As a psychologist with specialties in assessment and aging, I do many types of testing with adults of all ages. One type of testing that can be complex and may not be well-understood is capacity testing.
It's a nuanced area, and understanding when a capacity assessment is needed can be confusing. First of all, age, physical illness, disability, or a diagnosis of dementia, schizophrenia, or intellectual disability are not enough, on their own, to know whether a person lacks capacity. A condition that causes impairment in judgment is necessary to determine that someone does not have the capacity, but it’s not sufficient on its own to take away someone’s right to make their own decisions. This is incredibly important to remember as a frame for thinking about capacity.
Let's delve into some common situations where a capacity evaluation might be needed.
Medical Decision-Making:
Many of us have faced difficult medical situations, either for ourselves or loved ones, where major medical interventions are needed. In some situations, the person who needs treatment may not be able to fully comprehend the situation to make decisions. For example, if someone has an infection and is confused, they may not have the capacity to consent to a medical procedure they need to heal.
In other situations, a family member with cognitive impairment may need surgery or other serious treatment. If concerns arise about a person’s ability to understand the situation and make informed choices, a capacity assessment might be necessary. This involves a psychologist or sometimes a physician asking specific questions designed to assess the person’s ability to understand their condition, appreciate the consequences of being treated (or not), reason through their decision, and express a clear choice. This ensures their preferences are heard and respected, even when facing challenging health decisions.
Conservatorship or Guardianship Proceedings:
Sometimes, people need support in managing their daily lives because of an illness or disability, like dementia or schizophrenia. Family or medical professionals might begin the process of putting in place a conservatorship or guardianship that allows a family member or court-appointed fiduciary to manage finances, healthcare, or living arrangements for someone.
By the way, conservatorship and guardianship are the same thing, the language just differs somewhat from state to state.
Where I work as a psychologist doing capacity assessments in Los Angeles, this arrangement is called a conservatorship. Before any legal decisions are made, a capacity assessment helps determine if the individual can independently manage aspects of their life.
As a psychologist, my goal in these cases is always to prioritize a person’s right to autonomy over their own life, while also recognizing and balancing the need for safety. For example, if an older adult with dementia really wants to continue living independently in their home, but has recently had many brushes with danger, such as leaving the gas on the stove burning overnight, leaving without locking the doors, falling down the stairs, or failing to feed themselves consistently, there may be a need for a conservator to step in and make decisions about a safer living arrangement.
Financial Management:
Concerns about someone's ability to manage their finances responsibly can be another trigger for a capacity assessment. This might involve protecting individuals from exploitation or ensuring their well-being is not jeopardized by risky financial decisions. For example, if an older adult with dementia has lost thousands of dollars to a financial scam, and cannot demonstrate the judgment and reasoning to safely manage their finances, then the sacrifice of their independence in this area may be necessary to preserve their safety and financial security. These evaluations take into account the person’s current abilities, reasoning, history, values, and situation.
It's important to remember:
Capacity is decision-specific:
Just because someone might struggle with one type of decision, it doesn't mean they lack the capacity for all decisions. Each situation requires a specific assessment. For example, I have seen many people who can make their own healthcare decisions, but who cannot safely manage their finances and need support in that area.
Individual rights are paramount:
Every individual has the right to make their own choices, even if those choices seem unwise to others. Capacity assessments ensure these rights are upheld and protected, while also ensuring a person’s safety within reasonable boundaries. The goal is not to be overprotective or treat older adults like children this is the opposite of the purpose of a capacity assessment. Balancing autonomy and safety is the key.
The assessment process is collaborative:
Psychologists work closely with individuals, families, and other professionals to gather information and conduct a comprehensive evaluation. For example, I may need to review medical records or financial records or interview the patient and their caregiver or family member.
What does a fair and accurate assessment look like?
Respectful and person-centered: I always aim to conduct capacity evaluations in a way that is respectful of the individual's dignity and autonomy.
Culturally sensitive: I consider cultural background, personal values, and individual communication style, and I try to be aware of my own bias (which we all have!) coming into each capacity assessment.
Multifaceted: The assessment goes beyond cognitive testing or diagnosing dementia and considers the individual's understanding, communication, reasoning, and decision-making abilities, as well as their values and practical skills.
Independent and objective: It is very important that a capacity assessment is conducted by a neutral professional, such as a clinical psychologist, who isn't involved in any potential decisions arising from the evaluation.
Understanding capacity is crucial for older adults with conditions that alter their ability to make decisions, but there is no one-size-fits-all answer. Everyone deserves a nuanced and respectful approach to ensure their voice is heard and their rights are protected, for the best possible quality of life.
Begin a Capacity Assessment in Los Angeles, CA
Ultimately, capacity assessments are crucial tools for safeguarding individual rights and ensuring informed decision-making in many situations. If you have questions or concerns about someone's capacity, you can reach out to Dr. Reger for guidance through the process and advocate for fair and accurate evaluation. Start your therapy journey by following these simple steps:
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!