Post No 66...What is a DoLS, and how do they work in care homes?

Introduction

A Deprivation of Liberty Safeguards (DoLS) is used by both hospitals and care homes if a person is being deprived of their liberty by being in that setting. The applications are put in by either care home or hospital staff, they are not completed by family members and do not apply if the person is not in any of these two settings.

This post is going to cover what a DoLS is, why they are used, and some of the different reasons they are put in place.

What is a DoLS?

A DoLS is a set of checks that helps support and keep a person safe, whilst reducing their liberty in the most least restrictive way. This is based on an assessment, which is sent off for legal checking, and is also reviewed regularly. It is called a deprivation of liberty by the Mental Capacity Act and is different from being detained under the Mental Health Act 1983.

Why are DoLS used?

In short, a DoLS is put in place to legally allow a care home or hospital to restrict the freedoms of a person for their own best interest or safety. The care home or hospital also need to send off the DoLS application to the local authority, making the process transparent and agreeable at a higher level, so that the required care can then be provided in a safe environment for the resident.

DOLs and dementia settings

One of the more ‘obvious’ reasons that a person may be put under a DoLS is because they have advanced dementia, and have lost the capacity to make safe decisions about their wellbeing. In most purpose-built care homes dementia care is segmented into its own environment, which will be locked, normally via a key pad system.

If a setting is locked and the residents are not free to leave, then a DoLS needs to be put in place. There will be other considerations, including the need for ongoing staff support and supervision, and the lack of capacity to consent to leave / remain in the setting. If a person is moving into a setting of this nature, a DoLS will be applied for as part of the admission process.

Smaller, converted care homes do not necessarily have scope to segment the care types into different areas, but if they are providing dementia care it is likely the setting will still be locked / restricted, and therefore a DoLS may still be required.

DoLS in a residential / nursing setting

This may sound a little contradictory, but there are occasions when a DoLS maybe applied for in either a residential or nursing setting. In purpose-built care homes, there are many residents who live in the residential part of the home, but are also living with dementia. Often in these cases the severity of the dementia is low, or the diagnosis recent, meaning the person can still live well in a residential environment but may move if / when the disease progresses.

However, there could be a situation where a person is still able to live in a residential environment but, for example, because of progressing dementia they are refusing to wash or shower. If a DoLS is in not in place there is very little the care team can do to support the person if they refuse.

Before continuing, I should say that even if there is a DoLS in place, the care team cannot physically force the person into a shower, but it does provide them with more capabilities to support people if it is in their best interest. To do this successfully the approach needs to be right so that the person is not uncomfortable, but the DoLS means the care team can continue to try and shower the person, even if they are initially declining the care.

Conclusion

To conclude this post, if you are unsure about whether your loved one is under a DoLS, or what being under a DoLS means, perhaps request a quick meeting with the care home to discuss the matter further. As mentioned, if the person is living in a dementia setting, it is almost certain that a DoLS will be in place, but they can also (in the correct circumstance) be applied for in other care settings such as in residential or nursing.

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