Lasting power of attorney capacity assessment (mental capacity assessment for a lasting power of attorney)
An assessment to check whether a person can understand and make the decision to set up a lasting power of attorney.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- An LPA must be made while the person still has the mental capacity to make it — you cannot set one up after capacity is lost, so it is best not left too late.
- The assessment follows the mental capacity law where the person lives — the Mental Capacity Act 2005 in England and Wales, and separate laws in Scotland and Northern Ireland — but the core principles are the same: capacity is assumed, decision-specific, and an unwise choice is still allowed.
- It checks whether the person can understand, remember, weigh up and communicate this particular decision — not whether others think it sensible.
- Capacity can fluctuate; the assessor will try to choose the person's best time and give every practical support to help them decide.
- The 'lasting power of attorney' is the England and Wales document; Scotland uses continuing and welfare powers of attorney, and Northern Ireland currently uses an enduring power of attorney that only covers property and money — so check which one applies where the person lives.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your psychiatrist will give you advice for your situation.
Confirms whether the person can validly make the LPA now, protecting them and the document from later challenge.
It cannot create an LPA for someone who has already lost the capacity to make it — that route is then closed and the Court of Protection applies instead.
The assessor usually shares their view in person, explains the reasoning, and answers questions from the person and, where appropriate, the family.
A clear, reasoned written report that follows the relevant mental capacity law.
The assessor usually shares their view in person, explains the reasoning, and answers questions from the person...
A written report is provided. If the assessor is also the certificate provider, they sign the relevant part of the...
The LPA can be signed and witnessed, then sent to the Office of the Public Guardian to be registered before it can...
A further assessment may be arranged at a better time, or with more preparation and support to help the person...
What is a lasting power of attorney capacity assessment?
A lasting power of attorney (LPA) is a legal document that lets you choose people you trust to make decisions for you if, in future, you cannot make them yourself. There are two kinds: one for health and welfare, and one for property and financial affairs. This kind of LPA is used in England and Wales; Scotland and Northern Ireland have their own, differently named documents, described further below.
The law is clear that you must have mental capacity — the ability to understand and make this particular decision — at the time you make the LPA. An LPA cannot be set up once someone has already lost that capacity. A capacity assessment is a structured check, by a suitable professional, of whether the person can make this decision now.
The assessment follows the mental capacity law for the part of the UK where the person lives. In England and Wales this is the Mental Capacity Act 2005 and its Code of Practice; in Scotland it is the Adults with Incapacity (Scotland) Act 2000; and in Northern Ireland it is the Mental Capacity Act (Northern Ireland) 2016, which is only partly in force, so the exact rules there can depend on the decision and the setting. Wherever you live, the same core principles apply first: a person is assumed to have capacity unless shown otherwise, they must be given all practical help to decide, and an unwise decision does not mean a lack of capacity. Capacity is also decision-specific and can change with time, so the assessment is about this decision, at this moment.
The assessment does not decide whether making an LPA is a good idea, and it does not give anyone control over the person. It simply records whether, on the day, they can understand, retain, weigh and communicate the decision.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Options at a glance
These are the main approaches described in this guide. The right option depends on the diagnosis, your goals and what your clinician thinks is safe.
Capacity to make a property and financial affairs LPA
Checks understanding of who will manage money and property, what powers they would have, and that the document can be cancelled while capacity remains.
Capacity to make a health and welfare LPA
Checks understanding of who would make care and treatment decisions if the person could no longer do so, including, if chosen, decisions about life-sustaining treatment.
Certificate provider role
A doctor or other professional can act as the 'certificate provider', confirming the person understands the LPA and is not under pressure. This is a formal part of the LPA...
Standalone capacity report
A written assessment of capacity to make the LPA, sometimes requested where there is doubt, a family disagreement, or a likely future challenge.
Preparing for your test
- Be clear which LPA is being considered — health and welfare, property and financial affairs, or both — as the questions differ.
- Choose a time of day when the person is usually at their most alert and least tired.
- Make sure glasses and hearing aids are available, and arrange an interpreter or communication support if needed.
- Bring a list of medicines and any relevant medical history, as illness or medication can affect capacity on the day.
- Have the draft LPA or a clear explanation of who the chosen attorneys are and what powers are intended.
- Where helpful, prepare information in simple, written form so the person can take time to understand it.
What happens
The assessor meets the person, ideally somewhere familiar and quiet, and explains the purpose. They will give the information about the LPA in plain language and in whatever form helps the person understand, then explore whether the person can do four things for this decision: understand the relevant information, retain it long enough to use it, weigh it up, and communicate their choice.
They will ask, in their own words, what the LPA is for, who they would want to act for them, what those people could decide, and that the document can be cancelled while they still have capacity. The conversation is two-way and supportive, not a test to be passed or failed; the assessor's job is to give every reasonable help to enable a decision.
The person may be seen alone for part of the assessment to check the decision is genuinely their own and free of pressure. Afterwards, the assessor records whether capacity for this decision is present and usually provides a written report, and may act as certificate provider if appropriate.
