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by Joanne Eason, MA

There are more than 1.3 million guardianship or conservatorship cases active at any one time in the US.[i] That makes it likely that, as a case manager, you may be working with several people in this demographic. Guardianship is a legal process that is started when a person can no longer make or communicate sound decisions about themselves and/or their property.

Every person has a voice and deserves to be heard, especially those who are vulnerable due to age, health status or intellectual or developmental disabilities.

Advance care planning can directly make facilitating these discussions easier for Guardians and enable them to:

  • Be prepared ahead of time, before the crisis
  • Have an understanding of the person’s hopes and fears around illness and dying
  • Use specific beliefs to guide decision-making
  • Prevent multiple unwanted hospitalizations
  • Prevent unwanted or unnecessary procedures
  • Assess their understanding of any existing illnesses and fill the gaps in understanding where possible
  • Provide decisions that are consistent with what the person would have wanted
  • Give vital information to medical providers
  • Implement palliative and hospice care early
  • Improve quality of life
  • Allow the person to die with dignity
  • Create documentation of decision-making rationale

The earlier that advance care planning is introduced, the more helpful it will be. The following considerations can help you work with guardians to make the most of the opportunity to engage in a considerate and thoughtful way. Below are some tips to assist people in your care who also are in a conservatorship:

  • If the guardianship order covers healthcare decision-making, the guardian is already the decision maker and the individual will not need to name additional healthcare agents. Additionally, in most states, if the individual had named a health care agent prior to having a guardian appointed, the health care agent’s authority would supersede the guardian’s unless the court determines otherwise.
      • Advocate for the person subject to and determine who else they might want involved in the decision-making process—like a child or a pastor—to help ensure that they are as involved as possible in their own healthcare:
      • Explain the details of the guardian’s role. Specifically, that their primary role is to advocate for the person’s wishes and preferences, as well as communicate those wishes to medical providers, family, & friends (National Guardian Association Standards 7 & 14).
  • Explore family issues and past experiences with loved ones at the end of their lives, or other considerations that might help make decisions on their behalf.
  • Encourage the individual subject to guardianship to participate to the fullest extent of their ability.
  • Help to determine the individual’s understanding of the content and level of capacity to ensure they are participating to the full extent of their ability.
  • Explore any experiences the individual has had that might influence their end-of-life treatment choices: experiences with family or friends at the end of life, previous medical experiences, or stories they have heard.
  • Explore the meaning of any ambiguous or loaded language used by the person subject to guardianship (such as, “heroics,” “machines,” “natural,” etc.).
  • Review all the medical interventions listed on page 6 of Five Wishes and ensure that the individual subject to guardianship understands these to the best of their ability.

No matter what healthcare universe your patients live in – acute, post-acute or ambulatory – having advance care plans in place is more than helpful. If you find that more assistance is needed for the person in your care or the guardian whom is assigned, Five Wishes, a leading ACP program, has a Guardian package to assist in conversations and details regarding ACP and conservatorships.

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[i] https://www.usnews.com/news/health-news/articles/2021-10-18/how-13-million-americans-became-controlled-by-conservatorships#:~:text=About%201.3%20million%20guardianship%20or,the%20National%20Council%20on%20Disability.

Bio: Joanne Eason, MA, President of Five Wishes

With more than 25 years of communications experience – centered primarily in the health and insurance industries – Joanne provides strategic counsel on how best to implement advance care planning throughout healthcare and business organizations. She has led national crisis communication programs, rebranding programs for several health organizations, and counseled executives on effective and difficult communications.

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Interested in learning more about Advanced Planning? Check out our CE Course "Respecting Choices: A Guide to Advanced Care Planning" at https://www.pathlms.com/cmsa/courses/40415

This presentation will help the attendees to develop a toolkit for advanced care planning with patients and their families. Free to members!