Assessment Tools

When care managers assess an individual we look to determine if the client is mentally capacitated by evaluating their  cognitive status often using standardized Assessment Tools like the clock-draw, SLUMS, MMSE, CPT or whatever other tools are available.  These are all helpful screening tools, but we try not to place full weight on the score to determine someone's capacity because sound or lack of sound judgment may also have a bearing in determining someone's capacity.  Sometimes a client may present with a pseudo-dementia borne out of depression which might impact cognition.  One of the best tools we have is our interviewing skills.  First, we ensure the client is functioning at baseline (not sick, tired, confused from a new hospitalization or illness, etc., well nourished and hydrated).  The evaluation is happening in a calm, non-distracting setting as well.  In interviewing the client, we spend some time really discussing the particular issue which needs a decision.  Capacity should be assessed as pertains to a particular decision.  A client may be incapable of making some decision, but quite capable of others.  We attempt to discuss the particulars of the decision at hand in language the client can understand or by coming back to it another time if necessary to ensure comprehension.  Care managers discuss consequences or outcomes of different options. So when assessing, ensure a client has been given sufficient information in order to understand the situation and possible decisions.  In other words, determine if the client is capable of giving an informed consent for a particular question.   We'd love to hear what other strategies are used to determine decision making capacity.  Please feel free to comment.  

olga@agooddaughter.com