Navigating DoLS and Dementia Care: A Practical Guide for Carers

Providing 24-hour regulated adult social care for older adults with complex needs, dementia, and physical frailty is a highly skilled profession. Within the care home environment, the care model is strictly person-centred, with a strong emphasis on independence, dignity, and safeguarding.

However, balancing a resident's safety with their freedom can be challenging. A common question for care professionals is: If a resident refuses a wash, should they be pushed? If they try to leave, is stopping them a deprivation of their liberty?

Here is a detailed guide on what is allowed, what steps to take, and when a Deprivation of Liberty Safeguards (DoLS) authorisation becomes legally required.

The "Acid Test" for a DoLS

Legally, a resident is being deprived of their liberty if they lack the mental capacity to consent to their care arrangements and meet the "Acid Test":

1. They are subject to continuous supervision and control, AND

2. They are not free to leave.

   
   

Scenario 1: Resistance to Washing and Personal Hygiene

The Confusion: A resident with dementia is heavily soiled but becomes highly distressed and aggressive when staff attempt to help them shower.

• What is allowed without a DoLS? Carers are legally protected to act in the resident's "best interests" using the least restrictive methods. This includes gentle persuasion, prompting, or changing the approach.

  • Good Example: A resident refuses a shower and pushes staff away. Instead of forcing them, the carer steps away, gives them space, and returns an hour later. They offer a warm flannel wash in the resident's bedroom while playing their favourite music. The resident accepts. This is excellent person-centred care, not a deprivation of liberty.

    
    

• What MUST NOT be done: Routine physical force cannot be used. If carers hold a resident's arms down to forcibly wash them against their will, this is restraint. Unauthorised, routine physical restraint is unlawful and a safeguarding violation.

  
  

• When a DoLS becomes required: If the resident's cognitive decline means they never allow personal care, their skin integrity is at severe risk, and staff must resort to constant, highly restrictive interventions (such as continuous physical holding or sedation) to keep them clean and safe. At this point, they are under "continuous supervision and control." A DoLS application is required to legally authorise this highly restrictive care plan, and the approach must be formally reviewed by medical professionals.

  
  

Scenario 2: "I Want to Go Home"

The Confusion: A resident frequently packs their bags and tries to walk out the front door into the street. Staff stop them. Are they being unlawfully locked in?

• What is allowed without a DoLS? Having a keypad on the front door to prevent vulnerable residents from wandering onto a busy main road is a standard, proportionate safety measure.

  • Good Example: A resident walks to the front door at 3:00 PM, insisting they need to collect their children from school. A carer gently intercepts them, validates their feelings, and walks with them to the lounge for a cup of tea, distracting them with a conversation about their family. The resident has been protected without being deprived of their liberty.

    
    

• When a DoLS becomes required: If the resident's attempts to leave escalate—they are persistently pulling at the front door all day, trying to climb out of windows, or becoming physically aggressive when redirected—and staff must constantly shadow them or physically block their path to keep them inside. Because the resident is "not free to leave" and requires "continuous supervision and control" to prevent them from absconding, they clearly meet the Acid Test. A DoLS is legally required to ensure keeping them in the building is lawful and subject to independent scrutiny.

Speak with your manager or team leader

The Action Plan: What Should Carers Do?

1. Try the Least Restrictive Option First: Always use de-escalation, distraction, or delay. Never use force unless there is an immediate, unavoidable risk of severe harm (e.g., pulling someone back from a hot stove).

   
   

2. Record Everything: Ensure all instances of resistance, wandering, and the distraction techniques used are logged thoroughly in the digital social care records.

   
   

3. Escalate to Management: If a resident’s behaviour changes and staff are constantly having to supervise, control, or restrict them to keep them safe, this must be reported immediately to the shift leader.

   
   

The Registered Manager & Safeguarding Lead oversees all governance, risk assessments, and regulatory communication. If a resident's needs meet the DoLS threshold, the management team will coordinate with the local authority to submit the application and ensure the CQC is properly notified.