Does anyone know the difference between capacity and competence?
My Dad is back in the hospital for the 4th time in about 5 weeks. He is 90, lives alone in his apartment, has to rely on a senior shuttle. He has refused all help by anyone, except to demand his children give him rides to the bank and the liquor store many times a week. He has a dx of dementia, among other things. He was given a competency test about 3 weeks ago and passed “with flying colors”. Since then he has been hospitalized two times, never used his medical alert or phone to call for help. Yesterday, he was found wandering in a walkway between a clinic and hospital. He had taken a taxi there, saying he had a procedure scheduled. He told us not to come because he would be in quarantine and no family was allowed to be there. We thought he would forget about it, but sure enough, he went there. He had no doctor’s name, did not know the procedure or a time. He was taken to the ER by a security guard, and they called one of my sisters to come and take him home. By the time she got there, they had determined he was very very confused and admitted him for a psych eval to determine if he was able to make his own decisions about medical care. The social worker said it was different from the competency eval he had aced two weeks ago. The doctor at the hospital called me today (I am first on the list for durable medical POA). He said there were two types of evaluations:capacity and competence. I had not seen or heard of capacity before. Anyone familiar with what kind of evaluations they do? Dad is on a floor in the hospital for patients that might need a different placement. These nurses and doctors really get it-Dad can answer the questions, says he can do everything. However due to his confusion, anger, stubbornness, probably mental illness, he cannot actually do theses things. He lives in Ohio, I am in Western Minnesota. Four of my siblings live near him. They are all burned out and want him to be somewhere safe.
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The competency test he passed so comfortably may have been something like a mini-mental state evaluation or assessment? Marked out of 30, took about twenty minutes?
There are far more detailed and thorough evaluations that can be carried out. These will probably include written and verbal tests plus an interview with an older age psychiatrist, or something along those lines. It takes all morning and provides a much more nuanced picture of what is and isn't working.
All the same... what was your father hospitalised for? The marked confusion this time, yes; but what about the previous occasions? What's his general state of health?
Health dx include heart valve damage, heart attacks, strokes, dementia, hearing and vision problems.
Echocardiogram results were good so he does not need any follow up on that for 2-3 years.
He has lived independently his whole life. Was widowed twice before he was 48.
The capacity evaluation is to determine if he is able to make medical decisions. It is an observation and testing over several days to see if the confusion is medically caused (medications, nutrition, enzymes,etc). All 6 of us children do not think he should be at home alone.
An example-he can answer most questions. But if you try to have a conversation with him, he rambles on and on, makes no sense, jumps from one topic to another, gets into raging arguments about everything.
Another example-he came to a family party on Christmas Eve wearing a machete strapped on his waist.
He will not allow any help, nothing from anyone. He has no money, doesn’t pay his bills, takes out payday loans at 27% interest. He only has his SS check.
Yet, we have not been able to get anyone to understand how unsafe he is. He also has some guns “for protection”.
The capacity evaluation, as far as the doctor has described it, is a functional evaluation. Like Dad can tell you the steps in doing something, but he cannot sustain his attention or focus long enough to actually do it. Except for crazy way out there stuff that he has decided he is going to do. Like walk 6 miles to vote then get a ride back with a stranger.