Safeguarding Adults With Fluctuating Capacity After Acquired Brain Injury
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Fluctuating capacity is a common feature of acquired brain injury, particularly where fatigue, emotional stress or cognitive overload are present. This creates safeguarding challenges, as a person’s ability to make decisions may vary from day to day. Inspectors and commissioners expect providers to evidence how safeguarding adapts to fluctuating capacity rather than relying on static assumptions.
This article focuses on safeguarding adults with fluctuating capacity in ABI services. It should be read alongside Safeguarding, Capacity, Risk & Vulnerability and Person-Centred Planning & Strengths-Based Support.
Why capacity fluctuates in ABI
Fatigue, stress and environmental factors can affect decision-making ability.
Commissioner and inspector expectations
Expectation 1: Ongoing capacity review. Inspectors expect capacity to be reviewed when circumstances change.
Expectation 2: Respect for autonomy. Commissioners expect providers to maximise choice wherever possible.
Operational example 1: Time-sensitive capacity decisions
Staff delayed non-urgent decisions to support optimal capacity.
Adapting safeguarding responses
Safeguarding responses should flex with capacity changes.
Operational example 2: Capacity-triggered safeguarding reviews
Safeguarding plans were reviewed following capacity fluctuations.
Recording fluctuating capacity
Documentation must clearly reflect decision-specific capacity.
Operational example 3: Capacity trend monitoring
Providers monitored patterns of capacity fluctuation to inform planning.
Evidencing compliant safeguarding practice
Providers should evidence:
- Decision-specific capacity assessments
- Flexible safeguarding plans
- Clear MCA-aligned documentation
Why this protects rights and safety
Responsive safeguarding ensures lawful, person-centred support.
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