Best Interest Assessor (Social Care) Essay

Introduction : Best Interest Assessor (Social Care)

Best Interest assessors [BIAs] are trainers and decision makers in social care who are liable for making choices related to service users while considering legal frameworks (Mughal and Richards, 2022). BIA is responsible for assuring that best interest principle deployed by assessors in case management. In accordance with Deprivation of Liberty Safeguards [DoLS], BIAs is accountable for examining whether lawful decisions are proposed or not within assuring quality care to patient. It protects the right of service users as per Mental Health Act 1983 [MHA] (Mental Capacity Act 2005, 2023). BIA amendments practices concerned with- person centred, human right, autonomy, dignity and proportionality with respect to DoLS (Scott, Weatherhead and Manthorpe, 2021). An assessor adopts principles and themes align with case law in order to reach to final conclusion. Additionally, BIA’s key responsibility involves implication of practice as per evaluation of needs of patient (Deprivation of liberty safeguards, 2023). The prior motive is to undertake best decision within considering the requirements of service users which results in enhancing quality of care. 

The purpose of the essay is to witness best interest for Mrs BS who is an old lady experiencing walking and learning disabilities. Conceptual framework that would be used in case derives from relevant case laws and legal frameworks. The paper will contain six eligibility of BIA that is mentioned in schedule A1 MCA 2005. The present essay will reflect on the Best interest assessor practices relevant to a specific case, the application process would be described along with undertaking analysis of assessment and interview. Furthermore, risk assessment will be done and accordingly practical implication of legislative framework and guidance included. Moreover ethical dilemmas backed up with case are going to be highlighted. 

 Background To Case

Mrs BS is an old lady who is admitted in a residential unit in January, before that, she used to live with her daughter due to increasing care needs. Patient’s daughter visits care home on regular basis. Contextual information from case revealed that; Mrs BS has been experiencing frequent falls, self-neglecting and she is not taking appropriate nutritional intake. In past, she often wanders from her flat and get lost in street which shows patient had learning disabilities. Mrs BS has history of dementia [Moderate level], Recurrent UTI, Sigmoid diverticulosis and hip fracture. She depends upon Zimmer Frame and wheelchair as she is not able to walk properly. Currently, she wants assistance in her day to day task as she is not able to perform it. 

In accordance with the DoLS standard [4.61], it is essential to identify interest of patient and BIA needs to consider it in preparation of planning care (Mental Capacity Act 2005, 2023). Similarly, MCA section 4 guides about analysing the concern of service user before implementing choices (Shortis et.al, 2020). Consideration of Mental Capacity Act is essential in case of Mrs BS. Furthermore, section 4[6] of MCA would be involved; this is specifically for ascertaining client’s past and present beliefs (Deprivation of liberty safeguards, 2023).

Before proceeding with application procedure it is mandatory to get detailed insights related to legal framework and situation of patient (Keeling and Davies, 2020). As per the information provided in case, Mrs BS requires physical mental and emotional support. She is not able to walk, apart from this; service user is not getting emotional support from her daughter, Mrs BS is not able to recognize things and due to this she is struggling with mental pressure as well. Hence, all of these aspects require to be taken in consideration so that appropriate decision could be taken. 

Considering the seriousness of case, patient wants assistance on regular basis and she is not free to go outside from care home due to her learning and physical disability. The care home implied court protection while declaring that; Mrs BS best interest is to live at care home for liberty deprivation. This is commenced as per section 42 of care act 2014 (Lee and Lyne, 2020).

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Application Process

Age Assessment: BIA is accountable for ascertaining whether age of patient is above 18 or not. This identification is essential as per Deprivation of Liberty as it only implied on the people above age of 18. From the case, it has been witnessed that, Mrs BS age is above 18 which means age criteria is met. 