Is this test right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- It cannot create an LPA for someone who has already lost the capacity to make it — that route is then closed and the Court of Protection applies instead.
- It is not a general 'fitness' test; capacity is specific to this decision and cannot be assumed from a diagnosis alone.
- It is the wrong tool where the real issue is acute illness, such as delirium, which should be treated and the assessment repeated when the person is well.
- It should not be used to override a person's own valid, if unwise, choices.
Delay or rearrange if…
- The person is acutely unwell, confused or recovering from delirium, when capacity may be temporarily affected.
- Tiredness, pain, infection or a recently changed medicine is clouding their thinking — choose a better time.
- Communication support, an interpreter, glasses or hearing aids are not yet in place.
- There are signs of pressure or coercion that need addressing before any valid decision can be made.
Alternatives to discuss
- Doing nothing for now if capacity is clearly intact and there is no urgency, but planning ahead while it remains.
- Reassessing at the person's best time of day, with more preparation and support.
- A Court of Protection deputyship application if capacity to make an LPA has been lost.
- Advance statements or, for treatment refusals, an advance decision, as part of wider planning.
- Independent legal advice where the situation is complex or contested.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Benefits
- Confirms whether the person can validly make the LPA now, protecting them and the document from later challenge.
- Makes sure the decision is the person's own and free from pressure.
- Encourages planning while capacity remains, which can prevent the need for a court application later.
- Provides a clear written record that follows the law, useful if anyone questions the LPA in future.
- Respects the person's right to make their own choices, including ones others might think unwise.
Risks & complications
- The conversation can feel sensitive or upsetting, as it touches on losing independence and on death and serious illness.
- The assessment is a snapshot; capacity can change, so a later decision may need a fresh check.
- An assessment may need rescheduling if the person is unwell, tired or distracted on the day.
- A finding that the person does not have capacity to make this LPA, which can be distressing and may close off that route.
- Family disagreement about the outcome, particularly where money or care is involved.
- The report being used in a dispute, so what is written must be accurate and balanced.
- A capacity finding being formally challenged, sometimes ending up before the Court of Protection.
- A flawed or rushed assessment leaving an LPA open to being set aside later.
The biggest pitfall is assessing capacity badly — not giving the person enough support to understand, mistaking an unwise but capacitous choice for incapacity, or rushing the assessment when the person is unwell. The other is timing: if capacity is already lost, an LPA cannot be made and families may face a Court of Protection deputyship instead. Ask the assessor how they will support the person to decide, and what happens if capacity is borderline or fluctuating.
Published figures to discuss
This is a legal–clinical assessment rather than a procedure, so adverse-event rates do not apply. The meaningful uncertainties are about judgement: whether enough support was given, whether the person's choice was genuinely their own, and how a fluctuating presentation is handled. We therefore give no numerical rates.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Capacity treated as global | Legal error | The question is whether the person can make the specific LPA decision at that time. | Guide sourcesClinical context |
| Undue influence or coercion missed | Important safeguarding risk | Private discussion and attention to pressure, fear, dependence or financial abuse are essential. | GOV.UK — Make, register or end a lasting power of attorneygov.ukSource-linked context |
| Insufficient documentation | Common dispute risk | The assessment should record the information given, understanding, retention, weighing and communication. | GOV.UK — Make, register or end a lasting power of attorneygov.ukSource-linked context |
| Assessment delayed until capacity is lost | Avoidable | LPA planning is best done early while the person can still decide and express wishes. | Guide sourcesClinical context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
There is no physical recovery. What follows is the written opinion on capacity and, if capacity is present, the steps to complete and register the LPA.
- Feeling tired or emotional after a conversation about losing independence.
- Needing time to reflect before deciding whether to proceed.
- Wanting to read the report and discuss it with family or a solicitor.
- Accepting that a fresh assessment may be needed for future decisions.
Aftercare
- Read the written report and keep it safely with the LPA paperwork.
- If capacity is confirmed, complete signing and witnessing correctly and register the LPA with the Office of the Public Guardian.
- Tell the chosen attorneys what has been decided and where the documents are kept.
- Consider taking independent legal advice if the situation is complex or contested.
- If capacity was borderline, agree a plan for reassessment at a better time.
- If capacity was absent, discuss alternatives such as a Court of Protection deputyship.
- Remember the LPA can be cancelled or changed while the person still has capacity.
- The written capacity report kept with the LPA documents
- Clarity on whether the assessor will act as certificate provider
- A plan for signing, witnessing and registering the LPA
- Contact details for any independent legal advice needed
- An agreed plan if a further assessment is required
- A clear note of what alternatives exist if capacity is not present
⚠ Get urgent help if…
- Anyone pressuring the person into making an LPA or naming particular attorneys — this should stop the process.
- Signs the person does not understand what they are signing or who their attorneys are.
- A sudden change in the person's confusion or alertness, which may mean an illness such as delirium needs assessing first.
- An assessor willing to certify capacity without properly meeting and supporting the person.
- Disagreement or coercion within the family around money or care decisions.
- Any suggestion of financial abuse or exploitation, which should be raised urgently.
