Capacity Psychologist Handbook

1 Assessment of Older Adults with Diminished Capacity : A Handbook for Psychologists American Bar Association Commission on Law and Aging American Psychological Association 1 Assessment of Older Adults with Diminished Capacity : A Handbook for Psychologists American Bar Association/American Psychological Association Assessment of Capacity in Older Adults Project Working Group Assessment of Older Adults with Diminished Capacity : A Handbook for Psychologists American Bar Association Commission on Law and Aging American Psychological Association 2 About the American Bar Association Commission on Law and Aging The mission of the American Bar Association (ABA) Commission on Law and Aging is to strengthen and secure the legal rights, dignity, autonomy, quality of life, and quality of care of elders. It carries out this mission through research, policy development, technical assistance, advocacy, education, and training.

2 The ABA Commission consists of a 15-member interdisciplinary body of experts in aging and law, including lawyers, judges, health and social services professionals, academics, and advocates. With its professional staff, the ABA Commission examines a wide range of law-related issues, including: legal services to older persons; health and long-term care; housing needs; professional ethical issues; Social Security, Medicare, Medicaid, and other public benefit programs; planning for incapacity; guardianship; elder abuse; health care decision-making; pain management and end-of-life care; dispute resolution; and court-related needs of older persons with disabilities. About the American Psychological Association The American Psychological Association (APA) is the largest scientific and professional organization representing psychology in the United States and is the world s largest association of psychologists.

3 Through its divisions in 53 subfields of psychology and affiliations with 59 state, territorial, and Canadian provincial associations, APA works to advance psychology as a science, as a profession, and as a means of promoting health, education, and human welfare. The APA Office on Aging coordinates the association s activities pertaining to aging and geropsychology (the field within psychology devoted to older adult issues). The Committee on Aging (CONA) is the committee within the APA governance structure dedicated to aging issues. Its six expert geropsychologists are selected for three-year terms. Together, the Office on Aging, CONA, and association members promote the health and wellbeing of older adults and their families through expanded scientific understanding of adult development and aging and the delivery of appropriate psychological services to older adults. Disclaimer The views expressed in this document have not been approved by the governing or policy-setting bodies of the American Bar Association or the American Psychological Association and should not be construed as representing policy of these organizations.

4 Materials in this book were developed based on the consensus of a working group. This document is not intended to establish a standard of practice against which clinical practice is to be evaluated. Rather, it provides a framework that psychologists may find useful and effective in Capacity determination. Although the principles presented herein are intended to be generally relevant across all legal jurisdictions, law and practice differ across state jurisdictions and sometimes even across county lines. Thus, this book is intended to supplement (and cannot substitute for) a Psychologist s working knowledge of relevant Capacity law specific to his/her jurisdiction. This book focuses on issues in civil Capacity determination in older adults, not all aspects of Capacity evaluation or all populations. Copyright (c) 2008 by the American Bar Association and the American Psychological Association.

5 All rights reserved. No permission is needed to reproduce the Capacity Worksheet for Psychologists, in print or electronic form, for classroom use in an institution of higher learning, or for use in clinical practice, provided that the use is for noncommercial purposes only and acknowledges original publication by the ABA and the APA. For permission to reproduce any other content from this Handbook , or for commercial use of the Worksheet, please request permission from the American Psychological Association at 10 Digit ISBN Number: 1-60442-234-3 13 Digit ISBN Number: 978-1-60442-234-4 ABA Product Code: 4280029 Assessment of Older Adults with Diminished Capacity : A Handbook for Psychologists American Bar Association Commission on Law and Aging American Psychological Association 3 Table of Contents Acknowledgements .. 5 Executive Summary .. 6 I. The Importance of Psychological Assessment of Capacities.

6 8 II. Legal Standards of Diminished Capacity .. 15 III. Conceptual Framework for Capacity Assessment .. 23 IV. Investigating the Referral and Planning Your Approach .. 29 V. General Approaches to Assessing the Older Adult .. 37 Capacity Worksheet for Psychologists .. 47 VI. Assessing Specific 51 Medical Consent .. 51 Functional 52 Sexual Consent Capacity .. 62 Financial Capacity .. 71 Testamentary 81 Driving Capacity .. 91 Independent Living .. 101 VII. Undue Influence .. 113 VIII. Working with Lawyers and Courts .. 121 IX. Emerging Issues .. 131 X. References .. 136 Assessment of Older Adults with Diminished Capacity : A Handbook for Psychologists American Bar Association Commission on Law and Aging American Psychological Association 4 Appendices Available online at Appendix A. Glossary .. 148 Appendix A. Glossary .. 149 Appendix B. Functional Assessment .. 156 Appendix C. Cognitive Assessment .. 163 Appendix D.

