What Is a Best Interests Meeting in a Care Home?

Posted 3rd June 2026

A best interests meeting is a formal discussion held when a person in a care home lacks the mental capacity to make a significant decision for themselves. Its purpose is to reach a decision on their behalf that reflects what is best for them, drawing on the views of those who know them well.

These meetings are a legal requirement under the Mental Capacity Act 2005. They are not optional, and they are not just a care home formality. They carry real weight in determining what happens to a person who cannot speak for themselves.

If you have been invited to a best interests meeting for a family member, this guide explains what to expect, what your role is, and what your rights are.

When Does a Best Interests Meeting Take Place?

A best interests meeting is called when three things are true:

A significant decision needs to be made about the person’s care, treatment, or living situation
The person lacks the mental capacity to make that decision themselves at that time
There is no valid Lasting Power of Attorney or court-appointed deputy with authority over that specific decision

Common reasons for a best interests meeting in a care home include:

A significant change in care needs requiring a new care plan
A decision about medical treatment, surgery, or a do not attempt resuscitation (DNAR) order
A move to a different room, unit, or care home
Decisions about contact with particular people, including family members
A Deprivation of Liberty Safeguards (DoLS) authorisation
End-of-life care planning

Capacity is decision-specific and time-specific. A person may have capacity to decide what they want for lunch but not to understand the implications of a complex medical procedure. The meeting only applies to the specific decision being made.

Who Should Be at a Best Interests Meeting?

The Mental Capacity Act sets out who must be involved. The decision-maker (usually a senior member of the care team, a social worker, or a clinician, depending on the nature of the decision) is responsible for chairing or leading the process and must consult with:

Anyone named by the person as someone they wish to be consulted
Anyone caring for the person or interested in their welfare, which usually includes close family members
Any Lasting Power of Attorney holder with relevant authority
Any court-appointed deputy
An Independent Mental Capacity Advocate (IMCA) where there is no appropriate family or friend to consult (see below)

In practice this typically means a combination of:

Role	Who This Might Be
Decision-maker	Care home manager, social worker, GP, or consultant
Family representative	Next of kin, spouse, adult children
Care staff	Key worker or senior carer with day-to-day knowledge of the person
Medical input	GP or specialist if the decision involves health treatment
Advocate	IMCA or other independent advocate if appropriate

There is no fixed number of people required. What matters is that the right people, those with genuine knowledge of the person and their values, are at the table.

What Happens in the Meeting?

The meeting is not a vote, and it is not about what family members want. Its entire purpose is to reach the decision the person themselves would most likely have made, or the decision that best serves their interests where their previous wishes are unknown.

A well-run best interests meeting will:

Confirm that the person lacks capacity for this specific decision (this should be formally assessed beforehand, not assumed)
Consider what the person’s own views, values, and preferences were when they did have capacity
Take account of any advance decisions or advance statements the person made
Hear from everyone present about what they believe is in the person’s best interests and why
Consider whether a less restrictive option is available that still meets the person’s needs
Reach and record a decision, with clear reasoning

The outcome of the meeting must be documented in writing, including the decision reached, the reasons for it, and who was present.

What Is Your Role as a Family Member?

You are there to represent the person, not yourself. That distinction matters, and it can be emotionally difficult in practice.

Your most valuable contribution is information: what did your loved one value? What did they say, in the past, about how they wanted to be cared for? What would they have wanted if they could tell us today? This is sometimes called substituted judgement, and it is central to best interests decision-making.

You can and should:

Share knowledge of the person’s personality, values, and past wishes
Raise concerns about any option being considered
Ask questions if you do not understand the reasoning behind a proposed decision
Request that an IMCA is appointed if you feel the process is not representing your loved one’s interests fairly
Request a copy of the written record of the decision

You cannot override the decision-maker. If a qualified professional has assessed that a particular course of action is in the person’s best interests, and that assessment is lawful and properly conducted, your disagreement alone does not prevent it. However, if you believe the process was flawed, you have the right to challenge it (see below).

What Is an IMCA and When Are They Involved?

