Incapacity versus Bad Decision Making: How Can We Tell the Difference?
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Shorkend Care Management

Incapacity versus Bad Decision Making: How Can We Tell the Difference?

There is a dilemma that I face with many of my clients. What do we do as caring professionals, and as family members, when we sense that a client no longer has the capacity to make their own decisions? There is a big difference between a person simply making bad decisions and someone who can no longer differentiate between good and bad options. Of course, if we simply don't like their decision, that doesn't mean that they lack capacity in a legal sense.

There are times for all of us when we need help with complex decisions, and this is why it is so important to have an Advance Healthcare Directive for medical decisions and a Durable Power of Attorney for financial decisions. We appoint someone we trust to take over from us temporarily, while we are hospitalized or otherwise incapacitated. The situation becomes much more complex when a person's mental capacity declines steadily over time, or when there are fluctuations. Sometimes, they seem perfectly OK, and at other times they really don't seem to know what is going on. If they themselves are unaware of their reduced capacity, they may become argumentative and fight the people around them, who are only trying to help.  In many cases, a Power of Attorney for Finances is "springing" - meaning that there needs to be some sort of trigger event and an assessment by a physician or a psychologist that determines that the person no longer has capacity. 
One of my clients was being isolated from her family by abusive caregivers, they were taking money from her and neglecting her care. Due to her reduced capacity (she suffered from dementia), she was unable to take steps to rectify her situation. Her daughter removed the "bad" caregivers and brought in "good" ones. This decision was made initially against her mother's will, but she soon connected with the new caregivers and became grateful for the changes. We were only able to make these changes because we had identified a clear plan of action to improve her care, and because the daughter had the legal authority to make these changes. 
Another client was happy to have someone else take over, but the person named in her documents was very hesitant to step in, and had not fully understood the responsibility of being chosen as agent (representative) on her documents.

As a Geriatric Care Manager, I am able to come in and assess the situation, and assist families in making difficult decisions. I help them differentiate between self interest (if mom moves into an assisted living now, there will be much more money left for me) and preserving the dignity and safety of their loved one (if mom moves into a good assisted living now, it will cost about the same, but she will have a better quality of life). I talk to as many people as possible, to get a full picture of the person's life, abilities and strengths.
As trusted professionals, we need to work together, consult with our client's attorney, CPA,  financial advisor, family and friends, so that we can build up a clear picture of our client's situation, and support them in maintaining their independence, while protecting them from abuse.


If you have questions or clients needing advice, please  email me  or
call (626) 437 5530 - Brenda
About Shorkend Care Management:
As a Geriatric Care Manager, I am an independent consultant and advocate, who can help your clients navigate the complex world of elder care. I provide comprehensive assessments, professional, practical assistance and emotional support.
Please  email me  or call (626) 437 5530 for more information.
Visit my website at:

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