Assessing The Capacity Of A Person With Dementia Social Work Essay

Assessing The efficiency Of A individual With lunacy Social Work EssayThe aim of this as peculiarityment is to talk of how a favor obligeed prole would assess the ami adequate to(p) electrical force of a attention intentr who has been diagnosed with derangement. This essay leave debate the various meanings of the varied pillowcases of insanity and how their mental health diagnosis affects an individuals exponent to shew definitive terminations in their spicys. This essay will discuss how the Person-Centred Dementia C ar (VIPS) material written by tom Kitwood (1997) is able to guide the br other(a)ly thespian in applying theoretical frameworks and overly by applying Law and assessing the circumstantial capacitor of a soul diagnosed with dementia. This assignment will also discuss how the citizenship, social and medical models differentiate in their watchings and meanings of dementia. When assessing aptitude it is eventful to distinguish what type of efficiency you are assessing. This could involve assessing finiss based on financial issues, lodgment situation, individualal or domestic defy do wants, the ability to assess assay and safety, and also weighing their somatogenetic health care motivatings.The social worker is able to apply the psychological mental object bend 2005 to provide justification and counselor when assessing the military service mathematical functionrs mental aptitude. The social worker will implement their professional individual judgement and accountability as well as work in a multidisciplinary manner and liaise with the GP, headhunter, neurologist, community psychiatric nurse or community mental health team. This would enable the social worker to m other more evidence and reports in determining the mental capacity of the service user. The social worker will assess the mental capacity of a service user diagnosed with dementia through any form of judicial purpose of need i.e. safeg uarding needs, check needs, housing needs and so on It is also meaning(a) to work in anti-discriminatory and anti-oppressive manner when works a giganticside service users.The Alzheimers confederacy (2010) plant that diagnosable dementia occurs in 5% of those aged 65 years and over and in ab bulge a quarter of those aged 85 years. Of those with dementia, 50-60% will arrive Alzheimers disease and a further 10-15% a vascular or multi-infarct dementia. There are more forms of dementias, which include potenti wholey reversible illnesses, much(prenominal) as alcohol-re riped dementia and those due to structural intracranial lesions. Dementia progresses as a very variable illness in the primordial stages patients with dementia bear continue to live at al-Qaida with the punt of family and friends. As the illness progresses, this support needs to be supplemented with tar puffed assistance to address aspects of daily living such(prenominal) as maintaining nutrition, self-care and compliance with medication.Tom Kitwood (1997) was the maiden writer to use the term soulhood in relation to nation with dementia. Kitwood (1997) defined individualhood as a holding status that is topperowed upon human beings, by others, in the scene of relationship and social being, it implies light, admire and depone (Kitwood, 199716). The soul-centred dementia care framework brings together ideas and ways of operative with the lived experience of multitude with dementia that emphasised communication and relationships. (Kitwood 1997 cited Brooker 200714).The soul-centred care involves tetrad major elements, the first being valuing muckle with dementia and those who care for them, promoting their citizenship rights and entitlements regardless of age or cognitive impairmentDrake (199919) assertsCitizenship is more than consumerism, which is where the expression of role is limited to reservation choices or expressing preferences it is virtually equality of oppor tunity and put to work although the fall come to the forecome whitethorn be limited by the abilities of any individual.There are umpteen ways of empathiseing dementia which consist of the medical model, the social progression and the citizenship border on to dementia The citizenship ascend to dementia is a stark naked approach which concentrates on how stack with dementia enkindle help society in terms of political, and social rights, talking part in work, leisure, political debates and unearthly celebration. This approach is based on reciprocity, which is why this is a new evolution as nobody was gestateing somewhat the commonwealth diagnosed with dementia as being able to relieve oneself as well as receive...dementia describes a group of signs which root from the destruction of infrastanding cells. Although dementia is a physical illness, almost of the symptoms and problems ca utilise by the illness enquire psychiatric expertise and care. (Brotchie 2003 p. 2) Dementia affects peoples ability to remember things for more than a few seconds, make sense datum of the world close to them, cope with daily living tasks and express their feelings. different factors which affect people with dementia are being able to think finish uply and solve problems, make plans, unable cope with an over-stimulating environment and befall it difficult to be squander in a popular way.Dementia is cardinal of the main conditions which are a result of mental confusion, memory loss, disorientation, clever impairment, or similar problems. (Mace et al 2006). Brotchie (2003) found that different people whitethorn suffer from different symptoms of dementia, depending on their individualality and their illness which lead to dementia. Brotchie (2003) outlines four most common symptoms of dementia which are memory loss, changes in soulality, problem in communicating and loss of practical skills. Memory loss is practically a sign which occurs earlier and highl ights something is