The Deprivation of Liberty Safeguards assessment
The DoLS assessment makes sure that the care being given to the person with dementia is in the person’s best interests. There are six parts to the assessment: age, mental health, mental capacity, best interests, eligibility and no refusals.
- Deprivation of Liberty Safeguards (DoLS)
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- What happens after a deprivation of liberty is authorised?
- Deprivation of Liberty Safeguards for people in supported living
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Deprivation of Liberty Safeguards
What is the Deprivation of Liberty Safeguards (DoLS) assessment?
The DoLS assessment is a safeguard as it makes sure that the care being given is in the person’s best interests.
An assessment will decide whether the deprivation of liberty is allowed to happen or not. If the assessment decides that it is allowed to happen this is called ‘authorisation’.
If a person with dementia is in a care home or hospital, a DoLS assessment will take place if it is felt that they are being, or will be, deprived of their liberty.
If the person is living in supported living accommodation including their own home, there is a different system for having a deprivation of liberty authorised.
Who can ask for an assessment?
Usually, the care provider (the care home manager or hospital administrator) will ask for a DoLS assessment.
In England, they request the assessment from the local authority (the social services department). In Wales, they ask the local authority to do the assessment of care home residents, but for hospital patients they will ask the local health board.
If you feel that someone is being deprived of their liberty, you should speak to the person in charge of their care.
In hospital this may be a doctor, nurse or administrator, and in care homes it will be the care home manager.
The first step is to talk about whether changes can be made to the way care is provided so that the person’s freedom is not limited. However, if the person in charge of their care believes that limiting the person’s freedom is necessary to keep them safe, they must apply for a deprivation of liberty authorisation.
If they have not got an authorisation, and they do not think that an authorisation is necessary, you should talk to the local authority (or local health board for hospitals in Wales). You should ask them to look into the person’s care arrangements and carry out an assessment, if necessary.
Who carries out the assessment?
DoLS assessments are carried out by at least two professionals. Neither assessor should be involved in the person’s care or in making any other decisions about it.
- the best interests assessor
- the mental health assessor.
They are appointed by the local authority (or health board), who make sure that they have had the correct level of training and experience.
Usually, the best interests assessor is a qualified social worker, nurse, occupational therapist or chartered psychologist.
The mental health assessor must be a doctor (often a psychiatrist) who is able to assess whether a person has a ‘mental disorder’ (the term used in law to describe a set of mental health conditions, including dementia) and how a deprivation of liberty will affect their mental health.
What does the assessment involve?
There are six parts to the assessment. The assessors will decide whether the person and the care that they receive meet the ‘criteria for authorisation’ (the conditions that allow a person to be deprived of their liberty).
The six parts are:
- Age – the person must be aged 18 years or over.
- Mental health – the person must have a ‘mental disorder’ (this includes dementia).
- Mental capacity – the must person lack ‘capacity’ (the ability) to make their own decisions about treatment or care in the place that is applying for the authorisation.
- Best interests – is a deprivation of liberty taking place? If so, it must be:
- in the person’s best interests
- needed to keep the person safe from harm
- a reasonable response to the likelihood of the person suffering harm (including whether there are any less restrictive options and if they are more appropriate).
- Eligibility – the person cannot be already liable to detention under the Mental Health Act 1983, or meet the requirements for detention under this Act. If they are, the Mental Health Act should apply and not DoLS.
- No refusals – the authorisation cannot contradict or conflict with any advance decision the person has made refusing treatment, or with any decisions made by, for example, a court-appointed deputy or someone with Lasting power of attorney.
If the person and the care they receive meet all the criteria, the assessors will report that the deprivation of liberty should be authorised by the local authority or health board.
Usually these assessments happen face-to-face, with the assessors meeting the person with dementia. Due to the coronavirus pandemic, assessments may be carried out virtually (online).
Assessors will look at the person’s medical and care records as well having video or telephone calls to assess the person.
If a face-to-face assessment is not possible, and if the deprivation of liberty is authorised, the review date may sooner than it would have been if the assessment had been carried out face-to-face.
What if the assessors do not allow a deprivation of liberty?
If the assessors decide that the person or the proposed care doesn’t meet the criteria, they will tell the local authority (or local health board) the reasons for their decision. The deprivation of liberty would then not be authorised, and it should not happen.
What happens next will depend on the reasons why the criteria were not met. For example, if the assessment showed that the person has capacity to consent to and make the decision about their care and where they will live, they should be supported to make their own decision. This decision must be followed.
If an assessment failed because it was decided that there are less restrictive options, these options should then be introduced. For example, the care home proposes to lock a person’s bedroom door at night to stop them from walking round the care home and into other residents’ rooms.
An assessment decides that this is not allowed as there are less restrictive options, such as:
- making it possible for the person to stay up later
- having staff on hand to talk to them and encourage them to not enter other people’s bedrooms having an alarm or monitoring system that alerts staff to them leaving their room.
What is an urgent DoLS?
In an emergency, or in situations where there is no time to go through the assessment process, the hospital or care home management can grant themselves an urgent DoLS authorisation.
This is valid for seven days, but they must also apply for the normal DoLS assessment and authorisation at the same time.
If the assessment has not been carried out in the following seven days and the deprivation of liberty is still needed, the urgent DoLS authorisation can be extended for a further seven days.
The definition of what counts as a deprivation of liberty is wide, and so most people with dementia living in care homes and hospitals will receive care that falls under the definition. It is usually necessary to provide care that in some way limits a person’s freedom.
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