COVID-19 and the Mental Capacity Act in care homes: Perspectives from capacity professionals

Abstract

This study explores the experiences of professionals who worked with care home residents with impaired mental capacity in England and Wales during the COVID-19 pandemic. It explores (i) how competing risks were balanced and (ii) how the Mental Capacity Act (MCA) functioned in care homes under pandemic conditions, with particular focus on its associated Deprivations of Liberty Safeguards (DoLS) and Independent Mental Capacity Advocacy (IMCA) systems. Between March and May 2021, we held an online survey and five focus groups aimed at professionals who worked in or with care homes during the pandemic. The study explored issues pertaining to residents with impaired mental capacity, alongside several other topics on which we report elsewhere. For this paper, we filtered data to only include responses from 'capacity professionals'. The resulting sample comprised 120 (out of 266) survey participants and 18 (out of 22) focus group participants. We performed manifest content analysis on the filtered data and found that (1) participants reported a 'massive discrepancy' between the ways different care homes balanced the risk of COVID-19 infection with the risks associated with severe restrictions. (2) Some suggested this was due to vague guidance, as well as care home type and size. Participants told us the pandemic (3) obstructed smooth operation of statutory safeguards designed to protect residents' human rights and (4) resulted in confusion about the remit of the MCA during a public health crisis. Our findings raise concerns about the impact of pandemic-related measures upon care home residents with impaired mental capacity. We urge further exploration and analysis of (a) the variability and inconsistency of restrictions applied at care homes, (b) the strain placed on key safeguards associated with the MCA, (c) uncertainty about the remit of the MCA during a public health crisis and (d) the human rights implications hereof.

Keywords: COVID-19; Mental Capacity Act (England and Wales) 2005 (MCA); best interests; care homes; human rights; mental capacity; public health.

FIGURE 1

This figure shows filtered survey responses by capacity professionals to the question: ‘In your experience, what has been the general impact of these restrictions (on visits and/or movement) on residents’? Respondents could select one answer only. A majority of respondents noticed a negative impact, be it severe (50%) or slight (30%)

FIGURE 2

This figure shows filtered survey responses by capacity professionals to the question: ‘When residents with impaired mental capacity were confined to their room, how often was a new DoLS authorisation provided’? Respondents could select one answer only. A majority of respondents (58%) said new authorisations were rarely or never provided

FIGURE 3

This figure shows filtered survey responses by capacity professionals to the question: ‘When a new DoLS authorisation was not provided, this was usually because...’ Respondents could select one answer only. A majority of respondents responded that there was already a standard DoLS authorisation in place for these residents (34%) or that residents were confined to their room in response to public health directives rather than under the MCA (31%)