Mental Capacity Assessment
Capacity to Decide About Care and Support Arrangements
A care and support capacity assessment is a decision-specific assessment of whether a person can make a specific decision about the care, support or supervision they receive, applying the Mental Capacity Act 2005. It considers whether they can understand, retain, use or weigh the information relevant to that care decision. Care is a separate decision from residence, so a person may be able to make one but not the other.
Decision-specific capacity assessments about the care and support a person receives, for families, solicitors, local authorities and the Court of Protection across England and Wales.
At a glance
Decision
Managing and arranging care and support
Legal framework
Mental Capacity Act 2005 and LBX v K, L, M
Format
Face to face or remote
Report
Court-ready and peer reviewed
Coverage
England and Wales
£600 + VAT
Standard fee, stated before instruction
5 working days
Turnaround from assessment visit
England and Wales
Nationwide coverage
Care, not residence
Decisions kept distinct
Plain-English explanation
What is a mental capacity assessment?
A mental capacity assessment is a decision-specific and time-specific process used to determine whether a person can make a particular decision for themselves. Under the Mental Capacity Act 2005, the assessor considers whether the person can understand, retain, use or weigh the relevant information, and communicate their decision. A person can only be found to lack capacity where an impairment of, or disturbance in, the functioning of the mind or brain causes their inability to decide. It is not a general test of intelligence, memory or diagnosis, and every practicable step must first be taken to support the person to make the decision.
The decision concerns the person's care and support: whether they can decide what care they receive, agree or decline a package, and manage and direct the arrangements that support them.
Capacity can differ between decisions. A person may be able to decide whether to accept help with personal care while being unable to manage direct payments, employ personal assistants or hold a provider to account.
An unwise decision is not the same as lacking capacity
A person is entitled to refuse care others think they need, and to accept risk in doing so. The issue is whether the person can make the relevant decision, not whether professionals or relatives agree with it.
Common situations
When you may need a care and support capacity assessment
A care and support capacity assessment is usually needed where a decision about care or support arises and there is doubt about whether the person can make it for themselves. This commonly arises where a person is refusing a proposed care package, saying they can manage without support, or where there is disagreement about carers coming into the home.
It is also frequently needed where there are self-neglect or safeguarding concerns, or where a hospital discharge or care planning decision depends on the person's ability to decide about care. Care, residence and discharge decisions often overlap but are not always the same decision, and a person should not be treated as lacking capacity simply because professionals disagree with a risky or unwise choice. A clear, independent, decision-specific assessment keeps everyone focused on the right question and the person's best interests.
A care package is being set up or changed
Support is being commissioned, increased or withdrawn and evidence is needed about the person's own decision-making.
Direct payments
The person holds or is applying for direct payments and their ability to manage the arrangement is in question.
Care is being declined
The person is refusing support that professionals or family consider necessary, and the refusal has to be understood properly.
A dispute with the local authority or ICB
A Care Act, section 117 or continuing healthcare arrangement is contested and capacity is part of the picture.
Court of Protection proceedings
A welfare application turns on whether the person can make decisions about their own care and support.
Concerns about a provider
There are concerns about the quality or safety of care and whether the person can recognise and raise them.
Decision-specific content
What this assessment covers
This assessment addresses the person's capacity to make decisions about their care and support: what care they have, whether to accept or decline it, and how the arrangements around them are managed. It is decision-specific: the assessor tests the actual care question in front of the person. In line with the Mental Capacity Act 2005, and following the relevant information for care decisions identified in LBX v K, L, M [2013] EWHC 3230 (Fam), the assessment considers whether the person can understand, retain, use or weigh that information, and communicate their choice. That information typically includes:
The areas of daily life they need support with, such as personal care, medication, meals, money and getting out
What that support would actually involve in practice, and how often it would be provided
Who would provide it, and the difference between family, an agency and directly employed carers
What could reasonably happen if they did not have the support they need
That carers may not always treat them well, and that they can say no, ask for a change or complain
How the care is paid for in broad terms, including any contribution they would make and what a direct payment involves
Care is not the same decision as where to live
The Court of Appeal confirmed in B v A Local Authority [2019] EWCA Civ 913 that residence, care and contact are separate decisions, each with their own relevant information. This assessment covers decisions about the care itself, including arranging and directing it. Where the person should live is assessed separately, and conflating the two is one of the most common reasons a capacity assessment is criticised.
