Publication - Advice and guidance

Adults with incapacity: guide to assessing capacity

Published: 1 Feb 2008

Guidance for healthcare and social work professionals.

46 page PDF

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46 page PDF

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Contents
Adults with incapacity: guide to assessing capacity
Chapter 3: Assessing capacity interview: money and property matters

46 page PDF

0 B

Chapter 3: Assessing capacity interview: money and property matters

This chapter provides an outline for conducting an interview to assess the capacity of a person with mental disorder or inability to communicate in relation to the management of his/her money and any other assets.

Steps to take

Step 1:
Explore the factual understanding of present financial circumstances

One reason for starting the capacity interview with a review of the person's understanding of his/her finances is to establish whether or not the power of attorney option remains open. A person may be capable of appointing someone to be their attorney and give instructions about how his/her money is to be spent, but at the same time lack the capacity to manage his/her money.

If the person lacks capacity to appoint an attorney and there is evidence that he/she is unable to manage their financial affairs, it will be necessary to consider what type of intervention will be most appropriate to the circumstances of the individual (and taking account of the principles of the Act). ( See Appendix 4.)

  • Find out the person's previous role in money management.
  • Explore and record the person's knowledge of his/her assets, income, expenses, debts and financial dependents (if there are any).
  • Accept approximations and only seek information on major income sources/debts.
  • If the person does not volunteer the information about significant aspects of his or her financial status, then gently prompt. If acknowledged, inquire at a later point to see if the information has been retained.
  • Probe for reasons behind any discrepancies between the self report and the records or third party report.

If you are assessing capacity for routine money management, it is reasonable to expect the person to show a basic awareness of his/her financial circumstances. He/she should also be able to show a basic understanding of using a cheque book or bank card/or managing in the way they always have. Bearing in mind some people will view such questions as an infringement of their privacy - the person may need to be reminded of the reason for the questions.

Specifically the person should be able to say roughly what

- his/her weekly or monthly income is;

- his/her weekly or monthly expenses are; and

- what he/she has by way of savings.

Points to consider

  • Is there a discrepancy between the person's understanding of his or her actual income and expenses that cannot be put right through learning?
  • Can the person be helped to develop skills to manage his or her money, e.g. learn to count change, understand regular weekly expenditure, learn to sign a cheque and use a bank machine?
  • Does the person have a basic understanding of money and its value, e.g. coin recognition and worth; decipher a bank statement; recognise a cheque book (provided they have been familiar with these in the past).
  • Is the person able to estimate the approximate worth of his/her various assets (if there are any, e.g. property/shares)? If managing large sums of money, can he or she appreciate the size of the estate in terms of purchasing power?
  • Is the person aware of obligations to financial dependants? (where appropriate).

Step 2:
Identify areas of unmet financial need

Not all of us can understand the complexities of stocks and shares and the management of larger investments but we can choose to delegate and to supervise activities as well as redress any improper action if it came to light. The same cannot be said of the person who because of significant cognitive impairment is open to exploitation if safeguards are not in place.

It will be informative to contrast the 'self report' with observations from others. Where discrepancies of information exist, these should be flagged up for further investigation.

Points to consider

  • Does the person admit to any problems with routine or complex money management skills?
  • For those areas the person acknowledges as problematic, does he or she seek appropriate help?
  • Is there any evidence of a recent change in the ability of the person to manage his or her finances?
  • Can the person recognise situations of potential exploitation and respond accordingly?
  • Can the person communicate his/her financial needs to others to obtain the necessary assistance?
  • Does the person face financial risks because of pervasive memory problems?
  • How does the person reconcile his/her perception of reality of financial management against objective evidence of inability?
  • Does the person recognise that he/she may not be able to implement decisions without help?

Step 3:
Explore decision-making within critical areas of unmet need

Try to find out the degree of insight the person has into the problem areas. First ask them about the concern raised by others.

Engage in decision-specific questions that probe recognition and appreciation of the options to deal with the problems. Explore factual understanding, what they think the options are and advantages and disadvantages of each - and what their decision would be. Look at the chain of reasoning. It may also be instructive to look at the person's history, the sorts of choices they made.

Points to consider

  • Is there evidence of stability of choice over a reasonable period of time? Does the person express same choice when questioned on separate occasions?
  • Is the person's appraisal of risk realistic? Are major negative consequences overlooked in favour of minor beneficial ones?
  • Is there any evidence of rational manipulation of information or the weighing of advantages/disadvantages as part of the deliberation process?
  • Even if the person is unable to articulate reasons for his or her choices, are these consistent with his or her values and beliefs?
  • If the person is refusing care, is this because of, for example, pride, prejudice or fear? If so, do they understand the consequences of not having care?