ALTERNATIVES TO GUARDIANSHIP RESOURCE GUIDE Outlined here are options for addressing the specific needs of or areas of concern regarding a patient who may be experiencing diminished capacity, followed by more comprehensive information about each option. Alone or together, these options can be used to help obviate the need for guardianship or be used to limit, modify, or terminate a guardianship. Alternatives can be put in place at any time and can be faster, less expensive, and more patient-centered than guardianship. You are likely familiar with most of these options. Be intentional about considering them as part of the IDEAL Approach. If these options cannot address a specific need, the patient may only need a limited rather than a full guardianship. If guardianship is necessary, consider using the Guardianship Referral Worksheet in Appendix C to
help your facility's lawyer. Need/Area of Concern Personal decision-making ☐ Making decisions ☐ Communicating decisions ☐ Carrying out decisions (with or without assistance) Medical treatment and discharge planning ☐ Informed consent for medical treatment (including end-of-life care) Mental health/psychiatric treatment ☐ Consent to treatment (including medication management) ☐ Admission to mental health facility ☐ Psychiatric bed Managing assets or benefits ☐ Access to financial and other records ☐ Applying for benefits ☐ Spend down options (for benefit eligibility) ☐ Paying bills or managing income ☐ Following a treatment plan ☐ Safe discharge or transfer
Options (examples) • Ensuring supports and accommodations • Supported decision-making
• Advance directive for health care • Surrogate decision-making
• Medical Order for Life-Sustaining Treatment (MOLST) • Withholding or withdrawal of medically ineffective treatment • Home & Community Based Services and informal options • Advance directive for mental health services • Voluntary admission to a mental health facility • Involuntary admission a mental health facility • Behavioral Health Administration (BHA) resources • Financial power of attorney • Authorized representative for medical assistance • Representative Payees and U.S. Department of Veterans Affairs (VA) Fiduciaries • Achieving Better Life Experience (ABLE) accounts • Trusts including special needs trusts • Banking services • Specific transaction (Transaction authorized by court without appointing guardian)
• Mediation • Long-Term Care (LTC) Ombudsman • Reporting abuse, neglect, or exploitation
Other issues/concerns ☐ Patient/family conflict ☐ Abuse, neglect, or exploitation
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