How do they judge he has capacity

Discussion in 'I have a partner with dementia' started by yorkie46, Jul 1, 2019.

  1. yorkie46

    yorkie46 Registered User

    Jan 28, 2014
    242
    Southampton
    My husband is in hospital with pneumonia. I asked the nurse on the ward to make sure the pharmacist discusses his medication with me as he foreign know it understand anything about it. I requested this last time he was in the same ward in April and it didn't happen hence the medication he was given to take home was not done correctly. When i.made this request yesterday I was told they would do their best but they can't guarantee they won't talk to him about it because he has capscity. How do they judge he has capacity to discuss his medication. He is extremely confused, told me yesterday that a man had accused him of stealing the bag his toiletries are in, thinks he has to go back to another place before tea. When asked where he had pain he looked to me for the answer. Told me he had been able to stand up out of bed but he can't even get to a sitting position himself, he hadn't been out of bed for the last five days. He mutters to himself while he's asleep. Who makes the decision he has capacity to discuss his health and welfare. When he was in intensive care the doctor was discussing it all with me, I was told that if they felt the need to intubate to support his breathing the outcome may not be good, I informed them then that I have power of attorney in place if it was needed, she was pleased to hear that. Obviously she wasn't convinced he had capacity at that stage. Can anyone tell me how they make this decision?


    .
     
  2. Louise7

    Louise7 Registered User

    Mar 25, 2016
    1,067
    What is it specifically that you wish to discuss with the pharmacist about the medication? When your husband is discharged the discharge letter should contain details of the medication he is taking on discharge and how often this needs to be taken - would this help with your concerns? Make sure that they give you a copy of the discharge letter though, as from personal experience with Mum they were sending a copy to the GP but not providing us/carers with a copy.
     
  3. RosettaT

    RosettaT Registered User

    Sep 9, 2018
    193
    Female
    Mid Lincs
    #3 RosettaT, Jul 1, 2019
    Last edited: Jul 1, 2019
    I have no idea yorie46. My experience was bazaar.
    My OH was asscessed the day after he went to rehabilitation whilst I was visiting. I had no idea what a DoLS was and was led to believe it was a ward admission accessment tho' she used the word DoLS. They asked him 4 questions he got 3 right she thanked him and walked off. 5 weeks later he was transfered back to the main hospital and was discharged back home after another 5 weeks. It was only when I read his discharge papers that included the report from the rehadbilitaion centre I read he had been acccessed as havng no capacity.
     
  4. Grahamstown

    Grahamstown Registered User

    Jan 12, 2018
    1,245
    East of England
    I am wondering if you have Lasting Power of Attorney (LPA) for health. When the GP saw my husband to discuss his health to make a decision she did an assessment and told me that he no longer had capacity to make decisions and that I and the family would have to do so and I do have the LPA.
     
  5. northumbrian_k

    northumbrian_k Registered User

    Mar 2, 2017
    712
    Male
    Newcastle
    #5 northumbrian_k, Jul 1, 2019
    Last edited: Jul 1, 2019
  6. Louise7

    Louise7 Registered User

    Mar 25, 2016
    1,067
    From experience, knowledge of the mental capacity act is very 'patchy' amongst hospital staff and they seemed to decide on capacity in a very haphazard fashion, depending on what made life easier for them. Despite knowing that the family held H&W LPA - and the hospital deeming Mum to lack capacity - we were not informed of what was happening with regards to her care, medication or medical conditions and were not included in 'best interests' decision making. In response to a complaint the hospital stated that all their staff 'are expected to undertake training every 3 years' in relation to the mental capacity act/power of attorney, however whether they actually do or not is another thing............
     
  7. canary

    canary Registered User

    Feb 25, 2014
    9,867
    Female
    South coast
    Not just hospital staff - I think the same it true for many SWs etc too.....

    I think that half the problem is that "mental capacity" is such a woolly concept to begin with and many people strive hard to acquiesce (for whatever reason) to the wishes of people with dementia. There is also the problem of fluctuating capacity, so that the same assessor testing the capacity of the same person on different days may get different results. Add to this Host mode and its a mess.

    I dont know what the answer is.
     
  8. Jaded'n'faded

    Jaded'n'faded Registered User

    Jan 23, 2019
    387
    Female
    High Peak
    It's exactly as @canary says.

    Interpretation of the various 'guidelines' seems to be very much a subjective thing. Most people here are familiar with the incredible phenomenon of host/hostess mode that PWDs are able to perform at the most annoying (!) times and know how different it would be had the person been assessed an hour later or earlier.

    The experience (with dementia) that an individual has when making an assessment also counts for a lot. Some seem unable to 'see through' to how the PWD really is. You'd think all dementia professionals would know that when a PWD says, for example, that they want to go 'home' they often don't mean it literally. Yet in my experience, few seem to understand this. For some reason when they interview a PWD they are happy to ignore all the random nonsense the person says, but if they happen to say those 5 little words ('I want to go home'), it's immediately pounced on and taken as completely rational and anything else - even contradictory statements - are then disregarded.

    It's time someone looked at the guidelines/training because currently it's really bad and the rules applied are totally inconsistent.
     
