Interprofessional Collaboration on Behalf of Older Persons With Compromised Decisional Capacity: Developing and Implementing Core Professional Competencies

Interprofessional Collaboration on Behalf Interprofessional Collaboration on Behalf of Older Persons With Compromised of Older Persons With Compromised Decisional Capacity: Developing and Decisional Capacity: Developing and Implementing Core Professional Implementing Core Professional CompetenciesCompetencies

Interprofessional Collaboration on Behalf Interprofessional Collaboration on Behalf of Older Persons With Compromised of Older Persons With Compromised Decisional Capacity: Developing and Decisional Capacity: Developing and Implementing Core Professional Implementing Core Professional CompetenciesCompetencies

Marshall B. Kapp, JD, MPHMarshall B. Kapp, JD, MPH

Florida State UniversityFlorida State University

Tallahassee, FLTallahassee, FL

[email protected]@med.fsu.edu

Marshall B. Kapp, JD, MPHMarshall B. Kapp, JD, MPH

Florida State UniversityFlorida State University

Tallahassee, FLTallahassee, FL

[email protected]@med.fsu.edu

FSU COLLEGE OF MEDICINEFSU COLLEGE OF MEDICINE

Introduction

Issues arise about cognitive and emotional decision making capacity of older persons in many contexts.

Balance between autonomy and protecting against risk of harm requires accurate capacity assessments.

Interprofessional (medicine & law) collaboration often is desirable.


“Capacity determination is a complex, cross-disciplinary process that ideally involves a range of professionals. It requires knowledge of medicine, ethics, and the law.”

– (Skelton, Kunik, Regev, & Naik, 2010)


Agenda

Strategies for developing core educational competencies

Public policy as facilitator of such development

Public policy addressing impediments to implementation of core competencies


Compromised Decisional Capacity

Lots of decisionsPresumption of autonomous decision

makingProblem of decisional incapacity– Affects individual, plus those who have

or are contemplating personal or professional relationships with the individual


Capacity is decision-specificCapacity depends upon ability to:–Make and communicate a choice– Give reasons for the choice– Factually understand the alternatives– Appreciate the personal consequences

of the choice


Need for Professional Involvement in Capacity Assessment

Attorneys (ABA Model Rule of Professional Conduct 1.14) and physicians independently

Attorneys and physicians collaboratively Poor educational preparation for this task*But see Amer. Bar Assn. & Amer. Psychological Assn.,

Assessment of Older Adults with Diminished Capacity: A Handbook for Lawyers (2005) and British Medical Association and Law Society, Assessment of Mental Capacity: A Practical Guide for Doctors and Lawyers, 3rd ed. (2010).


Delineating Professional Competencies

Competency-based professional education– Outcome/skills oriented, not focused on

process inputs or recitation of information– Premise: Teaching can improve performance– Assessing decisional capacity is a core

competency that attorneys and physicians should be able to demonstrate


Delineating specific competencies– Build on General Competencies of

Accreditation Council for Graduate Medical Education (ACGME)Interpersonal and Communication Skills

– “…work effectively as a member or leader of a health care team or other professional group.”

Professionalism


– Build on Interprofessional Education Collaborative (IPEC) (organizations of health education institutions), Core Competencies for Interprofessional Collaboration Practice (2011). Did not address working with attorneys.Core competencies:

– Values/ethics– Roles/responsibilities– Communication– Teams and teamwork


Roles of Public Policy

Encouraging and Facilitating the Development and Implementation of Core Competencies– Government grants (e.g., NIA, HRSA, AoA) to

support educational innovations, at least demonstrations, leveraged with private foundation support

– Medicare payment to physicians for interprofessional capacity assessments under Part B, factor cost of this service into payment rate offered by CMS to Medicare Advantage plans


Integrate expectation of interprofessional capacity assessments into legal standard of care for physicians through Clinical Practice Guidelines (whose development and dissemination is supported through grants from the Agency for Healthcare Research and Quality [AHRC]). Integrate expectation of interprofessional capacity assessments into legal standard of care for attorneys through changes in ABA Model Rules of Professional Responsibility.


– Government or private grants (e.g., HRSA) to support and encourage certain medical specialty boards to incorporate demonstration of relevant core competencies into specialty certification examinations.

– Government or private grants to support and encourage organizational and state Bar legal specialty designation boards to incorporate demonstration of relevant core competencies into specialty certification processes.


Removing or Mitigating Barriers to Implementation of the Core Competencies– Clarify/modify Health Insurance Portability and

Accountability Act (HIPAA) to facilitate information exchange and interprofessional communication involving medical information

– Clarify/modify ABA Model Rules of Professional Responsibility to facilitate information exchange and interprofessional communication involving information known by the attorney


Discussion?

Documents

Interprofessional Collaboration on Behalf of Older Persons With Compromised Decisional Capacity: Developing and Implementing Core Professional Competencies