Care home residents deprived of liberty in record numbers

Record numbers of care home residents are being deprived of their liberty by being put in straps, locked in or given behaviour-controlling drugs, fuelling fears that some are being mistreated.

Campaigners have voiced concern that some residents, including dementia patients, are being wrongly denied their freedom and treated as “second-class citizens” – for example, by being locked in their rooms.

In 2015-16, care homes in England asked local councils to approve 195,840 applications to deprive a resident of their liberty – most of them older people – under the deprivation of liberty safeguards (DoLS) legal framework. The figure was the highest since the system began in 2009 and a big jump on the 137,540 applications in the previous year.

Hospitals occasionally seek permission to keep a patient locked up, but care homes make by far the most DoLS applications and have been entering requests much more regularly since a supreme court ruling in March 2014. That judgment, which clarified the form of an “acid test” for what constitutes a deprivation of liberty, sparked an immediate and sustained increase in the number of applications.

DoLS requests are usually made to avoid someone harming themselves. Councils have to assess if applications have fulfilled six criteria and respond within 21 days, or within seven days if it is an urgent case. The system is meant to ensure independent assessment of decisions to deny the liberty of people deemed to lack the mental capacity to consent to the care they receive.

Of last year’s 195,840 applications, councils processed 105,055. They approved 76,530 (73%) of those and rejected the rest as inappropriate – a big rise on the 10,520 rejected in the previous year. However, applications are usually considered only after someone has been denied their freedom, which means that last year about 28,500 people were restrained, locked in or given medication before the move was deemed inappropriate.

Martina Kane, senior policy officer at the Alzheimer’s Society, said: “The safeguards granted by deprivation of liberty safeguards are an essential part of protecting the right to liberty of people with dementia. It is disgraceful that nearly 30,000 people were wrongfully deprived of their liberty, and in over a quarter of cases practitioners are still locking people in, sedating them, restraining them or otherwise treating them as second-class citizens.

“Depriving someone of their liberty should always be a last resort and only ever done in someone’s best interests. It is crucial that the quality of care provided to people with dementia is improved to ensure that.”

Understaffing in care homes could lead to every door in an entire premises being locked overnight, Kane added.

The latest annual DoLS figures collated by NHS Digital show that applications are more likely to be made for older age groups; 44% are for people aged 85 or over. Many of these older people suffer from dementia.

The Local Government Association, which represents councils, said the figures were of great concern. “These alarming figures are further evidence of the significant added pressure facing local government as a result of increased DoLS assessments, which is estimated to be costing councils more than £170m a year,” a spokeswoman said.

“The government needs to fulfil its promise to overhaul the system as a matter of urgency and provide adequate funding so that councils have the time and money to do this properly.”

Care home residents deprived of liberty in record numbers

Disabled people in care amenities "deprived of liberty", says judge

Charities doing work with disabled men and women mentioned it was a “landmark” for the protection of vulnerable individuals.

“It is axiomatic that folks with disabilities, both psychological and bodily, have the identical human rights as the rest of the human race,” mentioned Lady Hale.

“It may be that these rights have sometimes to be limited or restricted since of their disabilities, but the starting point must be the very same as that for everyone else. This flows inexorably from the universal character of human rights, founded on the inherent dignity of all human beings.

“Far from disability entitling the state to deny such individuals human rights: rather it locations upon the state (and on other people) the duty to make realistic accommodation to cater for the special demands of individuals with disabilities.

“People rights include the correct to physical liberty… This is not a proper to do or to go where a single pleases. It is a a lot more focussed appropriate, not to be deprived of that physical liberty.

“But, as it looks to me, what it means to be deprived of liberty need to be the same for everybody, no matter whether or not they have bodily or psychological disabilities.

“If it would be a deprivation of my liberty to be obliged to dwell in a distinct place, subject to consistent monitoring and handle, only allowed out with close supervision, and unable to move away without having permission even if such an possibility became accessible, then it need to also be a deprivation of the liberty of a disabled particular person.”

