Understanding Capacity in Aged Care
The term "capacity" carries significant weight, especially when discussing the care and well-being of older adults. In the context of aged care, capacity refers to a person's legal ability to make their own decisions. This includes decisions about medical treatment, financial matters, living arrangements, and daily activities.
A fundamental principle in aged care is respecting the autonomy of the individual. For a person to exercise their autonomy, they must possess decision-making capacity. When a person has capacity, they can consent to medical treatment or refuse it, thereby maintaining control over their own life and care journey.
What Does Decision-Making Capacity Mean?
Decision-making capacity is not an all-or-nothing concept; it is decision-specific and time-specific. A person may have the capacity to make a simple decision, such as what to wear, but lack the capacity to make a complex decision, such as agreeing to a major surgical procedure. Similarly, a person’s capacity can fluctuate. For instance, a resident in aged care might have the ability to make decisions at one point in the day but not another, perhaps due to temporary illness, delirium, or the effects of medication.
Legally, a person is considered to have capacity unless proven otherwise. The legal test for capacity focuses on what the person is actually able to do, not on their medical diagnosis or condition. Many people living with disabilities or illnesses, including some forms of dementia, still retain the capacity to consent to or refuse various medical treatments and other decisions.
Components of Capacity
To have capacity for a particular decision, a person generally needs to be able to do the following four things, as outlined by legal frameworks like the Mental Capacity Act in various jurisdictions:
- Understand information: The person must be able to comprehend the information relevant to the decision being made. This includes the potential benefits and risks associated with their choice.
- Retain information: They must be able to hold that information in their mind long enough to weigh it up and come to a decision.
- Weigh up information: The person must be able to use and weigh the available information as part of the process of making the decision. This involves considering the consequences of making, or not making, the decision.
- Communicate the decision: They must be able to communicate their decision, whether verbally, through writing, or by any other means, such as gestures or signals.
If a person cannot satisfy one or more of these four points, they may be deemed to lack capacity for that specific decision at that specific time.
Capacity Assessment in Aged Care
Assessing a person's capacity is a routine part of providing high-quality aged care services. This assessment should be done whenever a significant decision needs to be made, particularly concerning medical treatment. The assessment should be carried out by a qualified professional, such as a doctor, who is familiar with the legal requirements.
When assessing capacity, the focus should always be on supporting the person to make the decision themselves first. Efforts should be made to present information in a way that the person can best understand it. For example, using simple language, visual aids, or allowing extra time for processing the information. If the person has capacity with support, their decision is respected, even if it differs from the opinion of the supporter or care provider.
If it is determined that a person lacks the capacity to make a specific decision, a substitute decision-maker must become involved.
Substitute Decision-Making
When a resident in aged care is found to lack capacity for a decision, that decision cannot simply be made by the care staff or family members acting on their own authority. A legally recognized substitute decision-maker is needed. This person is typically appointed through legal means, such as an enduring power of attorney or guardianship tribunal, and acts in the person's best interests.
Care providers must confirm the legal authority of any substitute decision-maker. This is a critical step to ensure decisions made on behalf of the resident are legally valid and follow the individual’s previously expressed wishes, preferences, and values, often referred to as 'best interests' principles.
The goal of care remains the same: providing dignity and respect, even when the individual cannot make all decisions for themselves. Care must be delivered in a way that restricts the person's freedom and autonomy as little as possible.
FAQs About Capacity in Aged Care
- Q: Can a person with dementia still have capacity?
- A: Yes, a person with dementia may still have the capacity to make some decisions. Capacity is decision-specific. They might retain capacity for simpler or less complex decisions, even while needing support for major ones.
- Q: Who performs a formal capacity assessment?
- A: A formal capacity assessment is typically performed by a qualified health professional, most often a medical doctor, who is responsible for determining if the person meets the legal criteria for capacity concerning the decision in question.
- Q: What happens if a resident's capacity fluctuates?
- A: If capacity fluctuates, the assessment must be done at the time the treatment or decision is required. Care providers should monitor the individual and try to obtain consent when they believe the person is most likely to have the capacity to decide.
- Q: Does capacity affect consent for routine care?
- A: Yes, capacity relates directly to the ability to provide informed consent for any care or treatment. For routine, lower-risk care, capacity is generally assumed unless there is evidence to suggest otherwise, requiring ongoing assessment.