non right, however could be stupid for forgetfulness brought on my stress or feeling low in mood. A someone with dementia whitethorn gradually forget where they are and how to get home in that respectfore emphasising there is a cognitive problem. sight who whitethorn make believe dementia show changes in their personality as people struggle to function with a limited thinking capacity and over-react with unremarkable situations and daily tasks. People who are hit the hay to be calm may become aggressive or abusive, alternatively a person know to be reserved before they became ill may lose all social inhibitions.Changes in peoples behaviour are caused by legal injury to the brain and are not something the person can control or prevent. (Brotchie 2003 p.3)This gaze of damage to the brain as a cause of dementia is back up by the medical model. The medical model concentrates on brain damage and state there evidence by its nature of becoming worsened as tim e goes on. Jacques Jackson (2000 p.4) emphasise the amount of tibbs 2006 p16..damage dementia does to the lives of sufferers and those around them. It poses an enormous challenge to health and social services and to the community as a whole.People diagnosed with dementia may struggle in reservation themselves unders aliked e.g. forgetting the name of simple objects or familiar people. They may also find it difficult to make sense of what is being said to them as a result being unable to carry out instructions. People with dementia may forget things a few minutes afterwards they have been told which is done by mis exhaust and not intentional. Another symptom which may occur with a person who has dementia is having serious problems with carrying out simple tasks such as tying a shoe beef up or doing up a zip, other tasks such as eating, bandaging and washing become more difficult as the illness becomes worse. The majority forms of dementia are irreversible, there are limited di scretionments scarcely the most help a person can get is from their family to plan for the better(p) form of care in the future. It is vital for a doctor at this stage to be involved in the persons care and treatment (Brotchie 2003). Cantley and Bowe (2004) found that there can be other causes for these symptoms which may not be linked to dementia such as a general medical illness, drug toxicity or a life changing event.In the more advanced stages of the illness dependence increases and there is often the need for residential or nursing care. Issues of capacity and consent are all-important(prenominal) at many stages of dementia and ill-temperedly affect financial issues, ability to assess risk and safety, and also finales over physical healthcare (British medical exam linkup (2009). marshall Tibbs (2006) found that the psychical contentedness flirt 2005, which followed the big with Incapacity come 2000, way that we are more able to toss protection in law to adults w ho lose mental capacity, including people diagnosed with dementia. A major change to this law emphasised that presumption against lack of capacity, which means a person is now presumed to be capable of making their hold finales until proved otherwise.The second element from the person-centred framework consists of treating people as individuals winning into rumination their unique personality, physical and mental health, social and economic resources and that these will affect their response to neurological impairment (Brooker 200712). Marshall Tibbs (2006), have coped that this involves the straw man or absence of psychic Capacity, which can be determined by two questions in order for the service user to have the capacity to make the end they should be able to comprehend and adjudge the information which is material to the decision, especially as to the consequences of making or not making the decision in question. It is important for the social worker to don this into analyseation when assessing a person capacity and making a professional judgment. The service user should also be able to use the information and measure it up as part of the process of arriving at a decision (Marshall Tibbs 200634). The social worker should run through into consideration that an individual may retain capacity to make certain decisions such as, the choice of what to eat but, lack the capacity to make serious decisions such as managing their finances i.e. remunerative bills.According to the British medical association (2009) all adults are presume to have mental capacity unless there is evidence to prove this is not the case. There are many factors which can affect a persons capacity temporarily, such as dehydration, infection, medication or fatigue however assumptions around impairment cannot be based on age alone or frailty. It is important for the assessor to talk with the person when they are at their exceed taking in to consideration any physical problem s which could affect their cognitive ability.A wide spectrum of ability is found in people deemed to have impaired competence, including those living with dementia or with learning disabilities. It is important, therefore, to see all(prenominal) person as an individual. Disease or other factors can result in temporary, fluctuating or enduring stupidity. British aesculapian Association (200934).There are issues which need to be addressed before a person is assessed to have capacity or not such as, behavioural or cultural differences which are not indicators of impaired cognition. On the other business deal, decisions which come across as being rash or wrongful are not indictors of impaired cognition either but can lead to the process of a formal judicial decision.It can become clear by talking to a person with dementia if they have commensurate mental capacity to make special(a) decisions however, if this is not clear a GP or psychiatrist are often the topper professionals t o give a view, especially if the person