Freedom at Risk in Care Homes, Warns Charity

File photo dated Dec. 22, 2016, of an elderly woman's hands. Yui Mok/PA Wire

Staffing pressures and underfunding in social care risk the “nightmare scenario” that older people could be deprived of their liberties without justification as a result of insufficiently-conducted assessments, a charity has warned.

Age UK has blamed “chronic underfunding” for the “effective collapse” of the system that provides legal protection for older people who have lost their mental capacity. The charity said that as well as a backlog of cases in excess of 100,000, there is a risk that some assessments might not be conducted in a thorough enough manner, the charity said in a report published on Friday.

Deprivation of Liberty Safeguards (DoLS) is a legal procedure used to keep individuals who lack the capacity to consent to their care in a hospital or a care home for their own safety.

Local authorities can initiate DoLS assessments for those who lack or are perceived to lack, mental capacity, including those with mental health problems or dementia. They are conducted by “Best Interest Assessors.” The charity said that as 84 percent of people subject to a DoLS application are 65 and over, the problems largely affect older people.

But Age UK claims that “DoLS is not working well in practice and for an alarming number of older people is not working at all. Chronic under-funding by central Government has led to serious problems in its local administration, leading to an ever-growing backlog that is now so vast it can probably never be eradicated.”

DoLS Application Backlog at Over 100,000

The charity stated that since 2015/2016, the estimated number of incomplete DoLS applications has remained at over 100,000.

In 2022/23, 126,000 applications went uncompleted, and those that were completed took an average of 156 days for a standard authorisation, longer than the statutory timeframe of 21 days.

Some 49,325 people died while waiting for their DoLS application to be handled in 2022/23, the charity said.

Age UK said that “in many cases, the decision to constrain the individual’s freedom for their own good would have probably fulfilled the DoLS criteria,” but added that “within such a huge number there must be a risk of injustice for some individuals, whose lawful right to liberty will have been inappropriately denied.”

The charity said that a lack of Best Interest Assessors “may also impact on the extent to which the DoLS framework is meaningfully engaged with.”

“If there are too many cases to get through, it is likely that in some cases assessors will not have time to effectively engage with the framework, for example to consider whether there are less restrictive alternatives to depriving the person of their liberty,” the report said.

The authors quoted one local authority representative as stating: “Less people will be deprived of their liberty if there is more money. Are there enough people working to properly scrutinise each case and see if there are any other options?”

One family member told the charity that the Best Interest Assessor “barely engaged” with her father and the experience of the assessment felt like a “box-ticking” exercise.

“Such lack of engagement raises questions about whether the current operation of the DoLS process is meaningful, or whether it is effectively operating as a ‘rubber stamp,'” the report said.

‘Nightmare Scenario’ of Older People Being Deprived of Freedoms

Age UK Charity Director Caroline Abrahams CBE said it was “profoundly shocking that so many older people with diminished capacity are living and dying without the proper legal protections for limiting their freedoms being in place.”

“As a result, we risk the nightmare scenario that somewhere, there’s an older person locked in their room in a care home, supposedly in their own best interests when, in practice, an objective assessment by a trained social worker would have found this not to be justified at all.

“We have also heard of cases in which a care home is reluctant to constrain the movements of an older person with dementia who is clearly at risk because they wander, without an order saying that this is legally okay,” Ms. Abrahams said.

The charity called for reform of the current system, but in the meantime “we believe it is essential that the Government properly funds the system that is in place, until reform can happen. It should also give local authorities the resources to begin to tackle the backlog.”

The Epoch Times has contacted the Department for Health and Social Care for comment.