Hi we have a dementia patient on section 3, who declines shower quite often. His wife was very upset and demanding staff to shower him every day. She always use the phrase “he is not having capacity to decide “ but the patient sometimes agrees sometimes not agree. She reported to CQC and NHS Complaints against poor care. Does section 3 allows personal care without consent.
Please someone help
Thanks for spending your time
Have an IMCA assessment,then have a Best Interest Meeting with IMCA,wife,Ward Manager,staff nurse,ward doctors,if possible Psychologist etc.Make a clear plan about hands on to give personal care.In some wards they allow family/carer to help with personal care etc.The most important thing is documentation,when he is offered the shower etc by whom male/female/young carer or a bit older,the time of the day like an ABC chart to show you are doing everything possible you can.sometimes family is expecting unrealistically,family need Post diagnostic support by experienced Psychologist.
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This will be a mental capacity issue. IMCA isn’t indicated here as personal care isn’t Serious Medical Treatment. If the person is established as lacking capacity to manage their personal care, then the debate is what is required to happen in the person’s best interests. This will depend on the risks and the level of intervention (or restraint) to administer the care, and any best interests decision making must involve the patient and the carer/wife must be consulted.
Will depend very much on the individual person’s needs. If they are doubly incontinent, then the risks of skin breakdown and infection are significantly more acute than if they simply don’t want to shower every day. What risks is the person running if they don’t shower every day, and is their intermittent compliance sufficient to maintain their health and wellbeing? (rhetorical question only).
If restraint is (potentially) required to administer personal care, then MCA ss5/6 comes into play - is the restraint a proportionate response to the likelihood and seriousness of the risks if the actions are not done? Not to forget the 5th principle of the MCA which is to follow the less/least restrictive option.
So in short, s3 detention not sufficient simply to administer personal care without consent.
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Hi I work on a dementia inpatient service - we use a person centered approach to develop a care plan - with patient where/when able and NR re approach to personal cares and potential restrictive practice used in best interest where there is risk to health from neglected personal cares and considering dignity - robust Mental capacity assessments are carried out to inform this.
Daily assessment of capacity to consent/refuse support re these needs being met/supported, needs to be fully documented.
its a fine balance between risk and approach, lots of emotions here from all usually - least restrictive approach is needed, but a plan for when a restrictive approach can/should be used
Look for patterns - are there times of day the person is more accepting, certain staff that they are more accepting such support from, what does their life story tell you about their historical personal approach to their personal care/hygiene needs - ie prefered approaches, routines etc etc
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On our wards we always involve IMCAs if you are doing BI,unless the person has capacity understands the decision,weigh the consequences of refusing particular task/decision,able to give a reason/explanation may be due to Delusions/Hallucinations etc.Is there fear of water or needs simple step by step explanation of what the carer is doing etc.Treatment is not just medication,nursing care,psychology support,OT support,physio support so it is the holistic treatment & care.Just carer talking/spending 1:1 time is part of Therapy/treatment.
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I know this response doesn’t sound least restrictive or very patient centered but if a detained patient’s refusal to pay attention to his personal hygiene is assessed as being a manifestation or symptom of his mental disorder, I thought the patient could be washed/cared for under the authority of the Croydon case under s.63 of the MHA.
Giving someone a shower is arguably “nursing” or “care” and therefore potentially within the definition of medical treatment that can be given without consent under the MHA.
But only if it is treatment for mental disorder - ie to alleviate or prevent a worsening of the patient’s mental disorder, or one or more of its symptoms or manifestations (see s145(4) of the Act).
That depends on the facts of the individual case. If the refusal to shower were a manifestation of the dementia, or was somehow exacerbating it, then maybe. But from what you’ve said, that might be a stretch.
If it’s not treatment for his dementia, then (as everyone else has said), it’s first and foremost a question of capacity. If he has capacity to decide, then it’s his choice. Otherwise, the question is whether it’s in his best interests.
I suspect you’d have to be pretty ill not to have capacity to decide whether to have a shower - though of course it’s possible.
As a former carer I agree with Alex Irvine, to the extent that this is a caring issue rather than a legal/capacity issue. A “least restrictive approach” should be used - ie one which creates the least distress for P and is “good enough.”
Be creative. As Alex suggests, try another time of day. Work with the wife to find what aspect of showering is causing distress - eg initial coldness of water, soap/water in the eyes - and look for a solution - eg P wearing goggles? Try showering gradually from the feet up. Try allowing P to direct the nozzle. Try baths. Try bed baths. If nothing else works, a daily change of underwear.