‘…items and belongings…’ – a hoarding case at the Court of Protection

Stephen Martineau summarizes a recent case at the Court of Protection involving hoarding behaviour: AC and GC (Capacity: Hoarding: Best Interests) [2022] EWCOP 39. With thanks to Neil Allen for alerting us to the judgment via this Tweet.

The NIHR Policy Research Unit in Health and Social Care Workforce, where Stephen is Research Fellow, recently completed a study of self-neglect and hoarding behaviour among older people and it has just commenced another study on the commissioning of decluttering services by local authorities (this study is recruiting participants). Both projects are funded by the NIHR School for Social Care Research.

We are holding an online seminar engaging legal and psychological perspectives on hoarding: Mon 28 Nov 2022, 10am-11.30am. (2,294 words)

Introduction

This case concerned AC, a 92-year-old woman. She had been sharing her home (which she owned) with her son, GC, since her husband’s death eleven years earlier. GC had given up his job and had become his mother’s main carer. In February 2022 she was taken to hospital by emergency services and in March was discharged from hospital to a care home as a result of a best interests decision. There had been concerns about the unsanitary conditions at her home and their potential impact on her health and welfare.

The question to be decided in summer 2022 was whether AC should now return home for a trial period, receiving a package of care there. It was her wish to return home, while the local authority thought she should remain at the care home. We learn from this judgment (August 2022) that both AC and her son were diagnosed by a clinical psychologist, Professor Salkovskis, as having a hoarding disorder (among other conditions), and also that both have their own social worker.

The judge, HHJ Clayton, had already been managing the case for two years: there had been earlier applications to the Court of Protection by the local authority (and the judgment alludes to yet earlier proceedings that had ended in 2018). In August 2020, the local authority had applied for AC to be moved to a respite placement while the poor conditions at her property were addressed. More recently, it had sought an order that her son leave the property for the same reason.

Much of the difficulty of the case arose because of concerns around GC’s mental health. If AC were to return home, it was proposed that he would be the ‘second carer’ (after the care agency). Continue reading

Liberty, social care detention and the law of institutions

Stephen Martineau, Research Fellow at the NIHR Policy Research Unit in Health and Social Care Workforce at King’s College London, reviews Deprivation of Liberty in the Shadows of the Institution by Lucy Series (University of Bristol). Page numbers in brackets refer to the book, which was published in March 2022 (and is available for free). (2,642 words)

Introduction

One of the more familiar stories from recent UK history about the lives of people with longstanding serious mental illness or intellectual or cognitive disabilities is their move from large-scale institutional accommodation to living arrangements beyond the walls of such places. The extent of this ostensible deinstitutionalization is illustrated by the decline in hospital beds for ‘mental illness’, ‘geriatric’ patients and people with intellectual/learning disabilities—from over 200,000 in 1955 to under 20,000 in 2020 (Series, 2022: p.53). Much of this shift was to do with the closing of survivals of the Victorian era (which started out being called asylums, subsequently renamed mental hospitals) that took place through the second half of the twentieth century.

As Lucy Series describes in her book, Deprivation of Liberty in the Shadows of the Institution, these newer smaller-scale living arrangements may take the form of ‘quasi-institutions’ (residential care and nursing homes) or ‘quasi-domestic’ arrangements (‘supported living’, ‘independent living’, sheltered housing), or indeed ordinary homes.

Series describes this development as a passage from a ‘carceral’ to a ‘post-carceral’ era (after Unsworth, 1991). But in making the physical move away from institutions, to what degree have some less tangible aspects of the old institutional life been carried over to those new living arrangements, as far as these individuals are concerned? To what extent, Series asks, are they still living in ‘the shadows of the institution’?

This question was brought sharply into focus in the UK Supreme Court case of Cheshire West, the litigation that forms the dramatic fulcrum of this book. The court’s approach meant that its definition of deprivation of liberty applied to a much wider array of living arrangements than had hitherto been the case, extending to private homes, where family members were the carers (or custodians?) of the person concerned. It is the socio-legal ramifications of this move (which Series views as transgressive) that are the main concern of the book. To put it briefly and in human-rights terms, in its approach to concerns about liberty in the area of social care detention—under article 5 of the European Convention on Human Rights—the court seemed to set up a clash with a set of questions belonging more under article 8 (respect for private and family life), to do with the distinction between institutions and homes.

This review is split into five short sections: 1. Social care detention. 2. The acid test. 3. Liberty. 4. Home. 5. Out of the shadows? Continue reading

On best interests: values and participation in mental capacity law

Stephen Martineau is Research Fellow at the NIHR Policy Research Unit in Health and Social Care Workforce, King’s College London. (1,115 words)

At the British Academy earlier this month, Dr Camillia Kong (Birkbeck College) and colleagues presented their end-of-project findings on the place of values and participation in mental capacity law. As well as contributions from the research team, the day featured a group of international experts, three Speak Out Leaders from VoiceAbility, and it culminated in a panel made up of four senior former judges: Baroness Hale of Richmond, Sir Mark Hedley, Senior Judge Denzil Lush, and District Judge Margaret Glentworth.

