When Adult Protective Services (APS) agencies receive reports of neglect or abuse of older and vulnerable adults, they often struggle to determine the adult in question's capacity to make important decisions. Writing for the New York Times, Paula Span details how a new training tool is helping APS agencies assess older adults' decision-making abilities following a report of possible neglect or exploitation.

Resource library: Caring for America’s seniors

Interview training tool aids APS workers

To help APS workers better assess seniors' decision-making capacity, Mark Lachs, co-chief of geriatrics and palliative medicine at Weill Cornell Medicine, and Jason Karlawish, a geriatrician and co-director of the Penn Memory Center, developed a tool called the Interview for Decisional Abilities (IDA). The tool teaches APS workers how to use a standardized interview process to gather key information about a subject's decision-making ability.

Currently, around 500 APS workers across New York City, Massachusetts, and two regions in California have been certified through the program. This summer, Kansas APS workers will also receive training.

According to Karlawish, the IDA asks three key questions about a specific issue:

1. Do you recognize that this happens?
2. Do you think that this could be happening to you?
3. Can you come up with a plan to address it, reasoning through and weighing the upsides and downsides?

"Depending on a problem's complexity, people with diagnosed cognitive impairment or even dementia may still possess sufficient understanding to handle it," Span writes.

If a person successfully demonstrates understanding in the IDA, they likely possess the ability to make a sound decision—even if they decide to ignore a potential problem.

If an adult cannot demonstrate understanding during the IDA, they require a more comprehensive evaluation. These adults may then have consultation with family members or social service agencies, and, in some cases, these consultations could lead to guardianship or conservatorship.

Ultimately, "[p]eople have the right to make bad decisions," Lachs said. However, he added, the decision makers must be able to fully comprehend any potential consequences.

The IDA program may have broader uses

In California, APS workers are using the IDA tool to assess a wide range of issues, including self-neglect, health, and safety questions, refusal of physical care or medical treatment, and physical, psychological, or sexual abuse.

"It's not meant to replace a psychiatrist, but it tells you when to contact a psychiatrist," Lachs said. If an individual's IDA reveals an inability to grasp risks or consequences, Lachs said they should receive a full professional assessment.

According to Lachs and Karlawish, IDA could be used in other capacities. In fact, trust and estate lawyers and financial firms have already asked them about the possibility.

"Hospital discharge planners might use IDA to assess whether a patient has the capacity to insist on going home instead of to rehab," Span writes. In addition, a chain of assisted-living facilities reached out to Lachs to ask if IDA could help determine whether new residents fully understand the complicated contracts they are required to sign.

For now, Karlawish said the IDA program will primarily focus on APS workers because "the typical agency is understaffed, underresourced and struggling." APS agencies in California take on around 30,000 cases involving seniors each month, according to state data, and "are being asked to make decisions about capacity that a chair of a psychiatry department might have difficulty with," Lachs said. (Span, New York Times, 5/9)