| Course | NU 627 Geriatric Healthcare |
|---|---|
| Unit | Unit 8 |
| Paper type | Capacity and advance care planning document |
| Length | About 1,040 words, 6 pages |
| Format | APA 7 student paper |
| School | Herzing University |
| Program | MSN Family Nurse Practitioner |
| Updated | October 2026 |
Free sample paper for NU 627 Unit 8
Decision-Specific Capacity and Advance Care Planning for a 78-Year-Old Man With Mild Dementia Who Wants to Return Home
Student Name
Department of Nursing, Herzing University
NU 627: Geriatric Healthcare
Instructor Name
April 3, 2026
Decision-Specific Capacity and Advance Care Planning for a 78-Year-Old Man With Mild Dementia Who Wants to Return Home
The Decision at Issue and Why Capacity Was Questioned
Mr. Q., a composite 78-year-old retired postal supervisor in Illinois, has mild Alzheimer disease diagnosed a year ago (Montreal Cognitive Assessment 21 of 30). He is in a short-term rehabilitation unit after a hospital admission for pneumonia. The rehabilitation team recommends that he move to assisted living, because he lives alone, missed doses of his medications before admission, and was found by a neighbor two days after becoming unwell. He wants to return to his own house. His daughter supports the team's recommendation. Capacity was questioned because his choice goes against professional advice and because he has a dementia diagnosis. Neither reason, by itself, establishes incapacity: a person with capacity may make a choice others consider unwise, and many people with dementia retain capacity for specific decisions, particularly in the mild stage (Appelbaum, 2007).
Assessment of the Four Abilities
The assessment addressed one decision only: whether to return home with supports or move to assisted living. It was conducted in the morning, when staff report he is most alert, with his hearing aids in, in a quiet room, and over two sessions a day apart, because capacity can fluctuate.
Understanding. Asked to explain in his own words what the team had told him, he said: "They think I'll forget my pills again and get sick with nobody around, and in assisted living someone would check on me." He described both options and what each would involve. Understanding was present.
Appreciation. Asked whether he thought the concerns applied to him, he said: "I know I missed pills. My memory isn't what it was. That's why I'd want the pill machine and somebody coming in." He acknowledged the risk as his own rather than denying it. Appreciation was present.
Reasoning. Asked to compare the options, he said he would lose "my garden, my dog, and my neighbors" in assisted living, and that he would accept a daily visit, an automated pill dispenser, and a medical alert pendant to reduce the risk. When asked what he would do if these did not work, he said, "Then I'd have to think about moving. I'm not stupid about it." He weighed the options against his values and considered consequences. Reasoning was present, although he underestimated the likelihood of another missed illness.
Communicating a choice. He stated the same choice on both days and explained it consistently. This element was present.
Retention was checked separately: at the second session he recalled the main points of the first discussion without prompting, apart from the name of the automated dispenser.
Conclusion
Mr. Q. has capacity to decide to return home with supports, at this time. The conclusion is decision specific. It would change if his cognition declined, if his delirium from the pneumonia returned, or if he no longer recognized the risk as applying to him. The team's disagreement with his choice is recorded, and the plan now focuses on making his choice as safe as possible: an automated pill dispenser, a daily home care aide visit, a medical alert pendant, weekly check-in calls from his daughter, and a home safety evaluation. A review is scheduled for 30 days after discharge.
If a Future Decision Arrives When He Cannot Make It
Capacity is expected to decline as his dementia progresses, so planning now matters. Under Illinois law, if a patient lacks decision-making capacity and has no health care agent under a power of attorney and no applicable living will, the Health Care Surrogate Act sets a priority order for surrogates: a guardian of the person, then the spouse or civil union partner, then any adult child, then a parent, then an adult sibling, then an adult grandchild, then a close friend, and finally a guardian of the estate (Health Care Surrogate Act, 1991). Mr. Q. is widowed and has one adult daughter, who would be his surrogate under this order. A surrogate is required to make decisions using substituted judgment, that is, what the patient would have wanted, based on his known values, and only uses his best interests when his wishes cannot be determined.
Advance Planning Instruments in Force and Recommended
Currently in force: none. He had no power of attorney for health care, no living will, and no Physician Orders for Life-Sustaining Treatment form. While he has capacity, three instruments were discussed. An Illinois statutory short form power of attorney for health care would allow him to choose his agent, which he wants to be his daughter, with his nephew as successor, and to state his values in his own words; it has force only while he lacks capacity, and it is broader than the surrogate hierarchy because it covers decisions the statute leaves to his agent's judgment. A living will would state his preferences about life-sustaining treatment if he had a terminal condition, but it is narrower and applies only in those circumstances. A POLST form translates current preferences into medical orders and is appropriate for a person with serious illness; it was discussed but not completed, because he said he wanted to think about resuscitation. These instruments authorize different things and are not interchangeable. Advance care planning is a process of understanding and sharing values, goals, and preferences over time rather than completing a single form (Sudore et al., 2017).
He completed the power of attorney for health care during the second session, with two witnesses who met the statutory requirements. Copies are in his chart, with his daughter, and in his home.
