Rights and Choices of Individuals with Dementia

1 Understand key legislation and agreed ways of working that support the fulfilment of rights and choices of individuals with dementia while minimising risk of harm

WORD MEANING

RIGHTS Human rights; independence; respect; freedom to do what I want; to protect myself and my property; to be heard; to vote; to express my sexuality; right to an education/work.

RISK Danger; part of life; unacceptable or acceptable; who’s risk? risky activities; risk of harm; injury; protection.

CHOICE Independence; ‘my life’; variety of; priorities; making the right choice; making the wrong choice; what to eat; what to wear; relationships; place to live.

HARM Danger; pain; intentional or unintentional; long lasting or short lasting; reputation; sense of identity/safety.

ABUSE Physical; emotional; financial; sexual; neglect; law; vulnerable; prison; shocking.

TRUST Friendship; feeling – safe, secure, positive; enabling; back up; care; love. Money in Trust

DIGNITY Free from embarrassment; acknowledged as a human being; a way of being/carrying oneself; sense of self; lack of dignity – abuse, damage, pain, fear

1.1 Explain the impact of key legislation that relates to fulfilment of rights and choices and the minimising of risk of harm for an individual with dementia Human Rights Act of 1998 - This Act became law on the 9th November 1998 and mostly came into force on 2 October 2000. Its aim is to support individuals through the UK courts in some of the rights contained in the European Convention on Human Rights. In particular, the Act makes it unlawful for any public body to act in a way which is incompatible with the Convention, unless the wording of an Act of Parliament means they have no other choice.

The Human Rights Act also gives people the right to take court proceedings if they think that their Convention rights have been breached or are going to be. Human rights include:

• the right to life
• the right to liberty and security of person
• the right to respect for one’s private and family life, home and correspondence • the right to freedom of thought, conscience and religion

• the right to freedom of expression

Legislation about Mental Capacity - Mental Capacity Act of 2005 and Adults with Incapacity (Scotland) Act 2000: Acts that address mental capacity issues are the Mental Capacity Act 2005, for England and Wales and, the Adults with Incapacity (Scotland) Act 2000. The primary purpose of these Acts is to provide a legal framework for acting and making decisions on behalf of adults who lack the capacity to make particular decisions for themselves. The statutory principles of the Acts are designed to protect people who lack capacity to make particular decisions. The Acts also support their ability to make decisions, or to participate in decision-making, as far as they are able to do so. Both Acts are supported by a Code of Practice which doctors, nurses, social workers, care staff and others working in a professional or any paid role are under a legal duty ‘to have regard’ to this.

Mental Capacity and Deprivation of Liberty Safeguards 2005 - These were introduced in England and Wales into the Mental Capacity Act 2005 through the Mental Health Act 2007. The MCA DoL safeguards apply to anyone aged 18 and over who has a mental disorder or disability of the mind – such as dementia - and who lacks the capacity to give informed consent to the arrangements made for their care and/or treatment. Deprivation of liberty can only be implemented after an independent assessment finds it to be necessary in their best interests to protect them from harm. The safeguards cover patients in hospitals and people in care homes. The safeguards are designed to protect the interests of an extremely vulnerable group of service users and to ensure people can be given the care they need in the least restrictive way

Mental Health Act 2007 – The Mental Health Act 2007 amends the Mental Health Act 1983 and the Mental Capacity Act 2005 and is an Act of the Parliament of the United Kingdom that applies to people in England and Wales. Most of the Act was implemented on 3 November 2008. The Mental Health Act is designed to protect the rights of people in England and Wales who are assessed as having a ‘mental disorder’ and is used to provide individuals with a mental disorder with assessment, treatment, care and support.

Safeguarding Vulnerable Groups Act 2006 - The Safeguarding Vulnerable Groups Act 2006 was passed as a result of the Bichard inquiry arising from the Soham murders in 2002, when the schoolgirls Jessica Chapman and Holly Wells were murdered by Ian Huntley (a school caretaker). The inquiry questioned the way employers recruit people to work with vulnerable groups, and particularly the way background checks are carried out. Recommendation 19 of the inquiry report highlighted the need for a single agency to vet all individuals who want to work or volunteer with children or vulnerable adults and to bar unsuitable people from doing so. The Act was created for England, Wales and Northern Ireland in response to recommendation 19. The document ‘NO SECRETS’ (2001) sets out best practice in recognising and reporting abuse as part of a Multi Agency Policy and Procedure. Social Services have the lead (alongside the police when required) in investigating suspected abuse. In England and Wales, the term ‘Safeguarding Adults’ now replaces ‘Protecting Vulnerable Adults’ and refers to all work which enables an adult “who is or may be eligible for community care services” to retain independence, well-being and choice and to realise their human right to live a life that is free from abuse and neglect. Whilst the phrase “vulnerable adults” reflected the high prevalence of abuse experienced by many adults and older people in particular, there is recognition that this definition is contentious. One reason is that the label can be misunderstood, because it seems to locate the cause of abuse with the victim, rather than placing responsibility with the actions or omissions of others. The emphasis is now on supporting adults to access services of their own choosing, rather than ‘stepping in’ to provide protection.