No Refusals: This is another eligibility that is important in best interest assessment, it needs to be checked whether there is any conflict arising with DoLS (Lyne, Grimshaw and Brown, 2020). As per case study, it can be articulated that, there is no such situation experienced as Mrs BS had no issue at residential unit. It is clear that, no refusal happened in current case (Harding, 2021). The authorization of deprivation of liberty was acceptable. In accordance with Convention on the Rights of Persons with Disabilities (CRPD) article [12] decision related to shifting in care services should not be made without involving patient (Series, 2022). However, considering the condition of Mrs BS it was important to admit her in residential unit as it was the best interest as per her needs 

Mental Capacity Assessment: Mental Capacity Act 2005 is one of the important legislation to be considered in case of Mrs BS. The motive of this legislation is to strengthen patient and protecting the interest of service user who are lacking in mental health and not able to undertake specific decision for them (Series, 2022). This act is specifically for protecting the interest of patient, in current case Mrs BS was shifted to care home without her consent. This proves that there are five principles of BIA considered that was mentioned in CC V/S KK (2012). There was no consideration of MCA that involves the consent of patient (Court of Protection, 2023).

For example- As per NICE guidelines Par [1.4.10] written document should be given to Mrs BS before shifting her in care home. However, her daughter took this decision as involvement of family members is considerable. 

Mental Health Assessment: The assessor is accountable for undertaking mental health assessment in order to clarify whether inclusion of deprived of liberty done or not. In current case, there is no such information witnessed in this context. 

Eligibility Criteria: The decision makers and daughter of service user assumed that Mrs BS is not able to make choice due to her learning disability (Baker-Glenn and Price, 2024). Hence as per MCA, patient is not eligible for placement and she was authorized for deprivation of liberty. 

Best Interests Assessment: Article 5 under Human Rights Act 1998 suggest to review the condition of surroundings and provision of treatment in order to decide whether decision taken within considering best interest of patient or not (Human right Act 1998, 2023) In current case, staffs accompany Mrs BS when she goes outside in relation to ensuring her safety. This shows that, best interest choice is made for service user. 

Analysis Of Assessment And Interview

The role of best interest assessor is just not limited to authorizing and implementing clinical decision making. It is important to look at the facilities of provision and treatment given to patient. Mrs BS age has met the eligibility as she was above 18 (Liddell et al, 2021). The care services provided to her was best of interest as it is covering needs of patient (O'Mahony, 2023). The relationship between Mrs BS and staff found to be effective as she gets accompanied by members when she wants to go outside. Due to learning and physical disability of Mrs BS, leaving her alone was not the best option. The key question which arises in assessment is that whether any restrictions have been enclosed in the section 5 and 6 of MCA. Section 5 states that, when an individual provides care of treatment to that person who has lack of mental capacity in terms of taking decision. In such situation, caregiver is able to assure care without acquiring any kind of legal liabilities (Leonard, 2020). The choice needs to be made considering best interest of patient. As per this, it can be said that, accompanying by staff to Mrs BS was right choice as she was struggling with memory and often she was not able to walk (Brazier and Cave, 2020). When Mrs BS shifted to care services, it was important to undertake mental capacity act, considering the seriousness of patient case, this act was not included (Harrison, 2022). However, Mrs BS daughter was there with whom discussion could be made in this area and same has been done by care home. 

There are two formal stages for undertaking the assessment of capacity as per MCA and that are- stage 1- whether the person is able to undertake decision. Stage 2- inability of making choices is due to any kind of impairment or disturbance under mind functioning (Holmström, 2020). In current case, Mrs BS was unable to take decision and it was due to her learning and physical disabilities and therefore, choice related to placement at residential unit was taken by her daughter. VE v AO & Ors (2020) verdict highlights that patient gets discharged from care home as it was considered as best interest for patient and therefore, she was given permission to return home where she can live with her daughter. However, it was advised to care home to provide all necessary facilities to patient at home (Case law summary, 2022). In current case, Mrs BS daughter makes regular visit to check whether her mother is fine or not. There was no prior discussion made to service user regarding shifting to residential unit. 

On the behalf of Mrs BS, her daughter took decisions, therefore, it cannot be said that while implementing choices best of interest for patient considered. In accordance with the Section 21A proceedings, liberty of individual gets restricted under DoLS as the person [P] is not able to take decision for own (Boer et al, 2023). Whereas, Sec 21A of MHA 2005 is applicable when service user expresses any kind of objection while placing at home care services. As per this legal framework, it can be said that, there was no exploitation of interest is done (Mental Capacity Act 2005, 2023). There was no prior objection made by Mrs BS at the time of placement. Considering this, it is clear there was no exclusion of MHA. 

