Keywords: Best Interests, Care Planning, Alcoholism
Mr DM was a 69 year old man who had Korsakoff’s syndrome and a long history of alcohol dependency.
Previous self-neglect had led to his admission to hospital and he had been discharged (with his agreement) to a ‘dry’ care home which did not allow residents access to alcohol.
He had lived there for the past 5 years. He had been under constant supervision, including being accompanied in the community, due to becoming confused and disorientated.
During those 5 years, there was only one recorded incident involving Mr DM consuming alcohol. However, Mr DM had consistently expressed a wish to consume alcohol and to live independently. As a result, the current proceedings had been brought on his behalf as a s.21A challenge to the DOLS authorisation.
DM did not participate in social activities at the home, but was reported to have one friend – another resident there. He had no relatives.
It was quite clear from the medical evidence that:
- DM needed significant care with daily living tasks and was not able to care adequately for himself independently
- DM lacked any insight into or comprehension of either his alcohol dependency or inability to care for himself and did not have capacity to litigate or to decide his residence or care.
- If DM remained abstinent from alcohol his likely life expectancy was approx. 7 years. If DM were to drink even moderate amounts of alcohol this would be likely to result quickly in significant health problems and reduce his life expectancy to approx. 3 years.
Bodey J attached considerable weight to DM’s consistent expression of his wishes and feelings about alcohol and his apparent acceptance of the risk that it would shorten his life and considered carefully the potential harm to DM of his wishes being overridden. The option of a care home which permitted the consumption of limited and controlled quantities of alcohol was explored. DM’s social worker was firm in his view that DM’s quality of life would deteriorate in the specific alternative environment, describing how he had “observed the residents at the possible alternative care home to which he took DM sitting around in various stages of intoxication.”. In his view DMwould continue to feel frustrated by limitations on his alcohol consumption, whilst also feeling miserable from the resulting deterioration in his physical health. Additionally, it was likely that DM would continue to experience frustration that he was unable to live independently. Further factors weighing against a move were: that, apart from his wish to consume alcohol, DM appeared settled and reasonably happy in his current environment; his friendship with a fellow resident; the inevitable risks of any move in terms of failing to settle and lack of certainty that he could return to the current care home should he change his mind; and the uncertainty of developing new friendships in a new environment.
Consequently, Bodey J decided that it was not in DM’s best interests to move to another care home where the consumption of alcohol was permitted. He also decided that there was no benefit in a trial period in an alternative home as it would be cruel to give DM a renewed taste for alcohol and then expect him to revert to a dry environment if the trial failed. In his view it was a finely balanced judgement and could be revisited if continued residence at the current care home was causing DM real ongoing frustration and unhappiness.
It is useful to note that, in this case, both care home placements were options which could be considered in the best interests decision making process – since the local authority were willing to offer either placement. However, the option of independent living in the community was not an option open to consideration since the local authority was evidently unwilling to offer such a placement on the grounds that it would not meet Mr DM’s needs appropriately.
Full transcript at: http://www.bailii.org/ew/cases/EWCOP/2017/13.html