Bec is a housing worker meeting with her client, Andy, to discuss a possible move to supported accommodation. Bec is aware that Andy has dementia although he is still able to make some decisions for himself. Andy appears confused by the concept of moving and does not seem to understand the difference between having his own flat and supported accommodation. Bec identifies that Andy appears to be struggling with the decision and considers whether a capacity assessment is required.
Bec tries to help Andy make the decision for himself by writing information down, involving his friend Rob, and meeting Andy in the morning when he is less confused. These are practicable steps to support Andy’s decision-making and should be recorded.
Bec immediately identifies that there seems to be a problem with Andy making this decision. She asks him a few more questions than usual to confirm whether this is the case, and asks Andy to help her understand his thoughts on the matter. Having done this, Bec is clear that Andy is struggling, and decides that she needs to carry out an assessment of his capacity to make this decision at this time, as she doesn’t feel that the decision can be delayed due to his self-neglect.
Bec also doesn’t feel that Andy’s ability to make the decision himself is likely to improve because he has dementia, and his illness is rapidly progressing, although his illness doesn’t appear to impact on his decision to make other, more day-to-day decisions. Bec is aware that a diagnosis of dementia in itself doesn’t mean that people cannot make decisions, but it does give her reason to consider whether Andy does have difficulties in this regard. Having followed the MCA capacity assessment process, Bec is clear that she needs to make this decision on Andy’s behalf.
Bec considers whether he should remain in his flat or move to supported living accommodation. She encourages participation by speaking with him in the mornings, visiting the accommodation with him, recording his likes and dislikes, and involving his sister. She identifies what matters to Andy, including: independence, familiar routines, his church, his friend Rob, his sister, and his favourite restaurant.
Bec also considers professional views, family views, the possibility of home adaptations, the availability of supported accommodation, and the risks of each option. She uses a balance-sheet approach to weigh the pros and cons, recognising that the decision must reflect what Andy would choose if he were able to decide, rather than simply what appears safest.
On balance, Bec decides that if Andy was able to make this decision for himself, he would choose to remain at home, with some additional support, and this option seems most supportive of his rights and choices. Andy seems happy to try this, and doesn’t object to any of the suggested input. If Andy deteriorates, and the risks of him staying at home increase significantly, Bec plans to urgently review the Best Interests assessment to see if the decision to stay at home is still the best one for Andy.
Bec writes detailed notes including a clear conclusion detailing how she came to this decision and why she is satisfied that would closely match Andy’s wishes and is in his best interests.