Capacity Assessment:
Making Sense of the
Confusion
Clarissa Bush, Ph.D., C. Psych.
Designated Capacity Assessor (SDA)
Presentation at
The Geriatric Patient: Behaviour Management
and Safety
Ottawa, 2013
The Standard of Capacity- Uniform
Across Legislation
• Understand the information necessary to
make a particular decision
• Appreciate the consequences of a
particular decision or lack of decision
What is “Understand”
having the factual knowledge base and skills
needed to manage the decision-making
demands of his or her circumstances (or can be
educated in that regard) and having the
capacity to intellectually understand the options
for meeting his or her needs and the ability to
communicate his or her choices or decisions
What is Appreciate?
the ability to realistically appraise the risk and
likely outcome of a decision or lack of a
decision and the ability to plan and take action
to implement a plan and the ability to rationally
manipulate information to reach a reasoned
decision consistent with personal values and
free from delusional beliefs.
Current Legislation Relevant to
Capacity in the Context of
Health Care
Mental Health Act
Health Care Consent Act (HCCA)
Substitute Decisions Act (SDA)
Personal Health Information Protection Act
(PHIPA)
Substitute Decisions Act
Overall Purpose
to give people more control over what
happens to them if they cannot make their
own decisions about property or personal
care
to protect mentally incapable people from
harm
Substitute Decisions Act
When is it used?
longer term or recurring incapacity
person failing to manage property or
personal care decisions or likely to
giving or terminating POA with special
provisions (Ulysses contract)
Formal capacity assessment needed
for:Statutory Guardianship (property only; Form 4
required)
Court Appointed Guardian – Summary Disposition (1
assessment for property, 2 assessments and one needs
statement needed for personal care)
Power of Attorney coming into effect upon incapacity
where assessment is specified or no method of
determining capacity specified
What is a Capacity Assessment
an interview with a capacity assessor
questions will be about:
- the facts of the person’s current financial
or personal situation
- their understanding of the decisions they
face
- what would the consequences of
particular decisions be (appreciation)
Who Can Perform a Capacity
Assessment?
only people authorized by the Ministry of
the Attorney General
a list of capacity assessors can be
obtained from the Public Guardian &
Trustee in Ottawa (613-241-1202)
the list specifies languages spoken by
assessors
Who Pays for a Capacity
Assessment?
the person requesting it pays unless they
are in financial need
people in financial need can apply for
funding from the Capacity Assessment
Office in Toronto (866-521-1033)
usually, people on welfare or ODSP will
qualify for funding
What Happens after the
Assessment?
the capacity assessor completes the
required forms
they are sent to the person who was
assessed and either the Public Guardian
and Trustee or the person who requested
the assessment, depending on the
circumstances
If a person is incapable, does the
PGT always take over their
finances?
Not necessarily, it depends on:
– whether they had given power of attorney
– whether the person requesting the
assessment intends to apply for guardianship
Vignette I
80 year old woman, several medical
problems and poor memory
living alone in a house, failing to care for
herself, not paying bills, phone has been
cut off several times
refuses capacity assessment
what are the options?
Vignette II
89 year old man, living alone
indwelling catheter he continually
removes
lets strangers in and they rob him
grandson, major caregiver, has POA for
property & personal care but isn’t willing
to confront his grandfather
family all agree client needs to move to
residence
Vignette III
elderly couple living together
she has dementia, he is irascible and won’t
care for himself or her
she mixes up his medication, he becomes ill,
is hospitalized and she cannot manage alone
only relative lives in the US and is unable to
help at all