Legal Guardianship of an Adult: Rights and Responsibilities

In health care settings, the body gets medical attention, but the mind and soul matter, too. Older adults in medical care face a battery of health questions, but too often the most consequential one goes unasked and unanswered: What does a good day look like for you today?Medicare requires people to receive a spiritual assessment within their first five days of admission into hospice. Many states allow a nurse to conduct the initial spiritual assessment, but I think it helps both the person and the health care provider for the assessment to be done with someone who has theological training. Many have been certified in clinical pastoral education, or CPE. Nurses can get so focused on the technical to-do lists of medical work  the measurements, the tests, the drug regimens that it can be hard to make time for the issues that matter most to the living human, namely, their happiness, peace and contentment.  As a spiritual care provider with 17 years in senior care facilities, and as a chaplain in the Army National Guard and Air Force National Guard, I have counseled hundreds of people in the final days of their lives.  For older adults and their families, one of the most valuable resources is also little-known a Medicare option that provides spiritual counseling for people in hospice. Longing for ConversationToo often older adults in care are being talked at, not listened to. Many times, I've found that people in the last chapter of life want to discuss their path to the end more than their medical professionals and, especially, more than their loved ones.  It often helps to have that discussion with a professional who is trained to hear them, and, if requested, to comfort and advise them.  RecommendedOpinion: Why I Went on Hospice Even Though I'm Not Dying | Personal PerspectivesThe code of ethics for the leading chaplain and spiritual care associations all prohibit proselytizing. A spiritual care provider should be able to work with someone on their own terms, no matter their beliefs. The United States may be turning more secular, but the fact remains that older adults are the most faith-affiliated of any demographic age group.This initial spiritual meeting is likely to be about the basics: Is the person religious? What is their support system? Will a certain faith-based ritual bring meaning or comfort? Do they have a preferred faith leader? Or is a secular discussion a better fit for the person's beliefs? 

Guardianship of an elderly parent is a complex and often emotionally challenging process that requires careful consideration and understanding. This comprehensive overview delves into the intricacies of guardianship, its necessity, and the responsibilities it entails.Understanding GuardianshipGuardianship is a legal arrangement that becomes necessary when an elderly parent is no longer capable of making sound decisions about their health, finances, or daily care. It's considered a last resort option, requiring a court hearing and confirmation of incapacity by medical providers. When guardianship is granted, an individual - either a family member or a professional - is appointed by the court to make medical decisions and manage the daily care of the elderly parent.  The decision to pursue guardianship often comes with mixed emotions. While it may be the right choice for ensuring the parent's well-being, it can feel uncomfortable, especially if there's disagreement among family members. It's crucial to understand that guardianship provides absolute decision-making authority, allowing the guardian to make medical decisions and manage care in the best interest of the elderly parent. When is Guardianship Necessary?Guardianship becomes necessary in several situations. It's commonly appointed for elderly parents diagnosed with cognitive impairments such as dementia or Alzheimer's disease. Brain injuries or other serious health conditions that result in cognitive impairment may also necessitate guardianship. In some cases, elderly parents may reach a stage where their health concerns are overwhelming, making it difficult for them to make good decisions about their care.  The process of obtaining guardianship requires substantial documentation. A guardianship petition must be submitted to the court, accompanied by evidence that substantiates the degree of cognitive impairment and demonstrates poor decision-making. This typically includes a medical assessment, which may involve a neuropsychological evaluation.Contested Guardianship HearingsIt's important to note that not all guardianship proceedings are straightforward. Contested guardianship hearings can occur when there's disagreement about the need for guardianship or about who should be appointed as the guardian. These disagreements can arise between the elderly parent and their children, among adult children, or with other family members.  Contested hearings can be costly, with opposing family members bearing their own legal expenses. The elderly parent for whom guardianship is pending also incurs legal expenses. In some cases, particularly where family conflict is prevalent, appointing a professional guardian rather than a family member may be the better choice.Benefits of Guardianship and ConservatorshipWhile guardianship focuses on health and daily living decisions, conservatorship deals with managing money and property. Often, when a guardian is appointed, a conservator is also named. In family situations, one person can serve as both guardian and conservator. However, when professionals are appointed, these roles must be separate to ensure oversight and a system of checks and balances.  The primary benefit of having a conservator is the assurance that funds are managed in the best interest of the elderly parent. This arrangement can provide protection for both the guardian and the elderly parent. It's crucial to understand that the goal of guardianship and conservatorship is to ensure funds are spent for the benefit of the elderly parent, not to conserve an inheritance for adult children.The Responsibilities of a GuardianBeing a guardian carries significant legal responsibilities that are often underestimated or misunderstood, even by healthcare professionals. Guardians are required to make good decisions, not just easy ones. This often involves advocating for the elderly parent in various healthcare settings.  Guardians must be prepared to disagree with medical professionals when necessary. This requires confidence in advocacy skills and a willingness to engage in potentially uncomfortable conflicts. Guardians should be prepared to explain their legal responsibilities to healthcare providers who may not fully understand the implications of guardianship.  The guardian's role extends beyond medical decision-making. It includes managing daily care, whether at home or in a care community, communicating with medical professionals about care needs, and advocating with service providers. As the number of individuals involved in the elderly parent's care increases, so does the complexity of the guardian's responsibilities.Decision-Making in GuardianshipGuardians have total decision-making power, but this doesn't mean they can act arbitrarily. There are standards of decision-making that must be followed. One important concept is "substituted judgment," where the guardian makes decisions as if they were the elderly parent deciding for themselves.  To make informed decisions, it's crucial for guardians to have discussions with the elderly parent about their wishes for future care. These conversations should ideally take place before cognitive decline sets in and should be documented. If it's too late for such discussions, guardians may need to consult other family members or friends who knew the elderly parent well.State Differences in Guardianship LawsIt's important to note that guardianship laws and terminology can vary from state to state. In some states, the term "conservator" may encompass both medical and financial responsibilities. The availability of professional guardians and conservators also differs by state, with some having more advanced systems than others.The Growing Need for GuardianshipAs the population ages, the need for guardianship is likely to increase. Many individuals over the age of 85 have undiagnosed dementia, and elderly parents living alone are at particular risk if family support is not available. The rise in chronic diseases such as heart disease, diabetes, and cancer also contributes to the growing need for guardianship.The Importance of Caregiving SupportFor those serving as guardians, caregiving support is invaluable. The role of a guardian is often unexpected and can be overwhelming. As the elderly parent's needs increase, the responsibilities become more time-consuming and complex.  Caregiving support can offer solutions to common problems, provide access to expert advice, and help relieve the stress, anxiety, and frustration that often accompany caregiving responsibilities. It's crucial for guardians to seek out resources and support to help them navigate their important role effectively.Guardianship of an elderly parent is a significant responsibility that requires careful consideration, thorough understanding, and ongoing commitment. While it can be challenging, with the right support and resources, guardians can ensure their elderly parents receive the care and protection they need in their later years.

