Capacity Assessment Office
Presented by Hilary Callin
Acting Program Coordinator
Capacity Assessment Office (CAO)
The Substitute Decisions Act mandates who can be
Capacity Assessors and the occasions when these
legal assessments of capacity are required to bring in
to force provisions of SDA.
The CAO:
•provides initial assessor training regarding legislation
and the guidelines for assessing capacity
•provides ongoing support and education to assessors
•maintains a public list of qualified assessors
•administers a financial assistance program to pay for
assessments under certain circumstances
•monitors assessors’ quality assurance requirements
Who are capacity assessors under SDA?
• A member of one of the following Colleges:
Physicians and Surgeons of Ontario
Psychologists of Ontario
Social Workers and Social Service Workers Ontario
Occupational Therapists of Ontario
Nurses of Ontario (RN or RN-EC)
• Have successfully completed a CAO/Ministry of the
Attorney General training program
• Comply with ongoing Quality Assurance regulations
• Carry $1,000,000 of professional liability insurance
When is “capacity assessment” required?
To facilitate a legal process under SDA:
• to create Statutory Guardianship for property (s. 16)
• to terminate Statutory Guardianship for property(s. 20)
• in some cases to make a Power of Attorney effective
(postponed effectiveness s. 9(3) , s.49(2).
• to give or revoke a Power of Attorney for Personal
Care with special provisions (s. 50)
• may be used when applying for or terminating courtordered guardianship for property or for personal care
Less intrusive options for property if
Capable but needs help - may arrange for:
Bank Power of Attorney / for bank account only
Direct deposit of cheques, direct payment of bills
Assistance to write cheques; deposit/withdraw
funds-shop for groceries, etc.
Continuing Power of Attorney for Property
Continuing Power of Attorney
SDA s.8, capable to give CPOA if:
Knows what kind of property and its value
Is aware of obligations owed to dependents
Knows attorney will be able to do anything
with person’s property except make a will
Knows attorney must account for dealings
Knows he/she may revoke CPOA if capable
Appreciates property may decline unless
prudently managed
Appreciates attorney could misuse authority
Less intrusive options for property if
Trusteeship for government pensions only: ODSP/OW,
Someone is willing to apply and act as trustee
Evidence of misspending (risk of eviction, unpaid
utilities, no food)
Indications of incapacity - disorganized thoughts,
forgetful, paranoid, having difficulty with basic money
skills, being exploited by others
No other property to be managed
Options for property (continued)
Guardianship for property is a last resort when other
less intrusive options are not sufficient:
No POA in place, no one to name, or the person is
not capable of appointing a POA
Trusteeship is not enough authority to manage
property/finances or there is no one to act as trustee
When there are assets to be managed and someone
with legal authority is required to manage the property
of an incapable person (such as private pensions,
inheritances, stocks, bonds, investments, real estate,
collections - stamps, paintings, jewellery, antiques)
Capacity assessment may be requested
Capacity is a cognitive test:
• Ability to understand information (factual knowledge +
problem solving ability/making choices)
• Ability to appreciate consequences (realistic appraisal
of outcome + justification of choice)
• Question is not “do they understand” but “can they
understand”, can they understand and remember
“Does the level of decisional ability match the demands
for decisions on the person?”
Premise underlying SDA/Capacity
Main “threats” to decisional capacity:
Intellectual Disabilities
Psychiatric Disabilities
Other Neurological Disorders
It is suggested that:
•those with intellectual deficits and dementias would
most likely fail on the “know” or cognitive tests
•those with psychiatric and other neurological disorders
would most likely fail on the “appreciate” tests
•These “threats” to decision-making capacity suggest the
areas for focus when structuring interview questions10
Understand - 1st base
• Factual knowledge: preservation of old skills and
• How much knowledge does the person have about
their finances and/or has s/he been given the basic
• Has the person been educated to any new facts such
as a change in finances
• Ensure it is a test is of capacity not ignorance
Understand - 2nd base
• Able to comprehend information about options and
risks to make an informed choice
• Able to attend to relevant information, understand at a
conceptual level and retain information long enough to
reach a decision
• Able to remember prior choices and express them in a
predictable and consistent manner over time
• Able to problem solve around personal/financial
issues – assessor will probe specific examples
Appreciate - 3rd base
• Able to appraise potential outcomes of a decision or
lack of decision
• Focus is on the reasoning process; explore the
personal weights, values attached to each outcome
• Does s/he acknowledge personal limitations in
meeting demands (show insight)
• Decision-making is reality-based; is it being affected
by delusions (fixed false beliefs) or by emotional
states (depression, hopelessness causing an
undervaluing of survival issues)
Appreciate - 4th base
Justification of choice:
• shows evidence of rational (based in reality)
manipulation of information - a “reasoned
choice”, not necessarily a reasonable choice
• grounded in personal beliefs and values;
consistent with previous actions, expressed
wishes, cultural or religious beliefs
What do assessors do?
 Screen calls (can the person’s needs be met
in some other way, less intrusive / expensive)
 Collect background information – what needs
to be decided, what has been tried?
 Has the person been educated to the facts?
 Meet the person, * provide rights advice *
 Assess capacity if person does not refuse
 Confirm information with collateral sources
 Write report and file as required
Roster of SDA Capacity Assessors
 Assessors are listed by geographic areas,
second language facility, professional
qualification, areas of expertise
When choosing an assessor, consider:
 Matching the client’s needs and preferences
& the professional expertise of the assessor
 Proximity of assessors to the client’s address
 Obtain an estimate of costs (hourly rate and
total estimate) from more than one assessor
 Ask when they are available to do the
Cost of Assessment
• The requestor pays for the assessment
• Fees are determined by the assessor, each profession
has suggested guidelines for fees
• Range in cost from $300 to $1500+ depending upon
complexity of assessment
• Requestor may recover cost of assessment from
estate of incapable person or from the PGT if PGT is
appointed to manage property (if funds available)
• Financial assistance is available to individuals who
cannot afford to pay for an assessment - means tested
Financial Assistance
• Available through Capacity Assessment Office for
individuals (not agencies) who request assessment
• Based on financial situation of requestor, not of
allegedly incapable person (unless self-requested)
• Only for assessments required under SDA
 For financial assistance applications or rosters of
assessors contact the Capacity Assessment Office
416-327-6766 or 1-866-521-1033
Public Guardian and Trustee information, brochures
(‘Capacity Assessment Office’, ‘When the Office of the PGT
Becomes your Guardian of Property’)
Ministry of the Attorney General site, all Ontario
statutes and regulations (Forms) in downloadable form
Ministry of Health and Long Term Care
Ontario’s Consent and Capacity Board
 A Practical Guide to Capacity and Consent Law of Ontario

- Community Networks of Specialized Care