Brain Injury Group - Court of Protection Training Day Part Two

A neuro OT review part two

Brain Injury Group – Court of Protection Training Day

13 November 2018

The Brain Injury Group at their recent training day decided to tackle the complex issue of capacity. The day was opened with an overview of the common problems faced by Professional Deputies when dealing with an individual’s property and affairs. If you have not already read part one of our review, this can be read here(link).

Understanding the role of the Welfare Deputy

Traditionally, Welfare Deputies have been a rare breed of individual. A Welfare Deputy would be responsible for making routine decisions about day-to-day care needs, activities and holidays, etc.

Recently, there has been a rise in applications for Welfare Deputies, particularly for individuals with brain injury or complex neurological presentations. Deputy Head of Public Law Group at No 5 Barrister Chambers, Ian Brownhill, believes this can be attributed to a number of factors:

• For young people with special educational needs, once they reach 18 the individual’s parents no longer have rights over their child and this responsibility passes to the Local Authority. Parents’ rights groups have been encouraging parents to apply for Health and Welfare Deputyships because there is concern that Local Authorities will railroad parents into making decisions they do not wish to support. The Courts in London have been pushing back the applications, however, other Courts have adopted a varied approach to supporting these applications resulting in inconsistencies throughout the UK.
• In relation to community care, cuts in funding are leading families to apply for Welfare Deputyships; they believe this role will help them influence funding of care, but it is, in fact, a misguided view.
• Family members may also apply for Welfare Deputyships in an attempt to challenge medical care, Case Managers, Neuro OTs and MDT teams, especially with regard to the use of experimental treatment.

Careful consideration needs to be given as to why families are applying for these roles. It was discussed that clinicians, including Neuro OTs and Case Managers must implement an active process of consultation that includes the family and parents.

Collaborative decision-making should be encouraged to ensure that families feel central to any decision-making process. This approach may help families feel more empowered and less likely to seek out an alternative approach.

Occupational therapists and housing and adaptations

The issue of housing and adaptions for clients with complex needs is an important area. The case of a family was discussed involving Baby P.

Baby P’s family had requested to move out of MOD accommodation into purchased accommodation for their child, who suffered from a birth related brain injury.

It was discussed that when planning a house move for Baby P, Deputies were required to consider the following:

• Why does someone want Baby P to move, what are the benefits to Baby P and what is the impact of uprooting him?
• Do all parties agree with the move or is there any disagreement? If there is disagreement, should Baby P have separate legal representation to ensure his needs are met?
• Is someone else benefiting from the purchase of the new home? Deputies must ensure that the sole beneficiary of the property is Baby P.
• If family members are moving in to live with Baby P, it must clear what, if anything, they are contributing for the upkeep of the address and associated livings costs. In the case of parents, for example a mum who is providing gratuitous care may not have to contribute to the upkeep of the property, but this may not be the case for a sibling.

Housing and environmental adaptations is an area where the opinion of an Occupational Therapist is often obtained. It was discussed that housing stock of pre-adapted properties is limited and, therefore, Deputies should seek the opinion of an Occupational Therapist. Consideration should be given to the questions outlined below, including reference to how the proposed property could be adapted to meet Baby P’s needs.

In Baby P’s case, initial consideration needed to be given to the following:

• Is the proposed property accessible to Baby P and his carers (this includes primary access points, as well as rooms throughout the property)? If the property is not accessible, is there a possibility of adapting the property to meet Baby P’s needs?
• If adaptations are required, is the proposed property being adapted to meet Baby P’s needs, or that of the carers, and are the proposed adaptations reasonable? For example, using Baby P’s funds to install an en-suite bathroom for Baby P’s carer or family member would not be of benefit to Baby P; therefore, this could not be supported financially through a claim or any post settlement money.
• Is there enough money in the settlement to ‘run’ the home from a financial perspective? In Baby P’s case the example of the costs of maintaining a swimming / hydro pool was discussed. It was highlighted that whilst this type of therapeutic activity may be beneficial to Baby P, the costs associated with this must be considered thoroughly before agreement to install or use can be obtained.

Clearly, careful thought and consideration needs to be given to the purchase and, if required, the subsequent adaption of a new property for clients with acquired brain injury and complex needs. The opinion of a specialist Occupational Therapist who has skills within environmental adaptations is often obtained. This type of work falls outside of the remit of a neuro OT, whose primary focus is rehabilitation; however, it is important that all neuro OTs have an awareness of the decision-making process within this context.

Overall, it was a very enjoyable day with many topics being covered that were very relevant to neuro OTs working in the field of acquired brain injury.