Capacity Clinic

Autonomy, Self-Determination, Protection from harm

What is capacity?

Sometimes, it is not clear whether a person is capable of making important decisions. They may have a brain condition, such as dementia or a brain injury, that affects their thinking skills and ability to understand the risks and benefits of different options. A neuropsychological evaluation can help figure out how well a person is able to understand and make important decisions, or if it is necessary to have someone else make decisions that are in their best interests. The question of capacity balances a person's right to autonomy and self-determination and the need to protect a person that is cognitively impaired and at risk.

What are some different kinds of capacity?

• Medical - is a person capable of making medical decisions for themselves? Do they need a health care proxy or power of attorney to make these decisions?

• Financial - is a person capable of understanding and managing their finances?

• Testamentary - is a person capable of making a valid will?

• Contractual - can a person understand the nature and effect of a contract and any business that is being transacted?

What does a capacity assessment involve and how is it different from other neuropsychological evaluations?

A capacity assessment will generally include a full neuropsychological evaluation to help clarify a diagnosis and trajectory of cognitive status, and better understand a person's current mental status and cognitive strengths and weaknesses. Unlike other neuropsychological evaluations, a capacity evaluations also answers a specific, legal question by assessing a person's ability to make a particular decision.

Does insurance cover a capacity evaluation?

Unfortunately, no. This type of evaluation is considered legal and therefore not "medically necessary."

My parent/family member has been diagnosed with dementia and I am durable Power of Attorney. Can I legally make their medical or financial decisions for them?

A diagnosis of dementia or brain injury does not automatically render a person incompetent. They may have the ability to make rational and informed decisions in some areas but not others; for example, they may not be able to manage their own finances, but they may retain the ability to appoint somebody to do it for them. If you are unsure whether you have the ability to make legal decisions for them, it is advisable to check with an elder law attorney.

My parent/family member is clearly not safe to live on their own or make financial decisions. Do they really need a capacity evaluation?

Maybe not. Sometimes a person is very clearly unable to make informed decisions, and based on their diagnosis, prognosis, and mental status, their medical doctor can make the determination of competency or capacity.