Medical Staff Portal

Capacity Assessment

Understanding Decision-Making Capacity

What is Capacity?

It’s all about making decisions! Having capacity means you can understand information important for making a decision and can appreciate the consequences of that decision. When making a decision, an adult should be able to:

  • Take in key information,
  • Think about the pros and cons
  • Make a decision, based on his/her values

Facts about Capacity

It is assumed that all adults have capacity to make their own decisions. Capacity assessment is a process used to determine whether an adult is still able to make his/her own decisions. There must be proof that the capacity assessment is needed and the adult needs someone else to help make decisions.

Capacity is NOT a medical diagnosis, and it is NOT determined by performance in daily tasks. Making a risky decision, or a decision others do not agree with, does not necessarily mean that the adult lacks capacity.

It is possible to have capacity to make certain types of decisions but not others. For example, an adult may have capacity to choose where to live, but not have capacity to manage his/her money. If an adult does not have capacity, steps can be taken to help them make decisions. Capacity can fluctuate over time.

When Should Capacity Be Assessed?

Capacity should be assessed when:

  • An adult makes choices or behaves differently than they usually do, which puts themselves, or others, at risk
  • This change seems to be a result of impaired decision-making
  • There is conflict surrounding the decision.  For example, an adult does not want to give up driving when they should because of safety concerns.

How Is Capacity Assessed?

The assessment usually includes:

  • Getting information on the risk caused by the adult’s decisions from the adult/caregivers
  • Working with the adult to find out his/her strengths and limitations
  • Problem-solving by the health care team to try and resolve the issue 

If the issue is not resolved, a staff member will formally interview the adult to determine his/her capacity in a specific area.

The formal interview looks at whether the adult:

  • Understands the facts about a decision
  • Understands what might happen if they make one choice over another

Areas of Decision-Making

The decision an adult has to make can be assessed in any of the following areas:

  • Health care
  • Accommodation
  • Choice of associates
  • Social activities       
  • Education/Training     
  • Employment
  • Legal affairs      
  • Finances 

Capacity assessments are only done in the area of concern. For example, if an adult is refusing much-needed surgery and appears to lack capacity, the capacity assessment will only be done for the area of health care.

 

For additional information please see the Capacity Asessment: AGTA Brochure (click here for additional languages) or Fact Sheet: Capacity Assessments Under AGTA & PDA (click here for additional languages).

Capacity Assessment Resources

Capacity Connections

A quarterly publication with information on topics related to Decision-Making Capacity. Click on the link to access the article.

When Should Capacity Be Assessed? - January 2017

How to Proceed When a Personal Directive is in Place - April 2017

Supported Decision-Making Authorization - October 2017

Worksheets - Order Through DataGroup

Capacity Assessment Process Worksheet CH-1191

Capacity Interview Worksheet CV-0527

Capacity Assessment Brochure CH DE-358  

Capacity Assessment General Resources

Glossary of Terms

Capacity Assessment Process Worksheet Guidelines

Capacity Assessment Model Care Map

Assessment of Decision-Making Capacity, Corporate Policy #VII-B-35

Legal Acts

Personal Directive Act

  • Allows an adult to name a person he/she trusts (an agent) to make decisions on his/her behalf
  • Deals with personal decisions, including medical care, but not financial matters
  • Set up by an adult when he/she has capacity, and activated when the adult loses capacity

Powers of Attorney Act

  • Allows an adult to name a person to assist him/her with handling his/her finances and property
  • Deals with financial matters or property only
  • Set up by an adult when he/she has capacity and activated when the adult loses capacity

Adult Guardianship and Trusteeship Act

Supported Decision-Making

  • Supported decision-making gives someone authority to access your personal information and help you make and communicate your decisions. 
  • ​For adults who have the capacity to make their own personal decisions but would like to have someone they trust help them in the decision-making process.
  •  ​Helpful for capable people who face complex decisions, people whose first language is not English, and people with mild disabilities.

Specific Decision-Making

  • If an adult doesn't have the capacity to make decisions, a health care provider can choose one of the adult’s relatives to make a one-time, time-sensitive decision.
  • ​Specific decision-making can be about health care, and/or temporary admission to or discharge from a residential care facility

Co-Decision-Making

  • Capacity is significantly impaired, but the adult can make personal decisions (not financial) with guidance and support.
  • Decision-making authority is shared with the co-decision-maker, both to make and communicate decisions. 

Guardianship

  • Legal process which gives an adult (called a guardian) the legal right to make or help make decisions about non-financial matters on behalf of another adult who lacks capacity
  • Deals with personal matters (e.g. health care, accommodation), but not finances

Trusteeship

  • Legal process which gives an adult (called a trustee), the legal right to make, or help make, decisions about financial matters on behalf of another adult who lacks capacity
  • Financial matters include personal property, realty, money, investments and income

Additional Resources       

Understanding Personal Directives  (click here to access additional languages) This 24-page booklet provides in-depth information about what a personal directive is, how to write a personal directive, areas of decision making authority and how to choose an agent/representative.  

