Explain why it is important not to assume that an individual with dementia cannot make their own decisions

Under mental capacity act we must assume capacity. We also need to identify ‘unwise decision’ and prove ‘unwise decision’. Therefore, it is a legal requirement to assume an individual has capacity to make own decision. An individual with dementia can make their own decision if appropriate support is provided. An individual with dementia can make decision about their everyday choices which are not complex with or without support. We know different types of dementia affects different types of ability in the different stage. At the primary stage, an individual may make own decision with or without any support. At later stage, they may need more support to make decisions such as advocate, relatives, carer and adaptive technologies.

However, as a professional, we must not work on assumption, notion, beliefs, thoughts and hearsay.

Md Foisal Miah Talukdar

Describe how the ability of an individual with dementia to make decisions may fluctuate

Dementia is a set of symptoms and different types of dementia affects individual’s ability differently. Individual with dementia may be able to make decisions about everyday choices and preferences, but an individual may find very hard to making any complex decision, as they may not be able to understand and retain the information to make right decision. However, ability of an individual depends on types and stages of dementia.

Individuals with vascular dementia may suffer from memory problems (such as recalling recent or past events) and problems concentrating due to slower thought. They may not be able to speak very fluent or not be able to speak at all. Giving consent and taking decision may become very difficult for them. In early onset of the symptoms they may be able to make decisions without any interruption.

Individuals with fronto-temporal dementia can exhibit inappropriate behaviour or ruthless comments to others. Due to their behaviour and lack of empathy to others, decisions taken by them may not be legible for the purpose.

Individuals suffering from dementia with lewy-bodies may have disorganised speech or struggle with planning and decision making.

It is very important to understand that at the beginning of the symptoms of dementia, an individual can make own decisions and plan for their own care ahead even with little help and support. At later stage, it is almost impossible for them to make any decision or contribute to it at all.

Md Foisal Miah Talukdar

Demonstrate that the best interests of an individual with dementia are considered when planning and delivering care and support

One of the legal requirement for delivering care and support is person centred care. Therefore, all providers must create a person centred care plan for each individual they provide care and support. It must meet individual’s choices and preferences and be planned with the individual. However, when we create person centred care plan for an individual with dementia, it is not always possible to determine or establish their choices and preferences due to their memory impairment, poor mobility, medical conditions, poor judgement and inability to retain information and take decision. If choices and preferences of an individual with dementia cannot be readily established then we must take decision considering individual’s best interests. Best interests decisions are usually taken in the presence of various professionals (depending on the specific decision), individual and family members after assessing all the available information.

Example: One of the individual with dementia would like to go out himself for shopping. Due to individual’s forgetfulness and other associate behaviour, it is not suggested to let him go for shopping on his own.

Best interests decision: After reviewing all the available information and taking into account of individual’s and public’s health and safety, it is being decided that we can introduce online shopping to the individual. If it still does not fulfil individual’s preferences then one carer can escort him to do the shopping.

Md Foisal Miah Talukdar

Explain how and when personal information may be shared with carers and others, taking into account legislative frameworks and agreed ways of working

Data protection act 1998 states that individuals’ personal and sensitive information must be kept safe and secure and we must not share personal information without individuals’ consent. Therefore, we must obtain individuals’ consent prior to sharing their personal information. Internal policies and procedures put restrictions on who we can share with and what information we can share which can refer to legislation wording ‘need to know’ and ‘right to know’.

In any emergency situation where individuals’ life is at risk, we can share personal information with the appropriate authority that need to know such information to save individuals lives. An organisation has express powers and obligations to share information with only named organisation for certain purpose. You can share individual’s personal information with carers and other professionals such as GP, hospitals, physiotherapists, nurses, mental health nurse, social service, only to improve the individual’s health and wellbeing. The personal data can be shared only with other agreed professionals in order to improve individual’s health and wellbeing. Data also can be shared to prevent crime and identifying criminals with appropriate authority and we do not need to obtain consent for that.

In order to share individual’s personal data we must follow organisation’s policies and procedures on how to share such information. Few standards are described below –

·         Make sure person seeking information has right to know

·         Determine the purpose (it must be beneficial to the individual)

·         Make sure person seeking information is a real and right person

·         Ask the person to make a written request

·         Use encrypted mail server to exchange personal data    
·         In the event of any doubt, you must contact organisation's information security officer

Md Foisal Miah Talukdar

Explain how the likelihood of abuse may be reduced by supporting individuals with awareness of personal safety ?

Many individuals are unaware of the form of abuse and how may they become victim of one. Awareness of personal safety is very important as it can protect individuals from the likelihood of abuse. Awareness of personal safety involves informing individual form of abuse and how they can recognise and protect them. If an individual is aware of all forms of abuse then they can recognise them easily. They will also be aware of how they best can protect them in the event of abuse. Being aware of individuals’ personal safety can increase their self-esteem, which can support them to deal with any kind of potential violence and abuse easily.

·        Individuals are aware of and can recognise all forms of potential abuse

·        Individuals are prepared to deal with this kind of situation prior to any incidence

·        Individuals will know the action they need to take regarding any form abuse or potential    abuse

·        They will also know how they can protect them including techniques to prevention

·        They will also be aware of their legal rights and duties

Md Foisal Miah Talukdar

Evaluate agreed ways of working that relate to rights and choices of an individual with dementia

One of the agreed ways of working is safeguarding adults which relates to rights and choices of an individual with dementia. Every individual has right to be safe from harm and abuse regardless their physical and mental conditions. Therefore, we require to record and report any concern or abuse we observe or come across. Individual with dementia can be subject of abuse or become an abuser very easily as they have lack of mental capacity, poor judgement, poor mobility, disorientation and anger. Therefore, we must take reasonable action according to policies and procedures to promote and maintain rights and choices of an individual with dementia. An example is given below for you to understand better -

Example:

An individual with dementia always choose not to have any personal care. It is the individual’s choice which must be respected. Similarly, you have to consider your duty of care. Your duty of care is what action have you taken or technique you have approached to persuade the individual to maintain personal care. Recording individual’s refusal in provided form is not enough to prevent individual from being self-neglect. You must record what you have done to persuade or to make agree the individual including different time, different person, family meetings or involvement, who did you report and what is the outcome. 

 Md Foisal Miah Talukdar

Explain the meaning of ‘valid consent’

In legal terms, valid consent to care or treatment has three requirements:

·         The individual has the legal capacity and competence to give consent

·         The consent is the free expression of individual’s own accord (not obligated, bounded or pressurised by all means)

·         The consent must be based on sufficient information being provided, and all other advantage and disadvantage are being explained to the individual 

By Md Foisal Miah Talukdar