1. ASSESSING AN
ADULT’S CAPACITY
TO CONSENT

2. LEARNING OBJECTIVES Define autonomy, capacity, and incapacity.
4/22/2017
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 2

3. APS Process & Capacity Exercise
Using numbers 1-6, take a few minutes to order the steps in the APS process

4. Evaluate the Need for Protective Services Obtain Service Authorization
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

5. 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.

6. 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.

7. Capacity
APS Manual III-29
Being aware of the limitations or deficiencies in one’s surroundings
Being aware of one’s own mental or physical limitations
Being aware of resources available to assist in meeting one’s needs
Being aware of the consequences to oneself if nothing is done to improve or remedy one’s situation 7

8. 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.

9. Capacity Evaluation A 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

10. 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.

11. Factors that influence Capacity
Substance Abuse
Depression
Social Setting
Nutrition

12. 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.

13. 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.

14. Capacity vs. Competency
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

15. 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 Clerk
District Court Judge of Superior Court or Jury

16. IMPLICATIONS OF A JUDGEMENT OF INCAPACITY
Make decisions about medical treatment
Personal Care
Testify in court
Choose where to live

17. Common Mental Health Problems of Older Adults
Delirium
Dementia
Depression
Personality Disorders 17

18. 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

19. 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

20. Ask Questions That Focus On:
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

21. 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.

22. 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

23. 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

24. 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

25. 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

26. 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

27. Questions/Comments?