Session Three Planning in advance

1. Mental Capacity Act 2005: a practice-based courseSupporting older people in care homes and the community as they would like. Session Three Planning in advance

2. Revision! 5 key principles 2 stage test of capacity 4 stage assessment of capacity 5 stage summary of ‘best interests’ criteria.

3. Dignity in Advance Care Planning …can help promote for residents …because • You have had these discussions in advance with the resident • You will know howto care for them as they would want • All care home staff can know their wishes – they’ve been recorded A sense of being in control A feeling of confidence, knowing you will try to avoid undignified situations

4. Introduction to Advance Care Planning Key terms Advance Care Planning Advance Statements Advance Decisions ‘Living Will’ Lasting Power of Attorney

5. Advance Care Planning (ACP) Taken from ‘Advance Care Planning: A guide for Health and Social Care Staff’, NHS End of Life Care Programme, February 2007 Definition “ACP is a process of discussion between an individual and their care providers irrespective of discipline. If the individual wishes, their family and friends may be included. With the individual’s agreement, this discussion should be documented, regularly reviewed, and communicated to key persons involved in their care….”

6. Advance Statements Statement of wishes and preferences No legal status, not legally binding, but guidance and preferences If person lacks capacity to make a decision about health and welfare, then an advance statement will be taken into account when decisions are being made. Helps to inform ‘best interests’ for a person. An example is the Preferred Priorities of Care form

7. Advance Decisions to Refuse Treatment -1 Relates to an advance decision to refuse treatment Legally binding, if valid and applicable Must be in writing if it relates to refusal of life- sustaining treatment, signed & witnessed Must state clearly that if it still applies even if life is at risk Person must have mental capacity at the time of writing

8. Advance Decisions to Refuse Treatment -2 Validity and Applicability Must relate to treatment being considered Must relate to exact circumstances Questions to consider Has the person done anything that clearly goes against their advance decision? Has the person withdrawn their decision? Has an LPA been set up after advance decision? Would the person have changed their decision if they had known more about current circumstances? Taken from Mental Capacity Act Code of Practice

9. ‘Living Will’ and ‘Advance Directive’ Old fashioned terms Not clear as to meaning Usually accepted to be an advance refusal of treatment, but not necessarily so

11. Lasting Power of Attorney (LPA) • What does an LPA look like? Is simply a legal entity giving certain powers to another person • Newly established by the Mental Capacity Act 2005 LPA only operates when a person has LOST capacity • Unlike existing Enduring Power of Attorney EPA’s Differs from an Enduring Power of Attorney • LPA replaces EPA, though existing EPAs will still be valid Must be registered with the Office of the Public Guardian (OPG) • stamped and authenticated on each page • all of the forms are on the web

13. Lasting Power of Attorney (LPA) Now 2 types of LPA • Health & Personal Welfare (Personal Welfare Lasting Power of Attorney - PWLPA) • Property and Affairs • There’s only one type of EPA (Enduring Power of Attorney) for personal affairs PWLPA can make decisions about health and welfare • ONLY if specified PWLPA can make decisions about life-sustaining treatments • ONLY if specified Can be complicated to set up – but all documents on the web

14. Personal Welfare Lasting Power of Attorney (PWLPA) Group Work What do you think are the advantages of PWLPAs? What do you think are the potential problems? What actions do you need to take if a visitor or relative says they have a PWLPA for a resident?

15. Safeguards built into LPAs Named persons • Up to 5people need to be nominated who will be notified when an LPA created • All nominated persons have to agree with appointment of Attorney If no “Named persons”, then donor must appoint 2 Certificate Providers • Named persons confirm to OPG that Attorney has been appointed legitimately • 1 must know the person setting up the LPA • 1 skills based – a healthcare professional, solicitor but not care home owner or staff • Any of these Named Persons can raise concerns if in any doubt about Attorney Attorneys must act in best interests • Can be liable to a new offence of neglect/abuse under MCA Person setting up the LPA can limit the power of the Attorney • It will very rare for a “blanket” LPA to be created – nearly always specific Objections can be raised by anyone with a legitimate interest in the LPA • With the Office of Public Guardian, who will investigate

16. Lasting Power of Attorney (LPA) Summary Replaces Enduring Powers of Attorney • existing EPA’s still valid even if not registered LPAs now cover Health & Personal Welfare • not just property and financial affairs Can ONLY be used if the LPA Donor has LOST capacity Clear to all who can decide on person’s behalf • someone legally appointed by person to speak on their behalf • they become that person • Clarifies the role of ‘next of kin’ – can be consulted, but cannot make decision, unless has a PWLPA. Significant and valuable safeguards built in to LPAs • If in any doubt contact OPG and raise concerns CQC can ask you if you are aware of any LPAs with your residents or clients in the community.

17. Summary The process of planning in advance can enable people to think about, discuss and have their wishes recorded A written advance care plan is only to be referred to if/when a person lacks the capacity to make a decision about their care and treatment A person who has a Lasting Power of Attorney for health & welfare can make decisions for a person if they are unable to.