1
The functional test
A care and support capacity assessment applies the Mental Capacity Act 2005 to the specific care or support decision in question. The question is whether the person can:
Understand the relevant information about the care or support decision, including the support proposed, who would provide it and what may happen if it is refused
Retain that information long enough to make the decision
Use or weigh the information, including the risks, benefits and consequences of accepting or refusing support
Communicate their decision by any means
2
Impairment and causation
The question is not whether the person has a diagnosis, appears vulnerable, or makes what others consider a risky or unwise choice. If they cannot make the decision, the assessor considers whether that is because of an impairment or disturbance of the mind or brain. A person can refuse care they are assessed as having capacity to refuse, and that refusal does not, by itself, remove a local authority's duty to consider how eligible needs might be met in a different or less restrictive way. Care and residence are separate decisions, so each must be assessed and reasoned separately.
Framework: Mental Capacity Act 2005 ss 1 to 3 and the Code of Practice; Care Act 2014 where care and support needs are in issue. Care and residence are treated as distinct decisions.
For the framework in full, read our guide: residence capacity versus care capacity.
Legal framework
The legal test for a care and support decision
Initial enquiry and triage
Contact us by phone, email or website form. We gather the key details, confirm the care or support decision to be assessed, and note any refusal of support, safeguarding concerns, hospital discharge issues, family disagreement and who needs the report.
Quotation and booking
Once we understand the scope, we provide a clear quotation including VAT and any applicable travel costs, and arrange a suitable appointment as quickly as possible, prioritising time-critical cases such as hospital discharge.
Assessment appointment
A qualified assessor meets the person where they are, at home, in a care home, in supported living, in hospital or by video, and carries out a decision-specific care and support capacity assessment.
Report preparation and peer review
The findings are written into a clear report explaining the decision assessed, the relevant information, the practicable steps taken, the person's responses, the evidence considered and the reasoning, reviewed by a second qualified professional before issue.
Secure delivery
Your completed report is delivered securely by email, usually within your stated turnaround period, with reasonable clarification available afterwards to help inform the next lawful decision-making process.
What happens next
Our care and support capacity assessment process
Supported decision-making
How we support decision-making
The Mental Capacity Act 2005 requires that no one is treated as unable to make a decision unless all practicable steps to help them have been taken without success. That support is built into every assessment:
Plain language and real examples
Decisions are explained using the person's own circumstances and the decision actually in front of them, rather than abstract scenarios.
The right time and place
Appointments are arranged for when the person functions best, at home, in a care setting, in hospital or remotely.
A familiar person nearby
A relative, friend or carer can be close at hand where that reassures, while the assessment itself remains independent.
Communication adjustments
More time, information broken into stages, and written notes or aids where they help the person express a view.
Evidence base
Evidence we review
With consent, the assessor grounds the assessment in the person's real circumstances. For a care and support capacity assessment this typically means reviewing:
Medical records
GP summaries, hospital letters and any information about diagnosis or treatment that bears on decision-making.
The care plan on the table
The package being proposed, changed or withdrawn, so the person is asked about the actual arrangement rather than care in the abstract.
Social care and funding records
Care Act assessments, section 117 or continuing healthcare decisions, and any direct payment agreement.
Previous assessments
Earlier capacity assessments, cognitive testing or social care assessments, where these exist.
Care and support records
Daily notes, incident records and any refusal of care, which often show more than an interview alone.
Accounts from people who know the person
Observations from family, carers and professionals about how the person manages and directs their support in practice.
Deliverable
What the assessor evaluates
A well-reasoned care assessment explains how the conclusion has been reached, tied to the actual care decision and kept distinct from any separate question of residence.
