In British Columbia, consent is required before one can be admitted to a care facility. Cognitive impairment or dementia, may cause a decline in memory, reasoning, planning and judgement, and make one incapable to decide if they require such an admission. Thus, if incapacity is suspected, a patient's capacity for consent to a care facility needs to be assessed.
Due to recent changes in 2019 to the Health Care (Consent) and Care Facility (Admission) Act, allied health professionals such as social workers and occupational therapists can now also do long-term care capacity assessments.
HOMES
can be used remember things to ask about when doing a capacity for care facility admission assessment.H
- Home supportsO
- Overwhelmed/care giver burdenM
- Medical issues and medicationsE
- EatingS
- SafetyWhen doing the assessment, consider:
Silberfield & Fish (1994) identify 6 distinct elements as comprising intolerable risk:[1]
There are several core issues that can affect competency, including:
We discussed where the patient would go after discharge from hospital. The patient understands that his son is unwilling to have him return home and he will need a new place to live. The patient is hopeful that he can “find a house and live on my own.”
The patient seemed unbothered when I informed the patient that they cannot afford a place to live in the city based on their current monthly income. The patient replies that he will “find a way.” When asked to elaborate, the patient was vague and unable to. When we discussed that they had previously had a fall and were unable to call for help or 911, they did not recall this. The patient was also not able to appreciate that there were burnt pots on his stove from his attempts to cook, and could not appreciate the risks of a fire or serious injury.
When asked how he would afford utilities and groceries in addition to rent, the patient said “I don't need to eat much.” He declines the suggestion of a long-term care facility, stating, I do not need that. He does not recall burning several pots on his stove recently, and that this could pose a safety risk to others. Collateral information from other organizations suggests the patient was not reliable with home support and care, and also refused care at times.
Although the patient seems to provides a reasonable estimate of income, expenses, and cost of living, the patient lacks the ability to problem solve for more realistic and reasonable solutions. The patient has poor insight and marked executive dysfunction due to [diagnosis].
Based on my assessment today and the collateral available to me, the patient does not have capacity to manage finances and does not have capacity to make decision around LTC placement. The patient's care needs would be best supported in a structured setting like an assisted care or long term care facility.
The patient is not capable to give/refuse consent to a care facility admission at this time based on the above information [and serial assessments, collateral from others, etc.].