Case Studies / IMCA Client J

IMCA Client J

J was a hospital patient after being admitted due to a stomach problem. Whilst in hospital he was deemed to lack capacity to make a decision regarding his discharge and IMCA was instructed in relation to a Long Term Move of Accommodation decision.

Barriers faced in being heard:

The IMCA attended the ward and spoke to both staff and J. The IMCA also accessed J’s hospital file and noted that the capacity assessment completed did not state that J had any impairment of the mind or brain. The IMCA raised this in the Best Interest Meeting and highlighted that this could not be considered to be a valid Capacity Assessment as the ‘two stage test’ had not been followed correctly.

J was deprived of his liberty on the ward and was expressing a wish to return home. When the IMCA initially attended the ward, no application for a DoLS authorisation had been made. The IMCA reminded the ward of the ‘Acid Test’ set out in the Cheshire West Judgement and an application was made by the ward staff.

After it was established that J lacked capacity to make a decision regarding discharge home, following a CT scan and a formal diagnosis of vascular dementia, the IMCA attended a further Best Interest Meeting to represent J’s wishes to return to home. J was very firm and consistent in his wishes and did not wish to consider living in any other setting. The hospital raised concerns around this and did not feel that it would be safe for J to be discharged home.

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Advocacy undertaken:

  • The IMCA ensured that the best interest process was followed correctly and that no decisions were made on behalf of J without it first being established that he lacked capacity.
  • The IMCA ensured that J had access to his legal rights by ensuring that the ward had applied for a DoLS authorisation to be in place. The IMCA also reminded the MDT that as J was objecting to being on the ward, the RPR would have a mandate to instruct a solicitor on his behalf to challenge the DoLS authorisation.
  • The IMCA ensured that J’s wishes and views were at the forefront of the decision making process. The IMCA informed the MDT of J’s legal rights and challenged the discharge options discussed, questioning whether they were the least restrictive option.

Outcomes:

On meeting J on the ward, it appeared that a lot of the clothes he had were dirty and he required new clothes. The IMCA raised this with his appointed Social Worker, who was able to carry out a home visit to get him some new clean clothes. Unfortunately, J did not have many clothes at home, so a decision was made by the Social Worker to go out and buy him some new clothes. J was very grateful for this and was able to maintain his dignity.

The IMCA asked the Social Worker whether J had capacity to manage his finances, and if not, what legal framework would be in place to safeguard him. The Social Worker carried out a capacity assessment in relation to management of finances and it was deemed that J lacked capacity in this area. There is now an application to the Court of Protection being made for a deputyship order to be put in place in order to ensure that J’s finances are safeguarded.

J was discharged back to his home with a package of care, and access to a local day centre. The IMCA attended a review meeting for J following the best interest decision being made to discharge J to his own home.

The IMCA was informed that J is thriving at home with a package of care and access to a daycentre.