# Capacity to manage care needs | Nellie Supports Source: https://www.nelliesupports.com/services/mental-capacity-assessments/capacity-decisions-managing-care-needs Canonical: https://www.nelliesupports.com/services/mental-capacity-assessments/capacity-decisions-managing-care-needs # Capacity for care and support decisions We assess whether a person can decide about the care or support being offered to them. The focus is the actual arrangement: what help is proposed, why it is needed, the available alternatives and what accepting or declining it would mean for the person. Does the person have the mental capacity to decide about the care and support being offered? We look at what is actually being offered, why it is proposed and the choices available. Needing care, declining help or living with risk does not, by itself, mean someone cannot make their own decision. You receive a written report explaining our opinion, the evidence behind it and any limitations. Decisions about where to live, managing direct payments or employing carers may need separate assessment. Assessments for families and professional referrers across England and Wales. A written report on the agreed care or support decision. Court forms and court-directed expert work are quoted separately. ## When might you need an assessment? A new care package, a change in carers or repeated refusal of support may prompt a capacity question. We first clarify the choice the person is being asked to make. Having unmet needs does not itself show that someone cannot decide about the support they receive. ### Accepting or refusing care Explain the help offered, why it is considered necessary and what the person says about it. We assess their ability to make the choice. Refusal, self-neglect or disagreement with professionals is not, on its own, proof of incapacity. ### Changing an arrangement The question may concern different visiting times, another provider or a change in the type of help. We need the actual proposal and the alternatives, not simply a statement that the person needs care. ### Direct payments and employing carers Agreeing to personal care is different from managing a budget, employing carers or directing support. Tell us which decisions need to be assessed so that we can agree the work and address each question properly. ### An example: declining a care package An older man living alone refuses proposed visits, despite concerns about his health and self-neglect. The assessment considers the help offered, who would provide it, what may happen if he refuses and how he could raise concerns about the care. He is given time and support to consider that information; the refusal itself does not settle capacity. This is an illustrative example, not an individual client’s case or a promised outcome. This assessment concerns the person’s ability to decide. It is not a care-needs assessment or a decision about what a public body must fund or provide. ## What will the assessor discuss? We begin with the presumption of capacity and take all practicable steps to help the person decide. We consider whether they can understand, retain, use or weigh the relevant information and communicate their decision by any means. If they cannot, we then consider whether that inability is caused by an impairment of, or disturbance in, the functioning of the mind or brain. - The daily activities for which help is proposed, such as washing, meals, medication or getting out. - What the help would involve, how often it would happen and who would provide it. - The differences between help from family, an agency or directly employed carers, where relevant. - The likely consequences of accepting or refusing the proposed support. - That poor treatment can happen, and how the person can refuse, complain or ask for a change. - Broad financial implications, including contributions or a relevant direct-payment arrangement. ### Making the proposal clear We use plain language and examples from the person’s day-to-day life. Written information, communication aids, shorter discussions and breaks may help. We need to know what support enables the person to take part, rather than assuming difficulty with the conversation means incapacity. ### Making a choice and carrying it out A person may need help with washing, dressing or taking medication but still be able to decide what support they want. We distinguish their ability to make the care decision from their physical ability to manage without assistance. ### What happens in everyday life Care records and accounts from people who know the person may help us understand how decisions are made in practice. We distinguish those accounts from our own observations and consider them alongside the assessment discussion. ### What the report explains The report names the care decision, the records considered and the support provided. It explains the person’s responses, our reasoning and conclusion, and any limitations. Cognitive screening may be useful in some cases, but it does not replace the capacity assessment. ### Checking and delivering the report A second qualified professional peer reviews the reasoning, evidence and structure before secure delivery. This is a check of the report, not a second assessment of the person. The person instructing us can ask for clarification after receiving it. ## How to arrange the assessment ### Explain the care decision Tell us what is proposed or refused, who needs the report and any deadline. Mention safeguarding concerns, a planned discharge or disagreements about the care. ### Agree the work and records needed We confirm the question, fee and timetable in writing. We discuss the relevant care records, communication needs and the best place and time to meet. ### Meet the assessor We explore the proposed support and available choices with the person. A home visit is usual; a care setting, hospital or remote appointment may be appropriate. We use the support and adjustments needed to help them participate. ### Receive the report After peer review, we send the report securely. If there is insufficient evidence for an