Appendix B Public Guardianship Office Ethical Principles and Standards

The Division of Aging Services (DAS) Public Guardianship Office (PGO) serves as guardian representative for the Department of Human Services. The Ethical Principles and Standards below the are based on the National Guardianship Association’s Ethical Principles and Standards of Practice and have been modified to more specifically address PGO policies and practices. The principles and standards have been developed to communicate the office’s values and expectations as well as provide a framework that can be used as a reference for decision making processes and case management responsibilities. The nine principles and corroborative standards encourages ethical conduct, business honesty, integrity, and best practices. (While the standards easily lend support to certain principles, they are not limited in application to a single principle.)

Autonomy

Principle: The guardian representative respects and supports the right of the person under guardianship to make their own decisions whenever and wherever possible.

  • The guardian representative maximizes the self-reliance and independence of the person.

  • The guardian representative shall provide the person with every opportunity to exercise those individual rights that the person might be capable of exercising as they relate to the personal care and financial needs of the person.

  • The guardian representative shall wherever possible, seek to ensure that the person leads the planning process; and at a minimum participates in the process.

  • The guardian representative shall involve the person to the greatest extent possible in all decision making.

  • The guardian representative shall seek to obtain informed consent where possible and only depends on surrogate decision making when necessary.

  • The guardian representative shall encourage the person to develop or regain his or her own capacity to the maximum extent possible.

  • Only when the person, even with assistance, cannot express his or her goals and preferences, shall the guardian representative seek input from others familiar with the person to determine what the individual would have wanted.

  • The guardian representative shall determine whether the person executed any advance directives and shall inform the court and other interested parties of the existing health care and fiduciary documents such as powers of attorney, mental health power of attorney, living wills, organ donation status, advance directives, Portable Medical Orders/Physician Orders for Life-Sustaining Treatment (POLST).

Nonmaleficence

Principle: The guardian representative acts in the best interest of the person under guardianship at all times.

  • The guardian representative shall weigh the risks and benefits and develop a balance between maximizing the independence and self‐determination of the person and maintaining the person’s dignity, protection, and safety.

  • Only when the person’s goals and preferences cannot be ascertained may the guardian representative make a decision in the person’s best interest.

  • If required to make a decision, the guardian representative shall select the option that best meets the personal and financial goals, needs, and preferences of the person under guardianship, placing the least restrictions on the person’s freedom and rights without causing harm.

  • The guardian representative shall seek to ensure that the person receives appropriate health care consistent with person‐centered health care decision‐making.

  • To the extent the person cannot currently direct the decision, the guardian representative shall act in accordance with the person’s prior general statements, actions, values, and preferences to the extent actually known or ascertainable by the guardian representative.

Beneficence

Principle: The guardian representative treats the person with dignity.

  • The guardian representative shall ensure that provision is made for the support, care, comfort, health, and maintenance of the person.

  • The guardian representative shall take reasonable measures to promote and protect the health and well‐being of the person.

  • The guardian representative shall identify and advocate for the person’s goals, needs, and preferences.

  • The guardian representative shall monitor the effectiveness of services provided as well as the person’s living environment.

  • The guardian representative promotes social interactions and meaningful relationships consistent with the preferences of the person under guardianship unless it will substantially harm the person.

  • The guardian representative shall promptly report to the appropriate authorities abuse, neglect and/or exploitation as defined by state statutes.

  • The guardian representative shall petition the court for limitation or termination of the guardianship when the person no longer meets the standard pursuant to which the guardianship was imposed, or when there is an effective alternative available.

  • The guardian representative may request and consider family input when making medical decisions.

Confidentiality

Principle: The guardian representative respects the privacy rights of clients and keeps confidential the affairs of the person under guardianship.

  • The guardian representative shall actively protect personal identifying and health related information in a secure manner and location.

  • The guardian representative shall adhere to state law, the Health Insurance Portability and Accountability Act and related laws regarding the release of a person under guardianship’s information and records.

Objectivity

Principle: The guardian representative respects, accept and/or seek to understand and learn about the culture, beliefs, values, norms, preferences and self-identity (e.g. race, gender, age, sexual orientation, religion, social class, disabilities) of those they serve.

  • The guardian representative will not impose their own culture, beliefs, values, norms, preferences, social demographics, and self-identifiers on the person under guardianship.

