As a psychologist, I have worked with many families struggling with the delicate issue of when and how to seek a capacity assessment. Most often, an adult child and/or caregiver of an older adult has observed concerning changes in their parent’s ability to manage finances, make medical decisions, or live independently, because of cognitive decline.
Approaching a parent or partner with this concern can feel heavy with emotion, fear, and the potential for conflict. Yet, when done thoughtfully and with empathy, it can be a catalyst for understanding, support, and ultimately, better care for our loved ones.
So, how do you navigate this challenging terrain? Here are some steps to guide you:
1. Choose the Right Time and Place
This isn't a quick elevator-ride chat. Pick a calm, private moment when distractions are minimal. Allow ample time for open discussion. Consider a familiar setting like your home or a favorite park, where your loved one feels most comfortable and safe. I always recommend against having complicated conversations in the car, because you can’t make eye contact and at least one person is distracted by, you know, driving. It’s ideal to sit face-to-face and see all of the nonverbal communication between you.
2. Start with Empathy, Not Accusations
Frame the conversation as coming from a place of concern and love (hopefully, this is actually true!). Start by reassuring your loved one that you care about their wellbeing, and recognize they are an adult and value their independence, just like anyone else. Use "I" statements like, "I'm worried about your forgetfulness lately, and I want to check in about some things I’ve noticed.”
3. Focus on Functioning, Not Diagnosis
Avoid labeling your loved one's capabilities or jumping to conclusions about their mental health. Instead, focus on specific areas where you've observed challenges, like managing finances, remembering medication, or making safe decisions about daily living. “I’ve noticed that some of your bills seem to be piling up because they’re going unpaid,” is likely to get you further than “I think you have dementia.”
4. Listen Actively, Without Judgment
Give your loved one the space to express their perspective, fears, and frustrations. Remember that their feelings are valid, even if you disagree with their views of the situation. Use open-ended questions like, "Can you tell me what's been happening lately?" or "How have you been feeling about managing your finances?
5. Education is Key
Explain the purpose of a capacity assessment – to understand their strengths and weaknesses in specific areas, not to take away their independence. A capacity assessment is about protecting an older adult, but also, about preserving their autonomy. Any psychologist doing capacity assessments is trained in balancing the right to independence and autonomy with the need for safety and support in certain situations. You might find it helpful to share resources like informative websites or brochures to foster understanding.
6. Address Fears to the Best of Your Ability
Many people fear losing control or being labeled "incompetent" when faced with the potential need for a capacity evaluation. Acknowledge these anxieties and emphasize that the assessment is collaborative, not punitive. Reassure them that the goal is to find the best support if they need it, not remove their autonomy.
7. Offer Choices and Control
Present different options for the assessment process. Suggest involving their doctor, choosing a familiar evaluator, or even having them initiate the conversation with their lawyer. Empower them to feel involved and in control.
8. Be Patient and Prepare for Resistance
This conversation might not go smoothly. Denial, anger, limited insight into safety issues, and resistance are common, and it’s important to know that if your loved one is indeed experiencing cognitive decline, they may not be aware of the changes in their capacity. Be patient, stay calm, and avoid getting defensive. Acknowledge their emotions and revisit the topic when they're ready, with the understanding that in certain situations, safety has to be the priority. For example, if your loved one has left the gas range on all night for the second time, or has suffered a fall because their home has become cluttered as a result of their cognitive change, or they have been the victim of a financial scam, those may be more urgent situations. You may need to balance giving them time to process your concerns, and also moving forward to schedule a capacity assessment in order to support their safety.
9. Remember, You're Not Alone
Seek support from other family members, friends, or healthcare professionals. Join online communities or support groups for caregivers if appropriate. Sharing your journey with others who understand can be immensely helpful, and you may learn strategies for navigating the situation that have worked for others.
10. Celebrate Small Victories
Acknowledge progress, no matter how small. A willingness to talk to their doctor, research resources, or even just acknowledging that a financial decision may have been off, or a situation may not have been safe – all these are steps forward.
Receive Support with a Mental Capacity Assessment in Los Angeles, CA
Talking about the need for a capacity assessment with an older adult or a vulnerable adult is never easy, but it can be crucial. If you are in need of consultation related to capacity assessment, or a capacity evaluation, please don’t hesitate to reach out. Dr. Reger is happy to offer support. Follow these simple steps to start the assessment process:
Contact (424) 262-1925 to schedule your appointment
Meet with a Los Angeles Psychologist for an evaluation
Start receiving the support your loved ones deserve!
OTHER SERVICES OFFERED BY DR. REGER IN LOS ANGELES, CA
Capacity assessments aren’t the only service I offer. I know that you may encounter more than one mental health concern at a time. This is why I’m happy to offer multiple neuropsychological and psychological assessments. Other assessments include cognitive and dementia testing, pre-surgical assessments, and med-legal evaluations. In addition to evaluations, I also provide individual therapy, counseling for older adults, and mental health consultations and presentations. Visit my blog for more helpful support today!