What Is the Mental Capacity Act?
The Mental Capacity Act 2005 (MCA) is a law providing a statutory framework for individuals aged 16 and over who lack the mental capacity to make decisions for themselves. In care homes, it guides care for residents unable to consent due to conditions like dementia or brain injury. The Act applies to specific decisions, not a person's general ability, requiring capacity assessment for each decision. Care providers must follow MCA principles, ensuring actions are in the resident's best interests and are the least restrictive options.
The Five Key Principles of the MCA
The MCA is based on five core principles for staff, families, and attorneys when interacting with someone who may lack capacity:
- Principle 1: Assumption of Capacity. Always assume capacity unless proven otherwise. A diagnosis like dementia doesn't automatically mean lack of capacity.
- Principle 2: Providing Support. Take all practicable steps to help a person decide before concluding they lack capacity. This could involve simpler language or visual aids.
- Principle 3: The Right to Make 'Unwise' Decisions. Don't treat someone as lacking capacity just for making a decision others deem unwise.
- Principle 4: Best Interests. If a person lacks capacity for a decision, any action must be in their best interests. This includes considering past wishes and values.
- Principle 5: Least Restrictive Option. Decisions should be the least restrictive of the person's rights and freedom.
Assessing Mental Capacity in a Care Home Setting
Care staff and professionals use a two-stage test for capacity, always specific to the decision:
- Stage One: The Impairment Test. Identify if there's a disturbance in the mind or brain function, such as from dementia or a learning disability.
- Stage Two: The Functional Test. Determine if the impairment prevents the person from making the specific decision. This applies if they cannot understand, retain, use, or communicate the decision.
How "Best Interests" Decisions Are Made
If a resident lacks capacity, care staff and relevant parties determine their best interests, focusing on what the resident would likely have chosen. The MCA's Code of Practice offers guidance, including considering past wishes and values, involving the resident, consulting family or a Lasting Power of Attorney (LPA), considering if capacity might return, and choosing the least restrictive option.
The Role of Deprivation of Liberty Safeguards (DoLS)
For residents whose care involves restrictions that constitute a 'deprivation of liberty' for safety, DoLS ensure such arrangements are lawful. Care homes must apply for DoLS authorization from the local authority if a resident is under continuous supervision and control, unable to leave freely, and lacks capacity to consent. This involves independent assessments to confirm the arrangement is in their best interests.
Lasting Power of Attorney (LPA) and the MCA
The MCA allows individuals to plan for future lack of capacity via a Lasting Power of Attorney (LPA). There's a Health and Welfare LPA for daily care and medical decisions (used only when capacity is lost) and a Property and Financial Affairs LPA. Care staff must follow an attorney's instructions if they are acting in the resident's best interests.
Comparison: Making Care Decisions with and without MCA
| Aspect | Pre-MCA (Common Law) | Under MCA (Best Interests) |
|---|---|---|
| Presumption | Capacity often based on a diagnosis, potentially leading to a 'status' approach where capacity is globally assumed to be absent. | Assumption of capacity for every adult unless proven otherwise for a specific decision at a specific time. |
| Focus of Decision-Making | Historically, relied more on what the carer or professional thought was 'reasonable' for the person. | Mandates a person-centred approach based on the individual's past and present wishes, feelings, beliefs, and values. |
| Rights of the Individual | Limited legal framework for people to express future wishes if they lost capacity. | Gives legal weight to advance decisions and allows for appointing Lasting Power of Attorney (LPA). |
| Legal Protections | Less statutory protection for those making decisions on behalf of others; greater legal ambiguity. | Provides a clear legal framework (Section 5) that protects carers and professionals acting in the person's best interests, provided they follow the Act's principles. |
| Formal Safeguards | Fewer formal safeguards for significant restrictions on liberty. | Introduced Deprivation of Liberty Safeguards (DoLS) to provide checks and balances for care that amounts to a deprivation of liberty. |
Understanding Your Rights: MCA in Practice
For residents and families, the MCA clarifies decision-making, ensuring that even when a resident can't express wishes, their historical preferences are central. Families are consulted in 'best interests' decisions but lack automatic legal authority unless they are an LPA. The MCA protects vulnerable individuals' dignity and autonomy. Effective implementation relies on staff training and understanding.
Conclusion
MCA stands for the Mental Capacity Act, a key law in England and Wales protecting decision-making for care home residents and other vulnerable adults. Its principles, including assuming capacity, best interests, and least restrictive options, provide a strong ethical and legal framework. Awareness of the MCA is vital for families, residents, and staff to ensure care respects individual autonomy and human rights.
Resources
- NHS: Offers guidance on the Mental Capacity Act for those making decisions for someone else.
- Social Care Institute for Excellence (SCIE): Provides resources and guides on the MCA.
- Alzheimer's Society: Gives information on the MCA and its implications for people with dementia.
Note: This article is an overview and not legal advice. For specific situations, consult a qualified legal professional or local authority.