7 Psychiatric and Emotional Assessment .. 168 Appendix E. Values Assessment .. 170 Appendix F. Interventions to Address Diminished Capacity .. 172 Appendix G. Medical Conditions Affecting Capacity .. 178 Appendix H. Temporary and Reversible Causes of Confusion .. 182 Appendix I. Useful Web Sites .. 184 Assessment of Older Adults with Diminished Capacity : A Handbook for Psychologists American Bar Association Commission on Law and Aging American Psychological Association 5 Acknowledgements his book is the result of a collaborative effort of members of the American Bar Association (ABA) Commission on Law and Aging and the American Psychological Association (APA). Assessment of Older Adults with Diminished Capacity : A Handbook for Psychologists is the third work product of the ABA/APA Assessment of Capacity in Older Adults Project Working Group, established in 2003 under the auspices of the interdisciplinary Task Force on Facilitating APA/ABA Relations.

8 The first work product, Assessment of Older Adults with Diminished Capacity : A Handbook for Lawyers was published in 2005. The second product, Judicial Determination of Capacity of Older Adults in Guardianship Proceedings: A Handbook for Judges was published in 2006. Copies of both handbooks are available online at and Members of the ABA/APA Working Group for this project are: Barry Edelstein, PhD; Peter Lichtenberg, PhD, ABPP; Daniel Marson, JD, PhD; Jennifer Moye, PhD; David Powers, PhD; Charles Sabatino, JD; Aida Saldivar, PhD, ABPP; Erica Wood, JD; Stacey Wood, PhD; and Deborah DiGilio, MPH. Stacey Wood, PhD, and Jennifer Moye, PhD, are the editors of the Psychologist s Handbook . Special contributors to this Handbook include: Angela Jefferson, PhD (research consent Capacity ); Michele Karel, PhD, and Brian Carpenter, PhD (values); Lori Stiegel, JD (elder abuse and undue influence); and Susan Bernatz, PhD (undue influence).

9 We thank Susie Hwang and Jamie Philpotts for their superb editorial assistance. This Handbook was reviewed by an advisory panel of psychologists convened for this project: Norman Abeles, PhD; Rebecca Allen, PhD; Adam M. Brickman, PhD; Michelle Braun, PhD; Brian D. Carpenter, PhD; Gordon J. Chelune, PhD, ABPP (CN); Eric Y. Drogin, JD, PhD, ABPP; Colleen Fairbanks, PhD; Michelle Dawn Gagnon, PsyD; Randy Georgemiller, PhD; Thomas Grisso, PhD; Irving Hellman, PhD; Bret Hicken, PhD; Leon Hyer, PhD; Angela L. Jefferson, PhD; Sayaka Machizawa, PsyD; Joseph R. Miles, MA; Barton W. Palmer, PhD; Sara Honn Qualls, PhD; Cheryl L. Shigaki, PhD, ABPP; and Martin Zehr, PhD. The Handbook also was reviewed by Barbara Soniat, PhD, Arthur R. Derse, MD, JD and Kathleen Wilber, PhD, members of the ABA Commission on Law and Aging. Finally, we thank the Borchard Foundation Center on Law and Aging for its financial support of this project.

10 T Assessment of Older Adults with Diminished Capacity : A Handbook for Psychologists American Bar Association Commission on Law and Aging American Psychological Association 6 Executive Summary he ABA-APA Working Group on the Assessment of Capacity in Older Adults was established in 2003 under the auspices of the Task Force on Facilitating ABA-APA Relations. The workgroup has produced two volumes thus far, a Handbook for attorneys and a Handbook for judges. The current volume is designed for psychologists evaluating civil capacities of older adults. Contemporary probate law encourages functional assessments that describe task-specific deficits rather than global findings. With training in standardized cognitive and functional assessment, psychologists are in an ideal position to provide such evaluations. The specific goal of this Handbook is to review psychological assessment of six civil capacities of particular importance to older adults, namely, medical consent Capacity , sexual consent Capacity , financial Capacity , testamentary Capacity , Capacity to drive, and Capacity to live independently.