Assessing capacity and making best-interests decisions

When there is doubt about capacity for a particular decision, the assessment must focus on that decision and that time. Practically, the person must be able to understand the relevant information, retain it long enough, use or weigh it in making the decision, and communicate their choice in some way.

Capacity can fluctuate. Someone with dementia, delirium, mental illness, or an acute medical problem may be clearer at a different time of day or after treatment. Staff should not treat a single poor conversation or an old file label as definitive. Assessments and decisions must reflect the person's current presentation.

If the person lacks capacity for the decision, any act or decision made for them must be in their best interests. Best interests does not mean "what staff prefer" or "what the home usually does". It requires a structured, person-centred approach that considers the person's wishes, feelings, beliefs, values, likely preferences, and the views of relevant others.

Best-interests decisions should also choose the least restrictive option that meets the purpose. This is important in residential care, where restrictions can gradually increase around mobility, personal care, food, finances, contact, routines, and leaving the home.

Best-interests thinking should include

• What is the exact decision that needs to be made?
• What are the person's known wishes, feelings, beliefs, and values?
• Who should be consulted, such as family, attorney, deputy, or advocate?
• Is there a less restrictive way to meet the same need?

For seniors and team leaders

Best interests is a structured decision-making process. Records should show the person's wishes, the evidence considered, the options weighed, and why the chosen option is the least restrictive safe one.