If acute inpatient care is not necessary, isn't it best practice to administer a competency evaluation in context of the home environment?

Competency is a legal issue. That would be determined by a court, and the court would want the opinions of medical doctors and others.

Someone who has POA can act on behalf of the principal, following the principal's wishes. For example, if the principal wants to sell stocks and give the money to charity the POA can do that. But if the POA doesn't think that is a good decision and wants to protect the assets for the principal's own care, then (depending on the terms of the POA) it may be necessary to prove that the principal is no longer competent to make his/her own financial decisions. Depending on the terms of the POA, the attorney in fact may then be able to make decisions or it may be necessary to seek guardianship.

Evaluating someone's level of dementia for purposes of advising on levels of care needed usually requires input from the people who have been providing care. When my husband had his annual visit to Mayo clinic and spend half a day taking tests, I was interviewed during that period and answered a long questionnaire about his activities and abilities. And then together we spend a couple of hours with the behavioral neurologist who administered other tests and simply talked to us.

Considering all the people involved, I don't think it would have been practical for the evaluations to take place in our home. We traveled to the clinic. But I don't know that it would have made any difference to the outcome.

Having a highly skilled neurologist running all over the countryside to see patients in their home environment to assess their dementia just isn't practical, in my opinion.

I keep reading this question, but don't make sense of it. What is being determined? Cognitive decline, physical incapacity, or mental incompetence? There are different ways of measuring these three things. Perhaps if you tell us the full story we could make better sense of the question.

I don't know if this would be so good for determining competence. People can lack the ability to walk, bathe, or prepare their food, but still be mentally competent. Other people can do all the physical things, but are crazy as a bessie bug. When it comes to legal affairs, we are normally considering mental competence. I don't know if you can get a snapshot of mental competence. To me it would take knowledge of the decision of bad reasoning. It must be a challenge to determine if someone is mentally incompetent or not in a single day.

jeannegibbs - What if the purpose was two-fold. To determine competency as well as level of care. I am not sold that an inpatient response is necessary (or required) in order to determine competency and need for activation of a POA. The court is not involved. I'm willing to listen, though. Thank you for your reply and query.

An evaluation of dementia and memory loss is not the same thing as a competency hearing. Is the purpose of these evaluations to determine a treatment plan, or to establish a legal status of the person? Or something else? Is this about whether the DPOA should be activated or whether the person needs a different level of care?

I think it might be better done in an office than at home. Can the person even describe how they would do something? I think we're talking here about mental competency, not the physical ability to do something, like shower. Competency should include being able in the outside world, not just the home cocoon.

So, patient in natural environment can tell you this is here, that is there? The real question should be " show me how you.." pay your bills, shower, prepare a mesl.

Visiting Nurses, OT and PT have all done mini-mental exams with mom at home. I imagine social workers do the same. Orientation? A blind person in their own home could convince you they have sight. Self-care? Mom showed the OT her shower chair and insisted she showered every morning. The OT did not notice that the tub and under the tub mat was bone dry. Finance? Mom showed two stacks of bills, one paid, one unpaid. What she didn't show them was the bills she didn't like and hid. At home the patient can cheat the test and they DO.