As a Geriatric Psychiatrist, I am sometimes asked to determine if a patient is able to manage his/her own financial affairs. Concerned family members often want to help put things in place so that their loved one's financial needs are met and their assets are kept safe. If this is the case a request from the person's lawyer is necessary to ensure that all proper legal proceedings are followed.
However, there is often some confusion about how psychiatrists determine whether or not someone is able to manage their own financial affairs. Here are some things you should know:
Determining someone's financial capacity can be complicated
If you have ever considered taking over the financial affairs of an older, loved one, you would know that power of attorney often does not apply to dementia patients in T&T, and so local banks will often not accept a power of attorney as a means of giving a relative control over bank accounts. It is just the way the law works here.
Consequently, people come to mental health specialists like myself to determine a person's financial capacity, or their ability to manage their financial affairs. I often get requests for 'a letter to the bank' saying that mummy/daddy/tanty has dementia and can't manage their money anymore... Sometimes I get this request before mom/dad/tanty has even been formally diagnosed with dementia!
Family members may notice that their loved one is not able to keep track of bills anymore, or maybe they can no longer visit the bank or ATM and need help to pay for doctor's visits, medication and nursing care.
However, family members should also understand that it is not right to take away a person's control over their assets unless it is deemed absolutely necessary by a mental health specialist and a court of law.
This process can take several months, and starts with a diagnosis. Following a diagnosis, of Alzheimer's disease for example, a separate financial capacity assessment is needed. This is a private interview in a quiet, comfortable, safe space where a specialist can determine, through a series of questions, whether someone is able to make decisions about their assets, what kind of decisions they are able to make and how this may affect them, their financial security and their family members .
An older person may not trust others with their assets, and with good reason
Many family members are often just trying to help and protect their older loved ones. However, if there are substantial assets involved, some relatives may be tempted to secretly 'pay themselves' by keeping money, property, jewellery, vehicles or other valuables belonging to the older person.
Financial abuse is something I often mention, but some relatives believe that taking from a parent or someone who is dependent on them is acceptable.
So it can be difficult for older persons to figure out who is trustworthy and who is not. Understandably, they may want to be extra careful about who they give up control of their finances to. Or maybe they are very private and possessive about their assets and do not want to give up control at all.
Considering someone outside of the family, like a trusted lawyer, can be an option in this case. Also, if the person is in the early stages I always recommend that they add a trusted person onto their bank account(s) and that will negate the need for the entire legal process in the first place.
However, if that is not a possibility and the person lacks the capacity to manage their financial affairs and property then families need to apply to the High Court for 'Committee' status, which is the legal term under our law to obtain Legal Guardianship of the person.
Ultimately, it is a judge who will decide who can be allowed to take over this person's affairs. The financial capacity assessment plays a big role in this decision. So it needs to be done carefully.
Dementia does not always mean that a person lacks financial capacity.
Like I said earlier, a financial capacity assessment can be complicated. There are many factors which need to be considered, such as the diagnosis and if it's dementia, the stage of dementia the person is in (early, middle or late), the person's extent of understanding and judgement, the size of their estate and their relationship with persons who are willing to help.
It is important to note that just because a person has dementia, this does not always mean that they are not capable of making some financial decisions. For example, a person may not be able to keep track of their bills or visit the bank anymore, but they may know exactly who they trust and do not trust.
They may remember exactly how many properties and bank accounts they own and while they may not remember what they had for breakfast, they may very well remember what money they set aside for their old age, and how they would like to have that managed.
Financial capacity therefore goes beyond the dollars and cents and cannot be determined with one quick letter to the bank.
This challenge is best done along with Age Caribbean Consultants, following a staff training program.
Each week for 4 weeks, the staff at the home is asked to watch one of the below videos by US Dementia expert, Teepa Snow, and discuss the questions posted under it. These questions are directly related to the training sessions that have been completed by staff. (These videos are not sufficient on their own to train staff or improve the quality of care homes).
After the 4 weeks are over, an Age Caribbean consultant will speak to management about the next steps.
Week 1: How to Approach Patients with Dementia
Can you state 3 key things to remember when approaching a patient?
Week 2: De-escalating a Crisis
Has there been a dramatic incident or event similar to the one described in your care home?
How was it handled?
How could it have been handled differently?
Week 3: Bathing a patient with Dementia
Did you find the above advice practical?
Are there ways you can change your current approach to bathing patients to make it more comfortable and dignified for both you and your patient?
Week 4: Getting patients to do things
How can staff better engage with patients at your home?
How can staff support each other when trying to engage patients?
Dr James Bratt, Lead Consultant at Age Caribbean and Geriatric Psychicatrist.