Participation and values

The event coincided with the launch of the second of two films produced by the project. The first, from 2021, had addressed the importance of good communication with the person at the centre of Court of Protection proceedings and discussed some of the ways of enabling their involvement (see particularly the ‘role-play’ at about 22 mins in). Three contributors in the film, Speak Out Leaders from VoiceAbility, took part in a panel at the event. The new film, Making Values Matter in the Court of Protection, includes a remarkable ‘demonstration’ of the exploration of a person’s values by a barrister engaging with the person and their father (from about 9 mins in). By modelling one way that requirements in the best interests checklist in s.4 Mental Capacity Act 2005 can be met, it provides a corrective to any notion that a finding of incapacity in respect of a decision amounts to an ‘off-switch’ for a person’s rights and freedoms.* Continue reading

Exploring the effects of the rise of living costs on small to medium sized care home providers and care professionals

Head and shoulders of a person

Dr Caroline Emmer De Albuquerque Green, Post-Doctoral Fellow at the ARC South London, introduces a new study. Caroline works within the NIHR Applied Research Collaboration South London: Social Care Theme at HSCWRU.

 

Our work is to care for the most vulnerable in society and after the pandemic… [the costs of living crisis] is more reason why providers will be closing homes” (A small care home provider)

The United Kingdom (UK) is currently experiencing the steepest rise of inflation in the past 30 years. Consumer prices in February 2022 were 6.2% higher compared to the previous year. The Bank of England estimates that inflation may rise to 9% in 2022 (Francis-Devine et al. 2022 Rising cost of living in the UK – House of Commons Library (parliament.uk)). For people living in the UK, this means increased costs of living, including fuel, energy and food prices. This is also the case for care homes and people working in them, which next to the rise of living costs are still facing Covid-19 related restrictions, staff shortages as well as further rises in operational costs and taxes. Continue reading

Action not words: Race Equality Week 2022

Adele van Wyk, social worker and PhD student at University of Edinburgh, reports from Race Equality Week, which is run by London ADASS and supported by the ARC South London Social Care Theme (based at the NIHR Policy Research Unit in Health and Social Care Workforce). (985 words)

The London Association of Directors of Adult Social Services (London ADASS) presented a series of online luncheons as part of its Race Equality Week (7-13 February 2022). In this blog, I reflect on the Thursday lunchtime conversation (10 February), attended by 122 practitioners and managers from a wide range of social care services, which focused on cultural competence in adult social care. In the first section, I share some of my thoughts about the key points made about cultural competence, and in the second, some thoughts about spirituality in care homes.

# Culture is a strength and an asset. Fact: It might be, but it might not.

# All members of a culture subscribe to the same values. Fact: Not everybody is interested in having kosher food or going to the prayer room. Some people stay away from religious celebrations but enjoy the cultural associations with religion.

# People from Asian and black African backgrounds have big extended families supporting themFact: This might be true for some, but for many it is not. Continue reading

The Gallery of Spiritualities – welcome to a new exhibition in a care home

olivia luijnenburgOlivia Luijnenburg is a Research Associate in King’s College London’s NIHR Policy Research Unit in Health and Social Care Workforce. (460 words)

What is ‘spirituality’ in care? How can care home staff attend to residents’ spiritual needs? For my PhD project, I had the task of finding answers to such questions. When thinking about spirituality and spiritual needs, many people’s minds immediately go to religion and religious needs. However, what about care home residents who do not practice a religion or are not part of a religious community? We know that spiritual wellbeing is found through a sense of community, connection, nature, or the arts, which can but does not have to be of a religious nature. Surprisingly, the spiritual needs of older people in residential care have often been overlooked.

To address the lack of knowledge around spirituality in care and illuminate the intangibility of what spiritual needs might look like, I collected ‘artefacts’ from care home residents before talking with them. These could be an object, a space, a song, a person, or anything else that represented a sense of joy, peace, safety, or fond memories for the person. The ‘artefacts’ functioned as a conversation starter, as well as a stimulant to the imagination of what ‘spirituality’ might mean to the participant. They were photographed and collected in a ‘Gallery of Spiritualities’. Continue reading

Caring in company: a pre-Covid snapshot of day centres in south London 

Dr Caroline Green and Dr Katharine Orellana are Post-Doctoral Fellows, National Institute for Health Research Applied Research Collaboration South London. (346 words)

