Ethel is a White UK woman aged over 85.  She was admitted into a nursing home following a lengthy spell in hospital. Ethel is unable to mobilise due to problems with her hip and following a previous fracture after a fall in  her home.

Ethel is also diagnosed with dementia but refuses to accept the diagnosis. The Local Authority (LA) moved Ethel to a nursing home but did not identify a DOL would be required, nor did the Managing Authority (MA) apply for a DOL until almost a year after Ethel had been at the home. Ethel does not want to stay at the home but wants to return back to her flat, and has continued to request to return back home.

Ethel manages her own finances and is not willing to dispense any money from her account to meet basic needs such as toiletries, new clothing etc. since she has been at the home.

How you established the level and type of support which the client required and how this support was provided:

Ethel is deprived of her liberty under MCA DOLS and a named RPPR advocate was appointed by the Supervisory Body (SB) to provide support to the her during the period of deprivation. The authorisation was not subject to any conditions. However when the RPPR read the BIA’s report, it was observed that there were recommendations that  was  not included in the section on the Form 3, and this did not appear to have been identified by the SB.

 RPPR raised the observation of omitted recommendations in the BIA’s report with the SB and the MA,  whom disclosed they also did not read the reports during first visit.

Options discussed and details about which option(s) the client pursued:

Options discussed and options pursued by the client through the support of the RPPR:

RPPR discussed the recommendations in the BIA’s report with the client during visit; in particular to instructing that the LA make an application to the Court of Protection (COP), rather than the RPPR as this was not done by the LA for almost a year that the client has been at the home. Client instructed and consented that an application be made to the COP as she does not want to be at the home.

Option pursued by the client through the support of the RPPR:

Following a best interest meeting organised by the social worker where I represented Ethel; the LA agreed to make an application to the Court of Protection for the court to decide what is in Ethel’s best interest.

Identify any barriers experienced and how you overcome these barriers:

Barriers experienced are as thus:

  • The standard authorisation should have been subject to conditions as identified by the best interests assessor (BIA) but there were none logged.
  • The managing authority did not read the reports and the staff on duty had no clue about the contents of the DoLS assessment reports or standard authorisation.
  • The SB missed the recommendations in the report of the BIA which would have been useful conditions to support Ethel at the home, leading to some delays prior to commencing the implementation of the conditions.


Overcoming barriers:

RPPR called the attention of the MA to the BIA’s report and following discussion ensured the report was read and recommendations were commenced by the MA.

RPPR contacted the SB regarding the omitted recommendations in the BIA’s report

The SB varied the conditions of the authorisation with the recommendations in the BIA’s report and complimented the RPPR for the observation.

RPPR liaised with the social worker of Ethel, calling her attention to the DoLS assessment report and her role in ensuring the implementation of the recommended conditions.


The DOL granted to the Ethel became subject to conditions following the representations made by the RPPR and, the conditions were implemented by the MA and the relevant professionals involved in Ethel’s care and support.

Following a best interest meeting involving a multi- disciplinary team, the LA made an application to the Court of Protection as the RPPR made representations at the meeting that it was their responsibility to do so and as outlined in the BIA’s report.

The best interest meeting and the involvement of the RPPR with the social worker led to Ethel agreeing to release some money from her bank account to meet some of her basic needs at the home; as Ethel has hitherto refused to cooperate with the MA.

Client’s feedback about the support that they had received:

Ethel was aware that an application had been made to the COP, and although the judge ruled she was to remain in the care home as this was in her Best Interest under the Mental Capacity Act, Ethel was happy she had been listened to. Ethel also fed back to RPPR that she was happy to be able to meet her basic needs by paying a fee for a professional in put regarding her urgent need in maintaining personal hygiene, as an NHS appointment was not forth coming.