Capacity Assessment

My dad (61) is currently in an Ontario hospital after breaking his femur and having surgery. I'm becoming increasingly concerned that he isn't safe to return home, and I'm wondering what options exist if the hospital team doesn't feel he's capable of making safe decisions.

Some background:

• Type 2 diabetes for ~27 years.
• Severe chronic pain and has spent most of the last 7–8 years in bed.
• Before the fall, he was only out of bed for about 1–2 hours a day.
• Very poor hygiene. His doctor even commented on how dirty his skin was and appeared concerned that he wasn't bathing properly.
• He wears the same clothes for days, the house has become unsanitary, and he struggles with basic self-care.
• He doesn't really cook and survives on very simple foods or online grocery orders.
• Recently I found that he had gone through multiple insulin pens in just a few days, suggesting he may not be managing his insulin safely.
• He has had severe hypoglycemia before, and we believe his recent fall may have been related to low blood sugar.

The hospital staff have told me he isn't participating well with walking or rehabilitation, and I'm worried he'll insist on going home even if he isn't able to care for himself.

My aunt, uncle, and I are wondering whether he needs a formal capacity assessment. We're less concerned about whether he understands where he is, and more about whether he truly understands the consequences of returning home and whether he can appreciate the risks of living independently.

Has anyone in Ontario been through something similar?

• Who decides whether a formal capacity assessment is done?
• Should we ask for the attending physician, social worker, or another specialist?
• What evidence is most helpful for the healthcare team when they're deciding if someone is safe to return home versus needing long-term care or another placement?

We're trying to do what's safest for him while also respecting his rights. Any advice or experiences would be greatly appreciated.