If someone diagnosed with dementia and under the MCA/DoLs act has been doubly incontinent but refuses a bath, can I give them a bath anyway?

Answered by Sheila Scott

Dear Catherine,

Thank you for your question.

You need to carry out a Mental Capacity Act assessment. This is straightforward and is something you should be familiar with. I cannot stress enough that you must carry out the assessment and record the outcome of the assessment. You will know that the assessment is the same in all cases:

The test for assessing mental capacity is in two stages.

Stage 1

In order to decide whether an individual has the mental capacity to make a particular decision, you must first decide whether there is an impairment of, or disturbance in, the functioning of the person’s mind or brain (it does not matter if this is permanent or temporary).

If so, the second question you must answer is does the impairment or disturbance make the person unable to make the particular decision?

Stage 2

A person is unable to make a specific decision if they cannot:

1 Understand the information relevant to that decision, including understanding the likely consequences of making, or not making the decision.

2 Retain that information.

3 Use or weigh that information as part of the process of making the decision.

4 Communicate their decision (whether by talking, using sign language or any other means).

You will find more information about carrying out an assessment and Best Interest decisions in the guidance document: “Making decisions A guide for people who work in health and social care” which you can find here:

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/348440/OPG603-Health-care-workers-MCA-decisions.pdf

If having carried out this assessment you decide that the individual does not have capacity to make this particular decision then you should carry out a best interests decision to decide what is the best interests of the individual. You should consult at this stage any family or friends of the individual any health professionals such as the GP. The multidisciplinary meeting should negotiate and agree what the best strategies should be. Its also important to review and if the strategies don’t work, whether the adult safeguarding team need to be involved. All of this needs to be properly documented and in detail. Obviously this takes time and its important the person is supported with their hygiene so spending time to understand what they will agree to is an important part of this process.

I hope this is helpful

Sheila