PRACTICAL Tool

ABA Practical Tool

The American Bar Association, along with the National Resource Center for Supported Decision-Making, has developed a new ‘PRACTICAL’ tool to help lawyers identify and consider decision-making options for persons with disabilities that are less restrictive than guardianship.  Something to encourage of course.

‘PRACTICAL’ is an acronym for the nine steps for lawyers to identify these options. The lawyer can use the PRACTICAL checklist of steps during the client interview and immediately after to assist in case analysis.


9 Steps in PRACTICAL Tool

#1 – Presume – presume guardianship not needed

Consider less restrictive options like:

  • power of attorney
  • Representation agreement
  • advance directive,
  • trust, or
  • supported decision-making

Review Adult Guardianship Act for requirements about considering such options


# 2. Reasons – review the reasons for concern

Money management?

  • Managing accounts, assets, and benefits
  • Recognizing exploitation

Health care?

  • Making decisions about medical treatment
  • Taking meds, hygiene, diet
  • Avoiding high risk behaviour

Relationships?

  • Appropriate behaviours
  • Safe decisions about sexual relationships

Living Space?

  • Maintain habitable conditions
  • Living independently, accessing resources

Personal Decision Making

  • understand legal documents, legal consequences of behaviour
  • Communicate wishes

Employment

  • Looking for, gaining and retaining employment

Personal Safety

  • Avoids common dangers
  • Recognize and avoid abuse
  • Know what to do in an emergency

#3 – Ask – if a triggering concern may be caused by any temporary or reversible conditions:

Medical Conditions – Infections, dehydration, delirium, poor dental care, malnutrition, pain

Sensory deficits – hearing or vision loss

Medication – side effects

Psychological conditions – stress, grief, depression, disorientation

Also consider:

Stereotypes – ageism? Ableism?

Cultural Barriers – Ensure cultural competency so cultural variations and language differences are not barriers

Look for steps to reverse the condition or postpone the decision until the condition improves


#4 – Community – find out about any family or other resources that will help, and making accommodations

Community support programs

  • Home care, meals, adult day care
  • Care management, counseling, mediation
  • Professional money management

Informal support from Family/Friends

  • Medical and money management support
  • Communication assistance
  • ID’ing potential abuse

Accommodations

  • Assistive technology
  • Home modifications

Residential Setting:

  • Supported housing or group home
  • Senior residential building
  • Assisted living or residential care facility

Ask “what would it take?” to enable the person to make the needed decision(s) or address the presenting concern.


#5 – Team – ask if older adult has already developed a team to help make decisions:

Does the person have friends, family members, or professionals available to help?

Has the person already appointed a surrogate to help make decisions?:

  • Attorney under EPOA
  • Representative under Rep Agreement
  • Pension Trustee
  • Veterans Pension Administrator

#6 -Identify – areas of strength and limitations in decision-making (if no team)

Can the person:

  • Make decisions and explain his/her reasoning?
  • Maintain consistent decisions and primary values over time?
  • Understand the consequences of decisions?

#7 – Challenges – Screen for and address any potential challenges presented by identified supports/supporters

Possible Challenges to identified supports

  • Eligibility, cost, timing or location
  • Risk to public benefits

Possible concerns about supporters?

  • Risk of undue influence
  • Risk of abuse, neglect, exploitation (have supporter report suspected abuse to designated agency?)
  • Lack of understanding of person’s medical/mental health needs
  • Lack of stability, or cognitive limitations of supporters
  • Disputes with family members (is issue family dynamics and/or sibling rivalry)

#8 – Appoint – consider appointments that might meet needs:

  • Attorney under an Enduring Power of Attorney
  • Representative under s9 Representation Agreement
  • Trustee under Trust
  • Pension Trustee (Income Security Programmes Canada)
  • Veterans Pension administrator (Veterans Affairs)
  • Supporters under s. 7 Representation Agreement

#9 Limits – to powers of any necessary substitute decision maker or guardianship order

Limit committeeship to what is absolutely necessary, such as:

  • Only specific property/financial decisions
  • Only property/finances
  • Only specific personal/health care decisions
  • Only personal/health care decisions

State how committee will engage and involve person in decision-making

Develop proposed person-centered plan

Reassess periodically for modification or restoration of rights


Downloads

While this is an American tool, it has a lot of useful information.

PRACTICAL Tool

Download the Tool in either fillable PDF or Word:

PRACTICAL Tool and Resource Guide

Download the full publication with four-page Tool and 22-page Resource Guide.