Integrity

Principle: The guardian representative honors the trust placed in them and works to meet obligations and keep promises.

  • The guardian representative’s decisions made on behalf of the person under guardianship shall be based on the principle of Informed Consent.

  • The guardian representative does not engage in any act of a dishonest, deceitful, or fraudulent nature in serving persons under guardianship.

  • The guardian representative manages any monetary responsibilities for the person under guardianship in compliance with the Division of Aging Services Policy by:

    • Working cooperatively with the Conservator if applicable

    • Assisting client in applying for benefits

    • Completing a PGO Client Cash Tracking Form when directly handling client funds

  • The guardian representative shall monitor the person under guardianship’s personal effects (e.g., clothing, toiletries, assistive devices) and comfort items (e.g., tv, stuffed animals, radio, bedspread) for availability.

  • The guardian representative shall actively pursue and facilitate periodic independent review of their provision of guardianship services (e.g. case record review, staffings).

Professional Competence

Principle: The guardian representative acquires, maintains, and utilizes the skills and knowledge required to provide necessary, appropriate, and person-centered services.

  • The guardian representative actively seeks trainings and conducts research to remain current on organizational policy as well as national and state laws regarding guardianship.

  • The guardian representative maintains a current knowledge of national, state, and local resources available to the person under guardianship.

  • The guardian representative develops and displays attributes (e.g., self-awareness, critical thinking/problem solving, self-management, social awareness, relationship skills, responsible decision making, teamwork) required to provide necessary, appropriate, and person-centered services.

  • The guardian representative shall seek ongoing education concerning the following:

    • Person‐centered planning

    • Surrogate decision‐making

    • Responsibilities and duties of guardians

    • Legal processes of guardianship

Behavior

Principle: The guardian representative works within the scope of their expertise (based on education and training and experience) and the boundaries of their role as guardian.

  • The guardian representative shall perform duties and discharge obligations in accordance with current state and federal law governing guardianships.

  • The guardian representative shall comply with the requirements of the court that made the appointment.

  • The guardian representative shall know the extent of the powers and the limitations of authority granted by the court and all decisions and actions shall be consistent with that court order.

  • The guardian representative shall meet with the person as soon after the appointment as is feasible and:

    • Communicate to the person the role of the guardian representative

    • Provide emergency contact information

    • Explain the rights retained by the person

    • Assess the person’s physical and social situation, needs, preferences, and support systems

    • Attempt to gather any missing necessary information

  • The guardian representative shall gather and/or complete information and required assessments to develop and maintain a plan that addresses the person’s needs and where possible preferences.

  • The guardian representative shall maintain substantive communication with the person, and as appropriate, service providers, caregivers, family, and others attending to the person.

  • If a person under guardianship is in need of specific professional services, the guardian will coordinate as necessary to try to meet the goals, needs, and preferences of the person.

  • The guardian representative shall make a good faith effort to cooperate with other surrogate decision‐makers for the person. (e.g., power of attorney agent, health care proxy, VA fiduciary, mental health power of attorney agent, and representative payee.)

  • The guardian representative shall treat all professionals and service providers with courtesy and respect and shall strive to enhance cooperation on behalf of the person.

  • The guardian representative shall notify relevant agencies and individuals of the appointment of guardianship

  • The guardian representative shall document case activities in an accurate, informative (i.e., contain sufficient information to clearly describe all significant actions and interactions) and timely manner.

  • The guardian representative shall promptly inform the court of any change in the capacity of the person that warrants an expansion or restriction of the guardian’s authority as well as other changes to which the court must be notified (e.g. change of address).

Conflict of Interest

Principle: The guardian representative avoids conflicts of interest and self-dealing and the appearance thereof.

  • The guardian representative shall avoid personal relationships with the person, the person’s family, or the person’s friends. If such a relationship existed before the assignment of the case, the guardian representative shall let their supervisor know so that an appropriate assignment can be made.

  • The guardian representative shall become fully educated as to what constitutes a conflict of interest and self-dealing, and why they should be avoided.

  • The guardian is not a direct service provider and may not directly provide housing, medical, legal, or other direct services to the person.

I affirm that I have reviewed and understand the PGO Ethical Principles and Standards.

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Staff Signature

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Date