Objective: Mental Capacity legislation defines when a person lacks capacity and subsequently supports individuals to make
as many decisions as possible for themselves. Whilst frameworks exist, care home staff often feel unsupported with insufficient
knowledge and training. This review aimed to understand barriers and facilitators of implementing mental capacity legislation
in care homes for older adults in the United Kingdom.
Methods: A systematic review was conducted and 3041 potentially relevant studies identified, with 13 studies eligible for
inclusion. 11 focused on the Mental Capacity Act (2005) and two on the Adults with Incapacity (Scotland) Act 2000.
Barriers and/or facilitators were extracted and subsequently mapped to the Capability, Opportunity and Motivation model
and Theoretical Domains Framework.
Results: Barriers included poor access to training, low staff confidence and a lack of understanding about using legislation
in context. Conversely, staff reported in-person training using real-life examples, robust organisational policies and processes
and respecting person-centred care were key facilitators. Sense-checking conversations were conducted with care home staff
(n = 18) to interpret findings in the context of current practice.
Conclusions: This review presents complex and multi-faceted barriers preventing the implementation of mental capacity
legislation in care homes for older adults. Whilst care home staff have now started to appreciate the importance of such
legislation, insufficient time, resources and an inability to track staff knowledge prevents effective implementation of the law.
Future research should explore how staff are trained about legislation and identify best practices.
ORCID: 
CORE (COnnecting REpositories)
CORE (COnnecting REpositories)