Advocacy can be complex, especially when someone’s situation involves multiple needs and layers of decision-making. George’s story shows how different advocacy roles can come together to provide consistent, person-centred support in a challenging case.
George* (name changed) was admitted to hospital following a car crash. During his stay, staff noticed he was struggling with confusion and memory difficulties. After further assessments, they suspected he might have dementia. It also became clear that George’s wife, his next of kin, was experiencing similar memory issues and wasn’t able to be consulted about his care. With no other family or close friends, George faced an uncertain future regarding his support.
When George was assessed as lacking capacity to make decisions about his care, a Cloverleaf Care Act Advocate was appointed. This advocate also took on the role of Relevant Person’s Representative (RPR) under the Deprivation of Liberty Safeguards (DoLS).
In addition, the Advocate became involved as an Independent Mental Capacity Advocate (IMCA) to help George express his views about clinical decisions, including emergency care and Do Not Resuscitate (DNR) discussions.
The Advocate visited George regularly at his care home, ensuring that the DoLS conditions were being met and that the home was acting within the principles of the Mental Capacity Act.
Through reports, the Advocate learned that before his hospital admission, George had a daily routine of walking to the local shop for a newspaper and doing “jobs around the house.” Recognising how important these routines were to George’s wellbeing, the Advocate encouraged the care home staff to support him in maintaining them.
As a result, George began going out for regular walks again to the shop and even to a local social club. The care home manager also found ways for George to help with small tasks around the home, such as assisting the handyman. Staff noted how much he enjoyed being involved and contributing.
George often says he likes living at the care home, but he also talks about wanting to return to live with his wife, though he no longer remembers exactly where their home is.
After George moved into the care home, the post-discharge team closed his case. The Advocate contacted Gateway to Care and the locality team manager to ensure George was prioritised for ongoing social care support — which was arranged promptly.
As his Care Act Advocate, the Advocate supported George in a meeting with his social worker, where he was able to clearly express his wish to live with his wife again.
Later, a referral was received from George’s Quest Nurse to support him through the ReSPECT process — a plan that records a person’s preferences for treatment in a medical emergency. Acting as an IMCA, the Advocate spoke with George about his views on hospital care and what he would want if he became seriously ill. They encouraged the nurse to spend more time consulting with George and to explore whether his wife’s views could also be included.
George continues to live in the care home under a DoLS authorisation while a best interest decision is made about his long-term care and residence. His social worker is exploring how both George and his wife could move into supported living accommodation with a care package that meets their needs. In the meantime, an outreach package is being arranged to enable George to visit his wife weekly.
The Quest Nurse and social worker are also discussing how best to consult George’s wife regarding future decisions, and George’s ReSPECT form will be reviewed by his GP if he returns home.
George’s story illustrates how multiple advocacy roles can work together to ensure that a person’s rights, views, and wishes are central to every decision about their care.
By maintaining consistent involvement, the Advocate has been able to represent George across different systems from hospital care to social work meetings to end-of-life planning and ensuring his voice is heard throughout.
George has been clear about what matters most to him: being with his wife. Through effective advocacy and collaborative working, professionals are now exploring how to make that possible safely and with the right support.
