If an older person lived in an environment that was at odds with what most other people thought was acceptable…would that mean they lacked capacity with lifestyle or accommodation decisions?
Is it our place to question how and where that older person chooses to live?
Even if our intentions are good…that we just want to protect that older person?
Some curly questions….
Let’s break it down and take a look at decision making regarding lifestyle.
Making poor decisions is not the same as having impaired capacity. 
For example (and this scenario is one that I have seen a few times) an old man lives in his caravan on a remote property.
He has lived here for the past 40 years.
He lives by himself.
There is no electricity to power the caravan and he gathers his water from the tap outside and boils it up on his camp stove, if he wants hot water to bathe.
He comes to the attention of the local hospital when he drives himself to the Emergency Department after accidently hammering his thumb while fixing his fence.
The attending clinicians become nervous about discharging this gentleman home when they become aware of his living environment.
Our man becomes really annoyed that such a fuss is being made about his personal life, as he has been living this way for a long time.
The attending clinicians become more concerned now because the old man isn’t ‘compliant’ and accepting their point of view on his alternative lifestyle.
They start to question his ‘capacity’.
Does this gent have impaired decision making capacity?
Luckily for this gentleman, a doctor with an interest in geriatric medicine sits with him and asks him questions about his accommodation, teasing out answers that will demonstrate his awareness of the possible consequences related to his decisions.
Our poor old guy tells this empathetic doctor that he has lived this way for most of his adult life, that he doesn’t like to be around people, that he has arranged with neighbour on the next property to deliver his groceries once a week (when the neighbour goes into town to do their own shopping) and that if he should come to grief on his property, that he would rather die peacefully under the stars than die in a hospital with tubes sticking out of him.
The attending clinicians are still nervous because they have a ‘duty of care’ and are worried that if they release this gentleman and something happens that they will be held liable.
Someone suggests doing Mini Mental State Examination (MMSE) to see if this gent has capacity.
Our doctor explains that a MMSE is a screening tool and not diagnostic tool to establish capacity.
Our doctor strikes a deal with the old man to have a community nurse come out and visit once a week and he is 
released from the Emergency Department to drive himself home.
Our old gent was not released home because he accepted the community nurse coming to visit once a week, he was able to demonstrate his understanding of his choice and any possible consequences of living a life they way he chose.
He demonstrated that his capacity was intact with regard to this lifestyle decision.
Key points.
A person has capacity to make a decision about a matter if they are able to
• understand the nature and effect of the decision,
• freely and voluntarily make that decision and
• communicate the decision in some way.
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