ASSESSING AN

ADULT’S CAPACITY

TO CONSENT

Define autonomy, capacity, and incapacity.

Be empowered to make the capacity decision

Become familiar with factors that may influence capacity.

Be able to access other professionals to assist with gathering information to make a capacity decision

APS Process & Capacity Exercise

Using numbers 1-6, take a few minutes to order the steps in the APS process

FAMILY ASSESSMENT AND CHANGE PROCESS AS USED IN ADULT PROTECTIVE SERVICES

Receive and Screen Referral

Evaluate the Need for Protective Services

Obtain Service Authorization

Plan and Mobilize Essential Services

Close Protective Services Case

APS Process & Capacity

Making the capacity decision is the first step in obtaining service authorization.

The capacity decision is not made at intake.

Repeat referrals must be accepted if they meet the screening criteria.

An alleged disabled adult cannot refuse an evaluation.

Key Terms of Capacity Assessment

WHAT IS AUTONOMY?

Autonomy is the highest principle in legal, psychological and medical issues.

“Autonomy” means the right to make one’s own decisions.

Capacity APS Manual III-29

1. Being aware of the limitations or deficiencies in one’s surroundings

2. Being aware of one’s own mental or physical limitations

3. Being aware of resources available to assist in meeting one’s needs

4. Being aware of the consequences to oneself if nothing is done to improve or remedy one’s situation

Capacity to Consent to Protective Services

Refers to an adult’s ability to fully comprehend his/her situation and exercise judgment regarding the particular services that are protective in nature.

Capacity EvaluationA complete capacity evaluation can include:

A physical examination

A neurological examination

Short and long term memory assessment

Assessment of executive function

Exam for existing psychological disorders

Capacity May Vary…

‣ As a result of physical or mental stress.

‣ According to the complexity of the decision

‣ From day to day.

‣ From morning to evening.

Factors that influence Capacity

Substance Abuse

Depression

Social Setting

Nutrition

Lacks the Capacity to Consent

APS Manual III-28 108A-101(l)

Lacks sufficient understanding or capacity to make or

communicate responsible decisions concerning his

person, including, but not limited to, provisions for:

health or mental health care, food, clothing or shelter,

because of physical or mental incapacity.

Incapacitated due to a disability

Is part of the definition of a disabled adult. It is related to the person’s functioning and ability to care for himself/herself or arrange for care to be provided.

Capacity vs. Competency

Capacity Functional/Clinical Term Mental/Cognitive ability to understand

the nature and effects of decisions

Competency Legal Term Having sufficient capacity, ability, or

authority to make decisions

CAPACITY VS. COMPETENCY

Capacity Competency

Decision used for Provision of Decision used for Protective Services Appointment of Guardian

Often temporary Usually long term

Decision made by DSS or Decision made by ClerkDistrict Court Judge of Superior Court or Jury

IMPLICATIONS OF A JUDGEMENT OF INCAPACITY

Make decisions about medical treatment

Personal Care

Testify in court

Choose where to live

Common Mental Health Problems of Older Adults

Delirium

Dementia

Depression

Personality Disorders

Assessing Capacity and Interviewing Tips

Use a strength-based approach Assess capacity throughout the evaluation Interview the adult alone Interview the adult more than once Judge capacity in the best of

circumstances

Interviewing Tips cont’d….

Be aware that strangers are perceived as outsiders

Take the time to establish rapport

Speak Clearly, avoid professional jargon/slang

Be Respectful

What do I Say???Ask Questions That Focus On:

The client’s understanding of relevant information

The quality of the client’s thinking process

The client’s ability to demonstrate and communicate a choice

The client’s understanding of his/her own situation

G.S. 108A-103(B)

The staff and physicians of local health departments, area mental health, developmental disabilities, and substance abuse authorities, and other public or private agencies shall cooperate fully with the director in the performance of his duties. These duties include immediate accessible evaluations and in-home evaluations where the director deems this necessary.

When to Access Another Professional

Adult has a known history of psychosis.

Adult exhibits psychotic symptoms.

Adult actively receives treatment for mental health problems.

Adult has fluctuating capacity.

Adult is Non-Verbal

Information of Interest to Other Professionals

Mood or Attitude of Adult Orientation of Adult Memory Deficits Treatment History Thought Content and/or Process Sleep and/or Appetite Changes General Medical Conditions

Capacity Dismantled Intensity: refers to the severity of the symptoms and the

impact on capacity

Duration: refers to how long a symptom or symptoms have been present and the impact on capacity

Frequency: refers to how often a symptom or symptoms occur and the impact on capacity

Capacity may be situation specific

Capacity may be time limited

Mental Status Tools

All assessment tools:

Have limitations

Cannot measure all variables in assessing capacity

Should never be used exclusively to assess a client’s capacity

Mental Status Tools

Mini Mental Status Exam (MMSE)Does Not:

address decision making for specific tasks elicit the client’s desires, wishes, or fears detect mild dementia or advanced cognitive disorders

Short Portable Mental Status Questionnaire Briefly assesses Orientation, Long Term Memory One of the easier tools to administer

Questions/Comments?