Keen readers of the dementia project blog will have noticed a rather long break since the last post on the Dementia Project blog. There are various reasons for this, not least that I have been away on holiday. I then moved to take up a new post at the University of Birmingham, and was then caught up in all the craziness of the new academic year. Thinking about this break, and being away on holiday for a couple of weeks got me thinking about a recent court of protection case, Cardiff County Council v Ross (unreported). Unusually for the Court of Protection, reporting restrictions were lifted on this case, because the parties had spoken directly to the media about their experience.
Norman Davies and Peggy Ross had been in a relationship for over 20 years and were regular cruise passengers. They had enjoyed many such cruise holidays together (over 50!) during their relationship. Sadly, Mrs Ross was diagnosed with dementia, and following a period of ill health and spell in hospital, moved into residential care as she needed assistance with the activities of daily living. She did, however, continue to spend time staying at Mr Davies’ home over the weekends, with him caring for her. They had booked a cruise holiday prior to Mrs Ross’ move into residential care.
A week before the cruise was due to take place, the local authority commenced proceedings in the Court of Protection for a declaration that it would not be in Mrs Ross’s best interests for the cruise to take place. The local authority also argued that Mrs Ross lacked the capacity to make the decision whether or not to go on the cruise. The judge disagreed.
In his judgement, His Honour Judge Masterman noted that: “My strong impression is that her social worker and the staff at the home want to do the right thing for her but are focussed on her safety and are acutely aware of things that might go wrong. Perhaps the prime example of this was the concern that Mrs Ross might ‘wander’ (as she undoubtedly has in the past when living alone) on the ship and go over the side. It was suggested, not without some force in my view, that this smacked of saying that her best interests were best served by taking every precaution to avoid any possible danger without carrying out the balancing exercise of considering the benefit to Mrs Ross of what, sadly, may be her last opportunity to enjoy such a holiday with Mr Davies. This led, in my view, to trying to find reasons why Mrs Ross should not go on this holiday rather than finding reasons why she should.” In conclusion, the judge held that, on the balance of probabilities, Mrs Ross did have the capacity to make the decision to go on the cruise, and that even if she did not, it was in her best interests to go. He is to be commended for coming to this decision.
This case is interesting because of the balancing of risk and benefit that the court carried out. It is always easier for local authorities, social workers and others responsible for providing care to a person with dementia to err on the side of caution, by attempting to make life with dementia risk-free. Indeed it is often important to carry out careful risk assessment exercises to minimise the risk of harm. But this is not to say that a diagnosis of dementia should mean the end of enjoyable activities for a person living with dementia. Several participants in the Duties to Care project spoke of the importance of holidays. Telling us that stays in a hotel can give the carer and the person living with dementia a break from the routine domestic labour associated with care. We all know it can be very refreshing to have someone else responsible for cooking and cleaning!
Taking holidays shouldn’t be restricted to those in the very early stages of living with dementia either. Whilst those in the later stages may find significant changes in environment unsettling, there are increasing numbers of specialist holiday providers who advertise breaks for people with dementia and their familial carers. For example, Vitalise (http://www.vitalise.org.uk/) offer breaks specifically aimed at people living with dementia and their family carers, including excursions and activities, and dementia adventure (http://www.dementiaadventure.co.uk/) offer a range of supported activities for people living with dementia. Tourism for All (http://www.tourismforall.org.uk/) also list a range of other holiday possibilities for people living with dementia. Living well with dementia was a key priority of the National Dementia Strategy, and I think should be a major focus for all of us with an interest in dementia. Encouraging people living with dementia and their carers to take holidays could play a key part in helping them to live well with dementia.