At first glance mental capacity assessments and the Mental Capacity Act can seem fairly daunting concepts to get to grips with. However, the subject really isn’t as complicated as it might seem on the surface and most of the content covers actions and activities you’d recognise from your own best practice as a care provider.

This article will help you to understand what mental capacity is, what the Mental Capacity Act is, work out when you should perform an assess­ment, why they need to be performed, how you do them and who in a care setting is best placed to get involved.

Mental capacity isn’t a state which is all-or-nothing. Commonly people feel that diagnoses such as Alzheimer’s, dementia or learning disabilities – even heightened levels of frailty, automatically mean someone lacks the capacity to make their own decisions. This is not always the case!

Mental capacity is defined as the “ability to make your own decisions” and  can be broken down down into four main questions:

The Mental Capacity Act 2005 (also known as the MCA) is an act designed to help protect and empower people who might lack the mental capacity to make their own decisions about their care and treatment.

It’s not easy to ensure that someone isn’t wrongly stopped from making decisions that are rightfully theirs to make. Nevertheless, a person needs to be protected from making decisions when they don’t have the capacity.

Before you decide that an individual lacks capacity to make a decision for themselves, you need to ensure that you’ve:

Someone’s mental capacity needs to be assessed when they are:

The Mental Capacity Act puts forth a two-stage test you can perform in order to ascertain a person’s capacity. This is called the, “2 stage test” and consists of:

Remember someone’s mental capacity can fluctuate, therefore you need to make sure you allow the person time to make a decision themselves. The best way to do this practically is to start a conversation. Ask that person how they got to that particular decision. Remember that they might need more information and so you need to be ready to provide that if at all possible.­

In a care setting this will typically be carers who are directly concerned with the person at the time. This means that multiple care team members and even teams can become involved in the assessment. However, this isn’t a negative factor, as this will allow a broader time spectrum to be taken into account and how a person’s capacity varies over time. If a care worker feels that they’re following the care plan and have a, “reasonable belief” that the person lacks capacity to make specific decisions they need to make the assessment – this could be anything from accepting food to personal care. This means that their care plans need to be created collaboratively with the person, who agrees to them or an assessment must be made of their capacity to decide if they refuse specific care interventions.

Nourish empowers care workers by providing them with an easy way to plan, record and manage care. This means that carers can easily work with people on their care plans and identify whether they have the capacity to make choices about their particular set of care interventions.

For more information on Nourish, then please get in touch – our team of experts are always happy to help.

At Nourish we don’t take the typical path when it comes to care plans. Rather than telling care providers how they ‘should’ go about their care planning, we prefer to learn how they like their own care plans built. We know that care plans are not a one-size-fits-all exercise. There are a whole host of good reasons for care providers to adopt different styles in the care plans they choose to use.

How is a robust care planning template created?

Much has been written about how care plans should be put together. But ultimately, the structure of the care plan template needs to be decided by the senior team of the care provider (including its owners) who will set how the service should be led and by the care managers who will conduct service delivery day to day.

Care planning isn’t just about documents, its about shared journeys with each person

Although it is tempting to shrink the care planning exercise to a structure of needs assessments, a list of support services and the risks involved; good care providers are increasingly recognising that a good care plan covers a representation of a person as a whole. This means they need to cover their wants as well as their needs, their abilities as well as their frailties.

Getting this information goes well beyond an admission interview, or a comprehensive assessment; getting to know a person takes time, and people change their preferences and habits. Care planning is part of all interactions with the person and their close circle of support, family and close friends, not just at discrete times.

Care providers are different and so is their care planning

Some care providers may prefer to tackle recovering mobility with garden activities, others will focus on dancing, this will allow different care providers to resonate with different clients. This is why care plans cannot be the same for all care providers. Because care providers decide, which services to provide and together with their team decide how they are provided, how they are adapted to each individual’s wants and needs, the care planning framework must support the team in this journey.

Fundamental building blocks to a robust care planning framework

The building blocks you need to consider when building each care plan include:

In a modern care planning framework, people receiving care have the ability to continuously give feedback about their care, as well as help to improve and adapt the care they receive. This includes the ability to manage consent, allow a next of kin and other informal carers to record relevant notes, raise warnings and alarms, as well as help to stay involved in the care of the person.

