Making Care Decisions

It is important to recognise that a diagnosis of dementia does not necessarily mean that you can no longer make decisions for yourself.   People with dementia may lose capacity over time and the rate at which a person’s condition progresses varies according to each individual.  With earlier diagnosis and new treatments people are retaining the capacity to make decisions for longer.   However it is best to discuss important issues with your carer and family or someone else who is supporting you and Plan for the Future so that your wishes are known as this may become more difficult as dementia progresses.  It is important to review these wishes over time, as you may find that your views change in the future as you continue through your journey.

As dementia progresses you may also need to make plans about receiving care and support services. It is a good idea to consider all your options carefully while you still have the ability to make informed choices, so that arrangements can be made as soon as more help is needed. Getting to Know Me is a document for you and the people who know you to complete. This information will help anyone supporting you to understand what is important to you.

What Does Capacity Mean?

The law in Scotland generally presumes that adults are capable of making personal decisions for themselves and of managing their own affairs. A person’s capacity could be impaired suddenly as a result of an accident or illness or gradually as a result of a condition such as dementia.  A registered medical doctor or solicitor will be able to say whether or not a person lacks capacity to make a specific decision at a particular time. A person may be able to make some decisions and not others.  If someone is assessed as lacking capacity in relation to their welfare or finances a person with Legal Powers under the Adults with Incapacity (Scotland) Act 2000 may act on their behalf. Please note that a person can instruct someone to manage their finances when they have capacity.

It is important to remember that having a diagnosis of dementia, does not mean, of itself, that the person is unable to make decisions for themself. It is also important to remember that just because someone acts unwisely – whether or not mental disorder is present – does not mean that capacity is lacking.

In broad terms incapacity means being unable to:

  • Acting on decisions; or
  • Making decisions; or
  • Communicating decisions; or
  • Understanding decisions; or
  • Retaining the memory of decisions

in relation to any particular matter due to mental disorder or inability to communicate because of physical disability.

Involving the Person with Dementia in Decision-making

The Adults with Incapacity (Scotland) Act 2000 aims to protect people who lack capacity to make particular decisions, but also to support their involvement in making decisions about their own lives as far as they are able to do so. Anyone authorised to make decisions or take actions on behalf of someone with impaired capacity must apply the following Principles:

  • Benefit
  • Least restrictive option
  • Take account of the wishes of the person
  • Consultation with relevant others
  • Encourage the person to use existing skills and develop new skills

Supervision and Regulation
Under the Act four public bodies are involved in the regulation and supervision of those authorised to make decisions on behalf of a person with incapacity. These are: the Office of the Public Guardian (Scotland), the Mental Welfare Commission for Scotland, the courts and Local Authorities.