  9. Banjomansmate

    Banjomansmate Registered User

    Jan 13, 2019
    967
    Female
    Dorset
    One of The Banjoman’s Social workers (the best one) was surprised at his “deterioration “ when, at my request, she visited him at home without warning. At last she finally saw him wandering around his flat completely lost, with no idea where the bedroom was and unable to find his clothes or get himself dressed.
    It was already agreed that he “lacked capacity” but the extent had not been recognised because on a previous visit a couple of months earlier he had pulled it together and shown her the kitchen and sounded pretty logical.
     
  10. northumbrian_k

    northumbrian_k Registered User

    Mar 2, 2017
    712
    Male
    Newcastle
    This is an ongoing issue. My wife is pretty much beyond 'hostess mode' these days but can still seem almost OK for a couple of minutes. Then she mentions going to her gran's for tea ... One can only try to assist those who ought to know the signs (the professionals) to see what to us seems blindingly obvious.
     
  11. charlie10

    charlie10 Registered User

    Dec 20, 2018
    287
    I watched this training video from Hounslow and Richmond for their staff.....gave me a better understanding of simplistic their guidelines are when it comes to capacity. Having said that, not sure how they could be more 'investigative' into each case without recruiting thousands more staff. From our point of view it would make sense to rely heavily on family observations, but then you have, sadly, the problem of families exaggerating in order to make the 'problem' go away. Can't see how this is going to get better.....21st Century problems!

     
  12. Grannie G

    Grannie G Volunteer Moderator

    Apr 3, 2006
    69,098
    Kent
    When my husband spent some time in an assessment unit following a psychotic episode his consultant advised me to register the PoA because it was considered he no longer had capacity.
     
  13. Moggymad

    Moggymad Registered User

    May 12, 2017
    336
    Female
    Thanks your posting that video @charlie10. I have never been present when mums capacity has been assessed so it was interesting to watch how it was done in that scenario. Also I help a lady with a learning disability so again it was informative in that respect.
     
  14. charlie10

    charlie10 Registered User

    Dec 20, 2018
    287
    yes I found it interesting to see how 'casual' it seems....makes me very glad I'm not a social worker, would hate to make decisions about someone else's life based on such little interaction. The whole process of assessing capacity seems to be so subjective they might as well toss a coin!
     
  15. anxious annie

    anxious annie Registered User

    Jan 2, 2019
    112
    Hi yorkie46
    I sympathise with you, all you want is to be informed so that you can support your husband, but many of those in authority seem to feel that the pwd is able to take in and understand information , but this is often not the case, even when they are deemed to have capacity.
    The SW and others in authority just accept what mum is saying to them about what she does, when it is really a load of rubbish. I can never understand why this is, they seem , in my opinion to have very little understanding of dementia, or capacity!
     
  16. Palerider

    Palerider Registered User

    Aug 9, 2015
    429
    Male
    North West
    Capacity can be very difficult to assess because of the legal criteria that needs to be met, which itself is dependent on the person assessing it, so it will vary between different professionals in different circumstances and how they apply it. There are however some basic rules:

    1. The person has capacity until proven otherwise
    2. Capacity is decision-dependent (i.e a person may not have capacity to make one decision, but have capacity to make another)
    3. If a person lacks capacity then action must be in their best interests
    4. If a person makes a strange or irrational decision, this does not mean they don't have capacity

    Best interests is another matter having decided a person does not have capacity
     
  17. canary

    canary Registered User

    Feb 25, 2014
    9,867
    Female
    South coast
    All of these things are true @Palerider, but it doesnt actually help you decide whether they really have capacity or not. The rules seem to imply that testing for capacity/incapacity is a separate issue and reminding you what to do bearing it in mind. It doesnt tell you how to decide whether they have capacity or not and that seems to be very subjective.
     
  18. Palerider

    Palerider Registered User

    Aug 9, 2015
    429
    Male
    North West
    I agree. It is in itself a grey area, because we can't see into someone elses mind, we can only observe and weigh-up their responses -which makes it frustrating and creates an element of doubt either way. I'm afraid I don't have an answer on this one.

    How can we know for certain someone has capacity and allow them to make decisions and find later we were wrong and equally how can we know someone doesn't have capacity and make decisions for them and find that we have got that wrong as well? Its a paradox.

    Edited: I forgot to mention that in dementia it is more difficult because pwd can fluctuate. I think it only really becomes a certainty in end stages -I don't know if anyone has any experiences on this?
     
  19. canary

    canary Registered User

    Feb 25, 2014
    9,867
    Female
    South coast
    Indeed.
    I dont know what the answer is either.
     
  20. kindred

    kindred Registered User

    Apr 8, 2018
    2,141
    Yes, those little words, I want to go … When my OH was assessed for capacity in his nursing home (though he must have had loads of other assessments - I mean, how many do you need??), and they asked if he was allowed out to go birdwatching, I interrupted and said, look, he can't stand up and he doesn't know what a bird is … . They hushed me and then K said, I want to go. and the three people there looked at each other, smiled knowingly and leant forward for the rest of the sentence … Fortunately it was … to the toilet ...
    love and best, Kindred.
     

Share This Page

  1. This site uses cookies to help personalise content, tailor your experience and to keep you logged in if you register.
    By continuing to use this site, you are consenting to our use of cookies.
  1. This site uses cookies to help personalise content, tailor your experience and to keep you logged in if you register.
    By continuing to use this site, you are consenting to our use of cookies.