Who Makes Decisions About a Loved One’s Care?

Understanding Capacity, Lasting Power of Attorney, and Your Role as a Family

When someone you love starts to need support, one of the most difficult questions is often not what care is needed — but who has the right to decide.

Families can find themselves unsure, sometimes even in disagreement, about what should happen next.

At Koti Home Care, we see this regularly. And the reality is this:

There is a clear legal framework — but it isn’t always well understood.

This guide will help you make sense of it.

1. The Starting Point: Does Your Loved One Have Capacity?

Everything begins with one question:

Can your loved one make this decision themselves?

Under the Mental Capacity Act 2005, capacity is decision-specific.

That means:

• Someone may be able to decide what they want for lunch
• But not understand complex financial or care arrangements

What is “capacity”?

A person has capacity if they can:

• Understand the information relevant to a decision
• Retain that information long enough to make it
• Weigh up the options
• Communicate their decision

If they can do all of the above, they make the decision — even if others disagree with it.

That can be hard for families, but it is a fundamental legal principle.

2. If They Have Capacity — They Decide

This is often misunderstood.

Even if:

• You are their son or daughter
• You are providing most of the support
• You disagree with their choices

👉 You do not have the legal right to override their decisions

Your role becomes:

• Supporting
• Advising
• Helping them understand options

But the decision remains theirs.

3. If They Lack Capacity — Decisions Must Be Made in Their Best Interests

If someone is assessed as lacking capacity for a specific decision, then decisions must be made under a “best interests” framework.

This involves:

• Considering their past and present wishes
• Involving family and those close to them
• Choosing the least restrictive option
• Acting in a way that promotes dignity and wellbeing

This is not about what is easiest —
it is about what is right for the person.

4. Lasting Power of Attorney (LPA) — Planning Ahead

A Lasting Power of Attorney allows someone (while they still have capacity) to formally appoint another person to make decisions on their behalf in the future.

There are two types:

Health and Welfare LPA

• Covers care decisions, living arrangements, medical treatment
• Only comes into effect if the person loses capacity

Property and Financial Affairs LPA

• Covers money, bills, property
• Can be used with permission while the person still has capacity, or if capacity is lost

Once registered with the Office of the Public Guardian, the appointed person (the “attorney”) has legal authority to act.

5. Without an LPA — What Happens?

If no LPA is in place and someone loses capacity:

• Family members do not automatically have legal authority
• Decisions are made through best interests processes
• For more complex or ongoing decisions, an application may need to be made to the
  Court of Protection

This can be:

• Time-consuming
• Costly
• Emotionally challenging

Which is why planning ahead is so important.

6. Common Misunderstandings

Let’s clear up a few things we hear often:

• “I’m next of kin, so I can decide.”
  ❌ Not legally true on its own
• “We can just manage it as a family.”
  ❌ Only if the person still has capacity
• “We’ll sort it out later.”
  ❌ Later can be too late if capacity is lost

7. Where Care Providers Fit In

At Koti Home Care, our role is not to make decisions for families —
but to support them within the correct framework.

That means:

• Respecting the person’s wishes where they have capacity
• Working with attorneys where an LPA is in place
• Contributing to best interests decisions when needed
• Ensuring care is always person-centred and lawful

8. The Emotional Reality

Behind all of this legal structure is something much more human.

Families want to protect.
Loved ones want to stay independent.
And sometimes those two things don’t align easily.

Understanding the legal position doesn’t remove the emotion —
but it does provide clarity at a time when clarity is needed most.

Final Thought

The key principle is simple, even if the situations are not:

As long as someone can decide, they should decide.
If they cannot, decisions must be made properly, lawfully, and in their best interests.

Planning ahead — particularly through a Lasting Power of Attorney — can make an enormous difference when the time comes.

If you’re unsure where you stand or what to do next, we’re here to help guide you through it.
Clear advice, no pressure — just support when you need it most.