You've noticed something. Maybe your mom paid the same bill three times, or your dad wants to hand his savings to a stranger who called. You're not sure if this is just aging, a bad day, or a real change — and you don't want to strip away someone's independence over a hunch. That worry is exactly the right one to have.
Knowing whether an aging parent can still make decisions comes down to one distinction: are they making a choice you disagree with, or have they lost the ability to reason through a choice at all? Those are very different things, and the difference matters legally, medically, and for your relationship.
What "decision-making capacity" actually means
Capacity is not about being right. A person with full capacity has every right to make choices you think are foolish — to eat poorly, refuse a hearing aid, or stay in a house that's hard to maintain. Capacity is about the process of deciding, not the result.
Professionals generally look at four abilities. Can your parent understand the relevant information? Can they appreciate how it applies to their own situation? Can they reason — weigh options and consequences? And can they clearly communicate a choice? When one or more of these breaks down, capacity is in question.
Capacity is also decision-specific. Your mother might be perfectly able to decide what to eat and when to see friends, yet unable to grasp a complicated reverse mortgage. So the question is rarely "can she decide?" It's "can she decide this?"
Signs to watch for
No single moment tells you much. Anyone can misplace keys or repeat a story. What matters is a pattern that's new for your parent and getting worse over time. Look for these:
- Trouble with familiar money tasks — unpaid bills piling up, duplicate payments, or unusual withdrawals.
- Poor judgment that's out of character — falling for scams, giving money to people they just met, or unsafe choices they'd never have made before.
- Getting lost or confused in familiar places, or losing track of the day, season, or year.
- Difficulty following a conversation, finding words, or holding a plan in their head long enough to act on it.
- Not grasping consequences — signing something without understanding it, or dismissing real risks as no big deal.
- Withdrawing from decisions they used to handle, or becoming easily overwhelmed by choices.
An unusual choice vs. a loss of capacity
This is where families get stuck. It helps to separate the two clearly before you act.
A parent who says "I know the stairs are hard, but this is my home and I'm staying" has capacity. A parent who agrees to move, forgets by dinner, and can't say why they signed the lease may not. Same topic, very different situations.
How capacity is formally assessed
Family members don't get to declare a parent incapable — and shouldn't. When it matters legally or medically, a professional makes the determination. Here's how to get from concern to answer.
- 1Write down specific examples with dates — what happened, what your parent said, how it differed from their old self. Concrete notes are far more useful than 'she seems off.'
- 2Rule out reversible causes first. Ask the doctor to review medications, check for infection, dehydration, thyroid issues, and depression, which can all mimic decline.
- 3Request a capacity evaluation from their physician, or ask for a referral to a geriatrician, neurologist, or geriatric psychiatrist for a fuller cognitive assessment.
- 4For legal decisions (signing documents, managing money), an attorney or the court may require a doctor's written opinion on capacity for that specific act.
- 5If capacity is impaired and no power of attorney exists, ask an elder law attorney about guardianship or conservatorship — a last resort, but sometimes necessary.
Bring your written examples to the appointment. Ask the doctor directly: "Can my father still make his own medical decisions? His own financial ones? Is this likely to change?" Vague questions get vague answers.
What to put in place before capacity slips
The kindest thing you can do is plan while your parent clearly still can decide — because these documents can only be signed by someone with capacity. Waiting until there's a crisis often means the only option left is court guardianship, which is slow, costly, and takes control out of the family's hands.
- Durable power of attorney for finances — lets a trusted person manage money if your parent can't.
- Health care proxy or medical power of attorney — names who decides on medical care.
- A living will or advance directive — records your parent's wishes for serious illness.
- A current list of accounts, passwords, doctors, and medications, kept somewhere you can find it.
Frame it as your parent staying in control: "You choose who steps in and what happens, on your terms, while it's fully your call." That's an easier conversation than one that starts with "I'm worried you can't handle this."
How daily contact helps you notice sooner
Capacity rarely changes overnight — it drifts. If you only see your parent every few weeks, you miss the small shifts: the repeated question, the confusion about the date, the new story about a phone caller asking for gift cards. The families who catch changes early are usually the ones in frequent, low-pressure contact.
That's the gap a daily check-in can fill. Call Mabel is a warm phone companion that talks with a parent who lives alone every day, and shares gentle notes with the family — so if your mom Ruth starts sounding confused about her medications or mentions a suspicious caller, you hear about it early instead of at the next holiday. It's not a doctor and it doesn't assess capacity. But it keeps you close enough to notice, which is often what makes the difference between acting in time and finding out too late.
- ✓Judge the reasoning, not the outcome — a risky choice a parent can explain is still their right.
- ✓Look for a new, worsening pattern, not one-off slips.
- ✓Treat sudden confusion as urgent and get it checked; it's often reversible.
- ✓Let a doctor make the formal capacity call, and be specific with your concerns.
- ✓Set up power of attorney and health directives now, while your parent clearly still can.