As Your Parent Ages: Cognitive Decline and Determining Competency

We do not like to think about it. However, the time may come when adult children face the prospect of having to consider the level of competency of their aging parents. Through this article, we provide frank and essential information about cognitive decline and the competency of aging individuals.

What Is Competency?

Competency is a legal, formal term that is used to describe a person’s ability (or inability) to function independently. Cornell Law School defines competency as:

Competence is the capacity or minimal ability to do something; the mental and physical ability to carry out a given task. A few examples are: competence to stand trial, competence to be executed, competence to hold public office, and competence to practice law. While context determines the specific inquiry, the foundational requirement, common to all measures of competence, is a basic awareness of one’s identity, condition, surroundings, and the identity of others. 

Minimum Requirements of Competency

Each state has its own laws regarding competency. With that said, there is a trio of considerations that can be used to ascertain if a parent or other individual with cognitive issues remains competent. A competent individual is able to:

  • Obtain and apply necessary information
  • Reason in accordance with a set of beliefs and values
  • Communicate the basis of a decision effectively to other individuals

Professional Assistance if Competency of a Parent Is a Concern

If there are real concerns about the competency of an aging parent, a pair of professionals should be contacted:

  • Primary care physician
  • Legal counsel

Ideally, your parent has been in regular contact with a primary care physician or another appropriate healthcare provider. If you believe that your parent’s cognitive abilities are degrading, if you believe your parent may be afflicted by dementia, including Alzheimer’s, an appointment needs to be made with his or her primary care physician. Odds are that your parent’s doctor will make a referral to a specialist that works with patients who have cognitive issues like dementia. 

Depending on what is learned from the medical process, the need may exist to establish what legally is known as a guardianship and conservatorship. (The ins and outs of a guardianship and conservatorship will be discussed in greater detail later in this article.) Because additional legal protections may be needed for your parent who may not be competent, the second professional you should consult with is an attorney with a background in establishing guardianships and conservatorships.

What Is a Guardianship and Conservatorship?

A guardianship and conservatorship is created by order of the court (as is discussed in a moment). Through a guardianship and conservatorship, a trustworthy person is appointed by the court to serve as a guardian and conservator for your parent. A guardian and conservator is charged with taking care of matters associated with a person’s day to day life as well as his or her financial matters. The adult child of an aging adult with cognitive issues that have resulted in concerns about competency can seek to be appointed the guardian and conservator.

Signs of cognitive decline and the onset of a condition like Alzheimer’s or another type of dementia include:

  • Memory loss, generally noticed by the near and dear ones
  • Difficulty in communication, especially finding the right words to communicate
  • Reduced ability to organize, plan, reason, or solve problems
  • Difficulty handling complex tasks
  • Confusion and disorientation
  • Difficulty with coordination and motor functions
  • Loss of or reduced visual perception
  • Metallic taste in mouth, decreased sense of smell
  • Agnosia – unable to identify objects or persons
  • Changes in personality and behavior
  • Depression
  • Anxiety
  • Hallucinations
  • Mood swings
  • Agitation
  • Apathy – lack of interest or emotions

Establishing a Guardianship and Conservatorship

Establishing a guardianship and conservatorship for your parent (or anyone else) is a rather complicated legal matter. It involves the court and experts to ensure that a person’s rights are protected and that a guardianship and conservatorship is established only when legally necessary.

The process of establishing a guardianship and conservatorship begins with filing a petition or application with the court in the county where the person evidently in need of this type of protection is located. A lawyer can assist in the preparation of the necessary paperwork.

Once filed with the court, an initial hearing is scheduled. At this initial hearing, preliminary information is presented to the court. The judge presiding at the hearing will designate a medical professional to evaluate the competency of your parent. (Information provided by your parent’s doctor can be presented to the court. However, it is possible if not likely that the court will appoint an independent healthcare provider to evaluate the competency of your mother or father.)

A final hearing follows. It is at the final hearing that evidence regarding the need for a guardianship and conservatorship will be presented to the court. In addition, if there are people who object to the establishment of a guardianship and conservatorship, these individuals will also be heard at the hearing. (There may be another family member who does not think a guardianship and conservatorship is necessary.)

Other Resources for a Parent With Cognitive Issues

Assisted living can be an ideal community for an aging parent. However, when cognitive issues become so profound that a guardian and conservator is needed for an aging mother or father, assisted living likely is no longer going to be an option.

With that said, there are residential memory centers that provide home and board as well as other specialized services for an older person with cognitive issues like dementia. In addition, there are in-home care options that are also available to older individuals who have cognitive issues. Bear in mind that in most instances a person with the level of cognitive issues like dementia will require 24-hour in-home care and assistance to ensure the safety and wellness of that individual. 

As an adult child, witnessing a parent’s cognitive abilities decline can be a very challenging experience. Taking the steps outlined in this article can put your parent and yourself in the best possible position to protect and enhance the safety and wellbeing of your mother or father.