Adaptation of the Capacity Evaluation Process to Make Admission Decisions: Increasing Access for People with Aphasia and other Communication Barriers

Background – Every competent person in Ontario has the right to decide whether or not he or she will be admitted to long-term care. If your capacity to make such a decision is in doubt, then it is evaluated. The current evaluation process is inaccessible to people with aphasia or other communication barriers, and social work evaluators report significant problems in communicating with this population. Competent individuals have been found lacking in capacity because of communication barriers. Aims – To create a communicatively accessible capacity evaluation process with training in specialized communication techniques. Also, to test the validity and effectiveness of the Communication Aid to Capacity Evaluation (CACE) to reveal the inherent capacity of participants with aphasia using social work evaluators. Methods – 32 social workers were partnered with 32 competent participants with aphasia. They were randomly divided into an experimental and control group. Both groups administered the current ‘Capacity to Make Admissions Decisions’ questionnaire to establish a baseline measurement of capacity. The social workers in the experimental group were introduced to CACE and received communication training. Following a two-week interval they administered CACE and the control group re-administered the current capacity questionnaire. The 64 capacity evaluations were video recorded and 3 independent speech-language pathologists administered standardized assessment measures on the recordings. Finally, the participants completed surveys measuring confidence and communication abilities. Outcomes - Using the current capacity questionnaire, one social worker found a competent participant lacking in capacity and one third of social workers were unable to determine capacity. Following the introduction of CACE with communication training, analyses of the standardized measures and survey results showed a statistically significant difference between the participants in the experimental group and the control group. The social workers in the experimental group had significantly better communication skills, (‘Revealing Competence’ f (2, 29) = 12.03, p = 0.002), the participants with aphasia’ abilities to ‘Transfer Information’ increased, (f (2, 29) = 10.51, p < 0.003), and the evaluators’ confidence in their determinations of capacity improved (f (2, 29) = 13.511, p = .001). The use of CACE with communication training resulted in accurate determinations of capacity in competent participants with aphasia. Conclusions - CACE was an effective tool to evaluate the capacity to make a decision regarding admission to long-term care. It was communicatively accessible for this research population with aphasia, enhancing comprehension of the capacity process and enabling the person to communicate a response. Improved communication skills, transfer of information and confidence allowed the evaluators to accurately determine capacity.

Keywords: Capacity evaluation
Communication barriers
Advisor: Black, Sandra
McDonald, Lynn
Kagan, Aura