Understanding mental capacity
Understanding mental capacity

Start this free course now. Just create an account and sign in. Enrol and complete the course for a free statement of participation or digital badge if available.

1.2 Balancing risk with well-being

Graham (2016) argues that mental capacity legislation is increasingly used for its safeguarding measures, ‘inasmuch that people are often assessed in relation to health and social care outcomes when elements of risk to the person are deemed to be present … the ability to make a decision is a central tenet to well-being in older adults’ (Graham, 2016, p. 152). This suggests that, in the care of older people who may lack mental capacity, safety is commonly prioritised over personal preferences and choices, especially when they want to make what may seem to be an unwise decision.

The person assessing the capacity of the older person to make a decision must make sure that disagreeing with the person’s choice is not interpreted as meaning that the person lacks capacity. A balance must be struck between what may be in a person’s best interests, especially in terms of their safety, and allowing the person to make their own decision. 

One important part of undertaking a capacity assessment of an older person is to understand the narrative about how they have lived their lives. The unique ‘story’ for each person contains clues that give both context to their current choices and evidence of previous decision making. It can reveal what they think contributed to their well-being in the past.

Mental capacity legislation incorporates and celebrates these person-centred approaches, but in the daily realities of providing care, especially when a person’s mental capacity is generally poor or fluctuates (as is commonly the case with dementia), sometimes the ‘person’ themselves can become lost. This is a particular risk in residential care, where the many organisational and administrative tasks demanded of staff can divert attention away from person-centred relationships. You see a glimpse of this in the next activity. 

Activity 2 Capacity in residential dementia care

Timing: Allow about 30 minutes

Watch the video below which is a clip from the 2009 BBC series Can Gerry Robinson Fix Dementia Care Homes?

In the video, Gerry Robinson – a management guru with a wealth of business experience – visits a residential care home for older people with dementia in Torquay. Gerry attempts to engage with the residents but is alarmed to find that the range of activities in the home is very limited and apparently driven more by institutional routines than the expressed choices of the residents. 

Download this video clip.Video player: The lack of activity in residential care for older people
Copy this transcript to the clipboard
Print this transcript
Show transcript|Hide transcript
The lack of activity in residential care for older people
Interactive feature not available in single page view (see it in standard view).

List the ways in which it might be possible to engage more successfully with the residents in this home. Try to think of ways of ensuring that any decisions are based on the best possible opportunity for residents to express their views and wishes. Make notes in the box below.

To use this interactive functionality a free OU account is required. Sign in or register.
Interactive feature not available in single page view (see it in standard view).

Now watch the video below, another clip from the same series, which gives a more positive picture.

Download this video clip.Video player: Residential care for older people: some positive experiences.
Copy this transcript to the clipboard
Print this transcript
Show transcript|Hide transcript
Residential care for older people: some positive experiences.
Interactive feature not available in single page view (see it in standard view).

How might the care arrangements in this home make it easier to make a more accurate assessment of the capacity of the older people compared to those in the first video? Make notes in the box below.

To use this interactive functionality a free OU account is required. Sign in or register.
Interactive feature not available in single page view (see it in standard view).

Comment

In the first video, the residents have very little to occupy themselves and are not very engaged with either the staff or each other. Gerry Robinson hinted that this might be related to the institutional need to prioritise safety above the quality of people’s lives. The staff may also not be aware of the variety and richness of the backgrounds of the residents, which makes it even harder for the staff to engage with them.

The exception seems to be Daisy, shown at the beginning of the second video. Daisy’s husband Don maintains substantial daily care and commitment, keeping her connected and contented. The residential home in Warwickshire, in contrast to the first home, showed staff and residents collaborating to run the home together, providing structure and ‘order’ reflecting the needs and rhythms of the residents, rather than of the managers and staff. This makes good business sense as well as emotional sense, creating a place where residents and staff want to be. 

In the next section, you will consider more particularly issues of decision making and older people.

Take your learning further

Making the decision to study can be a big step, which is why you'll want a trusted University. The Open University has 50 years’ experience delivering flexible learning and 170,000 students are studying with us right now. Take a look at all Open University courses.

If you are new to University-level study, we offer two introductory routes to our qualifications. You could either choose to start with an Access module, or a module which allows you to count your previous learning towards an Open University qualification. Read our guide on Where to take your learning next for more information.

Not ready for formal University study? Then browse over 1000 free courses on OpenLearn and sign up to our newsletter to hear about new free courses as they are released.

Every year, thousands of students decide to study with The Open University. With over 120 qualifications, we’ve got the right course for you.

Request an Open University prospectus371