Health insurance concept.
© fantasista / 123RF Stock Photo

Dr. Arlin Pachet

Occupation: Clinical neuropsychologist; founder and owner of Pachet Assessment & Rehabilitation Services

City: Calgary, Alta.

Age: 46

Practising since: 2001

Typical patients: People who have experienced a variety of brain changes. Those changes might be injuries, ranging from mild concussions to catastrophic accidents; we see many people struggling with the neurodegenerative condition often called dementia.

Up close and personal

We do capacity and neuropsychological assessments, come up with treatment plans, educate patients and their families about care and support, and do vocational assessments to see if people are capable of working. I’m also called in to courts fairly frequently to testify as to a person’s capacity—sometimes contemporaneously, and sometimes after death, in the case of a contested will.

Working with financial advisors

I’ll get in touch with a financial advisor at least every couple of weeks about one of my patients, typically just once at the assessment stage.

They can provide a wealth of information that is incredibly valuable to conducting a capacity assessment and deciding whether a power of attorney needs to be enacted. If a PoA is enacted, I often provide education to the attorney and advisor on how best to interact with that client and what the client is capable of. Capacity is a continuum: a client may not be able to make complex investment decisions, but can manage a limited “comfort fund” of a few hundred dollars that lets them take their grandchildren out for lunch.

Red flags

Advisors who have been in a long-term relationship with a client tend to notice changes: Has the client started repeating things? Do they forget details that they used to remember, like the decisions made at the last meeting? Has their risk tolerance changed dramatically? Do they not grasp concepts or directions they used to understand? Maybe there’s a new person—a new spouse or an adult child—coming to meetings and who seems to be having an undue amount of influence. Advisors can also confirm details like the amount of assets a client has and how they’re invested, which can help me assess a client’s memory and understanding of their portfolio. All these details are incredibly useful when I’m determining a person’s capacity to manage their financial and other affairs.

Proper permissions

If I need to consult with a client’s advisor, I’ll get permission and send over the signed consent form before I make the first call. That gives them time to confirm that I have access to the client’s financial information and prepare for the meeting. Typically, if an advisor has concerns about a client’s capacity, the advisor will—with permission—relay those concerns to the client’s family, who will contact me.

A capacity assessment can only be done if the need has been established, and a person has the right to refuse one. Patients also have the right to have someone else present during an assessment for support, and to undergo the assessment under circumstances in which they’re likely to demonstrate optimum capacity.

What to expect at a capacity assessment

A capacity assessment begins with a detailed clinical interview, with questions that determine how well a client understands issues relating to income, assets, debts, charitable donations or testamentary decisions.

If the clinician identifies cognitive issues—such as troubles with memory, focus, or problem solving—the assessment may also include some cognitive tests. Questions from the tests include: How are an orange and a banana the same and how are they different? Tap the table only when I say the letter A in this string of letters. You’re home alone and you smell smoke: What will you do?

There is no physical exam. An assessment usually takes between one and two hours, and can be broken into two appointments if fatigue is an issue. Clients should get a good night’s sleep the night before, and bring a list of their medications to the appointment.

“Just be yourself,” says Dr. Pachet. “It’s the clinician’s job to put the client at ease. A client should leave the appointment feeling included in the process and that they had their say.”