Adults & older adults, families and their advisers
Understanding decision-making capacity, one decision at a time.
A careful, independent capacity assessment for specific decisions, in Southport and across the Gold Coast, and by telehealth where that is suitable.
When there are questions about a person's ability to make a particular decision, a careful assessment can bring clarity.
We assess capacity for specific decisions, explain our reasoning in plain language, and provide a report that helps the person responsible make a sound, well-supported decision. We see people in Southport and across the Gold Coast, and by telehealth where that is suitable.
What it clarifies
What a capacity assessment can clarify
Capacity is not all-or-nothing, and it is not permanent. The question is always whether a person can make this decision, at this time.
- Whether a person can understand the information relevant to a specific decision, weigh it up, and communicate a choice
- Capacity for financial decisions (managing money, property and assets, or appointing someone to do so)
- Testamentary capacity (the ability to make or change a will), assessed against the established legal test
- Capacity to make health care and treatment decisions
- Capacity to decide on accommodation and living arrangements, including a move to supported or residential care
- Capacity to make or revoke an enduring power of attorney or other legal arrangement
- Whether a difficulty is better explained by a treatable or temporary cause (for example delirium, medication effects, depression or acute illness) rather than a settled change
A neuropsychological assessment describes thinking skills and how they bear on the decision in question. It is one part of the picture. The decision itself, and any formal or legal determination, rests with the appropriate person or body: the treating doctor, the Queensland Civil and Administrative Tribunal (QCAT), the Public Guardian or Public Trustee, a legal practitioner, or a court.
When to consider one
When an assessment helps
In Queensland, decision-making for adults is governed by the Guardianship and Administration Act 2000 and the Powers of Attorney Act 1998. Both begin from the presumption that an adult has capacity. An assessment is most useful where that presumption is genuinely in question for a specific decision, not as a routine formality.
- A family member is making decisions that seem out of character, or that put their wellbeing, money or property at risk
- A solicitor needs a considered opinion on testamentary capacity before a will is made or changed, or to support a will against later challenge
- There is a question about whether someone can make or change an enduring power of attorney
- A treating team needs to understand a person's capacity to consent to treatment or to decide where they live
- A decision about moving to supported accommodation or residential care is contested or unclear
- An existing arrangement is being reviewed, or an application to QCAT for a guardian or administrator is being considered
- Capacity has been questioned, and the person or their family would value a careful, independent opinion
What is involved
A structured, six-step approach
We follow a structured, widely used approach to capacity assessment, often described as a six-step process (Darzins and colleagues): being clear about which decision is in question, understanding the person's situation, assessing the relevant thinking skills, considering reversible contributors, forming a reasoned opinion, and acting on it appropriately.
- A clear referral question. We work out with you, the referrer or the legal practitioner exactly which decision is at issue, because capacity is always assessed against a specific decision.
- A clinical interview. We talk with the person about their situation, their understanding of the decision, and how they are weighing it up.
- Standardised testing. We measure relevant thinking skills, such as memory, attention, reasoning and judgement, set against what is expected for the person's age and background.
- Other information, with consent. Where helpful we review relevant documents and speak with family or the treating team.
- A reasoned opinion. We bring it together into a clear, decision-specific opinion, and we are explicit about its limits.
- Setting out what happens next. We explain the findings plainly so that you, the referrer or the tribunal can act on them, and with consent we talk the outcome through with the person and those supporting them.
Plan for a morning or an afternoon, sometimes split across two visits. Being rested helps. It is useful to bring glasses and hearing aids if used, a list of medications, and any relevant documents (for example the will instructions, the power of attorney, or correspondence from the solicitor or treating team).
“The law presumes capacity. We assess only where that is genuinely in question.”
What you receive
A report written for the decision
A written report in plain language that states the decision in question, describes the relevant thinking skills, sets out our reasoning, and gives a clear, decision-specific opinion together with its limits. Where the question is legal, the report addresses the relevant test (for example the elements of testamentary capacity) and is written to be useful to the solicitor, tribunal or court. With consent, we provide it to the referring doctor, solicitor or party. We are clear in the report about what the assessment can and cannot establish, and about who holds the decision.
For solicitors and treating teams. Tell us which decision is in question and provide the relevant documents, and we will confirm scope, timeframe and fee before proceeding. Make a referral or call us to discuss a matter.
Cost & funding
Clear on cost before we begin
Fees for this assessment are quoted at intake, and we confirm the fee with you before we begin. Capacity assessment is not rebated under Medicare's Better Access program. It is usually funded privately or by the instructing party (for example a solicitor or a family), and in some matters through the NDIS, DVA or an insurer. We confirm the fee and the funding pathway before booking. See our Fees and Policies page.
Take the next step
If you have a question about a specific decision, request an appointment or call 0452 452 262. GPs, solicitors and other professionals can refer through our referrer page, and it helps to tell us which decision is in question. You do not need a referral for a private appointment.
Request an appointmentSources: Guardianship and Administration Act 2000 (Qld). Powers of Attorney Act 1998 (Qld). Queensland Civil and Administrative Tribunal (QCAT), Guardianship and administration: applications and the appointment of guardians and administrators. Darzins P, Molloy DW, Strang D (eds), Who Can Decide? The Six Step Capacity Assessment Process, Memory Australia Press, 2000. Office of the Public Advocate (Qld), Capacity assessment guidelines and the presumption of capacity.