Guide to Capacity Assessment under the Personal Directives Act. This guide provides general information about capacity assessments under the Personal Directives Act. The guide is intended for the public, people who write a personal directive, people who are named as decision makers in a personal directive, and those who may have a role in conducting capacity assessments (someone named to assess capacity in a personal directive, physicians and psychologists, and service providers). 

Personal Directives: Choosing Now for the Future (click here to access additional languages)This brochure describes how to write a personal directive and instruct someone you trust to make decisions for you.

Personal Directive Registry Brochure (click here to access additional languages) informs people who have made a personal directive how to voluntarily register their document.  When you register your personal directive with the Government of Alberta, approved health care professionals can find out if you have a personal directive and the contact information for your agent, if needed. This way the people you trust can be contacted in an emergency

 

 

Adult Guardianship and Trusteeship Act Materials

All Office of the Public Guardian and Trustee Publications can be ordered for use with patients and families without cost.  Please click here to access the order form.

Decision Making Options : Adult Guardianship and Trusteeship Act  is a brochure that provides an overview of the various options available under the Adult Guardianship and Trusteeship Act.  

 

Understanding Guardianship This booklet is useful when someone is considering becoming a guardian. It explains the process and the duties and responsibilites of a guardian.  The brochure, Guardianship, provides a brief  summary and is available in other languages by cllicking here.   The Guardianship fact sheet also provides a good summary of guardianship.

 

Understanding Co-Decision Making This booklet is useful when someone is considering becoming or having a co-decision-maker.  It explains the process and duties and responsibilites of a co-decision maker.  The Co-Decision Making brochure (click  here to access additional languages) provides a summary of the booklet content.

 

Specific Decision Making This brochure (click here to access additional languages) will help clarify the role of the specific-decision maker and the process involved.  The fact sheet on Specific Decision-making may also provide clarity to both health providers and family members.  For further questions about specific decision-making please contact a member of your mentoring team or the CASS team.

 

Supported Decision Making This brochure(click here to access additional languages) provides information on what it means to have a supported decision-maker.  It can be entered into by completing a Supported Decision-Making Authorization.  It may be terminated by completing the Termination of Supported Decision-Making Authorization.

 

Protective Measures Investigations Under AGTA  This brochure (click here to access additional languages) provides information on the process involved in filing a complaint against a co-decision-maker, guardian, or trustee.  Information is also available in this Protective Measure Fact Sheet.

 

Alternatives for Financial Management Materials

 

Understanding Enduring Powers of Attorney  brochure provides a brief overivew of an Enduring Power of Attorney.  

 

Informal Trusteeship brochure explains what informal trusteeship is and when it is most useful.

 

Legal Forms & Schedules

Personal Directive Schedules

Schedule 1 - Personal Directive  (Instruction sheet for Personal Directive)
Schedule 2 - Declaration of Incapacity-agent with physician consultation
Schedule 3 - Declaration of Incapacity-service provider
Schedule 4 - Regained Capacity-agent initiated
Schedule 5 - Regained Capacity-service provider initiated
Schedule 6 - Regained Capacity-agent and service provider disagree
Schedule 7 - Complaint to the Public Guardian Respecting an Agent named in a Personal Directive

Adult Guardianship and Trusteeship Forms

Supported Decision-Making

Supported Decision-Making Authorization
Termination of Supported Decision-Making Authorization

Co-Decision-Making

Capacity Assessment Report for Co-Decision-Making  
Application for Appointment of a Co-Decision-Maker

Guardianship or Trusteeship or Both

Capacity Assessment Report - Guardianship or Trusteeship or Both 
Application for a Guardian, Trustee or Both

Application Kit for New Guardianship Order (Forms 14, 15, 24, 26, 30, 32)
Application Kit for New Guardianship and Trusteeship Order (Forms 14, 15, 24, 26, 27, 29, 30, 32, 34, 37)

Specific Decision-Making

Specific Decision-Making (Form 6) 
Capacity Assessment Report For Specific Decision-Making (Form 10)
 

 

Filing a Complaint

Complaint Respecting a Co-Decision-Maker, Guardian or Trustee 

 

Any forms not listed above can be accessed on the OPGT website. Click here to access.

Capacity Assessment Support Service

Capacity Assessment Support Service (CASS) 

The Capacity Assessment Support Service was created to support the Covenant Health Decision-Making Capacity (DMC) Model which is in keeping with the Covenant Health policy. The services offered will include guidance, problem solving and education (workshops and in-services.)

This service is designed to assist the Covenant Health Sites: Misericordia, Grey Nuns, Villa Caritas and Rural Covenant Health sites.

To access this service please complete the attached request form and fax it to (780-735-2391). Please note the Capacity Assessment Resource Person is available on Mondays only.  Your request will be addressed on the Monday following the receipt of the request excluding Statutory Holidays.

For general inquiries, please contact 780-735-2390 and press 3 to leave a message.        

