Capacity And Decision-Making
Nursing home staff often assume that residents with dementia lose all decision-making "capacity."  In truth, dementia usually begins by impairing capacity not totally destroying it. 

A person with impaired capacity still has some ability to take in information and communicate about her medical care or how she wants to live.  Often, someone's level of capacity fluctuates over the course of a day, or in different circumstances, depending on her level of comfort, the amount of medication taken, or familiarity with surroundings.

Some decisions require more capacity than others.  For example, someone with impaired capacity, might be able to name a health care agent but be unable to consent to experimental chemotherapy.
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WHAT YOU CAN DO TO PROMOTE YOUR RELATIVE’S
CAPACITY AND DECISION - MAKING
Don’t accept a view of capacity as black or white.  Instead, demand that the nursing home view your relative’s level of capacity as it relates to each individual decision.


Be present when staff bring important decisions to your relative. 
 

Discuss your relative’s capacity and patterns of alertness and lucidity with staff, before they evaluate your relative.  One caller told FRIA of a psychiatrist who thought her father lacked capacity because he made only evening rounds, when her father was least alert.


If you notice sudden changes in your relative’s ability to understand concepts or communicate, ask about changes in types or amounts of medication.  (As a designated representative or health care agent you should automatically be informed of any changes in your relative’s treatment plan.)


If you think your relative has more capacity than staff acknowledges, find out if there is an ethics committee at your home.  Members often receive training about capacity issues.


Call FRIA’s hotline if you have concerns about a nursing home’s evaluation of your relative’s decision-making capacity.

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