The following examples show situations where DoLS could be put in place, reviewed and challenged.
Deprivation of Liberty Safeguards and moving into care
Brenda lives at home with her husband. Since being diagnosed with Alzheimer’s disease, Brenda has found that she needs more care and support at home. As time goes by she becomes unable to make her own decisions about her care and where she will live to receive that care.
Her husband feels that she now needs more care and support than he can offer and that she may need full-time care. He arranges for the local authority to come out and assess her care needs, and the social worker agrees that she needs full-time care.
The next steps are to arrange the move into a care home, and the social worker explains that there will be a Deprivation of Liberty Safeguards assessment. This is needed as Brenda lacks capacity to make the choice to move into a care home, and so by moving there she will be deprived of her liberty. This is because her care needs mean that she will be under continuous supervision and control by staff and she will not be allowed to leave the care home.
Two assessors come out to assess Brenda and the proposed care she will receive. As part of this process they speak to her husband about his feelings on the proposed care. They agree that depriving Brenda of her freedom in this way is the right thing to do for her, and so this deprivation of liberty is authorised by the local authority. Brenda then moves to the care home, and her husband is appointed as her representative.
Asking for a review
Susan’s dad has been in a care home for just over five months. He originally moved into the care home following a fall at home in which he broke his ankle. 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 they could provide him with full-time care and support.
As he kept trying to get up and walk about, staff used various distraction techniques, as well as installing bed rails, to prevent him from trying to walk on his broken leg. 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. 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 no longer allowed and he has been given more freedom to walk about the care home and the gardens.
Appealing against a DoLS authorisation
Fatima’s aunt is rushed into hospital following a fall. Staff at the hospital become concerned about her weight loss. Her medical records indicate that she has recently lost some weight, and they feel this is the result of her memory problems caused by dementia. They suggest that when she is discharged she moves into a care home.
Fatima doesn’t agree with the decision and makes it clear at the discharge meeting. Her aunt also makes it clear that she does not want to move into a care home, although she lacks the capacity to be able to make this decision herself. Despite the fact that both Fatima and her aunt are against the idea, it is decided that she should be moved into a local care home.
At the care home, a DoLS assessment is carried out because Fatima’s aunt’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 aunt’s representative, and she visits her a couple of times each week. Her aunt 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 aunt cannot return home. Fatima feels that the care she receives is disproportionate, and that with the right level of support her aunt could return home.
Fatima gets some help from the local independent mental capacity advocate who helps her appeal against the DoLS authorisation. As a result, it is decided that her aunt can return home as long as the right level of care and support is provided for her.