Tara Kilkenny
Occupational Therapist
Capacity Assessment Resource Person
780.735.2390
Tara.Kilkenny@covenanthealth.ca

Dr.Lesley Charles
Physician
780.474.8827
Lesley.Charles@albertahealthservices.ca

Lisa Robanske
Unit Clerk
780.735.2390
lisa.robanske@covenanthealth.ca

CASS Poster

CASS Referral Form

Education Sessions

View the Education Calendar for upcoming workshops and brown bag sessions.

Decision-Making Capacity Interactive Workshops

Instructors: Physicians, Occupational Therapists, Social Workers, Nurses, Designated Capacity Assessors

Times
: Held twice per year

Locations: Grey Nuns Hospital and Misericordia Community Hospital

Course Description: In this workshop, participants will be provided with an overview of an established interdisciplinary model for the assessment of decision-making capacity of adults. Learning activities include pre-workshop readings, participating in exercises and completion of a capacity assessment process worksheet based on presented case studies.

Learning Objectives: At the end of the workshop participants will:

  • Be able to define capacity and the underlying guiding principles
  • Understand the Legislative Acts and their impact on the assessment of decision-making capacity
  • Be familiar with the CH capacity assessment model
  • Apply a capacity assessment process using case studies

Brown Bag Sessions

The brown bag sessions are presentations on the latest information regarding assessment of decision-making capacity which covers topics requested by staff members, case studies, updates on legislative acts, schedules and forms, and many other practical topics useful for staff involved in assessments.

Capacity Assessment Mentoring Team - Grey Nuns

For general inquires about the Capacity Assessment pages or the program, contact Lisa Robanske, Unit Clerk, at 780.735.2390 or lisa.robanske@covenanthealth.ca.

Mentoring Team Roles

  • Support and Guidance to attending teams in using the Covenant Health Capacity Assessment Model
  • Planning and implementation of education/information sessions and staff education workshops, as needed  
  • Seeking educational opportunities and promotion of model

Grey Nuns

Anita Gajadhar
Occupational Therapist
780.735.7161
Anita.Gajadhar@covenanthealth.ca

Binder Dhillon
Social Worker
780.735.7479
Binder.Dhillon@covenanthealth.ca  

Brenda Vos
Social Worker, DCA
780.735.7583
Brenda.Vos@covenanthealth.ca

Katrina Damer, BSW RSW
Social Worker
780.735.7580
Katrina.Damer@covenanthealth.ca

Dr. Lesley Charles
Lesley.Charles@albertahealthservices.ca

Misty Zisin
Nurse Practitioner
780.394.2419
Misty.Zisin@covenanthealth.ca

Nicole Kostiuk
Psychologist
780.735.7490
Nicole.Kostiuk@albertahealthservices.ca

Pat Gerrie
Social Worker, DCA
Tel. 780.735.7808
Pgr. 780.445.3043
Pat.Gerrie@covenanthealth.ca


 

Capacity Assessment Mentoring Team - Misericordia

For general inquires about the Capacity Assessment pages or the program, contact Lisa Robanske, Unit Clerk, at 780.735.2390 or lisa.robanske@covenanthealth.ca.

Mentoring Team Roles

  • Support and Guidance to attending teams in using the Covenant Health Capacity Assessment Model
  • Planning and implementation of education/information sessions and staff education workshops, as needed  
  • Seeking educational opportunities and promotion of model

Misericordia

Bonnie Launhardt RN MN
Program Manager, Medicine
780.735.9318
Bonnie.Launhardt@covenanthealth.ca 

Cathy Nowicki
Occupational Therapist
780.735.2757
Catherine.Nowicki@covenanthealth.ca

Dilpreet Sidhu
Social Worker
780.735.2668
Dilpreet.Sidhu@covenanthealth.ca

Gwen Thompson (Chair)
NP Internal Medicine
Gwen.Thompson@albertahealthservices.ca

Gladys Boateng
Transition Co-ordinator, Villa Caritas
Phone: 780-342-6523
Pager: 780-445-5171
Gladys.Boateng@covenanthealth.ca

Lisa Robanske
Unit Clerk
780.735.2390
Lisa.Robanske@covenanthealth.ca

Rudolph Kutama
Social Worker
780.224.8635
Rudolph.Kutama@covenanthealth.ca

Tara Kilkenny
Capacity Assessment Support Service
Occupational Therapist
780.735.2390
Tara.Kilkenny@covenanthealth.ca

 

Capacity Assessment Mentoring Teams - Other Covenant Health Sites

For general inquires about the Capacity Assessment pages or the program, contact Lisa Robanske, Unit Clerk, at 780.735.2390 or lisa.robanske@covenanthealth.ca.

Mentoring Team Roles

  • Support and Guidance to attending teams in using the Covenant Health Capacity Assessment Model
  • Planning and implementation of education/information sessions and staff education workshops, as needed  
  • Seeking educational opportunities and promotion of model

Youville Home -St. Albert

Donna Brown
Social Worker
780.460.6921
Donna.Brown@covenanthealth.ca