Guardianship is a serious legal process that serves as a last resort for caring for an elderly parent who can no longer make sound decisions for themselves. It requires a court hearing and confirmation of incapacity by medical providers.What is Guardianship?Guardianship means an individual is appointed by the court to make medical decisions and manage daily care for an elderly parent. This typically occurs when an elderly parent:Is diagnosed with cognitive impairments like dementia or Alzheimer's diseaseHas suffered brain injuriesExperiences serious health conditions that impair decision-making abilitiesKey Considerations in GuardianshipEmotional ChallengesDeciding to pursue guardianship often involves mixed emotions. Adult children may feel uncomfortable, especially if family members disagree about the necessity of guardianship.Legal RequirementsTo establish guardianship, documentation must be submitted to the court that:Substantiates the degree of cognitive impairmentProvides evidence of poor decision-makingIncludes a medical assessment, potentially a neuropsychological evaluationTypes of GuardianshipGuardian ResponsibilitiesMake medical decisionsManage daily careAdvocate for the elderly parent's best interestsFollow the principle of substituted judgment (making decisions the parent would make)ConservatorshipIn most situations, a conservator is also appointed to manage money and property. This can be the same person as the guardian or a separate individual.Challenges of GuardianshipAdvocacy and Medical InteractionsGuardians must:Navigate complex healthcare systemsCommunicate with medical professionalsUnderstand and research medical conditionsMake thorough, prudent decisionsFamily DynamicsGuardianship can create:Potential conflicts between family membersDisagreements about care and spendingEmotional stress that may damage relationshipsState-Specific ConsiderationsGuardianship laws and terminology vary by state. Some states have:Different definitions of guardianshipVarying availability of professional guardiansUnique legal frameworks for elder careImportance of PreparationRecommended StepsHave early discussions about care preferencesDocument the elderly parent's wishesUnderstand the full scope of guardianship responsibilitiesSeek support and resources for caregiversAs the population ages and chronic diseases become more prevalent, understanding guardianship becomes increasingly important for families caring for elderly parents.