Assessing capacity for a specific care decision

The law sets a two-stage test. First, is there an impairment of, or disturbance in, the functioning of the mind or brain? Second, does that impairment mean the person cannot make the specific decision at the time it must be made?

The functional test

A person lacks capacity for a particular decision if, because of that impairment or disturbance, they cannot do one or more of the following:

• Understand the information relevant to the decision.
• Retain that information long enough to make the decision.
• Use or weigh the information as part of deciding.
• Communicate the decision by any means.

What this means in care work

Frontline staff do not need to treat every routine interaction as a formal assessment. When there is a genuine reason to doubt a person's ability to make an important decision, staff should recognise that concern and escalate it. Acute illness, delirium, infection, intoxication, severe distress, drowsiness and sudden confusion can all reduce capacity temporarily.

Higher-stakes decisions will usually require a registered professional or a senior clinician to lead the assessment. Care staff remain important by noting changes, describing what support was offered, and recording what the person could and could not do in practice.

Capacity assessments are decision-specific and time-specific. Acute illness can temporarily change what a person can understand or communicate.