The exact care or support decision, and the real options actually being considered
The relevant information the person needs to understand for that care decision
Whether they were given that information with practicable support to decide
Whether they understand the support proposed, who would provide it and the consequences of refusing
Whether they can retain the information and use or weigh the risks, benefits and alternatives
Whether they can communicate a decision by any means
Whether any inability is because of an impairment or disturbance of the mind or brain
How the care decision has been kept distinct from any separate residence decision
Assessment option | Suitable for | What is included |
|---|---|---|
Standard Assessment | Most care and support decisions | |
Enhanced Assessment (EMCA) | Contested, high-value or high-risk matters | |
Court-specific instruction | Court of Protection or other proceedings |
Who we work with
For solicitors, deputies and other professionals
Instruction is straightforward and the evidential standard is consistent whichever decision is being assessed:
Scope confirmed in writing
The decisions to be assessed, the fee and the timescale are confirmed in writing before instruction.
A traceable evidential line
Evidence, analysis and conclusion are set out in a structure a court, bank or public body can scrutinise.
Peer review as standard
A second qualified professional reviews every report before it leaves the practice.
Follow-up clarification
Clarification for instructing parties is included after the report is delivered.
Standard Assessment
£600 + VAT
- Decision-specific assessment of the actual care or support decision
- Completed in line with the Mental Capacity Act 2005
- Care kept distinct from residence
- Court-ready report for families, local authorities and the Court of Protection
For most care decisions where the options are clear and undisputed.
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Enhanced Assessment
£3,500 + VAT
- Extended, multi-layered assessment
- Fuller consideration of wider welfare, safeguarding and risk issues
- Broader evidential framework for contested care decisions
- Robust reporting where the decision is disputed or before the Court of Protection
For complex or contested cases, or where wider welfare or liberty issues arise.
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Transparent pricing
Standard or Enhanced, which does your case need?
A standard assessment is right for most care decisions where the options are clear and there is no significant dispute. Where the case is complex or contested, or where there are wider welfare, safeguarding or deprivation of liberty issues, an enhanced assessment provides a deeper, more defensible evidential foundation.
For families
A clear fee, stated before instruction and confirmed in writing, with VAT and any travel set out up front. The assessment is arranged around the person, at home, in a care setting, in hospital or remotely, and your report is delivered within 5 working days of the assessment visit, in a form local authorities, ICBs and the Court of Protection can rely on.
For professionals
A permanent, employed multidisciplinary team, not an ad hoc associate or referral-panel model: Social Work England and Social Care Wales registered social workers and a Chartered Psychologist (BPS). Every report is peer reviewed by a second qualified professional and structured for scrutiny, with reports relied on in the Court of Protection, the Family Court and the Court of Appeal.
Provider evidence
Why choose Nellie Supports for your mental capacity assessment
England and Wales' largest identified specialist private social work and mental capacity assessment practice, with over 11,000 formal assessments and reports completed by a permanent full-time multidisciplinary team.
Why families, solicitors and local authorities choose Nellie Supports
Decision-specific, not generic
We assess the actual care decision, accepting or refusing a package, carers at home, a Care Act assessment, not a vague view of whether someone can manage care.
Care and residence kept separate
Following the law, care and residence are distinct decisions, so the evidence is precise about which has been assessed.
Risk is not treated as incapacity
Self-neglect, care refusal or risky choices do not prove incapacity. We assess whether the person can make the decision, not whether they choose what others prefer.
Person-centred and therapeutic
Care decisions are sensitive and often urgent, so the assessment is calm and supportive while remaining evidentially robust.
Built for safeguarding and the Court of Protection
Reports structured for care refusal, self-neglect, hospital discharge, safeguarding and Court of Protection welfare matters.
Employed, not outsourced
A permanent full-time team, peer reviewing every report, not an ad hoc panel of associates.
The situation
A local authority was concerned about an older man living alone who was refusing a proposed care package, despite deteriorating health and some self-neglect. The question was whether he had capacity to make that decision, or whether a best interests process was needed. Nellie Supports was instructed to assess his capacity to decide about the care and support on offer.
The assessment
We met him at home and focused on the specific decision: the support being proposed, who would provide it, what might happen if he continued to refuse, and what he could do if he became unhappy or unsafe. We gave him time and support to take the information in, and kept the care decision separate from any question about where he lived.