The question comprised with the needs of Mrs BS, in the case of VE v AO & Ors (2020) witnessed, patient returned to home within providing all facilities (Case law summary, 2022). In present case, there is no such evidence identified which states, Mrs BS was uncomfortable in residential unit. Article 5 of Human right act is specifically for protecting the rights of individual that cannot be deprived from liberty until it is backed up with legal aspect (Human right Act 1998, 2023). This simply means, care home are not allowed to restrict the choices of Mrs BS until her own decision creates harm for her. As per past information, it has been found out, patient used to wander from flat and many times lost at street, this was her own decision related to going outside that led to develop potential threat for her. Therefore, not leaving Mrs BS alone was the right choice implemented by decision makers (Series, 2022). The Section 8 of MHA 2005 determines, patient should get all the necessary treatment, training and education related to their diagnosis. However, this section was ignored. Best interest assessor requires undertaking interview of patient of their relatives as per the section 4 of MCA (Mental Capacity Act 2005, 2023. When an individual is deprived of liberty then, as per DoLS relevant person acts as representative (Roy et al, 2020). It is specifically done for assuring that rights of patient are respected and supported (Deprivation of liberty safeguards, 2023). In Mrs BS case her daughter is the representative and all the action by residential unit is considered after discussing with patient’s daughter. Hence, for undertaking interview it is important to approach daughter of Mrs BS. 

Decision And Risk Assessment

From the analysis of assessment, important insights are being developed those are crucial for undertaking risk identification for Mrs BS. The Mental Capacity Act determines 4th statutory principle. In accordance with this, any choices that are made on the behalf of patient needs to be taken as per the best interest of service user. As per MCA- BIA Should not implement any decision on the basis of assumption. It is important to identify the issues and choice must be implement within considering less restriction on service user (Spreadbury and Hubbard, 2020). Furthermore it is important to consider whether Mrs BS is likely to regain her mental capacity or not. Feelings and morals of patient must be involved while implementing decision. However, each option needs to be discussed with the daughter of Mrs BS. 

Support from the Independent Mental Capacity Advocate [IMCA] requires to be considered, IMCA is significantly trained in assisting individuals who are not able to implement decision for self. Hence, as a BIA most important element is to consider best interest of person. Section 1(5) of Act specifies, while implementing decision for services user consultation must be done with the people who are in touch of patient (Griffith, 2020). The most preferable approach for making decision in Mrs BS case is Balance Sheet approach, it assist in undertaking the pReferences of person within considering views and opinion of family members (PEOPLE, 2020). As per this approach benefits and potential risk both the components are mentioned. Below mentioned are options available in case of Mrs BS. 

Option 1- Mrs BS should be returned to home and care needs to be provided at home

Option 2- Mrs BS must admitted at Old Age & Elderly care homes 

There are two options available for Mrs BS; however, within reviewing the potential risks, this can be said that, staying at Old Age & Elderly care homes is the appropriate option for service user. In accordance with MCA 2005, second option is preferable as it highlights best interest decision making for Mrs BS, before undertaking this decision it is important to discuss it with daughter of patient. 

Practical Application Of The Legislative Framework And Guidance

Individuals who are lacking in mental capacities are subjected to DoLS, however, assuring person-centred care approach to patient acts as a strong base in decision making process. In accordance with Human Right Act 1988, it is important to focus on the preferences of service user (Deprivation of liberty safeguards, 2023). Similarly person-centred care revolves around this element and core decisions are made while considering patient preferences (Stone et al, 2020). In Mrs BS case, BIA is accountable for asking certain questions to her within developing interaction.

For example- it needs to be asked whether she likes to stay at care home, does she miss her daughter, she wants to go outside and etc. This interrogation helps in developing effectual insight that is prior for making decision (Ramesh and Kripalani, 2021).

The Care Act 2014 states, safeguarding is a crucial component of human rights which must be protected. In accordance with this, such steps are needed to be taken for Mrs BS that does not create harm for them (Human right Act 1998, 2023). Moving towards practical application of decision, it needs to be comprised with safeguarding acts (Montandon et al, 2023). It is important to ensure that, Mrs BS does not experience any kind of abuse and harassment while being at care home. AG v BMBC & SNH [2016] EWCOP 37 disclosed, using convert medication in order to manage the behaviour of patient with dementia at care home needs to be done under the strict supervision. The control procedure needs to be relevant to DOL. However, BIA must review the condition and afterwards, medication should be prescribed for shorter period. In case of Mrs BS no aggressive behaviour witnessed due to dementia, therefore, as per safeguarding policy no medication is required as this might lead to create potential harm for patient (Richards and Jankovic, 2020). N v ACGG and others [2017]; court only selects that option which concerned with best of interest for P (Case law summary, 2022). In current case, staying at residential unit is suitable option for Mrs BS.

