the Evaluation to Sign Consent was administered to 392 people diagnosed with dementia. Data on demographic variables, such as gender and age, as well as level of cognitive impairment, were also collected. Results: Just over one-fifth (22%) of the residents with dementia were judged as having the capacity to provide their own informed consent to participate in this specific research project. Consistent with existing literature, capacity to consent was significantly, and negatively, associated with cognitive impairment. Conclusion: This study demonstrates that assuming all people diagnosed with dementia are unable to provide informed consent for research on the basis of cognitive test scores, or on clinical assessment alone, potentially denies them the autonomy to make a decision that they may be capable of making. Research involving people with mild-to-moderate dementia needs to consider evaluating whether potential participants have the capacity to provide their own consent. (Edited publisher abstract)
Older people in care homes: sex, sexuality and intimate relationships
- Authors:
- HEATH Hazel, et al
- Publisher:
- Royal College of Nursing
- Publication year:
- 2018
- Pagination:
- 44
- Place of publication:
- London
- Edition:
- 2nd ed.
This guide aims to support best practice and help nurses and care staff work effectively with issues of sexuality, intimate relationships and sexual expression, particularly for older people living in care homes. As well as raising awareness of issues which can impact on the intimate relationships and sexual activity of older care home residents, the guide contains: legal and professional frameworks within which nursing and caring practice takes place; considerations for policies that address sexuality and sexual health needs in care homes; guidance on principles of good practice, including care environments, organisational systems and care practices; ideas on how to identify barriers to expression of sexuality and work towards removing these in practice; suggestions on how to broach issues concerning sexuality, intimate relationships and sex; guidance on dealing with situations where sexuality expression is seen as a concern; and suggestions on how staff can develop their own confidence and competence in dealing with sexuality issues. It also included case examples, which can be used to highlight issues for discussion and additional resources to support practice. (Edited publisher abstract)
Limits of Mental Capacity Act training for residential care homes
- Authors:
- GOUGH Matthew, KERLIN Lianne
- Journal article citation:
- Journal of Adult Protection, 14(6), 2012, pp.271-279.
- Publisher:
- Emerald
The Mental Capacity Act (MCA) was implemented in 2007 as a piece of legislation to empower and protect adults who require support making decisions. Many older adults in residential care homes will be in this position due to developmental disabilities associated with functional impairments of the mind and brain. This paper evaluates the impact of MCA training within older persons' care homes within an East-Midlands local authority. Semi structured interviews were conducted with 9 key informants who had strategic responsibility for implementation of MCA training as well as a focus group conducted with managers/deputy managers of care homes within the local authority. The paper offers methods of delivery with the Mental Capacity Act with a tailored, engaging and cost effective alternative to conventional “away day” training sessions.
Deprivation of knowledge
- Author:
- SAMUEL Mithran
- Journal article citation:
- Community Care, 10.11.11, 2011, pp.24-25.
- Publisher:
- Reed Business Information
Depriving care home residents of their liberty is fraught with problems for managers as legal guidance is vague on when it is appropriate. This highlights the problems of implementing the Deprivation of Liberty Safeguards (DOLS).
A small group study examining the integration of the Mental Capacity Act into health and social care record keeping and planning
- Author:
- NATIONAL CARE ASSOCIATION
- Publisher:
- National Care Association
- Publication year:
- 2008
- Pagination:
- 19p.
- Place of publication:
- London
The National Care Association has developed the Mental Capacity Act Assessment Toolkit which allows for an assessment to be carried out which, if an individual lacks mental capacity, identifies the functions of daily living that the person cannot make decisions about. This study was designed to examine whether the processes surrounding both assessment and best interests are being embedded into care organisations through the use of the assessment tool and whether any further awareness raising and training is required. The individuals that responded to the questionnaires have clearly made significant strides in embedding the principles of the Mental Capacity Act into their care homes using the National Care Association Toolkit. The results of the questionnaire have identified some gaps in training and information provision.
Living 'a life like ours': support workers' accounts of substitute decision-making in residential care homes for adults with intellectual disabilities
- Authors:
- DUNN M. C., CLARE I.C.H., HOLLAND A. J.
- Journal article citation:
- Journal of Intellectual Disability Research, 54(2), February 2010, pp.144-160.
- Publisher:
- Wiley
In England and Wales, the Mental Capacity Act 2005 (MCA) provides a new legal framework to regulate substitute decision-making relating to the health and personal welfare of adults who lack the capacity to make one or more autonomous decisions. Substitute decisions must be made in the 'best interests' of the person lacking capacity. This study explored how statutory legal regulation under the MCA interfaces with the practical and ethical dynamics of care and support in the context of community-based support of adults with intellectual disabilities living in residential care homes in England. The data are drawn from 21 qualitative interviews with support workers in this setting and observations of care practices. In contrast to the narrow legal responsibilities placed upon them, it is argued that support workers interpret substitute decision-making within a broad moral account of their care role, orientating their support towards helping residents to live 'a life like ours'. They described how they draw on their own values and life experiences to shape the substitute decisions they make on behalf of residents. Support workers' accounts revealed discrepancies between the legal regulation of substitute decision-making and the ways that they made sense of their work. It is suggested that such discrepancies have implications both for the implementation of the MCA, and for the role of support workers' values in the conceptualisation and delivery of 'good' care.
Mental Capacity Act 2005: residential accommodation training set
- Authors:
- STANLEY Nicky, et al
- Publisher:
- Great Britain. Department of Health
- Publication year:
- 2007
- Pagination:
- 61p., bibliog.
- Place of publication:
- London
Staff are bound to decide in the 'best interest' of the patient. Discretion is given to a local authority to instruct an IMCA (Independent Mental Capacity Advocate) to represent the person who lacks capacity where there is no appropriate person to consult when their residential accommodation is being reviewed, is set out in the Mental Capacity Act 2005.