3012 Universal Guardianship Roles

Georgia State Seal

Georgia Division of Aging Services
Public Guardianship for Adults Manual

Chapter:

3000 Case Management

Effective Date:

03/01/2022

Section Title:

Universal Guardianship Roles

Reviewed or Updated in:

MT 2022-01

Section Number:

3012

Previous Update:

MT 2019-02

Summary Statement

The Division of Aging Services recognizes Universal Guardianship Roles as described by the National Guardianship Association.

Basic Considerations

Universal Guardianship Roles include:

  • Advocate

  • Surrogate Decision-Maker

  • Coordinator and Monitor of Services

The guardianship must ensure that services, actions, and decisions are person centered.

Advocate

Advocacy through informed consent:

  • Decision the guardian makes on behalf of the person under guardianship shall be based on the principle of informed consent

  • Informed consent is a person’s agreement to a particular course of action based on a full disclosure of facts needed to make the decision intelligently

  • Informed consent is based on complete information regarding:

    • Adequate information on the issue;

    • Voluntary action

    • Lack of coercion

Surrogate Decision-Maker

Impairments in decisional capacity require decision-making supports or surrogate decision-making. Decisional capacity is the ability to:

  • Demonstrate understanding of the situation and facts

  • Demonstrate appreciation of the consequences of his or her decision

  • Provide the reasoning in his or her thought process, and

  • Communicate his or her wishes

If the person has been determined to lack decisional making capacity in a specific area, the guardian must act as the surrogate decision maker. Guardian, as surrogate decision-maker, whenever possible, shall practice substituted judgment, making decisions based on what the person under guardianship would do had decisional capacity not been impaired.

Substituted Judgment:

  • Preserves autonomy, values and beliefs

  • Asks, “What would the person under guardianship have done if making the decision for him- or herself”

  • May be based on advanced directives

  • Looks at what prior decisions were made

  • Includes the input of person under guardianship

  • Is based on knowledge of the person under guardianship

  • Is preferred if case manager can discover wishes

Guidelines for decision making:

  • Determine the current wishes and desires of the person under guardianship, if ascertainable.

  • Consider the expressed wishes and desires of the person under guardianship prior to incapacity, if ascertainable.

  • Consider the evidence of how the person under guardianship would have decided the question.

  • Diligently seek the opinions of the person’s spouse, partner, significant other, parents, children and next of kin.

  • Evaluate the burdens and benefits of continued treatment.

  • Obtain the opinion of a second physician, if needed.

  • Obtain the opinions of the nursing personnel and other staff who are currently or who have recently provided direct service to the person under guardianship.

  • Seek the opinions from medical or long-term care facility ethics committees or review boards if available.

  • Consider if there is any financial consequence to those who express an opinion about what the person under guardianship would or would not have wanted.

  • Develop a continuing plan of care for the person under guardianship with or without treatment.

In instances where the person under guardianship lacks decisional capacity and information regarding the person’s wishes, preferences and desires is minimal, the guardian must make decision in the best interest of the person.

Coordinator and Monitor of Services

The guardianship case manager has the affirmative responsibility for the person’s support, care, comfort, health, education, maintenance, and professional services. This means the guardian has an affirmative responsibility to investigate every service received and to determine:

  • The purpose of the service

  • The qualifications of the staff providing the service

  • How the staff providing the service treat people receiving the service

  • How the service or program is implemented

  • How a participant who exhibits inappropriate behavior is treated

  • What goals are set for the participants, related to the service provided

  • What other, related services are needed to participate, such as transportation or special assistance

  • What criteria will be used to evaluate the participant’s performance and who will set the criteria

  • How long the service will last

  • Whether there is any other provider for this service

  • How restrictive is the environment in which this service is provided

  • What is the next step after successful completion of this service

Guidelines for Behavior Programs

The following should be considered:

  • Is the target behavior clearly identified? Has a baseline been set?

  • What has been done to address and change behavior? What is the behavior intervention process? Who does it? Have they been trained to do it consistently and properly?

  • What is the expected outcome?

  • What are possible alternative outcomes?

  • How and who will collect necessary data on program implementation?

  • How and who will track how well the behavioral program is implemented?

  • How will the program be monitored?

  • When will the program be re-evaluated (date)?

  • What are successful outcome criteria?

References

2000, 2002, 2007, 2017 National Guardianship Association: Standards of Practice