AG 8: Guardian of the Person
The guardian of the person:
- honors the wishes of the individual to the greatest extent possible;
- makes informed decisions on behalf of the individual;
- promotes improved quality of life and continued development of capabilities; and
- monitors the quality and appropriateness of direct services as needed.
NA The organization acts as guardian of the estate only.
The individual participates in personal decision-making to the greatest extent possible given his or her assessed capacity for decision-making and subject to state law and court order.
The organization has established procedures for ethical decision-making that include the consideration of:
- available options;
- how each option can support the achievement of desired outcomes;
- risks and benefits of each option;
- the expressed wishes of the individual as appropriate and subject to state law or court order;
- input from involved parties as appropriate; and
- the court order outlining their decision-making authority.
Update: Added First Research Note - 06/01/10
Added First Research Note
Ethical decision-making procedures must be consistent with state law and the court order. The guardian should determine the individualís wishes by considering how the individual has made similar decisions in the past, verbal and non-verbal indicators
of preference, or written documentation of the individualís expressed wishes, such as advance directives that were developed prior to the individualís loss of decision-making capacity. Involved parties can include close friends and family
, doctors, internal ethics
committees, the court, attorneys, or religious leaders.
Research Note: The National Guardianship Association has developed two resources that provide additional guidance concerning guardianship ethics: the NGA Standards of Practice, and A Model Code of Ethics for Guardians. For more information about accessing these resources, please see the AG Reference List.
Research Note: Advance directives are documents which enable the individual to make decisions about the care he or she wishes to receive during periods when the individual may be unable to make his or her wishes known. Advance directives fall into two major categories: (1) instructive directives, commonly known as a living will, and (2) proxy directives, more commonly known as durable power of attorney, including financial and medical powers of attorney. Instructive directives allow the individual to make advance decisions regarding the specific therapies or interventions to be used should he or she become incapacitated. A proxy directive allows the individual to identify a surrogate decision-maker, who will take responsibility for his or her medical or psychiatric care in the event he or she becomes incapacitated.
In some states, parents of children with disabilities are encouraged to develop written documents or plans that outline steps to meet their son or daughterís personal or financial needs should the parent no longer be able to care for him or her. It may be appropriate for organizations to consider the contents of such plans when making decisions on the individualís behalf.
To ensure compliance with previously established advance directives, guardianship workers:
- provide copies to relevant medical and/or psychiatric service providers; and
- store copies in a safe and accessible location.
Research Note: Studies have shown that a major cause of non-compliance with advanced directives is a lack of awareness among service providers that a directive exists.
Improved quality of life and increased capacity are promoted by:
- encouraging relationships and a sense of connectedness;
- identifying services and supports that will promote continued growth and improved capacity;
- helping the individual to develop a sense of value or purpose; and
- regularly re-assessing the individualís capacity and pursuing termination of guardianship or a change to the court order as appropriate.
The guardianship worker works with, or on behalf of, the individual to:
- arrange for needed or requested services as identified in the guardianship plan;
- monitor the quality and appropriateness of services; and
- facilitate the initiation or termination of services as appropriate.
The guardian tailors the type and frequency of service monitoring
according to the requirements of the court order, the needs of the individual, frequency and intensity of the services being provided, and frequency of contact with informal caregivers
and cooperating providers.
The guardianship worker monitors the quality and appropriateness of services by:
- directly communicating with current service providers;
- attending case conferences as appropriate;
- observing the effectiveness of services through regular contact with the individual; and
- participating in direct-service planning teams with outside providers.
The organization maintains a comprehensive, up-to-date list of community programs
and services, and information on how to access them.
Each Individual has an emergency response plan that includes, as appropriate:
- developing food or emergency kits;
- awareness of evacuation procedures at residential facilities where the individual resides;
- conducting emergency drills as needed;
- inclusion in local or state-wide emergency plans or evacuations; and
- search and rescue procedures for individuals with a history of wandering.