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Person-Centered Planning in Guardianship: A Little Hope for the Future
Course level: Intermediate
Written by A. Frank Johns

You can download and print a pdf file of the course here, or read the full text below. There will be a 10-question test at the end which you will need to fill out and submit along with payment details.

Having problems with the form or linked content? Contact info@guardianship.org

Take the test now.

** All footnotes are available in the PDF file.

Person-centered Planning in Guardianship: A Little Hope for the Future

I. INTRODUCTION

Across the states, territories, and the District of Columbia, American guardianship1 functions as a statutory grant of legal authority to a person or entity over an adjudicated incompetent or incapacitated person (“AIP”).2 It is widely described as the most intrusive of the fiduciary powers,3 having earned such a reputation in recent decades as to have AIPs declared “legally dead.”4

America’s inherited collective form of guardianship originated over the course of centuries and across many cultures of western civilization.5 A primary component rooted in the inheritance was the doctrine of parens patriae.6 The focus of parens patriae was the Crown’s (now state probate and guardianship judges’) exercise of its paternal royal prerogative over its subjects unable to protect themselves,7 but with the singular objective of protecting the subjects’ properties for the Crown.8 This myopic concern for guardianship property has continued in American jurisprudence, where concern for the AIPs themselves was considered beyond the expertise of the courts, and better relegated to public and private social agencies.9 This continues to be the indictment of guardianship, where vulnerable citizens, those mentally ill or mentally or physically challenged,10 have been condemned to a perverse legal system that protects property over the person.11 While countless American studies12 have found that guardianship protects those adults amongst us who are helpless and vulnerable, they have also uncovered evils in guardianship: removing all individual rights;13 denying access, connection, and voice14 to those lost in guardianship’s gulag;15 and still continuing a process rooted in systemic perversities.16 Recent reexaminations of monitoring17 and public guardians18 acknowledge that guardianship still limits the autonomy, individuality, self-esteem, and self-determination of AIPs.19

At Wingspan, the Second National Guardianship Conference,20 Richard Van Duizend, Executive Director of the National Center of State Courts, ended his keynote address with three provocative alternatives: 1) continuing to tinker with the existing guardianship system; 2) abolishing the guardianship system; or 3) creating a disability accommodation and support model, rather than a state sponsored preemption of individual rights model.21 If the second alternative were to be considered, something similar to the third alternative would have to follow.

A disability accommodation and support model would probably be fashioned after the American concept of person-centered decision making for persons with developmental disabilities,22 or after the European and Canadian concept of supported decision making for people with disabilities.23 On a stand-alone basis, it is not clear that there is a difference between this concept of person-centered decision-making and the concept of supported decision-making, which seems to have its origin in Canada.24 However, it received recognition and high visibility after the 2006 passage of Article 12 of the United Nations Convention on the Rights of Persons with Disabilities.25

In addition to the United Nations, other nations have supported decision making more as a replacement for guardianship,26 meaning that there is no judicial process or legal intervention that removes a person’s individual rights.27 However, the possibility is less than remote that the American states and territories would ever consider abolishing their models of state sponsored preemption of individual rights. Their independently crafted guardianship statutes and regulations have been a part of their jurisprudence since their statehood, or territorial organization.28 This makes Van Duizend’s second and third options no options at all.

On the premise above, Van Duizend’s first proactive alternative of tinkering with the existing guardianship system could provide guardians with education and training, empowering them to implement person-centered decision making with their AIPs. The tinkering could also enhance monitoring and accountability, assuring care giving, care planning, residential placement, and all other life planning with vulnerable elders and persons with disabilities requiring assistance.29

However, no statutes, regulations, or standards mandate person-centered guardianship.30 The work to be done will require more than tinkering, and whatever is done must be guided by an understanding of how guardians act, and by the current doctrines through which they act.31

Part II demonstrates that guardians’ current exercise of authority is not person-centered. Part III describes person-centered planning as a solution to the problems in guardianship. Part IV describes how person-centered planning can be incorporated in guardianship. Finally, Part V describes the manner in which states can adopt (and the degree to which they already have adopted) person-centered planning.

II. THE GUARDIAN’S EXERCISE OF AUTHORITY IS NOT PERSON-CENTERED

Although no good data regarding guardianship practice is available,32 the general consensus is that a majority of guardianship adjudications are plenary, removing most, if not all, individual rights and the independence of the person.33 Thus, the guardian has the authority to make decisions affecting the AIP’s person, property, or both.34 Rarely are limitations placed on the guardian, which would leave AIPs broader areas in which they are able to make independent choices or decisions.35 Often decisions are made without input from the AIP.36 Just as often, the guardian has had no prior relationship or connection with the AIP.37 Even more often, guardians are provided little or no education or training.38 This is the logical result when most state guardianship statutes offer no doctrines by which guardians exercise their authority, duties, and powers.39 No national empirical research is available to determine how guardians exercise their powers and duties. The exception comes from the survey that is part of the article of Professors Whitton and Frolik.40