Day centres can be a lifeline for some people. Day centres offer activities, meals and a place to connect with others. At the ARC South London, we wanted to find out more about what kinds of day centres are on offer in this part of London and how they operate. We searched the internet for day centres for older people, people living with dementia, people with disabilities and long-term conditions or palliative care needs and people experiencing homelessness across four boroughs of south London. Continue reading

Towards a UN Convention on the Rights of Older Persons: 11th session of the Open-Ended Working Group on Ageing 29.03-01.04.2021 

Caroline Green is Post-Doctoral Fellow at the Policy Research Unit in Health and Social Care Workforce, King’s College London. In December 2020, Caroline released a Human Rights toolkit as a means of reflecting on human rights in the context of social care. (218 words)

The COVID-19 pandemic has unleashed unprecedented concern over the treatment and rights of older people in societies globally. It has highlighted levels of structural and institutionalised ageism in addition to numerous issues that are in violation of the human rights and freedoms of individuals who are older. Calls have thus grown louder to adopt a UN Convention on the Rights of Older Persons. Its purpose could be to provide a legal human rights framework tailored to specific issues concerning older age groups as a powerful tool for change.

United Nations headquarters in New York, seen from the East River.

To discuss the possibility of such a Convention, delegates from around the world will meet between the 29.03 and the 01.04.2021 at the UN Headquarters in New York for the 11th session of the UN Open-Ended Working Group on Ageing. It will include a virtual element and will be accessible to follow on UN TV and open to all – no registration needed. The address to access this will be: webtv.un.org. More details about the hearing are available at: bit.ly/OEWG11_OlderPersonsRights. Additional info about this process is available via the UN website – specifically on the Open-Ended Working Group on Ageing part of the site. This is available via: https://social.un.org/ageing-working-group/ – then follow Eleventh Session tab for more info/documents relevant to the hearing.

Caroline Green is Post-Doctoral Fellow at the Policy Research Unit in Health and Social Care Workforce, King’s College London. In December 2020, Caroline released a Human Rights toolkit as a means of reflecting on human rights in the context of social care.

HOPES 2 study launches! Helping older people with mental health needs to engage with social care

The HOPES 2 study commences this month. Led from the University of York by Dr Louise Newbould and Dr Mark Wilberforce, the project’s full title is ‘Helping older people with mental health needs to engage with social care: Enhancing support worker skills through a prototype learning and development intervention’. Dr Kritika Samsi, Research Fellow at this Unit, is also working on the study, which is funded by the NIHR School for Social Care Research. (542 words)

This project is about the care of older people living with dementia and complex mental health needs. Many studies show that outside help can be hard to accept for people living with poor mental health or memory difficulties. Understanding the purpose of care and communicating any worries can be hard. Sometimes people will reject the care verbally or physically, which can result in them being labelled as a ‘difficult person’. Providing care in these situations can be hard, when home care workers are under pressure to deliver care in often short timeframes. As a result, relationships between the individuals and service providers can sometimes fall apart. Our previous research suggests that “specialist support workers” within community mental health services may help older people living with dementia or with complex mental health needs to accept social care. However, these specialist support workers often say that they do not have the chance to learn or share knowledge, strategies and skills between themselves.

Our earlier research also found that the training available is often unsuitable for this group of workers because it is either too basic and does not account for their specialist knowledge from their experience in mental health work; or else too advanced as it expects them to have professional qualifications. The aim of this study is to develop a way of helping support workers to share and develop their knowledge of ways of reducing resistance to care. This will be based on what we are currently learning in the ‘Helping Older People Engage in Social care project’ (or ‘HOPES 1’). Continue reading

Women’s activism across generations and the globe in the time of Covid

Dr Valerie Lipman is Honorary Research Fellow and Chair of the Patient and Public Involvement and Engagement Advisory Group at the NIHR Policy Research Unit in Health and Social Care Workforce, King’s College London.[i] (1,198 words)

We celebrate International Women’s Day 2021 with a story of an intergenerational project between young girls and older women in West Bengal, India and their global links with European feminists. As a result of the extraordinary determination and struggle of a group of girls, over a hundred homeless older women living in cyclone flooded and Covid-affected villages in the Bay of Bengal region, India will be moving into homes which have been especially designed and built for them.

In May last year the Amphan Cyclone in the Sundarbans in West Bengal wrought destruction in this area not witnessed for about 50 years. Already reeling from the Covid pandemic, thousands of people lost their livelihoods, homes and lives. Families were destroyed and as a local worker said: ‘The old village tradition of living with each other together has now become a fairy tale’.  Older people were left isolated with no one to look after them and older women who have no rights to land ownership or their own housing in this area, were left particularly stranded. The commonly held view locally was to prioritise those struggling to support their younger families, rather than help people nearing the end of their lives. Continue reading