has had previous contact with them. It is vital to earn in these circumstances an assessment cannot be rushed and time should be taken in feeling at the person medical record and the decision for which the person is being assessed. An individuals appearance and behaviour needs to be taken into account e.g. if they suffer from a mood disorder or a mental illness. If a person has suffered from damage to the brain, such as a stroke, this can make verbal communication near unacceptable however it is not necessarily an indicator of write outd mental capacity. Similarly, tenacious term memory loss is not an indicator of reduced mental capacity however being unable to retain information long enough to make a decision would invalidate it. British Medical Association (2009).If a person has to make a serious decision and there is still doubt about their mental capacity it would be advised for a formal assessment to be completed. If a person lacks capacity it is normally possible to assess their ability through conversation, but if they refuse assessment, it cannot proceed unless required by court. If it is clear a person lacks mental capacity and they havent given their consent decisions on their behalf are governed by the genial Capacity Act 2005.According to Br declare Barber (2008), the Mental Capacity Act 2005 begins, in Section 1, by emphasising five chance upon commandments to be followed whenever working within this framework of the Act. These are to work with the person with dementia with the assumption that they have capacity unless it is proved otherwise, not to treat the person as unable to make decision unless all the steps to help them to do so have been unsuccessful. The third principle of the Mental Capacity Act 2005 emphasises not to treat a person as unable to make decisions for themselves just because the person may make an foolish decision and a decision do, under this Act, on the behalf of a person who lacks capacity mustiness be done, or made, their best absorb. The final central principle of the Act isBefore the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can be as upshotively achieved in a way that is less restrictive of the persons rights and exemption of action Br confess Barber (20085-6).The third element of the person-centred approach is looking at the world from the perspective of the person with dementia, recognising that severally persons experience has its own psychological validity, that people with dementia act from this perspective and that empathy with this perspective has its own therapeutic potential (Brooker 200763). The assessment process will consist of many areas that should consider their environment, such as their home and finances many individuals with early dementia retain the capacity to complete an enduring power of lawyer which at a later date can be registered (Brooker 200767). The Me ntal Capacity Act 2005 includes the Lasting indicators of Attorney (section 9-12 and 22-23). A Lasting Power of Attorney in section 9 (1) asa power of attorney under which the donor (P) confers on the done (or donees) authority to make decisions about all or any of the following-Ps personal wellbeing or specified matters contacting Ps personal offbeat, andPs property and affairs or specified matters concerning Ps property and affairs, and which includes authority to make such decisions in circumstances where P no longer has capacity. (Brown Barber 200841).The social worker will also assess safety and risk. Marshall Tibbs (200844) argue as dementia progresses the risk of self neglect, exploitation and wandering may determine a persons ability to live alone, while risks posed to other from driving and misuse of gas appliances may cause great concern still. In this situation the level of this would be too high for that person to continue to live within their home environment due to health and safety reasons. This may result in the use of the Mental health Act 1983 for the purpose of permanent residential modification or 24 hour care by family members or carers.The Mental Capacity Act 2005, Section 2 refers to the diagnostic test which is narrowed down to the utilitarian test in order to identify the smallest area of decision-making to apply for the incapacity test. Further in the Act, Section 3 provides the test which should be used to determine a persons mental capacity on a particular decision e.g. refusal of medication. The Section 3 test is to establish whether a person is able to understand information germane(predicate) to the decision and if they are able to retain to information. The person is also tested of their abilities to use or burden that information as part of the process of making the decision or if they can communicate effectively regarding the decision (by talking, using sign language, or any other way) Brown Barber (2008).According to the Mental Capacity Act 2005, anyone involved in the care or support of a person could have a say in the capacity assessment, which would commonly include, family members, health and social care workers, but most importantly doctors, psychiatrist and psychologists assessments would be crucial. Typically the people who are responsible to carry out capacity assessments are nurse practitioners, social workers, doctors and neuropsychologists (Halton Council 2008).There five reveal principles of the mental capacity act 2005 have to be considered if a professional is to do an assessment with a person diagnosed with dementia. It is important that the social worker begins with the assumption that the person has capacity. It is also important for the social worker to understand a persons appearance or diagnosis is not a sign of a lack of capacity, therefore highlighting the need to document high-fidelity information for considering that a person may not have capacity in relation to a specific decision. The social worker has to consider mental capacity issues throughout the assessment as they would risk and safeguarding issues, noting the specific areas which raise concern. The Mental Capacity Act 2005, Code of Practice statesWhere assessments of capacity relate to day-to-day decisions and caring actions,no formal assessment procedures or recorded documentation will be required.