Mental Capacity Assessment
Capacity to Decide About Care and Support Arrangements
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.
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.
£600 + VAT
Standard fee, stated before instruction
5 working days
Typical turnaround
England and Wales
Nationwide coverage
Care, not residence
Decisions kept distinct
Nellie Supports is England and Wales' largest identified specialist private social work and mental capacity assessment practice, delivered by a permanent full-time team. Services are provided by employed, multidisciplinary professionals, not an ad hoc associate, contractor or referral-panel model. We have completed over 11,000 formal assessments and reports. This service sits alongside our full range of mental capacity assessment services.
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.
The legal test for a care and support decision
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
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.
Our care and support capacity assessment process
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 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
Care and support capacity fees and timescales
£600 + VAT
VAT at 20% and travel costs are not included. Enhanced: £3,500 + VAT.
A visit at home, in a care home, in supported living, in hospital or by video, whichever suits the person
A decision-specific focus on the actual care or support decision, not a general view of managing care
Assessment completed in line with the Mental Capacity Act 2005 and the relevant information for care
Care kept distinct from the separate question of residence
Montreal Cognitive Assessment (MoCA) where appropriate, at no extra cost
A clear, court-ready report suitable for families, local authorities, care providers and the Court of Protection
Travel charged at £40.00per hour
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.
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.
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.
A full-time, multidisciplinary team
Nellie Supports is built on an employed, permanent team: registered social workers, a Chartered Psychologist and specialist assessors working together to one standard, with every report peer reviewed by a second qualified professional. Your assessment is never passed to an associate bank or referral panel.
The right professional for the decision
Capacity questions range from care and residence to complex cognition and prognosis. A multidisciplinary team means the discipline is matched to the decision, not to whoever is available.
One consistent standard
The team works together full time, so every assessment follows the same methodology and peer review is built into every report rather than bolted on.
Accountability you can name
Your report is signed by an employed professional who answers for their work, and the practice stands behind it.
Continuity, not hand-offs
The people who take your enquiry, carry out the assessment and review the report all work in one practice, so nothing is lost between stages.
How this works in practice
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.
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.
Care and support capacity guides
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
Other assessment types
Care decisions often sit alongside others. If you need an assessment about where the person should live, a Court of Protection COP3, or an assessment about managing finances, our team can help.
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.
Nellie Supports provides independent social work assessment, evidence and advocacy support. We do not provide regulated legal advice, and where a legal remedy is needed we will say so and support your solicitor's work.
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.