Dignity / Alcoholism / Dementia quandry

Rachel Reid 26/07/22 Dignity Champions forum

Dear thoughtful people, I care for my father, who has dementia and alcoholism (more acute given the dementia). I'm trying to keep him in his own home, for obvious reasons (including the freedom to drink which is pretty fundamental to him now) but found that he was having too many falls and injuries and hospital visits. I experimented with diluted wine (he drinks white), which he wouldn't allow when discussed, so I started doing it without him knowing, and he didn't notice. I understand that this is a breach of dignity, but I feel strongly it facilitates him continuing with a more dignified life. What do you think about this decision? One care company that helps respects this view, and has seen the dramatic health and well being improvement. Another refuses to participate, saying it breaches the need for dignity in care according to the CQC guidance. He's ended up in hospital when they've given him full strength wine. I respect their principled stance, but feel I'm trying to protect a sustainable dignified life for my father. I'd really welcome thoughts.

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Tania Hudson 26/07/22

Hi Rachel,

Firstly I'm sorry to hear that you are going through this with your father but what a brilliant job you are doing to keep him in his own home and personally, I would do the same as you!

I guess this comes down to your fathers mental capacity and if he understands that if he drinks alcohol it causes him to have more falls and therefore more hospital admissions.

The care agency will probably be considering the 5 principles of the Mental Capacity Act:

- Presumption of capacity.
- Support to make a decision.
- Ability to make unwise decisions.
- Best interest.
- Least restrictive

So, we need to presume your dad has the capacity to make this 'unwise decision' unless proved otherwise. As your dad has had increased falls and injuries, you may want to discuss a capacity assessment with the GP?

The GP will be looking to see that:

- he can understand the consequences of drinking alcohol e.g. that it may mean he will be admitted to hospital again, or maybe in residential care.
- That he can remember the information for long enough to make the decision
- That he can weigh up the options (e.g. risk of hospital/care) and make a choice
- That he can communicate his decision

If he is found to lack the mental capacity to make this decision, then a decision can be made in his best interest. If diluting the wine reduces the risks then I would say that was most certainly in his best interest and the least restrictive option.

Wishing you all the very best to you and your father - he is lucky to have you!


mike stone 29/07/22

Hi Rachel,

You are in a very 'stressful' situation. I think Tania's answer looks correct, with a reservation that if your dad is capacitous, I think he can decline treatment after falls etc (so it isn't that he accepts that a fall will necessarily lead to hospitalisation).

As Tania said - your dad is lucky to have you.