When I go out on care home inspections as an Expert by Experience, one of the things the inspectors need to know about is any Deprivation of Liberty Safeguards (DoLS) that are in place.
There has been a recent expansion in the use of DoLS, as part of the Mental Capacity Act. These are intended to ensure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom.
However, in a recently reported case, a relative, whose aunt who had dementia and died at a care home in April, was only able to bury her loved one two months later. New rules require state inquests into the deaths of many with dementia before funerals can take place - even when there is little mystery over the cause of death.
The number of people with dementia subject to DoLS is increasing, following a Supreme Court judgement last year that effectively lowered the threshold for what constitutes deprivation of liberty in care.
When those subject to the Safeguards pass away, they are considered to have died ‘in state detention’ - meaning that an inquest is necessary. Many families are unaware of the rules, and say, understandably, these are unnecessary when their relative’s death was clearly linked to their age and health condition.
Recently, The Independent reported the story of a 90 year old care home resident, who was subject to the safeguards when she died, aged 90, in April this year. Her family had to wait for two months to arrange her funeral, due to delays in arranging an inquest.
Her niece had signed the DoLS papers in October last year, but was shocked to discover that an inquest would be necessary. Neither her GP nor the undertaker knew anything about the rule. The local Coroner’s Court sent her documents to sign giving her consent for a paper inquest, however the Coroner was then unable to process the inquest as her aunt had not been formally identified, even though the undertaker stated that she was no longer available for viewing.
After a 'profuse apology' from the Coroner for the delays, she was finally able to collect her aunt's death certificate and the funeral was finally held at the beginning of June – more than two months later.
There is widespread lack of knowledge and confusion about the rules – and little information about what is needed in the circumstances. Most of the 113,000 DoLS applications this year – a tenfold rise on 2014 - concern vulnerable people with dementia. More than one in three were granted, according to this month's figures from The Health and Social Care Information Centre.
According to the Chief Coroner’s office, applications for such orders for people with dementia in hospitals and care homes is widespread and increasing. The previous Government announced it would provide an extra £25m in 2015-16 to help councils manage the pressures on DoLS caseloads brought by the Supreme Court judgement. Let's hope they meant it.
More from the CQC here