(Davies 20088)The Mental Capacity Act 2005, Code of Practice, gives guidance on when there is a need for a clearly documented assessment. This is where a decision which needs to be made has major consequences, such as a decision to change accommodation or a decision to accept or decline support at home. Another reason for a clearly documented assessment may be if there is a dispute with the person, their family or the care team, as to the capacity of the individual. The person who may need the assessment may be subject to challenge therefore requiring an assessment for capacity or there ma y be legal consequences of finding capacity. (Davies 20089) One main reason for a person to have an assessment for capacity is to reduce the risk the person poses to themselves in terms of preventable suffering or damage (Davies 2008). Not all of these circumstances are exact and require professional judgement and ongoing supervision. Davies (2008) explains in some circumstances the capacity for an individual may be related to a specific decision at a specific point in time therefore, the need for an on-going assessment for capacity may be required.Brown and Barber (2008) discuss the concept best interests in regards to the Mental Capacity Act 2005. The Act 2005 states that one crucial principle is that if a decision is made for or, on the behalf of someone else who lacks capacity must be done, or made in that persons best interest. This principle applies to anyone who is carrying out the responsibility for making the decision such as a family member, paid worker or carer, an attorn ey, a court-appointed delegate or health professionals. Brown and Barber (2008) assert the need for people who have the responsibility for making other peoples decisions, being familiar with the Acts new requirements for the checklist approach. The Mental Capacity Act 2005 new checklist approach is set out to contain common factors which should be measured on every subprogram a decision is to be made. The Law Commission (1995, para 3.28)First, a checklist must not unduly burden any decision-maker or pass on un obligatory intervention secondly it must not be utilize too rigidly and should leave room for all considerations relevant to the particular case thirdly, it should be confined to major points, so that it can adapt to changing views and attitudes.A person who has the responsibility to make decisions on the behalf of someone who lacks capacity should consider the following steps to ensure the best interest of that person. These steps are to firstly encourage participation, w hich is for the person making the decision to do their utmost to encourage and support the person with dementia to take part in making the decision, secondly identify all relevant circumstances, this is to try include all the things the person who lacks capacity would usually take into consideration if they were making the decision themselves. Thirdly, find out the persons views who lacks capacity such as their past, present wishes and feelings, any beliefs and values, and any other factors which the person would usually consider. An important factor is to avoid discrimination and not make statements about a person best interest because of their age, appearance or diagnosis. It is necessary to consider whether the person might regain capacity, if so can the decision wait until then? Finally, the person making the decision should consider if the decision concerns life-sustaining treatment, and should not make assumptions about how the person should or shouldnt live (Falconer 2007). T he Mental Capacity Act 2005 also include consulting others an a find aspect of considering how a person best interest could be figure effectively. If it is appropriate to do so, discuss with other people for their opinions about the persons best interest, as they may have information about the person wishes and feelings. The Mental Capacity Act 2005 state the people that should be consulted areanyone previously named by the person as someone to be consulted on either the decision in question or no similar issues, anyone sedulous in caring for the person, close relative, friends or others who take an interest in the persons welfare, any attorney, and any deputy appointed by the coquet of security measures to make decisions for the person.(Brown and Barber 200834)If the decision is for an important medical treatment and there is no one to confer with then an Independent Mental Capacity Advocate (IMCA) must be consulted. In safeguarding concerns if a person is deemed to have no c apacity involving a specific type of risk and decisions, and family members are deemed inappropriate, it is essential that a IMCA is involved in important safeguarding investigations in providing best interest decisions for the individual.The Independent Mental Capacity (IMCA) Service was a late initiative to the Mental Capacity Act 2005, and has been available since October 2007. Section 35 of the Mental Capacity Act 2005 highlights the main purpose of IMCA , which is to support and stand for the person concerned, to establish their wishes and feelings and to monitor that the Acts principles and the checklist are being met.The Mental Capacity Act 2005, highlights that a decision-maker does more than making a decision on someone behalf who lacks capacity, but also ensures the persons human rights are met. The Mental wellness Act 1983 has a process whereby they are able to detain people who are mentally disordered which in specific circumstances would be an appropriate response, howe ver the Mental Capacity Act 2005 have a different approach seeing restraint as deprivation of liberty. When a person is said to lack capacity it is difficult for them to decide about being in a particular place and is in effect deprived of their liberty, and there are several options which could be taken dental plate down the level of restrictions to what would be seen as a restriction of motion rather than a deprivation of libertyarrange an assessment under the Mental Health Act with a view to using its powersmake an application to the Court of Protection to make a personal welfare decisionsfollow the new Bournewood procedureconsider short-term or parking brake use of common law powers.