Capacity vs. competency: Understanding the critical difference in care decisions
These two terms sound similar but have distinct meanings that can impact how families make care decisions for aging loved ones
(Aging Untold) — Making decisions about a loved one’s care can be challenging.
Can they make critical medical decisions for themselves, or does someone need to step in? Two concepts help determine that: capacity and competency.
The key difference
They might sound similar, but they’re not.
“These two get used interchangeably all the time, and they are not,” Sam Cradduck, a gerontologist, said. “Capacity is a medical term and competency is a legal term.”
Cradduck explained the distinction: “I may have the capacity to make my decisions and live my own life, but I’m not competent to drive at night any longer.”
Competency is determined through legal proceedings. If someone has been declared incompetent, they’ve had a court hearing, Amy O’Rourke, an aging expert, said.
Capacity exists on a spectrum
Unlike competency, capacity is not all or nothing. It can vary by situation and time of day.
“There’s different degrees of capacity,” Dr. Rhea Rogers, a board-certified physician, said. “I may not have the capacity to go at nighttime, but I have a capacity at a certain point in time to choose what I want to eat for lunch.”
The danger of overstepping
When adult children receive a letter from a doctor stating a parent can’t manage financial or medical affairs, they often panic and grab control over everything.
“That’s going to blow up in your face. It does not work,” O’Rourke said.
Respect and dignity matter most
Some families handle these situations better than others, focusing on respect and dignity rather than simply safety.
“Those are more important even than safety, the dignity and respect, and that people feel like they took part in the conversations and decisions,” Katherine Ambrose, an aging-well coach, said.
Seniors need more time to process decisions, according to the Aging Untold experts.
Adult children operating on a “to-do list” timeline need to slow down and allow their parents the time to work through decisions at their own pace.
O’Rourke noted that impatience can drive families to take over decision-making.
“I don’t want to take all that time. I’m impatient. So I’m just going to make the decision for them because I don’t want to sit around and wait for you to figure out,” she said.
But the consequences are serious.
“If you take my autonomy away, you’ve just stolen my personhood,” Cradduck said.
Plan ahead while you can
The best approach is to take charge while you still have both capacity and competency.
“That you are planning out how you want things to go and that way things are going to go better for you,” Ambrose said.
Six key takeaways
- Capacity is medical, competency is legal: Capacity refers to the ability to make specific decisions and is assessed by medical professionals. Competency is determined through legal proceedings.
- Capacity exists on a spectrum: A person may lack capacity for complex decisions like surgery but retain capacity for everyday choices like meals or activities.
- Don’t grab total control: When a doctor says a parent can’t manage certain affairs, it doesn’t mean they’ve lost all decision-making ability. Taking over everything can backfire.
- Respect and dignity come first: These values are more important than safety alone. Include your loved one in conversations and decisions whenever possible.
- Allow time for processing: Seniors often need more time to work through decisions. Patience is essential, even when adult children want to check items off a to-do list.
- Plan while you can: Make decisions about your future care while you still have full capacity and competency. This ensures your wishes are known and respected.
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