In their editorial examining the pros and cons of different places of living for older people, Bally and Jung considered who enters residential and nursing (care) homes and how care in these settings might be improved.1 Research cited drew attention to factors that have a bearing on quality of life and respecting people’s wishes.2 GPs should be able to identify those who may benefit from a care home,3 but should consider the person’s cognitive abilities, perceptions, and preferences.4 They noted the importance of advance care planning, integrated care models, and individualised care.
We feel that some of these matters should also be considered from a legal and human rights perspective, as care home placements will often have a profound and enduring impact on older people’s liberty, security, and family life — which are fundamental human rights. In England and Wales, the Mental Capacity Act 2005 (MCA) is an essential safeguard in this respect and its provisions are often at the forefront of GPs’ minds when residence capacity assessments and best-interests decisions are being made. Yet widespread evidence suggests that the MCA’s principles are still not ‘embedded’ as well as they should be in clinical practice.5 This is concerning, particularly when a move into care is being considered, given the impact that this will have on an older person’s dignity and human rights. A recent study of patients with dementia discharged from general hospital found that ill-conceived capacity assessments and ‘best interests’ decisions that failed to adhere to the legal (and ethical) standards of the MCA could result in institutional placements being the ‘default position’ for those with questionable capacity.6 The older patients concerned would often fade into the background during these decision-making processes, so their long-standing preferences were not heard.7
GPs with an appropriate understanding of the principles and ethos of the MCA (including the Deprivation of Liberty Safeguards) can be very influential in their ‘patient advocate’ role, when the rights of people whose home — which is so much a part of who we all are — is under scrutiny in relation to their health, care, and wellbeing.
- © British Journal of General Practice 2016
