When providing person-centred care, individuals are fully involved in the entire planning process of their care, which can be deemed to provide verbal consent. All discussions regarding their care and treatment must be delivered in a sensitive and understandable way and the individual should be provided with enough time to contemplate the information given and to ask any questions they may have. Through engaging with a care worker to create a care plan, they have implied their consent to the process, this is an acceptable way of obtaining consent. Written consent if often required when there is risk involved – such as with surgery. This written consent is kept within an individual’s notes detailing the treatment and care agreed upon written clearly and signed by representative giving the care and the individual. “The actual process of writing up the notes of the consent must be rigorous, accurately recording all discussions and decisions made relating to obtaining consent.” Tilmouth, Tina. Level 5 Diploma in Leadership for Health and Social Care 2nd Edition. Hodder Education.
When carrying out the care planning process it is assumed that the individual has mental capacity to consent or refuse the care and/or treatment on offer, unless there has been a mental capacity assessment which determines that said individual does not have the capacity to make an informed decision. If the individual has been determined to lack the capacity, the decision can be made for them by an advocate, although this must be reflective of their needs and in their own best interest. If mental capacity if unlikely to return the Mental Capacity Act advises the appointment of a trusted individual to act on their behalf. This could be a relative or friend. In an emergency situation, according to the Mental Capacity Act, when an individual requires immediate treatment but is unconscious, any treatment to preserve their life must be performed, unless a DNACPR form is presented.
If an individual with mental capacity refuses treatment or care, this decision should be respected and a record of this should be made. If the individual is mental incapacitated in any way care staff should make a full assessment of their care to ensure that their welfare is safeguarded.
“Deprivation of liberty
In certain cases, the restrictions placed upon a person who lacks capacity may amount to “deprivation of liberty”. This must be judged on a case-by-case basis. Where it appears a deprivation of liberty might happen, the provider of care (usually a hospital or a care home) has to apply to their local authority. They’ll then arrange an assessment of the person’s care and treatment to decide if the deprivation of liberty is in the best interests of the individual concerned. If it is, the local authority will grant a legal authorisation. If it isn’t, the care and treatment package must be changed – otherwise, an unlawful deprivation of liberty will occur. This system is known as the Deprivation of Liberty Safeguards. If you suspect a deprivation of liberty may happen, talk to the care provider and then possibly the local authority.” https://www.nhs.uk/conditions/social-care-and-support/mental-capacity/#finding-the-least-restrictive-option
As a health and social care professional it is my responsibility to ensure that those within my care are provided with adequate care to meet their needs and are safeguarded from harm. Often, it is my responsibly to make small decisions on behalf of individuals whom do not have mental capacity, such as what to dress individuals in, what to give them to eat etc, as an advocate of their care. Larger more serious decisions are always involving the individual’s relatives but smaller decisions are often left to care staff as we are in a trusted position to implement the individuals care, reflective of their care plan and the homes philosophy.
One example of when I implemented a person-centred approach, occurred when an individual was feeling poorly, on inspection staff noticed that the individual had a rash which was making the resident very uncomfortable. The GP was due to do his rounds within the home that day and I asked the individual if they would like to see the GP as they have mental capacity. The individual refused claiming that they “did not want to make a fuss”. I tried to reassure the individual and express my concern for their wellbeing to which they dismissed my opinions. As a care provider, I have a duty of care to safeguard all residents and staff within the home, and I was sure that the individual did not understand the scope of the decision I was presenting to them. I spoke to the GP when he came and encouraged him to visit the poorly individual. The GP confirmed that the individual had Scabies and provided a treatment. When being admitted within the home residents are acknowledging that they require support and on occasion it may be necessary to seek advice on their behalf when they are potentially at risk. If I hadn’t spoken to the GP the individual’s health may have deteriorated or the scabies could have been spread around the home, the incident would have then been reportable as a safeguarding incident and could be seen as neglect. The individual was pleased to receive a treatment and cooperated with this once she was explained what the was suffering with and why.