At the outset of the Covid-19 Pandemic, many capacity providers quickly decided to move all of their services to online virtual capacity assessments, using software such as Zoom, Skype and Facetime.
We were fortunate at Nellie Supports that our case management system had an integrated telehealth system, which allowed ut to quickly and safely provide this service. However, we always took the view that face to face assessments was always best practice on the basis that Principle 2 of the Mental Capacity Act (2005) states that "A person must be given all practicable help before anyone treats them as not being able to make their own decisions."
The Social Care Institute for Excellence (July 2020) advises, "This means every effort to encourage and support people to make the decision for themselves".
For us, this meant completing face to face assessments was necessary. While there was a reference to assessors completing face to face assessments being "super spreaders", we listened to government advise, watched our colleagues in local authorities and the NHS and used proper PPE and safety precautions to ensure we to every practicable step we could to help people make their own decisions.
Throughout the pandemic, we have advised we are client-led, and while we advise face to face is best practice, we can understand some people wish to remain as shielded as possible and require a telehealth assessment.
So what have we learnt?
At the outset, many care homes were struggling with technology; in some cases, they simply didn't have the equipment; in others, broadband speeds were to slow and in others, staff were unfamiliar with the technology.
Over the past year, we have seen Care Homes become more used to the new equipment, and improve their staffs understanding and update their internet connections...for the most part.
Is there a need for improvement? Absolutely! could the adoption of these technologies improve clients lives after the pandemic? 100%! But mostly the generations coming up are aware of this technology, it's part of their daily lives now so Care Homes in the future will have to keep up as much as the rest of us!
Video-Link Mental Capacity Assessments - The Magic Bullet?
It appeared back in March 2020 that video-link would be the magic bullet, that from now on, maybe all assessments would be done "virtually". But it simply hasn't been the case; 80% of the assessments completed by our team over the past twelve months have been facing to face.
Two reasons firstly, the majority of clients have requested it because their cases are contentious, and they fear a video-link assessment may be weakened in a court setting, as this hasn't (to my knowledge) been tested in a court setting (to-date).
The second reason is simply "grandma won't engage with technology." which reverts us back to Principle 2 of the Mental Capacity Act (2005) and delayed by what was (in March 2020) an indeterminate time period would be inappropriate, in a large proportion of cases, for the individual.
Video-Link and Undue Influence
Over the past year, we have heard some great ways of ensuring there is no undue influence; my all-time favourite has been "ask the client to pan the camera around to make sure there is no one else in the room". If your malicious enough to be placing undue influence on a vulnerable adult or child, then I would guess your intelligent enough to avoid a camera as it pans around the room.
Originally we advised that honesty is the best policy; tell the client your assessing is okay for someone to be with them. If someone is off-camera, they will either give a small body language indicator or invite the person onto the camera.
Of course, the assessor's skill and ability to read body language along with a good communication theory knowledge is essential at identifying key markers of undue influence.
However, my daughter tends to scratch the back of her hands when she is anxious; as a parent, it's quite a subtle tell that lets me know to speak to her and see if everything is okay. On video-link assessments, much of the body is not visible; for the most part, its the torso upwards, so much of this body language isn't visible.
But... 55% of communication is body language, 38% is the tone of voice, and 7% is the actual words spoken, so surely there is enough just in tone and words to identify undue influence! Well, Mehrabian's 55/38/7 rule is misquoted and based on two different pieces of research, and as he has said, communication is far more complicated than a simple rule.
What have we learnt
Over the past year, we have identified video-link assessments' weaknesses and developed ways to give additional supporting evidence to minimise these weaknesses.
To evidence the clients cognitive functioning at the specific time of the assessment, we have ensured all of our Social Workers are accredited Montreal Cognitive Assessors and, where appropriate, complete a MoCA Assessment alongside the video-link capacity assessments.
We have also ensured our Social Workers are trained in financial vulnerability and completed the financial decision tracker, which gives empirical evidence of the risk of undue influence and the Montreal Cognitive Assessment.
These tools are completed via video-link, giving additional supporting evidence to those weaknesses we have been able to identify.
Video-Link the future
Video-link probably isn't going anywhere soon, and for some clients, it really is the best medium for an assessment to take place; for others, not so much.
I fear at some point video-link assessments will be tried in a court setting and potentially be deemed lacking, which may be forgiven during the pandemic, but once the pandemic is over, will the question not be, what was the reasoning behind the assessment being completed via video-link for whos benefit - the individual, or the assessors?
We will continue to provide video-link assessments, yes as we will face to face assessments because we will continue to be led by our client's needs and government advice and guidance.
But as reflective practitioners, we will continue to identify weaknesses, as we do in all of our practice, and ensure tools and training is in place to overcome them where possible.
Will we promote it as the best option? No, face to face will always be best practice.