How many capacity assessments would we expect to see in a person's care records?

How Many is Enough? By Paul Wilkins

A common question asked by care providers is how many capacity assessments and best interest decisions are we expected to undertake and document?

The fact that people are asking this question shows that they appreciate that capacity is time and decision specific.

If we take a moment to reflect on our own lives we will realise that we make hundreds or possibly thousands of decisions each day, most small but punctuated by the less frequent big ones. The MCA tells us that we must first prove that a person lacks capacity before we can make a particular decision on their behalf. So do we need to document hundreds of capacity assessments to cover every decision a person needs to make?

The simple answer is no as this would not be practical or necessary.

The MCA Code gives us some indication of this at paragraph 4.60

“Assessments of capacity to take day-to-day decisions or consent to care require no formal assessment procedures or recorded documentation.”

So if day to day issues do not require a documented capacity assessment what does?

Desuto Ltd’s decision support tools have been calibrated to deal with this question. We are confident that we have identified the most common ‘big decisions’ that a person who requires care and support will have to make.

The Deprivation of Liberty Safeguards (DoLS) also indicate that we can reduce the number of individual capacity assessments that we need to undertake and document.

One of the DoLS qualifying requirements is that the person must be proven to lack capacity to make decisions about their care and accommodation. DoLS therefore requires a documented judgment about 2 aspects of a person’s care arrangements rather than a series of judgments about each individual aspect of the person’s care.

If a capacity assessment top 4 was required, the following would be recommended (when relevant):

1.    Consent to agree to care or going to a care home and continuing to receive care or remaining in the home.

2.    Consent to taking treatment including medication.

3.    Safely leaving care home/hospital or own home independently.

4.    DNACPR

Failure to evidence our proof that a person lacks capacity to make a decision that we later make for them could make that decision unlawful.

The Desuto tools can document a capacity assessment on one of 20 issues in a matter of a few minutes so there really isn’t an excuse.