Gaps
The existing documents do not cover three situations. First, a decision about moving to a care facility in the future if he loses capacity: the power of attorney gives his daughter authority over health care decisions, but placement decisions may involve additional legal questions, and a financial power of attorney was recommended so his daughter can manage his affairs if needed. Second, resuscitation preferences remain undocumented. Third, his daughter has not yet been told what he would want if he could no longer recognize her, which he said he is not ready to discuss; that conversation has been flagged for the next visit.
References
Appelbaum, P. S. (2007). Assessment of patients' competence to consent to treatment. New England Journal of Medicine, 357(18), 1834-1840. https://doi.org/10.1056/NEJMcp074045
Health Care Surrogate Act, 755 Ill. Comp. Stat. 40 (1991).
Sudore, R. L., Lum, H. D., You, J. J., Hanson, L. C., Meier, D. E., Pantilat, S. Z., Matlock, D. D., Rietjens, J. A. C., Korfage, I. J., Ritchie, C. S., Kutner, J. S., Teno, J. M., Thomas, J., McMahan, R. D., & Heyland, D. K. (2017). Defining advance care planning for adults: A consensus definition from a multidisciplinary Delphi panel. Journal of Pain and Symptom Management, 53(5), 821-832. https://doi.org/10.1016/j.jpainsymman.2016.12.331
NU 627 Unit 8 instructions, in plain terms
The final NU 627 assignment asks you to assess decision-making capacity for a specific decision and to address advance care planning for an older adult, often with cognitive impairment. Expect to name the decision, explain why capacity was questioned and assess the recognized abilities, usually understanding, appreciation, reasoning and expressing a choice, with evidence from the conversation. The conclusion should be decision specific and time limited. Advance planning should cover who would decide if the patient cannot, under the law of the patient's state, and which documents are in place or recommended. Gaps in the documents are a common requirement. Cite a capacity framework, advance care planning research and the relevant state law in APA 7, and treat the patient as a teaching composite.
How this NU 627 Unit 8 example is built
The document opens with the decision at issue: return home with supports or move to assisted living. It explains that staff questioned his capacity after a fall and a short delirium. The assessment section addresses one decision only and records how each ability was tested, with his responses, for example explaining his own risks and the supports he would accept. The conclusion states that he has capacity for this decision now and lists conditions, such as new delirium, that would require reassessment. Planning then explains who would decide under state surrogate law if he lost capacity. The instruments section records that none were in force and recommends a power of attorney for health care and a portable medical order. The gaps section names situations, such as a future facility move, that the documents do not fully cover.
Reading the NU 627 Unit 8 rubric
Herzing rubrics for this document usually reward definition of the decision, assessment of capacity, the conclusion, legal and advance planning content, identification of gaps and writing. Decision points require a specific choice, not a general judgment about competence. Assessment is often the heaviest criterion; markers look for each ability tested with evidence from the patient's responses. Conclusion points go to a decision-specific, time-limited finding with reassessment triggers. Planning points depend on correct use of the patient's state law and accurate descriptions of documents. Gap analysis earns credit when it names real situations the documents miss. Writing points cover professional tone, clear structure and APA citations, including the statute in legal citation style where used.
NU 627 Unit 8 help: mistakes that cost points
Capacity documents commonly lose points by treating a dementia diagnosis or a low cognitive score as proof that the patient lacks capacity. Students also assess capacity in general instead of for one decision. Evidence for each ability is often missing, so the conclusion looks like an opinion. Another frequent gap is a conclusion with no time limit or reassessment trigger. Advance planning sections sometimes describe documents incorrectly or ignore state law on surrogates. Recommending documents without explaining what each one does weakens the plan. Finally, gaps in planning are often left out, though they show the most careful thinking about what may happen as the illness progresses.
Get a NU 627 Unit 8 example written to your instructions
Send the Unit 8 instructions and the rubric from your NU 627 classroom, plus the patient case and the decision at issue. We write a custom example that assesses capacity for that decision specifically and separates it from the advance planning, returned in 24 to 48 hours. The first custom sample is free.
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NU 627 Unit 8 questions, answered
Why is capacity decision-specific?
Because the ability required differs by decision. A patient may be unable to manage complex financial arrangements and entirely able to decide whether to accept a particular treatment, and a global judgment removes rights they still hold. Assess for the decision in front of you, at the time it is being made, and say what would need reassessing later.
Does a dementia diagnosis settle it?
No, and treating it as though it does is a substantive error. Capacity fluctuates with time of day, illness, medication and the complexity of the question, and many people with cognitive impairment retain it for decisions they care about. The diagnosis is a reason to assess carefully, not a conclusion, and faculty grading this unit look for that distinction.
How do the advance planning documents differ?
By what they authorize and who acts on them. A statement of values guides interpretation; a directive expresses instructions; a healthcare proxy appoints a decision maker; a portable medical order is an actionable order clinicians follow immediately. Naming them precisely matters because families and clinicians routinely assume a document does something it does not.
Where can I find a free NU 627 Unit 8 sample paper?
This page offers the complete NU 627 Unit 8 document free, with the four abilities assessed, the decision-specific conclusion, state surrogate law, the documents recommended and the gaps. If your patient or state differs, send the case and a custom document is prepared at no charge, normally within 48 hours.
Does a dementia diagnosis mean a patient lacks capacity?
No. Capacity is decision specific and is judged by whether the person can understand the information, appreciate how it applies to them, reason about options and express a choice. Many people with mild dementia can still make some decisions.