A Best Interests Decision in a Senior Citizen Care Home is a decision made for and on behalf of residents who lack capacity to make their own decisions.
Where it has been decided that a person with dementia is unable to make a decision for themselves, care staff must do what is in the person’s best interests. This is known as a ‘Best Interests Decision’.
In India, the Mental Healthcare Act (MHA) 2017, Section 17(a) states; While fulfilling his duties under this Act, the nominated representative shall: (a) consider the current and past wishes, the life history, values, cultural background and the Best Interests of the person with mental illness.
Mental Healthcare Act 2017, does not specify Dementia and talks only about Mental Illness, due to which many aspects of Memory Care & Mental Capacity w.r.t “Best Interests” are not covered under the legal requirements and National Framework.
Unfortunately there are no National Guidelines in India on how to care for older people who have Dementia/Alzheimer’s due to which most Senior Citizen Care Homes in India do not have any standard operating procedures for Dementia Care.
Once it has been evaluated that a resident requires external support in decision-making, a Best Interest Decision Form need to be documented in his/her care plan.
This form must be used when an assessment has been made that a person DOES NOT have the mental capacity to make a specific decision.
The guiding principles used internationally to evaluate a resident for decision making capabilities are;
- A person is assumed to have capacity. A lack of capacity has to be clearly demonstrated.
- No one should be treated as unable to make a decision unless all practicable (reasonable) steps to help them have been
exhausted and shown not to work. - A person can make an unwise decision. This does not necessarily mean they lack capacity.
- If it is decided a person lacks capacity then any decisions taken on their behalf must be in their best interests.
As there are practically no guidelines in India for Dementia Care hence it is critical that Memory Care Homes should use their own knowledge, wisdom and experience in taking care of Older People in India.
The attached Mental Capacity Assessment and Best Interest Forms of Warrington and Halton Hospitals under NHS guidelines is an easy to refer document which could be consulted along with the Mental Capacity Act of United Kingdom.
Memory Care is a specialized field which needs in-depth understanding and training, hence basic standards on how to handle senior citizens with Dementia/Alzheimer’s is extremely important.
Document can be accessed on the website https://whh.nhs.uk/ or downloaded here (Best Interests Decision Form in Elderly Care Homes) or can be read below