Understanding Capacity and Competence
As our loved ones grow older, we may start to notice changes in their behavior or decision-making abilities. Perhaps your 87-year-old father’s house has become increasingly messy, but he stubbornly refuses to get help. Or your aging aunt seems to be giving away large sums of money to suspicious callers. These situations can be deeply concerning and may prompt questions about whether your parent or relative is becoming “incompetent.”
It’s a delicate and complex issue, but understanding the differences between capacity, competence, and incompetence is the first step in determining how best to support your aging loved one. Let’s dive in.
What is Capacity?
When we talk about capacity, we’re referring to an individual’s ability to make specific decisions. Capacity is not an all-or-nothing concept – it’s decision-specific. A person may have the capacity to make some choices, like what to eat for lunch, but lack the capacity for more complex decisions, like managing their finances.
Clinicians generally agree that capacity requires four key abilities:
- Understanding the relevant information about the decision at hand.
- Appreciating the potential consequences of the decision.
- Reasoning through the decision-making process.
- Communicating a clear choice.
These mental capacities can fluctuate based on a person’s health, medication, stress levels, and other factors. Someone with dementia, for example, may have good decision-making abilities one day but be impaired the next.
Competence vs. Incompetence
The terms “competence” and “incompetence” are more legally-oriented. Competence is a determination made by the courts about whether an individual has the legal right to make their own decisions. Incompetence is the opposite – a legal finding that someone lacks the capacity to manage their own affairs.
In the past, a finding of incompetence often resulted in the person losing nearly all control over their life. Today, the focus has shifted more toward assessing capacity for specific decisions or functions, rather than a global determination of competence.
Importantly, clinicians like doctors and psychologists can evaluate a person’s capacity, but only the courts can make a legal finding of incompetence. Their assessment of capacity can inform the legal process, but the ultimate decision rests with the judicial system.
Assessing Capacity
If you’re concerned about your aging parent’s decision-making abilities, it’s important to seek a professional evaluation. This typically involves a comprehensive assessment by a doctor, psychologist, or other qualified clinician.
The assessment may include cognitive testing, a review of the person’s medical history, and discussions with family members or caregivers. The clinician will aim to determine the person’s capacity to make specific types of decisions, such as:
- Managing finances and property
- Giving informed consent for medical treatment
- Deciding where to live
- Driving a vehicle safely
Clinicians may also assess a person’s capacity to complete everyday tasks like managing medications, preparing meals, and maintaining personal hygiene. This can provide important insights into their overall functional abilities.
It’s worth noting that capacity is not an all-or-nothing proposition. A person may have the capacity to make some decisions but not others. The clinician’s role is to provide a detailed, decision-specific assessment of the individual’s capacities.
When Capacity Is In Question
There are a few common scenarios where concerns about capacity may arise:
Dementia and Cognitive Decline
As people age, they are at increased risk of developing dementia or other forms of cognitive impairment. In the early stages, a person may still have the capacity to make many decisions, but as the condition progresses, their decision-making abilities will become more and more compromised.
Chronic Health Conditions
Certain medical conditions, such as strokes, brain injuries, or severe mental illness, can also impact a person’s capacity. Fluctuations in physical or mental health can cause temporary or permanent changes in decision-making abilities.
Refusal of Needed Care
If your aging parent is refusing to seek necessary medical care, get help with daily activities, or make important lifestyle changes, it may be a sign that their capacity is diminished. This can be particularly concerning if the person’s safety or well-being is at risk.
Financial Mismanagement
Unexplained changes in spending habits, unusual financial transactions, or the inability to manage bills and accounts may indicate that an older adult is losing the capacity to make sound financial decisions.
In any of these situations, it’s essential to seek a professional evaluation to understand the extent of the capacity issues and determine the best course of action.
Planning Ahead
One of the best ways to avoid capacity-related challenges is to plan ahead while your loved one is still cognitively healthy. Encourage them to:
- Designate a trusted power of attorney for healthcare and financial decisions
- Create an advance directive outlining their wishes for end-of-life care
- Consider establishing a revocable living trust to manage their assets
Having these legal documents in place can make it easier to step in and make decisions on your parent’s behalf if their capacity becomes compromised in the future.
It’s also a good idea for older adults to undergo regular cognitive assessments, either as part of their routine healthcare or through a specialized geriatric evaluation. This can help establish a baseline and identify any changes over time.
Navigating the Process
If you do have concerns about your parent’s capacity, the first step is to have an open and honest conversation with them. Approach the topic gently, emphasizing that your goal is to help them maintain their independence and quality of life for as long as possible.
Encourage your parent to undergo a comprehensive medical evaluation, highlighting that it’s for their benefit, not to take away their rights. Offer to accompany them to the appointment and provide any necessary information to the clinician.
If the evaluation confirms capacity issues, you may need to consider legal options, such as pursuing guardianship or conservatorship. This can be a complex and emotionally-charged process, so it’s advisable to work with an experienced elder law attorney who can guide you through the necessary steps.
Remember, even if your parent is deemed legally incompetent, it’s crucial to respect their autonomy and dignity as much as possible. Involve them in decisions, maintain open communication, and work to support their preferences and goals, even as their capacity diminishes.
Taking Care of Yourself
Navigating capacity issues with an aging parent can be an overwhelming and stressful experience. It’s important to remember to take care of yourself throughout the process. Make sure to:
- Seek support from other family members, trusted friends, or a caregiver support group.
- Practice self-care activities like exercise, meditation, or hobbies that help you recharge.
- Consider consulting a therapist or counselor to help process your emotions and find healthy coping strategies.
Caring for a loved one with diminished capacity requires patience, empathy, and a willingness to advocate on their behalf. By understanding the legal and clinical aspects of capacity, and seeking the right support, you can help ensure your parent’s needs are met while respecting their autonomy and dignity.
Remember, you’re not alone in this journey. The team at Stanley Park High School is here to provide resources, guidance, and a supportive community as you navigate this challenging but important process.
