Financial Capacity Assessment (ON)

Primer

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).

In the Province of Ontario

A Form 21 (Certificate of Incapacity to Manage One’s Property under Subsection 54(4) of the Act) is issued when a patient is deemed incapable to manage one's finances (property). When a Form 21 is filled, a concurrent Form 33 must be given to the patient to notify them of this finding.

Assessment

  • When doing a financial capacity assessment, first inform the patient the purpose of the assessment, and possible outcomes of the assessment explicitly explained to them (e.g. - “A financial capacity assessment tests the patient's ability to understand and appreciate the consequences of their financial decisions. If someone is incapable, it means they are declared incapable to manage their own finances, and you can challenge that decision.”)

The Assessor

In Ontario, individuals who are admitted on an inpatient psychiatric unit will have a capacity assessment done by the attending physician (psychiatrist). Outpatients have a right to decline a financial capacity assessment (i.e., it must be voluntary), and financial capacity assessments are specifically done by qualified capacity assessors (can be health care professionals such as social workers, nurses, and psychologists). In either case, the role of the assessor is to:

  • Determine whether the person’s understanding of the issues is factually correct.
  • Determine if the patient can accurately identify their income, assets, debts and other financial involvements.
  • Testing how much the person can retain, interpret and the use of financial information. The person’s responses are then analyzed to see whether they demonstrate an understanding of the information.
  • Importantly, for the assessor, an individual's poor financial decisions alone (e.g. - spending money on drugs and frivolous items) is not enough for someone to be deemed financially incapable.
According to the Ontario Mental Health Act, all patients in an inpatient psychiatric facility must be examined “forthwith” (i.e. - immediately) by their attending physician regarding their abilities to manage their finances. This is something often erroneously forgotten by attending physicians.

Questions to Ask

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 of income? What is your monthly income?
  2. Savings: What are your current savings?
  3. Assets: Do you have any assets or debts?
  4. Expenses: What are your monthly expenses?
  5. Cost of basic goods: Ask patient to identity the costs of basic consumer items and services (are they able to provide estimates?)
  6. Basic math skills: Ask your patient a basic calculation question (document: are they able to answer?)
    • 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?

Pearls

  • If a patient appeals your finding of incapacity, the actual monetary amount that the patient can spend does play a significant role on how the Consent and Capacity Board rules on physician's finding (i.e. $400 vs. $4 million)
  • Inpatients who are assessed as financially incapable must be given rights advice before they are discharged.
  • Patients who are not admitted and are outpatients cannot be deemed financially incapable UNLESS they themselves first consent to a financial capacity assessment
    • Thus, getting a financial capacity assessment can be very difficult in an outpatient setting

Documentation

Sample Documentation of Financial Capacity Assessment

Based on the financial capacity assessment today, there [IS/IS NOT] indication that: patient has defaulted on rent payment or other bills, patient is unable to save money, patient has [psychiatric symptoms: e.g. - delusions] informing their financial decisions.

Patient is CAPABLE/NOT CAPABLE to manage own finances.

Finding of Incapacity

  • If an individual is found to be financially incapable, the patient must first be informed by the assessor that they have been found not capable. This is then documented in the patient's chart.
  • A substitue decision maker (SDM) must then be identified, who will then manage the individual's finances
    • If there was a pre-existing power of attorney (POA) for property, this then takes effect and whomever is listed as the POA becomes the SDM
    • If there is no pre-existing POA, the office of the Public Guardian and Trustee becomes the SDM for the patient and relatives can then apply for guardianship (if there are any).

Forms

  • Once a patient has been deemed incapable for finances, the following forms must be completed:
    • Form 33: Notice to the Patient
    • Form 50: Rights Advice
    • Form 22: Financial Statement of Office of the PGT
    • Form 24: Notice of Continuance (to be filled within 21 days of discharge)

Resources