It’s a subject that can be misunderstood, often confused with poor decision-making or the natural struggles of ageing. Yet at its heart, capacity is not about whether we agree with someone’s choices, but whether they can understand, weigh up, and communicate decisions about their care.
In adult care, capacity refers to an individual’s ability to make specific decisions at the time they need to be made. It’s decision-specific; a person may have the capacity to choose what to eat for lunch, but not to manage complex financial arrangements. Consent, in turn, means agreeing to a proposed action or plan of care, freely and with full understanding.
The Mental Capacity Act 2025 is clear: every adult is assumed to have capacity unless there is a genuine reason to think otherwise. If a person does not have capacity, decisions must be made in their best interests, often through a structured meeting involving family, professionals, and an advocate who is typically an elected member of the family.
Capacity is not the same as making “good” or “sensible” choices. An older person who insists on staying at home despite risks does not automatically lack capacity; they may simply be exercising their right to independence. This can be particularly challenging for families who feel a move into care would be safer.
Another common misunderstanding lies in the deprivation of liberty. If someone has capacity, they cannot legally be prevented from leaving a care home. Only when a person is assessed as lacking capacity can a Deprivation of Liberty Safeguards (DoLS) order be made to ensure they remain in a safe environment.
Capacity assessments are structured around four key questions:
These assessments are only carried out when there is a clear reason, such as a diagnosis of dementia or noticeable difficulties in daily decision-making. The principle is always to assume capacity first, protecting the person’s right to autonomy for as long as possible.
Spotting the signs of declining capacity early can make a significant difference. Struggles with memory, confusion over time, or difficulty making everyday choices may all signal the need for professional assessment. For families, seeking support from a GP or social worker can help ensure the right steps are taken before a crisis point is reached.
Early diagnosis of conditions such as dementia is also key, not only to access appropriate care but also to give individuals the chance to express their wishes while they are still able. Further information on dementia can be found on the DementiaUK website – www.dementiauk.org
Families often ask what powers they need to support their loved one’s care decisions. The most important documents are Lasting Powers of Attorney (LPAs). There are two types:
Without these, decision-making can be more complex, sometimes requiring deputyship orders through the Court of Protection.
Where capacity is lost and no LPA exists, professionals will work closely with families, ensuring decisions reflect the individual’s known values and preferences. Independent advocates may also be appointed to safeguard the person’s rights.
Behind every capacity decision lies a personal story. One family, for example, struggled as their father insisted on staying at home despite clear safety concerns. Initial assessments suggested he had capacity, but further review showed he could not fully weigh the risks. A move to care followed, and far from losing independence, he found security, routine, and wellbeing in a new environment.
These moments remind us that capacity and consent are not just legal concepts; they are lived experiences that can transform lives when handled with respect and understanding.
Perhaps the most important principle is that care should always remain person-centred. Even when someone lacks capacity, their voice matters. Asking opinions, involving them in conversations, and respecting their identity are vital. It is about more than compliance with the law; it is about dignity, humanity, and compassion.
At Belmont Healthcare, we know that decisions around capacity and consent can feel daunting. Our role is to support families with clear information, empathy, and practical guidance, ensuring the person at the heart of the decision always remains central.
Our teams work alongside families at every stage of the care journey. Whether navigating complex legal frameworks, arranging assessments, or simply listening, we believe care should be a supported, informed choice made with compassion.
For Belmont, it is not just about care, but about people, families, and futures, for your care journey.
If you would like to find out more about our care homes, approach to care, or simply speak to one of our care professionals, call 0333 444 0121 or email enquiries@belmonthealthcare.co.uk.
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