Mental capacity assessments and discharge decisions

Abstract

Uncertainties and conflicts around place of discharge have always been a feature of the care of older people. On one hand, placing a person by coercion or deceit in an institution where they stand little chance of leaving is a fundamental human rights infringement. On the other hand, letting someone go home with poor memory, impaired judgement and little appreciation of risk may be irresponsible or even negligent.

The question of capacity commonly arises when an inpatient states that they wish to return home after discharge but where staff have concerns about their safety or when relatives insist that a care home placement is required. Currently, the trigger for formal capacity assessment largely depends on a person's ability to voice their opinion. A concentration on uncertain or contested cases is attractive, but good decision-making practice should go much further than that.