The outcome
The assessment concluded that, with support, he could understand and weigh the information and had capacity to refuse the care package, and it recorded his reasons in his own words. The report gave the local authority a clear basis to respect his decision while considering whether his eligible needs could be met in a different, less restrictive way.
This is an illustrative example, drawn from the common features of the care and support capacity cases we assess. It does not describe any individual client.
How this works in practice
Frequently asked questions
Common care and support capacity questions
Can someone refuse care if professionals think it is unsafe?
Yes. A person can refuse care even if professionals, relatives or services think the decision is risky or unwise. The key question is whether they can understand, retain, use or weigh the relevant information and communicate their decision. A refusal only indicates a lack of capacity if the person cannot make the decision because of an impairment or disturbance of the mind or brain. A capacitous refusal does not remove the local authority's duties where eligible needs exist; it may mean those needs must be met in a different or more acceptable way.
Is refusing a care package the same as lacking capacity?
No. Refusing a care package is not the same as lacking capacity. The assessment must consider whether the person understands what support is being offered, why it is being offered, who would provide it, what may happen if support is refused, and whether they can apply that information to their own situation.
Can the assessment cover both care and residence?
Yes, but they are two different capacity decisions and should not be treated as interchangeable. Capacity to decide about care is not the same as capacity to decide where to live. Where both issues arise, the report identifies each decision separately, sets out the relevant information for each, and reaches a separate conclusion, explaining any relationship between them rather than merging them.
Does a care and support capacity assessment decide what care someone should receive?
No. The assessment considers whether the person can make the specific care or support decision themselves. It does not decide what care package should be provided, what is in the person's best interests, or what services a local authority, NHS body or care provider must arrange.
What happens if the person lacks capacity to decide about care?
If the person lacks capacity, the decision will usually need to be made in their best interests under the Mental Capacity Act 2005, taking account of their wishes, feelings, values and available options. The assessment provides the evidence; it does not make the best interests decision. The next step may involve a best interests meeting, safeguarding consideration, solicitor advice or a Court of Protection application.
Can the report be used in a best interests meeting?
Yes. Where a person lacks capacity, the report may help inform a best interests meeting or wider professional decision-making. It provides evidence about capacity, including the decision assessed, relevant information, practicable steps, responses and reasoning. It does not replace the best interests decision itself.
What if the assessment does not reach the conclusion we hoped for?
Our assessments are independent, and that independence is what gives the report its value. We do not begin from a preferred answer. We assess the specific decision on its merits and record the reasoning, whatever the conclusion. A report that only ever confirmed what was hoped for would carry no weight with a solicitor, the Court of Protection or anyone else relying on it.
Where do you cover?
Assessments are carried out across England and Wales, at home, in care settings, in hospital or remotely where appropriate. Travel is charged at £40 per hour and confirmed before booking.
Who will carry out the assessment?
A registered professional from our permanent, employed team, which includes Social Work England and Social Care Wales registered social workers and a Chartered Psychologist (BPS). Every report is peer reviewed by a second qualified professional before delivery.
Residence capacity versus care capacity
Why the two decisions are assessed separately
The two-stage test for mental capacity explained
The diagnostic and functional stages, clearly
Complex, high-value and contested capacity decisions
Planning assessments for the hardest cases
How to instruct a mental capacity assessor
Getting the instruction and evidence right
Who can assess mental capacity?
The professionals involved and what makes an assessment suitable
Supporting guidance
Care and support capacity guides
Capacity to decide where to live
For a decision about where a person should live, such as home with care or a care home.
COP3 mental capacity assessment
For Court of Protection deputyship applications.
Capacity to Manage Finances
Independent, decision-specific assessment of capacity to manage money, property and financial affairs.
Other assessment types
Discuss the instruction
Book a care and support capacity assessment
Tell us about the person, the care or support decision being considered and any deadline such as a hospital discharge, and we will confirm whether a standard or enhanced assessment is right, the fee, and the earliest appointment.
Written by Ben Slater, Founder and Managing Director, Nellie Supports. Read our editorial policy.