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Capacity assessment for discharge destination — SCE Geriatric Medicine MCQ

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HardEthics and lawCapacity assessment for discharge destinationSCE Geriatric Medicine

An 86-year-old woman with moderate dementia is medically fit after pneumonia but refuses discharge to a care home, saying she wants to return to her flat. She believes her deceased husband will cook for her and cannot describe how she would obtain food or call for help. Her son has health and welfare LPA and favours a care home; she becomes distressed when this is discussed. What is the most important next step?

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Correct answer: D — Assess capacity specifically for the discharge decision

The best answer is “Assess capacity specifically for the discharge decision”. Assess and document capacity for the specific discharge decision, using practicable support to aid understanding The alternatives “Accept her refusal because disagreeing with professionals proves capacity”, “Follow the son's preference because health and welfare LPA overrides assessment”, “Request a DoLS authorisation before assessing capacity”, “Transfer to the care home because discharge delay is harmful” are credible in related presentations but do not match the defining finding, treatment threshold, legal test or care pathway in this stem.

Reference: NICE NG97 dementia recommendations: https://www.nice.org.uk/guidance/ng97/chapter/Recommendations