Patient needs assistance on daily basis and on a practical note it is not possible for her daughter to assure care services. Therefore, in accordance with MCA 2005, Mrs BS should be stayed at residential care under strict supervision. Different activities such as- open discussion and physical activities must be organized (Norman, 2020). However, Mrs BS requires support of wheel chair for long distance and therefore, she can use wheelchair while walking. A nurse needs to be appointed for patient who can look Mrs BS throughout day. Proper schedule must be made along with including plan related to healthy diet (Kirkham, 2024). The autonomy and dignity of Mrs BS would be maintained while creating safe environment for her. It results in enhancing interaction level with her and further contributes in providing quality care to her. In order to undertake decision for patient, inclusion of legislative framework has been done which shows that, choices are made while considering important element that proves to be effective in case of Mrs BS. 

Ethical Dilemma

Ethical dilemma refers to the situation when service user and caregiver do not agree with care plan; this creates a situation under which BIA needs to select between available options that are unsatisfactory on equal basis (Stone et al, 2020). This creates difficult situation, however there are no other choices available and therefore, it is essential to select from available ones. Mrs BS case is quite same, there are two options and that are- whether she should return home or she must stay at residential unit. As per MHA 2005, staying at care home is determined as best option. This might be unsatisfactory for patient however, in order to assure quality care this decision is effectual. The lack of mental capacity creates impact on social, physical and development components of person which further lead to influence decision making capabilities. In such situation, BIA is accountable for undertaking such decision which is comprise with the best of interest for the patient (Pace et al, 2020). Therefore, staying at care home is appropriate choice in the case of Mrs BS. There are certain ethics which are needed to be followed by BIA at the time of dealing with patient such as- maintaining confidentiality, dignity and autonomy of patient. The confidential information of Mrs BS should not be shared with anyone. The treatment and care must be assured in a confidential manner.

In health and social care, dignity plays most important role as it assures that, patient is getting care in ethical manner. It would be ensure that this principle is taken in consideration while providing care services to Mrs BS. As per MHA, best of interest decision has been taken for patient and she will be staying in residential unit. Therefore, it is mandatory to create such environment in which service user feel positive and this can be done while maintaining dignity (Amara, 2020). Mrs BS will be provided choice related to selecting their cloths, in this manner involvement in decision making is going to be promoted and further autonomy can be maintained. Mrs BS would be encouraged for taking part in discussion as this helps in developing social interaction with her. Hence, this can be said that, the prior focus needs to be implied on patient so appropriate choices can be made (Hubbard and Stone, 2022). Not focusing on this area might lead to create varied ethical challenges and further impacts the quality of care provided to Mrs BS. Thereupon, significant focus applied on this area. 

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Summary And Or Conclusion

The essay reflected upon the practices of BIA and important factor comprised with DoLS, in order to undertake case management of Mrs BS; she is an old lady with the history of dementia, hip fracture, sigmoid diverticulosis and UTI. Currently she is at care home where she needs assistance on daily basis. After considering background of case, age assessment has done under which it was witnessed that; she met age criteria, there was no refusal, and however, there was no mental capacity assessment undertaken. This was due to lack of mental capacity possessed by patient. In such situation her daughter determined as her representative who is liable for taking all decisions. Furthermore, while considering MHA, DoLS and Human right act, 1998, best of interest decision taken for Mrs BS. There were two options available whether Mrs BS returned to home or she should stay at care home. The second option comprised with best of interest for patient as this involves less potential risk. Therefore, this choice selected in case of Mrs BS. In order to undertake decision, balance sheet approach is used. Moreover, ethical dilemmas identified that might act as a barrier in the process of providing quality care to patient. Conclusively: this can be stated that; best interest assessor is accountable for suggesting the condition which decreases requirement of ongoing DoL and further reduce the influence of deprivation on relevant individual. Hence, same has been done in case of Mrs BS, after considering all legal frameworks appropriate decision implemented that reduce impact of deprivation and assure quality care to service user. 

REFERENCES

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Online

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