Decision making
Making decisions for someone with Dementia
This information below provides key guidance for families supporting a relative with dementia and includes useful Dementia UK resources for further reading.
What is Decision Making when supporting someone with Dementia?
Dementia can affect a person's ability to understand information, weigh up options, and make decisions. Decisions may include health care, finances, where they live, and their daily support needs.
The Mental Capacity Act 2005 states that people should be supported to make their own decisions wherever possible. If they cannot make a specific decision, any decision made on their behalf must be in their best interests.
What does Capacity mean?
Mental capacity is a person's ability to:
- understand information relevant to a decision
- retain that information long enough to make a decision
- weigh up the information
- communicate their choice
A person may have capacity for some decisions but not others. Capacity can also fluctuate over time.
Dementia UK: Understanding Mental Capacity
What is Lasting Power of Attorney (LPA)
A Lasting Power of Attorney is a legal document that allows a person to appoint someone they trust to make decisions on their behalf if they lose capacity.
Types of LPA
Health and Welfare LPA
Covers decisions about:
- Care and support
- Medical treatment
- Living arrangements
- Care home decisions
- Life-sustaining treatment (if authorised)
Property and Financial Affairs LPA
Covers decisions about:
- Managing bank accounts
- Paying bills
- Managing pensions and benefits
- Buying or selling property
- Managing finances
Office of the Public Guardian (OPG)
The Office of the Public Guardian (OPG) is a government organisation in England and Wales that helps protect people who may be unable to make decisions for themselves because they have lost mental capacity through conditions such as dementia. The OPG works alongside the Court of Protection to ensure people's rights, wishes and finances are safeguarded.
The Office of the Public Guardian:
- Registers Lasting Powers of Attorney
- Supervises deputies appointed by the Court of Protection
- Investigates concerns about attorneys or deputies
- Helps protect vulnerable adults
Dementia UK: Lasting Power of Attorney Guidance
What does the Office of the Public Guardian do?
The OPG has several important responsibilities:
Registers Lasting Powers of Attorney (LPAs)
- Processes and registers Health and Welfare LPAs.
- Processes and registers Property and Financial Affairs LPAs.
- Keeps an official record of registered LPAs.
Supports Attorneys
- Provides information and guidance to people appointed as attorneys.
- Helps attorneys understand their legal duties and responsibilities.
- Ensures decisions are made in the person's best interests.
Supervises Court-Appointed Deputies
- Monitors deputies appointed by the Court of Protection.
- Checks that deputies are managing finances and affairs appropriately.
- May require financial reports and records to be submitted.
Investigates Safeguarding Concerns
- Investigates concerns about attorneys or deputies who may not be acting in a person's best interests.
- Looks into allegations of financial abuse, neglect, fraud, or misuse of a person's money
Court of Protection
The Court of Protection makes decisions or appoints a Deputy for individuals who lack mental capacity and do not have a Lasting Power of Attorney in place.
The Court can make decisions about:
- Finances
- property
- welfare matters
Dementia UK: Lasting Power of Attorney and Court Processes
NHS Continuing Healthcare (CHC)
Continuing Healthcare is a package of care funded fully by the NHS for people who have complex and ongoing health needs.
Eligibility is based on the person's health needs rather than their diagnosis or financial circumstances.
Dementia UK: Paying for Care and Support
What are Deprivation of Liberty Safeguards (DoLS)?
DoLS are legal safeguards used when:
- a person lacks capacity
- restrictions are needed to keep them safe
- they are living in a hospital or care home
The aim is to ensure that any restrictions are lawful, necessary, and in the person's best interests.
Dementia UK: Rights, Capacity and Decision Making
Financial Assessment
A financial assessment helps determine how much an individual may need to contribute towards the cost of their care.
It will consider:
- Income
- Savings
- Property
- Pensions
- Benefits
Bolton Council Care Home Top-Up Policy
If a person chooses a care home that costs more than Bolton Council would normally fund, an additional payment known as a Top-Up Fee may be required. This is usually paid by a family member or another agreed third party. [bolton.gov.uk], [bolton.gov.uk]
Bolton Council Care Home Top-Ups
Personal Independence Payment (PIP)
PIP is a benefit that helps people with the additional costs of living with a long-term illness or disability.
PIP:
- is not means tested
- is tax free
- is based on how a condition affects daily living and mobility
Dementia UK: Benefits and Financial Support
Useful Questions for Families
- Does my relative have capacity to make this decision?
- Is there a Lasting Power of Attorney in place?
- Have future wishes and preferences been discussed?
- Should a Continuing Healthcare assessment be requested?
- Are all benefits being claimed?
- Has a financial assessment been completed?
- Are legal safeguards such as DoLS required?
Useful contacts
Dementia UK
Helpline: 0800 888 6678
Alzheimer's Society
Helpline: 0333 150 3456