An Independent Mental Capacity Advocate is an independent person trained to represent individuals who lack capacity and have no appropriate family member or friend to consult. They are not a care home employee and are not aligned with any medical or social care team. Their job is to represent the person’s interests and rights.

An IMCA must be instructed by the relevant NHS body or local authority when:

A serious medical treatment decision is being made, and
There is no one appropriate to consult other than paid staff

In some situations, an IMCA can also be instructed even when family is present, if there is concern that the person’s interests are not being adequately represented. This is a discretionary instruction, but it is available.

If your loved one has no close family or friends and is facing a significant care decision, ask the care home or local authority whether an IMCA has been or should be instructed.

What If You Disagree With the Outcome?

Disagreements about best interests decisions are not uncommon, and there are formal routes for challenging them.

Raise it with the care home manager first. If you feel the meeting was not properly conducted, that someone with relevant knowledge was excluded, or that the outcome does not reflect your loved one’s known wishes, say so in writing and ask for the decision to be reviewed.

Contact the local authority. If the decision involves social care and you believe it was made improperly, the local authority’s adult safeguarding team can review the process.

Seek a formal review of any DoLS authorisation. If the meeting relates to a Deprivation of Liberty Safeguards authorisation, your loved one has the right to a review, and you can request one on their behalf.

Apply to the Court of Protection. Where a dispute cannot be resolved through internal review, the Court of Protection has jurisdiction to make or review best interests decisions. This is a significant step and usually a last resort, but it exists precisely to protect people who cannot protect themselves.

For an honest conversation about your loved one’s care and rights, our guide on understanding care needs assessments and putting a parent in a nursing home against their will may also be helpful context.

Best Interests Meetings and Lasting Power of Attorney

If your family member already has a valid Lasting Power of Attorney (LPA) in place, covering either health and welfare or property and financial affairs, the LPA holder may be able to make certain decisions without a best interests meeting being required.

However, an LPA does not remove the best interests framework entirely. An LPA holder must still act in the donor’s best interests, and the care home or clinical team may still convene a meeting to ensure the process is properly documented and challenged if necessary.

If there is no LPA in place and your loved one no longer has capacity to create one, it may be necessary to apply to the Court of Protection for a deputyship. Our guide on how to change a Lasting Power of Attorney covers the LPA framework in more detail.

Frequently Asked Questions

Can a best interests meeting override my wishes as next of kin? Yes. Next of kin status does not give you legal authority to make decisions on behalf of an adult who lacks capacity, unless you hold a valid health and welfare LPA. The decision-maker is required to consult you and take your views seriously, but the final decision rests with the person responsible for the person’s care under the Mental Capacity Act framework.

Does my loved one have to be present? Where possible, the person should be included in the meeting or their views sought beforehand, even if they cannot participate fully. The Mental Capacity Act principle of maximum involvement applies: every effort should be made to communicate with and involve the person, using accessible formats or methods if needed.

How is capacity assessed? Capacity assessment follows the two-stage test in the Mental Capacity Act: is there an impairment or disturbance in the functioning of the mind or brain, and if so, does it mean the person cannot understand, retain, weigh up, or communicate a decision? Capacity should be assessed by the most appropriate professional for the type of decision being made.

What is the difference between a best interests meeting and a care review? A care review is a routine meeting to assess how a resident is getting on and whether their care plan needs updating. A best interests meeting is specifically convened when a significant decision needs to be made for someone who lacks capacity to make it themselves. They are distinct processes, though a care review may sometimes trigger a best interests meeting.

Can I bring someone with me to the meeting? Yes. You are entitled to bring a supporter, which might be another family member, a friend, or an independent advocate. Let the care home know in advance so they can accommodate additional attendees.

Care in Mansfield That Families Can Trust

At Newgate Lodge Care Home and Lowmoor Nursing Home, we follow the Mental Capacity Act framework in all decisions affecting residents who lack capacity. Families are kept informed and involved, and we instruct independent advocates where appropriate.

If you have concerns about a decision being made for a family member, or want to understand more about how we approach care planning, call us on 01623 622 322 or visit our contact page.