Financial Capacity Assessment (BC)

In British Columbia, a Financial Capacity Assessment should be done when there is concern that an individual could be incapable of managing their finances in the context of a psychiatric (e.g. - spending during a manic episode in bipolar I disorder) or neurocognitive disorder (e.g. - dementia). A certificate of financial incapability can be issued under Part 2.1 of the Adult Guardianship Act (AGA) and pertains only to the area of financial decision making. Through this law, the PGT may be appointed as statutory property guardian/committee of estate of an incapable adult to manage their financial affairs. This is not related to a certificate or certification under the BC Mental Health Act and MHA appeal mechanisms similarly do not apply.[1]

Financial capacity assessments in British Columbia depends on whether there is the presence of a power of attorney (POA)

  • If a patient has a power of attorney, then the assessor does a standard financial capacity assessment, and issues the decision from that letter to the POA.
  • If there is no power of attorney involved, then depending on the amount of money involved, the assessor can decide to:
    • If small net worth: the Bloom Group in British Columbia runs an Adult Guardianship program.
    • If large net worth: an assessor should contact the Public Guardian and Trustee (PGT) of British Columbia first, to obtain a “green light” letter before the assessment.
  • If an adult has not appointed a substitute decision maker (SDM) in advance of their becoming incapable for financial decision making or their plan fails, the PGT or another person could be appointed committee of estate by the court under the Patients Property Act.
  • The PGT may become the adult's statutory property guardian through a certificate of incapability issued for the adult under Part 2.1 of the Adult Guardianship Act.

Prior to starting a financial capacity assessment:

  1. First inform the patient the purpose of the assessment, and possible outcomes of the assessment explicitly explained to them (including a finding in financial incapability)
  2. A financial capacity assessment tests the patient's ability to understand and appreciate the consequences of their financial decisions and this should be explained to the patient.
  3. Comment on the patient's mental status at the time of the financial capacity assessment.
  4. Find collateral to corroborate the information provided by the patient. Ask collateral if the patient has missed payments, received charges or fees for failures to pay bills, or outstanding issues with tax arrears.

It is important to consider the different cognitive domains that may affect financial competency, and you may wish to document your observations in your mental status exam:

  1. Memory: does the individual remember the numbers involved, income, and expenses?
  2. Executive Function: does the individual appreciate the consequences of their decisions, detail the reasons for the choices, and acknowledge the limitations of their choices?[2]

An individual should understand and appreciate the nature of their financial decisions, this can be done by asking questions such as:

Understand:

  1. Income: What is your source(s) of income (if prompting required: ask about pensions, old age security, disability, family)? What is your monthly income?
  2. Savings: What are your current savings? Where are the savings stored (if prompting required: which bank, which account)?
  3. Assets: Do you have any assets or debts? How do you access your assets (e.g., withdraw cash)
  4. Expenses: What are your monthly expenses (if prompting required: ask about rent, utilities, groceries, insurance, car expenses; if prompting required: do they use authorized debit, credit card, debit, cash to pay the expenses)?
  5. Taxes: How do you pay your taxes each year (if prompting required: missed tax payments, arrears, back taxes, delinquency, charges?)
  6. Cost of basic goods: Ask patient to identity the costs of basic consumer items and services (are they able to provide reasonable estimates?)
  7. Basic math skills: Ask your patient a basic calculation question (document: are they able to answer? what is the latency/speed of their calculations)
    • Ask your patient to add up their monthly fixed expenses to figure out how much total spending they will have each month (are they able to do this accurately?)
    • Ask them to determine how much money is left over after these fixed expenses (are they able to estimate their monthly left over savings?)

Appreciate:

  1. Are there any delusions about their finances?
  2. Can they explain and justify their purchases?
  3. Are they able to make a decision on managing their money, and explain it in a logical fashion?
  4. Do they have insight and judgment about their financial situation?

Sample Documentation of Financial Capacity Assessment

It was explained to the patient that the purpose of today's assessment was a financial capacity assessment, and that should he be found incapable that another party would be identified to manage his finances. The patient was agreeable to this assessment.

  • [Comment on the patient's mental status exam]
  • [Mention any collateral obtained from friends, family, trusted sources regarding the accuracy of the financial information provided]

1. Reported Income: The patient reports monthly income is $[XXXX] as pension from the government
2. Actual Income: The patient’s actual monthly income is $[XXXX] (confirmed with John Doe or other Collateral)
3. Rent: The patient reports their son pays the rent.
4. Rent Estimation: The patient recalls rent is approximately $[XXXX] in [Location]
5. Groceries: The patient reports expenses of $[XXXX] weekly
6. Utilities: Collateral indicates son pays for those as well.
7. Commodity estimate: The patient has a fair estimate of commodity prices such as $[XXXX] for a box of cookies or $[XXXX] for a litre of milk.
8. Banking: The patient reports they bank at [XXXX]
9. Deposits/Withdrawals: The patient reports bank withdrawals monthly and using cash to pay for expenses.
10. Other Assets: The patient tells reports no other savings, property, assets, or investments
11. Calculations: The patient was/was not able to do monetary calculations (e.g., 10% of $200; $100 minus $43.)
12. POA: The patient does/does not have a POA
13. Representation Agreements: The patient does/does not have a Representation Agreement

If incapable: Based on the financial capacity assessment today, there is indication that:

  • The patient has defaulted on rent payment or other bills, patient is unable to save money].
  • The patient has [psychiatric symptoms: e.g. - cognitive impairment, delusions] informing their financial decisions].
  • The patient is not able to understand a realistic cost of [rent, groceries, utilities, mortgage]
  • The patient does additionally not appreciate the potential consequences of their financial situation, and that this could result in [eviction, homelessness, lack of ability to afford food, pay for utilities]

If capable: Based on the financial capacity assessment today, the patient expressed a clear understanding of his financial situation, including income, savings, expenses, assets, and basic calculation skills.

Based on this assessment, the [patient] is [CAPABLE]/[NOT CAPABLE] to manage their own finances. Note should be made that capacity is time and decision-specific, and a reassessment of capacity should be done if there are questions around the patient's capacity in the future. There [are/are not] reversible factors contributing to the incapacity (e.g., delirium [reversible] vs. dementia [irreversible]).

For Clinicians