3013 Universal Guardianship Roles in Case Management | PUBLIC-GUARDIANSHIP-5800-MANUAL
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Georgia Division of Aging Services |
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Chapter: |
3000 Case Management |
Effective Date: |
06/30/2023 |
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Section Title: |
Universal Guardianship Roles in Case Management |
Reviewed or Updated in: |
MT 2023-03 |
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Section Number: |
3013 |
Previous Update: |
MT 2022-01 |
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Purpose
This section provides practical examples of how PGO staff fulfill universal guardianship roles in case management.
Legal Basis and Requirements
The National Guardianship Association’s set of universal roles for guardians is congruent with Georgia law on the roles of a guardian. NGA’s universal roles are discussed fully at MAN 5800, Section 3012.
This policy section illustrates how PGO staff fulfills these roles in guardianship case management.
Surrogate Decision Maker
Surrogate decision-making is a major component of a guardian’s work.
A guardianship removes decision-making rights from an individual and gives those decision-making rights to the guardian.
For PGO purposes, the named guardian is the Georgia Department of Human Services, and as guardian’s representative, PGO staff are authorized to make decisions on behalf of guardianship clients.
The types of decisions the guardian is allowed to make will be enumerated in the final order from the court. Decisions the guardian may be authorized to make could cover issues such as where the client will live, services he or she will receive, the school he or she will attend, and medical treatment decisions.
Coordinator and Monitor of Services
In this role, the guardian is responsible for arranging and monitoring services required by a guardianship client. Services may include health care, vocational services, social services, and transportation.
An example of a coordinator and monitor of services is when the guardian has made a decision to sign a guardianship client into inpatient hospice services. The guardian will sign the paperwork for the client’s admission to hospice, coordinate the client moving in by arranging for transportation if needed and remain in contact with the hospice facility to monitor the care.
Guardians are not direct service providers; guardians are decision makers and coordinators of service and as such, are not obligated to provide direct services to a client.
Advocate
Advocacy involves the guardian ensuring services received by the client are the most appropriate, least restrictive that help maximize the independence of a guardianship client. The guardian may also advocate for the termination of the guardianship.
Practical Examples of the Duties of the Guardian
The examples below are a representation of tasks that may fall within the duties of the guardian. Again, the scope of the guardian’s duties is contained in the final order.
Each section also contains an example of a task that falls outside of the scope of the guardian’s responsibilities.
Medical/Psychiatric:
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The guardian may meet the client at medical appointments, treatment facilities, or other medical related appointments. The guardian may talk with physicians, nursing staff, and other health care professionals regarding the medical needs of the client.
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The guardian makes an appointment for the client’s annual physical and meets the client at the doctor’s office. The doctor recommends a mammogram and colonoscopy for the client. The guardian will talk with the client about the procedures and ask the physician why these tests are indicated. If the client does not want the procedures, and the doctor indicates there are no emergent indications that require a diagnosis, the guardian may approve or decline the procedures.
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When visiting the client in the nursing home, the guardian notices the client is not able to follow conversation as well as usually able and is having trouble keeping his eyes open. The guardian will talk with facility staff and review records to assess changes to medication, diet, etc. The guardian may ask for the facility physician to be called.
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The guardian is reviewing the client’s chart and reads nurses notes that say the client has been crying occasionally and staying in her room more often. The guardian may talk with the client and facility staff and ask for a referral to a psychiatrist or other mental health provider for the client.
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Not within scope: The client has a doctor’s appointment across town and asks the guardian to pick him up and drive him to the appointment. The guardian is not responsible for transporting the client in his or her own vehicle; the guardian arranges for transportation but does not provide direct services.
Housing:
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The hospital discharge planner calls to indicate the client is ready to be moved to a nursing home the hospital has located. The guardian speaks with the client and the hospital staff and reviews the chart. If the guardian agrees that nursing home level of care is indicated, the guardian may visit the nursing home before approving admission. The guardian signs the paperwork for admission to the facility. If the guardian decides a nursing home is not the proper placement for the client, the guardian may decline discharge from the hospital and search for a more appropriate placement.
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A personal care home provider calls to indicate the client is “behaving badly” and needs to be moved from the facility. The guardian investigates the incident(s), speaks with the client and care home staff, and advocates for the client to remain in the home. The guardian may work with the provider to determine events that may trigger the behaviors in question and discuss solutions. Referrals may be made to a Long-term Care Ombudsman, mental health provider, or physician if necessary, to address the issue.
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Not within scope: The client is moving from one personal care home to another and has furniture and personal belongings that need to be moved. The guardian is not responsible for moving belongings in his or her personal vehicle.
Educational:
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The client expresses an interest in fixing cars. The guardian may find a class at the local technical school and arrange for the client to attend.
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The guardian is assisting the client to create a plan for the termination of the guardianship, and the client would like to learn more about shopping for groceries. The guardian may arrange for the client to attend a class at the local grocery store.
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Not within scope: The client would like to attend a class at the local senior center but does not have enough money to attend. The guardian is not responsible for paying for the client’s needs out of his or her own money.
Vocational:
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A client wants to get a job at the local grocery store. Based on the abilities of the person, the guardian may assist the client in searching for desired employment, meeting the client at the job interview, and advocating for the client’s hiring. If the client does not have the capability to maintain employment in the community, the guardian may investigate vocational day programs for the client to attend and work in the supervised environment.
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Not within scope: The employer asks the guardian to bring the client to work every day to make sure the client is on time. The guardian does not transport clients.
Social:
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Upon reviewing a client file from the personal care home, a note was made regarding a visit from the nephew several years ago. The guardian may talk with the client to assess if the client wishes to reconnect with this, or other, family members.
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The guardian is concerned that the client is spending a great deal of time alone in her room and becoming withdrawn. The guardian may ask the activities coordinator to find a volunteer to visit with the client on a regular basis, and to accompany her to activities in the nursing home if so desired.
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Not within scope: The sister and brother of the client do not get along and ask the guardian to monitor the visits of the other sibling. The guardian is not responsible for monitoring visits.
Recreational:
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During a visit to the client in the group home, the client shows off his room and small collection of books. The client enjoys reading but hasn’t read any new books in quite some time. The guardian may talk with the client about going to the local library and getting a library card. The guardian can arrange to meet the client at the library to help select books.
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Many group homes attend Special Olympic events with their residents. The guardian may advocate for his client to attend an event and sign any permission paperwork necessary.
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Not within scope: The group home provider requires the guardian to accompany the client on a bus outing as the provider is concerned about managing the number of residents on the trip. The guardian is not required to accompany the client, nor should the provider place limitations on the client’s participation.
Other Tasks:
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A new client in the nursing home has very little clothing for the coming winter months. The guardian may receive money from the client’s facility account and buy the needed clothing.
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The client needs some furniture for her home. The guardian may meet with the client in the community to go shopping and arrange for furniture delivery.
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The guardian believes the client has regained capacity, and the client wishes the guardianship to be terminated. The guardian completes paperwork to initiate this process through his or her supervisor.