When capacity to consent is uncertain for a resident with cognitive impairment, which approach should the facility take?

• A. Proceed with decisions without resident or surrogate decision-makers.
• B. Involve surrogate decision-makers, use best-interest standards, and document decisions while seeking to maximize resident involvement.
• C. Delay decisions until capacity is clear.
• D. Deny access to information.

Answer: (B)

When capacity to consent is uncertain, the approach should balance protection with respect for the resident’s autonomy by engaging those who know the resident best, applying appropriate standards, and keeping clear records. Involve surrogate decision-makers—such as family or legally authorized representatives—to help interpret the resident’s values and wishes. Use best-interest standards to guide decisions when there’s no clear directive or known preferences, always aiming to choose actions that promote the resident’s well-being and align with what the resident would want if that can be determined. At the same time, seek to maximize the resident’s involvement in decisions to the extent possible, providing information in understandable terms and honoring any known preferences. Thorough documentation is essential to justify decisions, show how capacity was assessed, who was involved, what information was shared, and how the best-interest conclusion was reached, ensuring accountability and continuity of care.

Choosing this path is appropriate because it safeguards residents’ rights to participate in decisions while offering protection when decision-making capacity is uncertain. Alternatives like acting without decision-makers ignore autonomy and protections; delaying decisions until capacity is crystal clear can harm the resident and ownership of care; denying information undermines informed consent and the resident’s right to be involved.