David is a retired man who lived alone in his home of 40 years. Unfortunately, David’s health deteriorated to such an extent that he required a series of repeated acute hospital admissions. These admissions were linked to self-neglect and inconsistent management of both David’s medical and social care needs.
During his most recent admission, David was assessed as not having capacity in relation to his care and treatment, and as a result he was placed under a Deprivation of Liberty Safeguard (DoLS) whilst he remained in hospital.
David can communicate verbally, but he may experience some difficulties in understanding, retaining and managing information relating to his ongoing care requirements.
There were safeguarding concerns and differing views among family members, whose own personal circumstances limited their ability to provide support.
Throughout his stay, David expressed a strong desire to return home. Although David acknowledged that he needed some support, he did not want to explore alternative living arrangements; he was objecting to the restrictions which had been placed upon him and consistently said he wanted to go home.
If a person is objecting to their Deprivation of Liberty, they have a right for a paid RPR to be appointed. The paid RPR is an independent advocate who can obtain the person’s wishes and feelings and if necessary, support that person legally challenge their deprivation through the Court of Protection.
The Paid RPR visited David several times during a short period. This was important, as it enabled the Paid RPR to explain David’s rights, support his understanding of the legal framework, and most importantly explore David’s views and wishes. The Paid RPR attended multidisciplinary meetings in relation to the restrictive element of David’s living arrangements and facilitated communication between the individual, health professionals, and social care. Advocacy focused on ensuring that David’s views were clearly represented, particularly in group settings where he often felt overwhelmed.
David’s voice was central throughout. A person-centred and least restrictive approach was promoted, balancing independence with risk. An ethical dilemma arose regarding David’s wish to return home, despite concerns about his ability to manage safely. This was addressed through clear, accessible discussions about risks, available support, and potential outcomes to support informed decision-making.
A plan was agreed for David to be discharged home with an intensive support package, with funding processes initiated, David was satisfied with this outcome. The importance of the Paid RPR role was recognised by professionals, and their involvement continued to support and inform discharge planning and monitor David’s wellbeing.
This case highlights the importance of early, proactive involvement and clear communication to support informed choice whilst maintaining a least restrictive approach.
