The Capacity Assessment Report Under the ADM Act: What You Have to Record

The Act names you, and most people have not noticed

The Act came into effect on 26 April 2023. On the same day the Minister made S.I. No. 204/2023, which sets out who counts as a prescribed class of healthcare professional for the purposes of sections 4A, 31(b) and 79(2)(a).

Regulation 3 lists five, and the wording for your profession is "occupational therapists, being persons whose names are for the time being entered in the register of members of the profession of occupational therapist established and maintained under section 36 of the Act of 2005". So the qualification is your CORU registration and nothing else. There is one disqualification worth knowing: an immediate family member of the person being assessed is out, and the instrument defines that term broadly, running from spouse and child through to nephew and niece.

This matters commercially as well as professionally. Capacity work has been a medical preserve in Irish practice for a long time. It is not one any more.

One thing the published guidance does not agree on

The Decision Support Service Code of Practice for Healthcare Professionals says the prescribed group is six classes, and it names psychologists among them. The regulation lists five and does not mention psychologists anywhere. Both were read on 5 September 2026.

We are not going to tell you which is right. The Code itself says that where the Code and the legislation conflict, the Act prevails. If you are a psychologist reading this, or an OT working alongside one, put the question to the Decision Support Service before anyone signs anything. It takes one email and it is a much cheaper way to find out.

Two different jobs share one name

Most capacity assessment in clinical practice is not a formal capacity statement. Someone asks whether a patient can consent to a discharge plan, or whether an older adult can decide to keep living alone. That work is governed by the Act, but the Act is silent on who does it. As the Code of Practice on Supporting Decision-Making and Assessing Capacity puts it: "With limited exceptions set out below, the Act does not state who should undertake a capacity assessment. It only states how the assessment should be undertaken."

The limited exceptions are the decision support arrangements. When a co-decision-making agreement or an enduring power of attorney needs a capacity statement, the assessor has to be a registered medical practitioner or one of the prescribed classes. That is where your name in the regulation does actual work.

The recording standard is the same either way. Do not treat a ward-round capacity question as a lower grade of documentation than a formal statement. If it is challenged later, the record is the whole of your defence.

What the record has to contain

This is the part almost nobody has read, and it is written down. Section 7.5 of the Code of Practice on Supporting Decision-Making and Assessing Capacity sets out what an assessor documents.

• 7.5.1: the outcome of the assessment.
• 7.5.1: the decision that was assessed, and the information that was relevant to that decision.
• 7.5.1: the steps taken in preparing for and conducting the assessment.
• 7.5.1: where the person refused to take part, a detailed record of the interactions.
• 7.5.2: an explanation for the decision reached on capacity.
• 7.5.2: the outcome and the reason for the findings.
• 7.5.2: where capacity is found to be lacking, detailed and specific examples of each instance where the person did not meet one or more of the elements.
• 7.5.2: whether the person is likely to regain capacity.

The examples requirement is the one that catches people

A report that says "Mrs D was unable to weigh the risks of returning home" states a conclusion and calls it a finding. The Code asks for the instance. What was put to her, in what words, and what did she say back. If she could repeat the risk of a fall at the top of the assessment and not five minutes later, that is your retention evidence and it belongs on the page in that form.

Write the examples limb by limb, in the order the Act sets them out, and attach each one to the specific decision you named earlier in the report. A capacity report with no verbatim material in it is a report with no evidence in it.

Prognosis is a required field, not a courtesy. "Whether the person is likely to regain capacity" sits in the Code’s list alongside the outcome and the reasons. It is easy to leave out because it feels like speculation, and it is the line that determines whether the family is looking at a short bridge or a decision-making representation order. If delirium, an acute infection, a medication effect or a recent bereavement is in the picture, say so and say what you would expect. If you genuinely cannot form a view, write that you cannot and why.

The functional test, limb by limb

Section 3 of the Act sets the test. A person lacks capacity if unable "(a) to understand the information relevant to the decision, (b) to retain that information long enough to make a voluntary choice, (c) to use or weigh that information as part of the process of making the decision, or (d) to communicate his or her decision".

Understanding is assessed after your explanation, not before it. The Act says a person is not to be regarded as unable to understand "if he or she is able to understand an explanation of it given to him or her in a way that is appropriate to his or her circumstances". So your explanation is part of the assessment and belongs in the record: how you pitched it, what you simplified, what you used.

Short retention is still retention. The Act is explicit that being able to hold the information "for a short period only" does not prevent a finding of capacity. The question is whether it was held long enough to make a voluntary choice, not whether it was held afterwards.

Capacity is assessed at a moment, about a matter. Lacking capacity at one time does not prevent capacity at another, and lacking it on one matter does not prevent it on others. The Decision Support Service templates put it plainly: "The functional approach is time specific and issue specific; this means that it is an assessment of an adult’s ability to make a specific decision at a specific time." That is why a general finding is not a finding at all.

The supports you have to record before you can conclude anything

The Code is blunt about the order of operations: "A relevant person must not be considered unable to make a decision unless all practical steps have been taken to help them to make the decision."

You are the profession that already does this. Time of day, positioning, hearing aids in and working, fatigue after therapy, communication aids, a familiar room, a support person present. The Decision Support Service sample recording templates give whole sections to it, asking whether a support person attended and stayed, and whether communication tools, supports or assistive technologies were needed.

Those templates are worth opening even if you never use one. Their section order is a usable report skeleton: the person’s details, the decisions being assessed one by one, the information you gave them and the rights you explained, the supports required, consent, then the four limbs each with its own answer and reasoning, then a summary of findings.

Write it decision by decision, not person by person

This is the structural change that separates a strong Irish capacity report from a weak one.

A weak report is organised around the person. It describes her diagnosis, her history, her presentation, and then reaches one verdict about her. A strong report is organised around the decisions. Each decision gets its own heading, its own statement of what information was relevant to it, its own four-limb analysis, and its own conclusion. The Decision Support Service templates are built this way, with numbered slots for each decision being assessed. It reads longer. It is the only version that matches what the Act actually asks.

It also produces the right answer more often. Someone can have capacity to decide where she lives and not to decide how her savings are invested. A person-shaped report cannot say that. A decision-shaped one says it without effort.

Your CORU obligations sit on top of all of this

Section 18 of the CORU Code of Professional Conduct and Ethics for Occupational Therapists asks for records that are clear, accurate, up to date, complete, legible, identifiable as made by you "using your registered name and registration number", dated and timed, and completed as soon as practicable after the assessment. Section 9 asks you to work within the limits of your knowledge, skills, competence and experience, and to refer on where a case is beyond them.

A capacity assessment involving a decision you do not understand well enough to explain is one to refer, not one to attempt.

Where Carearoo fits

Carearoo drafts Irish clinical reports from your own assessment notes, in the structure the Irish rules ask for, including an Assisted Decision-Making capacity input. You review every line, edit it in your own words, and sign it. Your first report is free and each one after that is €59, no subscription, on Carearoo for Ireland.

Whatever you use to produce the document, the judgement in it stays yours, and so does the signature. If you are billing the visit privately, the Irish OT invoice guide covers what goes on the invoice.

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