Latest news stories and opinions about the Dental, GP and Care Industries. For your ease of use, we have established categories under which you can source the relevant articles and news items.
What do care homes have to do when they believe someone is being deprived of their liberty? They need to get this authorised. This is serious business – depriving someone of their liberty without authorisation would be against the law, it would be in contravention of peoples’ basic rights, and would be a serious failure in terms of care by any residential care home doing it. Now I’ve written before on a number of occasions about things to think about in terms of whether someone is being deprived of their liberty. In this article I want to try and outline a step by step guide in terms of statutory requirements on care and nursing home providers when they think someone in their care is being deprived of their liberty.
Managing authority and Supervisory body
First of all a couple of pieces of terminology – for the purposes of the law on the Deprivation of Liberty safeguards (DOLS), care homes and nursing homes or hospitals are called managing authorities. When they apply for an authorisation of a deprivation of liberty they apply to a supervisory body (that is a local authority when we are talking about care homes or nursing homes or to an NHS commissioning organisation where the person is in a hospital.) An easy way to remember whether you are a managing authority or a supervisory body is to think – ‘I’m managing a care home, therefore I’m the managing authority!’ So what are the responsibilities of the managing authority – if that’s you! A good reference guide to this is the Deprivation of Liberty Safeguards Code of Practice (available at: http://webarchive.nationalarchives.gov.uk).
Here you will find at the back of the Code a checklist and key points for care homes and some useful flowcharts to guide you through the process. So let’s go through the process.
- Do you have to apply for a DOL? Firstly decide whether it is necessary to apply for an authorisation to deprive someone of their liberty. Before you do that you have to believe the person lacks the mental capacity to decide where they should live, and that it is in the person’s best interest to be deprived of their liberty. Now you can take a step back from this if it is possible – and that is try and remove restrictions so that the person is no longer deprived of their liberty. Now remember you’ve still to be acting in the person’s best interest. You need to be working within a framework of care planning with others involved in the residents care and if by doing so you can ensure their safe and effective care without depriving them of their liberty – do it, it’s good practice!
- Applying in advance: Let’s say you can’t avoid depriving someone of their liberty. In this case you should apply for an authorisation to the supervisory body. In fact you should be applying for the authorisationbefore you have deprived the person of their liberty. This is not a straightforward decision. You will be needing to make a judgement before someone moves into a care home, or before you implement further restrictions on someone that might mean they would be deprived of their liberty.
- What if it’s already too late: So what happens if you decide that someone in your care is already being deprived of their liberty or you immediately need to deprive someone of their liberty? In this case you should get an urgent authorisation which can last for 7 days and then extended if necessary. (Non-urgent authorisations are called standard authorisations). A care home can give itself an urgent authorisation and there is a form for recording this and reporting this to the supervisory body. This is not a quick alternative to a standard authorisation. If you’ve granted yourself an urgent authorisation, you should at the same time be applying for a standard authorisation.
- Complying with the conditions: If following an application for a standard authorisation the supervisory body agrees to authorise the deprivation, there may be conditions attached and you need to ensure you are following these. Remember the DOLS process gives you permission to deprive someone of their liberty, it does not say you have got to keep the person deprived of their liberty at all times. It may be you find you can remove some restrictions and the deprivation is not necessary. Review of the DOL should be an ongoing process.
- Ensuring representation: One of the features of the Deprivation of Liberty Safeguards is that if a DOL is authorised, someone called the relevant person’s representative (usually a relative) must be appointed to look after the person’s interest. The managing authority (the care home) should make sure they are keeping in regular contact with the resident.
- Review and renew: Once the authorisation is in place that is not the end of the matter – in many ways it is the start. It should be reviewed before it is due to end – make a note of how long the authorisation lasts, this will be a maximum of 12 months but it could be a lot less. This should be done as part of the care planning process so that you can decide whether the authorisation is still necessary, and whether it is still in the best interest of the person.
- No blanket authorisations: Remember this is a process about the individual needs of the residents. You are not seeking authorisation for a deprivation of liberty order for your whole care home. That is a decision based on each individual. It is dependent on the restrictions placed on the individual and whether these are justified in terms of the person’s best interests and whether they amount to a deprivation of liberty.
- Recording is key: Keep records up-to-date because times and dates are critical, particularly in the case of urgent authorisations.
I’ve written all of this without defining what constitutes a lack of capacity, what is in someone’s best interest, and what is a deprivation of liberty! Well I’ve written about these before and will no doubt do so again!
David Beckingham – QCS Expert Mental Health Contributor