Q&A: Capacity versus competence

April 21, 2021
Medicare Web

Q: Case managers must know the difference between capacity and competence when working with patients of any age. How would you explain the difference between those two essential terms?

A: You are correct that these are extremely important terms for case managers. As Ellen Fink-Samnick, MSW, ACSW, LCSW, CCM, CCTP, CMHIMP, CRP, DBH(s), of EFS Supervision Strategies LLC in Burke, Virginia explains in her HCPro book End-of-Life Care for Case Management, capacity is a person’s ability to make informed decisions and provide informed consent. For example, is the patient able to understand the purpose of recommended medical or surgical interventions or treatment plans? Is the patient able to fully comprehend the potential risks and/or benefits of receiving or not receiving particular medications, diagnostic tests, or procedures?

Informed consent is a key initial phase of all treatment efforts. Can the patient understand the information and alternatives presented toward discharge planning? Too often, case managers are approached by members of the treatment team to assess patient competence when they actually should be verifying patient capacity. Capacity focuses on the patient’s:

  • Comprehension
  • Free choice
  • Reliability (or consistency)

Physicians and psychiatrists are able to consult on making a determination of a patient’s capacity. However, they cannot help to determine a patient’s competence.

Competence is a legal term that speaks to determining the capability of a person to act on his or her own behalf or have the mental capacity to participate in the legal proceedings or transactions (e.g., business, medical decisions).

For more information on this topic, see End-of-Life Care for Case Management.

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