If a professional believes a client’s decision making might be impaired, then the professional must discuss his or her concerns with the client.
Broaching this sensitive subject can be difficult and requires finesse. Although there is no guarantee that any one method will promote an open conversation, here are several options to introduce the delicate and much-feared topic of cognitive impairment:
- If you and the person are of a similar age, or if you are noticing changes in your own memory and mental processes, you might open the discussion by expressing concern about the subject in your own life. For example, you might say that you are frustrated with your inability to recall names or to multitask, then ask the older person if he or she ever has that problem. If the person agrees, you can take advantage of the opportunity to ask whether it concerns him or her.
- If a recent news feature, movie, or book highlights memory change, use it as the foundation to strike up a conversation about the topic.
- Have information and brochures about cognitive decline visibly available. If the person shows any interest in these materials, take the opportunity to talk. You might suggest that the person consider seeing a doctor who specializes in geriatric care.
These ideas might help initiate a conversation, but there comes a time when professionals must disclose their concerns to the client. Following are suggestions for approaching the topic gently:
- Express great concern and provide examples you have seen that might indicate the client is experiencing a cognitive decline. Remember, this is a discussion, not an inquisition or sentencing.
- Listen more than talk, and ask your client open-ended questions about his or her perception of the situation.
- If the client understands his or her condition, you can ask whom the client would like to make decisions for him or her. Clients might feel that they can make all their own decisions, or they might name a family member or a friend to help them. Honor this decision and, following standard professional practice, document the discussion. If the client wants assistance, you might even ask the client to sign a statement to the effect that he or she would like another person to make or to help make decisions.
Who has the authority to make decisions?
If you are unable to elicit a reliable answer, or if the client is unsure, you must take additional steps to determine who can make decisions for the client. For instance, have you served this person and his or her family in the past? If so, how were decisions made? Who was the decision maker? Has the client ever mentioned whom he or she wants to make decisions in the case of incapacity? Has he or she completed an advance directive that names a health care agent? Does someone hold a power of attorney?
Determining who has decision-making authority might require some sleuthing, accompanied by good documentation.
Remember, each time a professional suspects that a client has a failing mental capacity or works with a client who has a diagnosis of dementia, that professional needs to document:
- Why he or she believes the client lacks decision-making capacity in the context of particular decisions.
- The steps he or she takes to determine who should have decision-making power for the person with dementia.
Society of Certified Senior Advisors, Working with Older Adults: A Professional’s Guide to Contemporary Issues of Aging (2015). Adapted from Maximizing Integrity in Decisions with Seniors. Copyright © 2005 by WebCE LP LLLP. Used with permission of WebCE LP LLLP.