(Brown Barber 2008 p.39)The Bournewood Judgement involved an NHS trust to remove an autistic man unable to speak and limited sagacity from a day centre to an in-patient unit without his consent. In 2004, the European Court of Human Rights upheld the families view that detention under the Common L aw of an unable(predicate) patient using the best interest argument was unlawful because it was too arbitrary (Marshall Tibbs 200643). If people are to be deprived of their liberty, there must be some lawful justification and some safeguards. For patients with mental illness, use of mental health legislation should be considered if the patients meet the statutory requirements. The Bournwood brain marked a significant step forwards in the recognition of the rights of incompetent individuals (British Medical Association 200987). It also enforced to the empowerment and rights of older people with impaired capacity.The fourth element of person-centred care is proving a adjunct social environment, recognising that all human life is grounded in relationships and that people with dementia need an enriched social environment which both compensates for their impairment and fosters opportunities for personal branch (Brooker 200783). This is view of considering the social environment of a person with dementia is support by the social model as it is based upon a person environment and social circumstance, considering dementia as an impairment which results in a person becoming unable to function as a normal person. This is a positive outlook on dementia as it can adopt a rehabilitation approach allowing chance for change and making the experience of dementia a better one, whereas, on the other hand the medical model which argues otherwise which is often a pessimistic view. Marshall Tibbs (2006) book expands the concepts of rehabilitation to include teamwork, working with families, prostheses, removing causes of excess disability, learning motivation and focusing on what the main problem is which needs to be addressed.Whilst working with older people social workers must remember to work in an anti-discriminatory and anti-oppressive manner at all stages, such as, an assessment, planning and intervention. The person-centred framework enables a social worker who works alongside people diagnosed with dementia to understand there medical conditions and to provide a package of care at a deeper level and to provide them with many opportunities in leading a valued and fulfilling life.These standards are underpinned by values and ethics that must support the development and delivery of practice. These include a social worker demonstrating respect for an individual, maintaining trust and maintaining confidentiality. Other values consist of understanding and making use of strategies to challenge discrimination, disadvantage and other forms of inequality and injustice (Crawford Walker 2009). butler Lewis (1973 p.30) argueAgeism can be seen as a process of systematic stereotyping of and discrimination against people because they are old, just as racialism and sexism accomplish this for skin colour and gender.Crawford Walker (2009) argue that working with in older people may include people who are vulnerable, who may be oppressed and disadvantaged howeve r, each person is individual and have their process of getting older (Crawford Walker, 200934) therefore it is important to treat each person individually. Whilst working with older people it is essential to consider a whole range of issues such as demonstrating awareness of the legal, policy, and political context of the work being completed, combined with an in-depth understanding of the experiences of that older person in their specific situation. The social worker must be attentive to potentially abusive situations, whilst at the same time working in a multidisciplinary manner with other relevant professionals and organisations. Social workers must work towards growing a holistic approach to assist their practice in working with older people as it allows them to take into account the persons situation in society and the values and ethics of social work.Overall the main principle to assess a person diagnosed with dementia is to remember to assume the person has capacity if prov ed otherwise. Once an assessment is completed and the appropriate professionals are consulted and it is deemed that the person is deemed to lack capacity then it is vital to work towards the person best interest ensuring them of their human rights. This is done by using the checklist approach ensuring all the factors are covered before a decision is made. The person who has the responsibility for make the decision on someone behalf could be a professional, family relative, Power of Attorney or an Independent Mental Capacity Advocate. all in all these issues must be considered whilst working with someone who lacks capacity. It is crucial when assessing and determining a persons mental capacity to take into consideration all aspects of the persons life, health and important decisions that require to be made. It is also essential that the social worker has to take into consideration that a mental capacity is based on a specific aspect of a persons capacity for example managing finance s, housing etc.Word Count 4,740