Attorneys, deputies, IMCAs, and advance decisions

Friends and family often provide vital support, but being next of kin does not give automatic legal authority. Care staff should know who can make decisions, when they can act, and when to involve independent advocates or the Court of Protection.

Key roles and documents

• Health and welfare lasting power of attorney: can make specified health and care decisions, but only when the person lacks capacity for that decision and only within the attorney's authorised powers.
• Property and financial affairs lasting power of attorney: covers money and property matters; it does not authorise personal care or treatment decisions.
• Court-appointed deputy: is appointed by the Court of Protection to make ongoing decisions within the scope the court specifies.
• Independent Mental Capacity Advocate (IMCA): must be instructed for certain serious decisions when the person lacks capacity and there is no suitable unpaid person to consult.
• Advance statement: records wishes and preferences and should be taken into account when deciding what is in the person's best interests.
• Advance decision to refuse treatment: can be legally binding if valid and applicable; it applies to refusal of specified treatment, not to all aspects of care.

If there is doubt about someone's legal authority, staff must check rather than assume. This is especially important if someone asks to restrict contact, refuse treatment, change accommodation, or override what the resident appears to want.

Family involvement matters, but legal authority depends on the particular decision, the person's capacity at the time, and the exact scope of any document or court order.