What happens after a deprivation of liberty is authorised?
After a deprivation of liberty has been authorised there are still important safeguards to make sure they are protected, including appointing a representative. The authorisation should have an end date and it can be reviewed at any time.
- Deprivation of Liberty Safeguards (DoLS)
- The Deprivation of Liberty Safeguards assessment
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- Deprivation of Liberty Safeguards for people in supported living
- Deprivation of Liberty Safeguards (DoLS) - useful organisations
Deprivation of Liberty Safeguards
If a deprivation of liberty has been allowed by the local authority or local health board, this is called ‘authorisation’. The person with dementia is said to be ‘under DoLS’.
Even after authorisation, there are still important safeguards to make sure that they are protected.
What does the ‘relevant person’s representative’ mean?
If a person’s care is approved following a DoLS assessment, they must have a representative appointed. This person is known as the ‘relevant person’s representative’.
The local authority or health board will usually talk to and mention this representative (often a family member, friend or other carer) during the best interests assessment.
Who appoints the representative?
The local authority or health board must choose a paid representative if the person with dementia doesn’t have an available or suitable relative or friend able to take on this role. This paid representative will be trained and experienced and will act for the person. They might work for a local advocacy organisation.
What does the representative do?
A representative’s role is to stay in contact with the person with dementia.
They should check if the person’s care arrangements change, be given access to documents about decisions, and ask for a review of an assessment decision, if necessary.
The representative can also appeal against the DoLS authorisation, and should do so where the person under DoLS disagrees with it, even if they themselves do not.
Example of a person appealing against a DoLS authorisation:
Fatima’s partner, Mary is rushed into hospital following a fall. Staff at the hospital are concerned that Mary’s medical records show that she has recently lost weight and has some pressure sores. They feel this is the result of her memory problems caused by dementia and the difficulty in getting enough care at home. They suggest that when she is discharged, she moves into a care home.
Fatima doesn’t agree with the decision and makes this clear when informed of the discharge plans. However, she is not able to show how she could help Mary get the care she needs. Mary does not have the capacity to make the decision about moving into a care home but makes it clear that she does not want this to happen. Despite the fact that both Fatima and her partner are against the idea, it is decided that she should be discharged into a local care home.
At the care home, a DoLS assessment is carried out because Mary’s care means that she is under continuous supervision and control by staff – they decide on her daily activities and routine, keep an eye on her and provide her with all her care and support. It is clear that if she was to try to leave, they would stop her.
Fatima is appointed as her partner’s representative, and she visits her a couple of times each week. Mary tells her during these visits that she wishes to return home, and Fatima wonders what she can do. She speaks to staff at the care home who tell her that due to the DoLS authorisation her partner cannot return home. Fatima feels that the care Mary receives is disproportionate. She has now arranged to have home care workers to help her, and hopes Mary could return home with this better support.
Fatima gets some help from the local independent mental capacity advocate (IMCA) who helps her appeal against the DoLS authorisation. As a result, it is decided that Mary can return home as long as the right level of care and support is provided for her. So her support plan includes, for example, assistance with skin care and with eating and drinking.
Fatima is given help to get the home care workers ready to come in to help Mary as soon as she is ready to leave the care home.
How should the representative be supported?
The representative should be kept informed about the person’s care and treatment and any changes to it.
The local authority or local health board should work together with the care home or hospital to make sure that both the person and their representative understand the DoLS process and know their rights.
If a representative needs support, they can ask to talk to an independent mental capacity advocate (IMCA). The local authority can signpost the representative to the local IMCA service.
Care home visiting during the pandemic
Due to the coronavirus pandemic, it may not be easy or even possible to visit someone in a care home or hospital.
The person’s representative should speak to the care home or hospital staff. The representative carries out an important safeguard for the person with dementia, and this should be allowed to continue.
The care home or hospital should enable video or telephone calls if the representative is not allowed to visit.
How long is the DoLS authorisation allowed for?
A DoLS authorisation should be for as short a time as possible, and only up to a maximum of 12 months. Each DoLS authorisation will mention its end date. However, during this time both the care provider and local authority (or health board) should:
- make regular checks to see if the authorisation is still needed
- remove the authorisation when it is no longer needed
- provide the person’s representative with information about their care and treatment.
What does a review of DoLS authorisation involve?
A review of a deprivation of liberty authorisation is a formal process to decide whether the care that deprives someone of their liberty is still needed. This can take place at any time and doesn’t have to be at the end of the authorised period.
It is up to the care home or hospital to make regular checks to see if the authorisation is still needed, and they must let the local authority or local health board know if circumstances change.
This means that a review should take place if there is a change in circumstances, and also if it is felt that the criteria are no longer met. If the deprivation is no longer in someone’s best interests, or if it is not managed in the least restrictive way, then this should be looked at again in a review.
The person under the authorisation, their representative or IMCA, can request a review if the situation has changed. The local authority or local health board is responsible for carrying out the review and must make sure that everyone is kept up to date and involved during the review.
Read an example of someone asking for a review:
Susan’s dad, Mitch, has been in a care home for just over five months. He moved into the care home after a fall at home, when he broke his leg and there were further complications.
Due to his vascular dementia, he lacked capacity to consent to his care. It was felt that the care home was the best place for him following discharge from hospital, as it could provide him with full-time care and support.
Mitch kept trying to get up and walk about, so staff used various distraction techniques, as well as installing bedrails following the advice of the physiotherapist, to prevent him from trying to walk on his broken leg and causing more complications. As this was depriving him of his liberty, a DoLS assessment was carried out and the deprivation of liberty was authorised.
The review date on the order was set at 12 months, however after five months Susan decides that the authorisation should be looked at because her dad is now able to put some weight back on his leg and other problems have been resolved. As a result, she feels the bedrails are no longer needed and he is being caused unnecessary distress.
She speaks to staff at the care home, who tell her that because the DoLS order is valid for a full year, they are allowed to continue to use the rails and to stop him from moving about or leaving the care home.
Susan is her dad’s representative, so she is able to ask the local authority for a review. They agree to carry out a review, and as a result, her dad’s care is changed. Though he is still under a DoLS order because he is supervised by staff and is not allowed to leave the care home, changes have been made to his care. The bedrails are removed and he has been given more freedom to walk about the care home and the gardens with some help from a walking frame.
After a few more weeks, Mitch is able to move back to live with Susan as she has always wanted.
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