She additional: “The fact that my residing arrangements are comfortable, and without a doubt make my lifestyle as satisfying as it could possibly be, ought to make no distinction. A gilded cage is nevertheless a cage.”

7 Supreme Court justices analysed the instances of two sisters with learning issues and a man with cerebral palsy.

The did not recognize any of the people concerned.

But they stated the neighborhood authority with responsibility for the sisters was Surrey County Council and the nearby authority with accountability for the man was Cheshire West and Chester Council.

Justices stated 1 sister was in a foster residence and would have been restrained from leaving. The other sister was in a residential house, requiring some bodily restraint and receiving tranquilisers.

The man lived in a staffed bungalow and intervention was at times necessary when he exhibited “tough behaviour”.

Justices stated they had regarded the criteria for judging no matter whether residing arrangements for mentally incapacitated individuals amounted to a “deprivation of liberty”.

They explained this kind of deprivation had to be authorised under the terms of the 2005 Mental Capacity Act and living arrangements subjected to normal independent checks.

All 3 instances had initial been regarded by Large Court judges sitting in the Court of Safety, then by the Court of Appeal.

In all three situations, appeal judges concluded that living arrangements did not quantity to a “deprivation of liberty”.

But the Supreme Court disagreed and explained all 3 had been “deprived of their liberty”.

They upheld the man’s appeal unanimously and the sisters’ appeals by a four to three majority.

Disabled people in care amenities "deprived of liberty", says judge

Disabled people in care amenities "deprived of liberty" - judge

Charities working with disabled people stated it was a “landmark” for the safety of vulnerable men and women.

“It is axiomatic that people with disabilities, both psychological and bodily, have the same human rights as the rest of the human race,” mentioned Lady Hale.

“It may possibly be that individuals rights have sometimes to be limited or restricted due to the fact of their disabilities, but the starting level should be the very same as that for every person else. This flows inexorably from the universal character of human rights, founded on the inherent dignity of all human beings.

“Far from disability entitling the state to deny this kind of men and women human rights: rather it locations upon the state (and upon other folks) the duty to make sensible accommodation to cater for the special needs of these with disabilities.

“Individuals rights consist of the proper to bodily liberty… This is not a appropriate to do or to go exactly where one pleases. It is a far more focussed right, not to be deprived of that bodily liberty.

“But, as it would seem to me, what it means to be deprived of liberty need to be the identical for absolutely everyone, regardless of whether or not they have physical or psychological disabilities.

“If it would be a deprivation of my liberty to be obliged to reside in a distinct location, subject to continual monitoring and manage, only allowed out with close supervision, and unable to move away without having permission even if such an possibility became obtainable, then it should also be a deprivation of the liberty of a disabled individual.”

She additional: “The truth that my residing arrangements are relaxed, and without a doubt make my daily life as fulfilling as it could potentially be, must make no difference. A gilded cage is nevertheless a cage.”

Seven Supreme Court justices analysed the cases of two sisters with learning issues and a man with cerebral palsy.

The did not recognize any of the folks concerned.

But they stated the nearby authority with duty for the sisters was Surrey County Council and the neighborhood authority with responsibility for the man was Cheshire West and Chester Council.

Justices explained one sister was in a foster house and would have been restrained from leaving. The other sister was in a residential home, requiring some physical restraint and getting tranquilisers.

The man lived in a staffed bungalow and intervention was occasionally needed when he exhibited “difficult behaviour”.

Justices said they had deemed the criteria for judging regardless of whether living arrangements for mentally incapacitated folks amounted to a “deprivation of liberty”.

They stated such deprivation had to be authorised below the terms of the 2005 Mental Capacity Act and residing arrangements subjected to regular independent checks.

All 3 cases had first been deemed by High Court judges sitting in the Court of Protection, then by the Court of Appeal.

In all three situations, appeal judges concluded that living arrangements did not volume to a “deprivation of liberty”.

But the Supreme Court disagreed and said all 3 had been “deprived of their liberty”.

They upheld the man’s appeal unanimously and the sisters’ appeals by a four to 3 vast majority.

Disabled people in care amenities "deprived of liberty" - judge