Who Can Stay at Home? Assessing the Capacity to Choose to Live in the Community

Abstract

While the courts have final responsibility, physicians are often asked to evaluate the ability of an older individual to remain living alone in the community. A person's capacity to make this decision can be more difficult to assess than the capacity to make medical decisions. Unsafe actions alone do not restrict the choice of individuals. Inability to understand the implications of these actions may also limit this choice. Decision-making ability is not well measured by global tests of cognitive function. Deficits in executive function resulting in impaired insight, problem-solving ability, and goal-directed planning limit one's ability to make and carry out decisions. Unsafe actions and deficits in executive function, combined with the refusal to accept help from family and social agencies, may indicate that independent living in the community presents unacceptable risks.