Legal Representation of Patients with Dementia in Long Term Care Settings

Abstract

Introduction: Dementia is a neurodegenerative disease which affects cognitive, physical, and behavioural abilities. To date there is no effective disease-modifying treatment, so the course of disease is progressive [1]. Worsening cognition in advanced stages can impair the person’s mental capacity to make decisions. Consequently, advanced care planning (ACP) is an important aspect in dementia management [2]. Guardianship is an integral part of ACP where the patient legally appoints a trusted person to make best interest decisions for them should they lose capacity. As a result, this study aims to assess the legal representation of patients suffering from dementia. Method: Patients residing in all the nine dementia wards at Saint Vincent De Paul Residence (SVPR), were recruited (203 patients). A diagnosis of dementia is a requirement for admission to these wards. A data collection sheet was designed and included data on the patient’s demographics, MMSE scores and guardianship statuses. Data was collected retrospectively from the patient’s medical records and their caring medical team where documentation was lacking. The data collection period included September to October 2022. Results: Only 7 patients had a guardianship present (3%). The patients’ children (57.1%) were more likely to apply for guardianship, followed by the patients’ spouses (28.6%). The guardianship status was clearly documented in the doctors’ notes and next of kin (NOK) paper, together with the name and contact details of the guardians. 196 patients (97%) did not have guardianship. 5 of these had a power of attorney (POA) but the type was not specified. 190 patients had a relative or friend listed as the next of kin (NOK) and a patient had no legal guardian or NOK. Conclusion: Most patients with Dementia did not have formal legal representation like guardianship or valid POAs. However, the majority of NOK documented were in line with the legal definition of the responsible carer according to the MHA