Interactions in someone’s day to day care are typically recorded by carers as daily notes. However increasingly, there is information from connected devices, Telehealth or Telecare equipment, wearables and internet of things (IoT), as well as notes from relatives and volunteers outside of the care provider’s organisation. All of this information, when managed digitally, can be used to automatically update care plans, trigger reviews and enable care managers to have the best possible representation of the context of the person and their care, and feel reassured by the clarity of transparency of the quality of the care being provided.

How can Nourish help with your care planning?

Nourish is designed to support organisations in transforming how care information is managed, with radical improvements to the operation of care services and continuous improvement to care delivery. To find out more please don’t hesitate to get in touch.

At Nourish there are a number of principles that guide our work. Firstly we understand the importance of planning in care, which is why we put care plans at the heart of what we do. Establishing a care plan is key to providing truly personalised care, so we designed Nourish to make that process as smooth as possible.

No two care settings are ever the same, which is why Nourish is flexible and customisable. Our approach is to tailor Nourish to work for care teams, not the other way round. So if a care team has well-established care plans that they are already using, we work with the team to take those care plans online with Nourish – creating the same order that carers are used to. Other settings may prefer to use Nourish care plan templates and then customise them to the care they provide – from nursing care to dementia care to domiciliary care to learning disabilities.

Secondly we use clear, user-friendly design to allow Nourish to fit into carers’ daily work. Care plans can be set up to generate tasks on a daily schedule – for example, if part of a person’s care plan is to monitor a person’s weight loss, daily tasks can be set on the timeline to check nutrition and food intake. Carers have told us time and again that the two hours they used to spend at the end of a shift on paperwork has simply gone, because by the time the shift has finished they have already made all the notes they need to.

Thirdly, care is provided not by a single person, but by a circle of care. Within a residential setting, this may involve the care team, visiting medical staff and family. In home care settings, friends and neighbours may also play a role. With Nourish, notes can easily be made by each person providing care. That information is then stored and organised in the care plan logs in a clear way so that others can access it when they need to.

With all this in place, generating reports no longer involves spending hours retrieving files from the shelves but can be done with just a few clicks, before, after or even during a CQC inspection if required. Care plans can easily be reviewed and audited, which is also vital when it comes to inspection. Reviews may be scheduled, but care teams also have the flexibility to react to changes in a person’s condition which may trigger the need for a care plan review.

Care requires both consistency and flexibility. We designed Nourish to support those needs. Which means care teams can get on with doing what they do best – provide the real, human, compassionate care that enables the people they care for to enjoy the best quality of life possible.

When we first went into a care home with Nourish, it took a couple of days to get users online. But time has moved on. We listened to feedback, we watched how users interacted with Nourish, and we adapted design and functionality for the very real world of care. Now when we go into a care home, we expect to see the entire care team up and running by lunchtime. This includes those people who say “oh I don’t like technology”, and those who say “I’ll never get to grips with a mobile device”, and the 76-year-old carer who recently told us that she would never use Facebook but she uses Nourish every day. Because we use design to make Nourish intuitive and fit into the way people care, not work against them.

The speed at which the care setting feels the effects is palpable. We recently introduced Nourish to a care setting which was fully online with over 200 records created on Nourish by the end of day one. We work with a care home that only has a small team but on average they create over 600 records a day – that’s a lot of information to capture, and could only happen with a system that is quick, efficient, and makes sense in the very real world of care with all its challenges. And because of the way Nourish is structured, that information is easily retrievable. With just a few clicks, that same care team can create a report on any category of information captured, with no need to return to the filing cabinet and sift through 600 sheets of paper.

And what about care plans? Will it take hours to change the fit of the care plans used by a team for many years, that work so well, into a new shape? Not at all, because Nourish is fully customisable. We work with care managers to make Nourish fit into the way they work already.

It is people who care that inspire us to do what we do. The best care will always come from teamwork, so talk to us and let’s see what we can do, together, to make care the best it can be.