Care decisions for someone with dementia

Assess for each decision, each time

Someone may be unable to decide about selling their house but perfectly able to choose what to eat or where to sit. Ask at the best time of day, in a familiar place, with information given simply. An attorney only acts where the donor cannot decide. See mental capacity explained.

When the donor resists care

• Look for the cause: pain, infection, fear, noise, an unfamiliar carer.
• Try the least restrictive option and record what you tried.
• Covert medication, locked doors and physical restraint go beyond an attorney's authority and need a proper authorisation.
• Ask for a community mental health or dementia nurse review rather than deciding alone.

A worked example

Consider Eileen, who has moderate dementia. Her daughter Marion holds her registered health and welfare LPA. Some mornings Eileen can clearly say she wants a shower rather than a bath and is capable of that decision; by early evening the same day she may be too confused and distressed to weigh up a much simpler choice about what to wear for bed. Marion does not treat Eileen as permanently lacking capacity — she reassesses in the moment, defers to Eileen whenever she can decide for herself, and only steps in as attorney for the specific decisions Eileen genuinely cannot make at that time. When Eileen begins refusing all personal care from a new agency carer, Marion does not simply insist; she asks the GP whether an infection or pain could explain the change, and it turns out a urinary tract infection was the cause, resolved with treatment rather than argument.

Medication and covert administration

Attorneys are sometimes asked by a care home or family member whether medication can be hidden in food when the donor refuses it. This is a serious step that goes beyond ordinary attorney authority: it needs a proper best-interests process involving the GP or pharmacist, a documented decision that it is the least restrictive way to give essential treatment, and usually sign-off through the care home's own safeguarding procedures. An attorney should never authorise it alone on the strength of the LPA only.

Decisions that need the Court of Protection

• Depriving the donor of their liberty outside a care home DoLS.
• Serious disputes with clinicians or between attorneys.
• Statutory wills, large gifts and tax planning.
• Stopping contact between the donor and a family member.

If a dementia diagnosis is recent and no LPA is in place yet, capacity to make one may still exist for some time after diagnosis — see LPA after a dementia diagnosis for how quickly to act and what a solicitor or our capacity-checked process looks for.

Common questions

Read next

• Making an LPA after a dementia diagnosis
• Choosing a care home as an attorney
• Mental capacity explained (and why timing matters)