n your reply posts, discuss challenges in knowing when to evaluate a person’s capacity in decision making. Are there instances, such as refusing to care for a chronic illness or choosing to drink alcohol while on complex medications, that may trigger action, and if so, what challenges might you encounter? posts should be 100 to 150 words, with a minimum of one supporting reference included.
Evaluating capacity for older adults poses a challenge as there is a high prevalence of cognitive impairment, such as dementia, as well as medical and neurological comorbidities for this patient population. According to Moye and Marson (2007), these cognitive and physical changes are linked with declines in everyday functioning that includes loss of decision-making skills. This raises legal and ethical concerns in healthcare as some older adult patients may lack the capacity to make decisions regarding their own care. When a patient is deemed incapable of making decisions for themselves, decision making falls to the patient’s guardian or health care proxy (Moye et al., 2005).
From the assigned readings, I was pleasantly surprised to understand the legal implications in place for protection when an individual is deemed incapable of making decisions for themselves. As capacity evaluations strive to protect the dignity and autonomy of all persons (Moye et al., 2005), the legal healthcare proxy or guardian is also in place to represent the individuals’ perceived intentions and desires. It is also reassuring that evaluation of capacity is thorough as to not to inaccurately deem an individual incapable of making their own decisions. Moye et al. (2005) explains that capacity assessment involves causal, functional, interactive, and judgmental abilities.
As a healthcare provider working with elderly patients, it is necessary to utilize all resources when determining an individual’s legal capacity. Moye et al. (2005) states that psychologists working in rehabilitation settings are called on to use their expertise in psychological assessment to help address complex presentations and related capacity questions. Utilizing the expertise of clinical psychologists assists in making the more efficient and concise decisions regarding an elderly individuals’ capacity. Challenges of capacity arise inpatient as well, with the concern if elderly individuals have the capacity to consent for various acute procedures. From my experience, when the nurse practitioners I work with have concerns regarding their patient’s legal capacity, they will consult psych and sometimes social work for guidance. It is important to have a capacity assessment guide in place when working with an older patient population. Tools such as the virtual reality functional capacity assessment tool assist healthcare providers in assessing a patient’s ability to complete instrumental activities such as searching a pantry at home, making a shopping list, or paying for groceries (Atkins et al., 2015). Additionally, providers must develop a framework for assessing cognitive ability and decision-making skills in order to accurately evaluate capacity.
The definition of capacity varies from state to state. In the state of California, the Health Care Decisions Law of 2000. In the legislation the definition of capacity is defined as “a patient’s ability to understand the nature and consequences of proposed health care, including its significant benefits, risks, and alternatives, and to make and communicate a decision” (California’s Health Care Decisions Law Fact Sheet, 2005). As healthcare providers, it is important to provide competent care. It is a patient right to have self-determination over his body or her body and property. However, when the individual is a minor or deemed incompetent, they have the right to have someone to protect their interest and basic rights. According to California Hospitals Association, a patient has capacity to make their own decisions when they are able to response knowingly and intelligently to queries about medical treatment, participate in the plan of care, and understand the information necessary to give or refuse informed consent. A physician needs to assume the role of determining capacity or incapacity and this should be documented in the patients record.
Something I found interesting is a health care agent can make most principal health care decisions regarding an individual care, but there are exceptions. A health care agent can not authorize commitment into an mental institution, electroconvulsive therapy, psychosurgery, sterilization, abortion, or limitation that are specified in the patient advance directive. Another issue is when there is no one in the patients life who can make medical decision in case they become incapable to making medical decisions, there are certain steps an institution needs to follow. The option in place for this situation is to contact the Public Guardian’s Office and seek a conservatorship. The other is to get a court order per Probate Code 3200. However, this is time consuming and costly method. Sadly, patient being unrepresented occurs often. According to a 2006 3study, 16 percent of ICU patients were unrepresented. This group is compromised predominately for patient who are mentally ill, homeless, lives alone, or the elderly who have out lived family and friends (Van Hall & Garret, n.d.).
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