opinion, we explain what further information or assessment may be needed rather than treating uncertainty as incapacity. ## What information will help? Start with the decision, who needs the report and any deadline. We will explain which documents would help and how to share them securely. Please use the general enquiry form for a short summary; medical, legal and financial records should be sent through the secure route agreed with our team. - The care plan or package being proposed, changed or refused, including any alternatives. - Relevant social-care, funding and direct-payment records. - Medical information relevant to decision-making and any previous capacity assessments. - Daily notes, incident records and accounts of refusals or difficulties with support. - Observations from family, carers and professionals, identifying who supplied each account. - The person’s concerns and wishes, communication needs, deadline and intended use of the report. ## What does it cost? The standard fee is £720 including VAT for one assessment and report on the agreed care or support decision. Relevant-record review, peer review and secure delivery are included. If you also need a residence assessment or an assessment about managing direct payments, we agree that work and its cost separately. ### Standard care and support capacity assessment £720 including VAT (£600 net; £120 VAT). One standard assessment and written report for the agreed care or support decision, including relevant-record review, peer review and secure delivery. Mental capacity assessment reports are delivered within five working days of the completed assessment. Appointment dates are arranged through our reception and client liaison team. ### Is your case more complex? The assessment and fee on this page cover our standard service, which is suitable for most instructions. If your case is more complex, high-risk or potentially contested, additional evidence may help. We can advise on the appropriate scope before booking. [Explore Advanced and Enhanced assessments](https://www.nelliesupports.com/services/mental-capacity-assessments/complex-capacity-assessments) [Enhanced mental capacity assessment: scope and quotation](https://www.nelliesupports.com/services/mental-capacity-assessments/enhanced-mental-capacity-assessment) All travel is charged separately at £48 per hour including VAT (£40 excluding VAT). Enhanced assessments, additional decisions, court forms and court-directed expert work are quoted separately. We agree any extra work and its cost before it starts. Private clients pay in advance. Professionals and businesses are offered 30-day payment terms. We can arrange interpreters at an additional cost, agreed before booking. ## Common care and support questions ### Does refusing care mean someone lacks capacity? No. We assess whether the person can make the decision about the actual proposal, with the relevant information and practicable support. Refusal, self-neglect or a risky choice does not by itself establish incapacity. ### Can someone decide to accept care but struggle with direct payments? Yes. Accepting help and managing money or employment arrangements can involve different decisions and information. We identify the questions that need assessment rather than assuming one finding answers them all. ### Can you assess care and residence together? Both can be included in an agreed instruction, with the scope and fee confirmed first. They remain separate decisions, each with its own information, assessment and conclusion. ### Does the report decide what care or funding they should receive? No. It gives an opinion on capacity for the specified decision. It does not determine funding entitlement, what services must be provided or which care package is in the person’s best interests. ### Can the report be used at a best-interests meeting? Yes, where it answers the relevant capacity question. It can inform the meeting, while the best-interests decision and any authority for restrictions remain separate. Where deprivation of liberty is in question, AGNI and current DoLS or court requirements need their own consideration. ### What if we disagree with the conclusion? The assessment is independent. We explain the evidence and reasoning, even if the conclusion differs from what the person instructing us expected. If the evidence is insufficient, we explain the limits and what else is needed; lack of evidence is not proof of incapacity. ## The law and further reading These sources explain the Mental Capacity Act 2005 framework for England and Wales. The related guides provide more detail about preparing for an assessment and understanding the report. [GOV.UK: checking mental capacity](https://www.gov.uk/make-decisions-for-someone/assessing-mental-capacity) [GOV.UK: Mental Capacity Act Code of Practice](https://www.gov.uk/government/publications/mental-capacity-act-code-of-practice) [Our professional standards](https://www.nelliesupports.com/about-nellie-supports/professional-standards) [Our editorial policy](https://www.nelliesupports.com/policy-pages/editorial-policy) ### Explore the detail [Residence capacity versus care capacity](https://www.nelliesupports.com/guides/residence-capacity-versus-care-capacity) [The two-stage test for mental capacity explained](https://www.nelliesupports.com/guides/the-two-stage-test-for-mental-capacity-explained) [Complex, high-value and contested capacity decisions](https://www.nelliesupports.com/guides/complex-high-value-and-contested-capacity-decisions) [How to instruct a mental capacity assessor](https://www.nelliesupports.com/guides/how-to-instruct-a-mental-capacity-assessor) [Who can assess mental capacity?](https://www.nelliesupports.com/guides/who-can-assess-mental-capacity) Content draws on the existing Nellie Supports service page and the sources above. Fees are taken from the service catalogue supplied on 13 October 2026. This trial rewrite has not received new clinical or legal sign-off. --- Nellie Supports Ltd · 0333 987 5118 · nellie@nelliesupports.com Office 11 and 12, Unit 20, Springfield Business Park, Grantham, NG31 7FZ