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your psychiatrist gives you.
Results & realistic expectations
A clear result is a reasoned opinion on whether the person can, today, make this specific LPA, with the evidence behind it. If capacity is present, the LPA can be completed and registered; if it is borderline, a reassessment with more support may help; if it is absent, the assessor should explain why and what the alternatives are.
A capacity assessment cannot guarantee that an LPA will never be challenged, and it does not judge whether the choices are wise — only whether the person can validly make them. It is specific to this decision and this point in time.
A capacity assessment is a snapshot. Capacity can improve, worsen or fluctuate, so a finding for one decision today does not settle capacity for other decisions or for the future. A registered LPA, once validly made, remains valid even if the person later loses capacity — which is exactly its purpose — but it can be changed or cancelled only while capacity remains.
Related tests, treatments or support
Capacity to make an LPA is sometimes assessed alongside capacity for other specific decisions, such as making a will (testamentary capacity), deciding where to live, or consenting to particular treatment. Each decision is judged separately under the same legal test.
Follow-up & long-term care
If capacity is confirmed, follow-up is practical: completing, witnessing and registering the LPA with the Office of the Public Guardian. If a further assessment was needed, it should be arranged at a time the person is at their best. Where capacity is absent, the family may be signposted towards a Court of Protection application.
- Review and update an LPA while capacity remains if circumstances or wishes change.
- Keep the registered LPA and capacity report somewhere safe and known to the attorneys.
- Arrange a fresh assessment for any new, significant decision rather than assuming earlier findings still apply.
- Be alert to changes in health that might affect capacity and prompt reassessment.
Repeat, follow-on and what comes next
- Capacity findings can change, so a fresh assessment is often needed for a new or later decision.
- A borderline or fluctuating presentation may need reassessment at a better time rather than a single yes/no.
- A disputed finding may be tested formally, including before the Court of Protection.
- An LPA can itself be changed or revoked while the person retains capacity.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- A clear, reasoned written report that follows the relevant mental capacity law.
- A plain explanation to the person and family of the outcome and next steps.
- Support to complete and register a valid LPA where capacity is present.
- A clear plan for reassessment if capacity was borderline, or for alternatives if it was absent.
- Signposting to independent legal advice where the situation is complex or contested.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- The professional doing the assessment and their seniority and expertise.
- Whether it is a home visit or a clinic appointment, and travel involved.
- How complex the situation is — for example borderline capacity or a likely dispute.
- Whether a written report and certificate provider role are included.
- Whether more than one decision is being assessed at the same time.
- Whether a repeat assessment is needed at a better time.
- The assessor's fee and what the appointment includes.
- Whether a written report is provided and when.
- Whether the assessor will also act as certificate provider.
- The cost of a home visit if needed.
- What happens, and what it costs, if a second assessment is required.
- What happens if the finding is that capacity is not present.
On the NHS? Capacity is assessed within NHS care when it concerns that care, but a standalone capacity assessment specifically to set up an LPA is usually arranged and paid for privately.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Treating a dementia diagnosis as automatic proof of incapacity, contrary to the Act.
- Failing to give the person practical support to understand and decide.
- Mistaking an unwise but capacitous decision for a lack of capacity.
- Not seeing the person alone, so coercion or undue influence is missed.
- Rushing the assessment when illness or medication is temporarily affecting capacity.
Marketing red flags
- Anyone offering to 'certify' an LPA without properly meeting and assessing the person.
- A guarantee that an LPA, or a capacity finding, can never be challenged.
- Pressure to complete an LPA quickly without time to understand it.
- An assessor who will not see the person privately or check for coercion.
Choosing a specialist safely
- Check the psychiatrist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the psychiatrist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good psychiatrist will welcome every one of these.
- Which LPA is this assessment for, and what exactly will you be checking?
- How will you support the person to understand and make the decision?
- What happens if their capacity is borderline or changes from day to day?
- Will you also act as the certificate provider, or is that separate?
- What are the alternatives if capacity is not present?
- How do you make sure the decision is the person's own and free from pressure?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the psychiatrist who carries out my test, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this test not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Can someone with dementia still make a lasting power of attorney?
What happens if the person no longer has capacity?
Who can assess capacity for an LPA?
Does an unwise decision mean someone lacks capacity?
Is the assessment done at home?
Is this available on the NHS?
Is this the same across the UK?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: GOV.UK — Make, register or end a lasting power of attorney Office of the Public Guardian — about us Mental Capacity Act 2005 — legislation.gov.uk SCIE — Mental Capacity Act resource NHS — Mental Capacity Act Alzheimer's Society — Lasting power of attorney Scottish Government — Adults with Incapacity (Scotland) Act: section 47 certificate Department of Health (NI) — Mental Capacity Act (Northern Ireland) 2016 Scottish Government — Code of practice for continuing and welfare attorneys nidirect — Managing your affairs and enduring power of attorney (Northern Ireland)
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
Related guides: Dementia diagnosis · Confusion and delirium assessment · Capacity and medico-legal psychiatric reports · Alzheimer's disease assessment and treatment · Best-interests and care-planning assessment