To refer an elderly client for counseling paid by her insurer, which consents are required?

• A. The supervisor's approval
• B. The daughter's consent
• C. The client's assent
• D. The daughter's consent and the client's assent

Answer: (D)

The situation hinges on respecting the elder client’s autonomy while recognizing that some individuals may have impaired decisional capacity. In social work, you obtain the client’s assent to participate in counseling, which means they understand, agree to, and can withdraw from the service at any time. If there’s any doubt about the client’s ability to consent, a surrogate decision-maker—often a family member such as a daughter—can authorize care on the client’s behalf. In practice, you would obtain the client’s assent to engage in counseling and, if needed, the daughter’s consent to authorize the service and the related care arrangements. This dual approach protects the client’s preferences and ensures they receive appropriate services when capacity is uncertain.