Mrs. Lloyd* was very unwell when she was admitted to a care home.
Due to her progressive dementia, she had been forgetting to eat and drink or keep warm. She was dehydrated, incontinent and very underweight, and had both a urinary tract infection and several infected toes. She was very anxious and confused. This anxiety made her unable to concentrate on anything people were saying to her because she was always ‘het up’ and worried by compulsive thoughts that she was in danger of being robbed or scammed.
She did not have the mental capacity to consent to admission. A best interests decision about the care home was made by her social worker, after consulting with Mrs. Lloyd’s sons, and exploring Mrs. Lloyd’s present and past wishes and feelings about where she would like to live.
Six weeks later
The social worker and Mrs. Lloyd’s sons came to the care home for a review of her care plan. They were all amazed at how well she looked. A report from the GP outlined how her infections had been treated successfully, and the manager explained how staff recorded Mrs. Lloyd’s eating and drinking and encouraged her to eat and drink enough, by offering her some favourite treats, such as hot chocolate and scrambled eggs on toast.
The manager explained that the staff had found out from Mrs. Lloyd’s relatives and friends about her likes and dislikes: staff had learned that her relatives had found that personal care was much less stressful for Mrs. Lloyd if the workers sang to her, and started by washing her face and hands very gently.
Capacity can improve with good care
Mrs. Lloyd is still living with her dementia. But she’s able to make far more of her own decisions. For example, she is no longer incontinent, as long as staff ask her at intervals whether she needs the toilet. She goes out to lunch with her sons and is enjoying the garden, although she no longer remembers the names of the plants.
A major change is that there is no reason to think Mrs. Lloyd now lacks the capacity to decide where to live. She has decided to stay in the care home, since she’s made friends there and knows that her forgetfulness would lead to her being again unwell and frightened, without care.
She was very pleased to be invited to lead the discussions on her care plan, and has given her consent to live in the care home. She signed the care plan, which outlines how she is to be supported to remain as independent and mobile as possible. But she set one condition for staying: ‘Stop giving me hot chocolate – you all think it’s my favourite drink but I’ve got sick of it!’
*All names are changed to protect confidentiality