Health & Social Care Act 2008
This Act came into force to:
• establish and make provision in connection with a Care Quality Commission.

• make provision about health care (including provision about the National Health Service) and about social care.

• make provision about reviews and investigations under the Mental Health Act 1983.

• establish and make provision in connection with an Office of the Health Professions Adjudicator and make other provision about the regulation of the health care professions.

• confer power to modify the regulation of social care workers.

• amend the Public Health (Control of Disease) Act 1984.

• amend the functions of the Health Protection Agency.

Together these legislations formed the fundamental rights and freedom of an individual. These affect the rights of everyday life of an individual including what they can say and do, their beliefs, right not to be tortured and right to a fair trial. These rights have limits to ensure that other people's rights are upheld.

1.2 Evaluate agreed ways of working that relate to rights and choices of an individual with dementia

Evaluate the following in your workplace :

Policies and procedures :
* Mission Statement
* Health and Safety
* Risk Assessment (performed every month in my work placement) * Safeguarding
* Person Centred Care Planning
* Equality Policy
* Complaints Procedure
* Safety and Security
* Anti-Discrimination
* Moving and Handling

Include policies and procedures where these exist; they may be less formally documented with micro- employers
policies/procedures/contracts/agreements An individual’s care plan is an agreed ways of working where the plan has to be followed. Duty of care is our obligation and we have to exercise a level of care individuals in our care so that we can avoid any injury to that individual. As the law required curtain practices and training our employer has to arrange in-house training courses such as infection control, moving and handling individuals, health and safety and how to deal with emergency situations. The company has to implement these in their policies to protect ourselves and the service users. There are training courses that all carer workers have to undertake in order to be completely competent in doing the job

1.3 Explain how and when personal information may be shared with carers and others, taking into account legislative frameworks and agreed ways of working Consent from the individual should be taken into account in cases of emergency, abuse or neglect is suspected, decisions, treatment or information that is of best interest to the individual. If the resident is mentally incapable, informed consent should be given to the family or next of kin. Information shared to an advocate should be of individual’s best interest. Exchange of information from one health professional to the other should be done securely and access to it is carefully controlled: Care worker, Family  Advocate  Colleagues  Managers  Social worker Occupational Therapist  GP  Speech and Language Therapist  Physiotherapist  Pharmacist  Nurse  Specialist nurse  Psychologist  Psychiatrist

 Independent Mental Capacity Advocate  Independent Mental Health Advocate  Advocate  Dementia care advisor  Support groups

2 Be able to maximise the rights and choices of individuals with dementia 2.1 Demonstrate that the best interests of an individual with dementia are considered when planning and delivering care and support This is an essential aspect of the Mental Capacity Act (2005). To support the financial health, emotional and social well being of an individual and to take into consideration their past and present wishes and feelings, advance directives, beliefs and values

2.2 Demonstrate how an individual with dementia can be enabled to exercise their rights and choices even when a decision has not been deemed to be in their best interests

2.3 Explain why it is important not to assume that an individual with dementia cannot make their own decisions

Each individual have a basic need to express themselves, to show others who they are, what they believe in, and how they are different. This is what makes individuals unique. Individuality is what makes life and people interesting Each individual have the right to make his or her own choices and decisions and must be assumed to have the capacity to do so unless it is proved otherwise. Individuals must be supported as much as possible to make a decision before anyone concludes that they cannot make their own decision and every effort should be made to encourage and support that individual to make decision. It is important to respect Individuals ‘privacy by ensuring that their dignity is safeguarded, and by protecting them from situations that might cause them distress Individuals should be encourage and supported by service providers, families or support workers to maintain their independence and dignity by helping them to become more confidence so that they can take control of their own lives. Their dignity should also be maintained this may mean an individual from doing something that would cause them embarrassment or humiliation. We should always treat individuals that are supported with respect by showing consideration and change our actions and our attitudes to show that every individual is worthy of respect

2.4 Describe how the ability of an individual with dementia to make decisions may fluctuate

3 Be able to involve carers and others in supporting individuals with dementia

3.1 Demonstrate how carers and others can be involved in planning support that promotes the rights and choices of an individual with dementia and minimises risk of harm

3.2 Describe how a conflict of interest can be addressed between the carer and an individual with dementia whilst balancing rights, choices and risk

3.3 Describe how to ensure an individual with dementia, carers and others feel able to complain without fear of retribution

4 Be able to maintain the privacy, dignity and respect of individuals with dementia whilst promoting rights and choices

4.1 Describe how to maintain privacy and dignity when providing personal support for intimate care to an individual with dementia

4.2 Demonstrate that key physical aspects of the environment are enabling care workers to show respect and dignity for an individual with dementia Physical:  Signage  Colour  Furniture  Flooring  Technology  Room layout  Storage  Space for personal belongings

4.3 Demonstrate that key social aspects of the environment are enabling care workers to show respect and dignity for an individual with dementia Social:  Communication skills  Positive approach  Relationship centred approach  Professional boundaries  Abilities focus  Whole team approach