These deficiencies are apparent at a time when census demographics and empirical research have forecasted significant increases in the aging and developmental disabilities populations.41 Couple these increases with the fact that many family members no longer live within close proximity to each other and one quickly sees why nonfamily guardianship is on the rise.44 The increases are occurring at a time when there are insufficient support networks, whether family, friends, church members, or individual advocates from whom guardians may be chosen to serve.43 By default the courts are granting an increasing number of guardianship appointments to private professional guardians and public agencies.44 The current state of the American economy and the significant reductions in state and county budgets will force many guardianship case managers to carry much larger guardianship caseloads with little or no person-centered planning.

One thing is apparent across this country: guardians act with little if any uniformity, much less adherence to person-centered philosophy.45 Anecdotally, a few cases may be mentioned or individual guardians’ efforts noted.46 Also recognized is the push by nonprofit organizations and councils serving persons with developmental disabilities to educate a range of professionals (which could include guardians) to be more person-centered.47 Beyond a scatter of cases, or advocacy operations, there are few noteworthy initiatives that infuse guardianship statutes, regulations, or practice standards with a greater semblance of personcentered planning, which focuses greater attention on the personal wants and needs of those under guardianship.48 Regardless of the dire forecast, strategies could be developed to create stronger person-centered standards of decision-making and to educate all guardians about person-centered philosophy.

III. PERSON-CENTERED PHILOSOPHY

Person-centered planning offers a solution to these problems.49 This part (A) describes person-centered planning and distinguishes it from traditional guardianship and (B) illustrates how person-centered planning “tools” can be applied in certain instances.

A. Person-Centered Planning Rather than Traditional Guardianship

Person-centered planning traces its origin to the concept of normalization,50 gaining sophistication during the decades of deinstitutionalization and civil rights.51 Since the early seventies, person-centered planning has established a name and description singularly focused on individuals with developmental disabilities.52 As noted by the O’Briens, person-centered planning came from a shared passion for understanding and teaching how the principle of normalization might be applied to improve the quality of services to people with developmental disabilities.53

Within communities of practice, the pioneers of person-centered planning had laboratories, forums, workshops, and mediums for communication where they shared general philosophical backgrounds that targeted similar outcomes.54 From the communities of practice came dozens of distinct but mostly related approaches that have designed systematic ways to actionably understand persons with developmental disabilities as contributing community members.55

According to experts in the field, there is no one definition of person-centered planning; it is described more as a spectrum of processes based on one general philosophical background.56 One description defines it as planning that specifically empowers individuals to be directly involved in their social inclusion, while challenging their devaluation.57 It is also described as a response to systems, agencies, and services set up to respond to the problems of social exclusion, disempowerment, and devaluation of individuals with developmental disabilities— all too often unintentionally making these problems worse.58 Another definition comes from the Centers for Medicare and Medicaid Services (“CMS”).59

From this spectrum of processes comes a general understanding of just how person-centered philosophy is applied. While traditional guardianship is systemdriven, person-centered philosophy is a person-directed process where the individual identifies what is important.60 It is a philosophy that applies the principle of self-determination.61 The individual’s circle of support is expanded to include anyone important in the person’s life, thereby assisting the individual to achieve goals while maintaining safeguards.62 The key elements of personcentered planning include person-directed preferences and establishing a vision based on the person’s abilities, and strengths, which are determined from informal and formal knowledge.63 There is an emphasis on network building, which requires collaborative teamwork with the use of a facilitator.64 Person-centered planning has been successfully developed within bureaucratic environments.65 Agencies and programs serving individuals with developmental disabilities, and in delivering person-centered planning, strive to make individuals the center of planning and decision making, while treating family members as partners.66 Person-centered planning maintains focus on the positives of a person’s life, discovering gifts, skills and capacities of the individual, and staying mindful of the person’s priorities of life.67

In contrast, conventional service models operate for, not with, the individuals being served.68 Instead of the individuals identifying the types of supports they need; professionals, such as care managers, medical professionals, therapists, and social workers, who make support decisions often focusing on deficits and negative behavior which can create a disempowered mindset.69 This could also be the charge leveled against guardians, especially those operating in large agencies with excessive caseloads.

B. Person-Centered Philosophy in Action: Person-Centered Planning Tools

Person-centered planning could fit well within the guardianship construct because when properly implemented, both are based on human rights, values of independence, choice, and social inclusion,70 even though the differences between person-centered planning and conventional service models could pose some difficulties with respect to implementation.71 Person-centered planning could help guardians develop an awareness that enables them to assist AIPs to direct—to the extent they can—their personalized services and supports.72 This subpart demonstrates that (1) the distinguishing “important to” from “important for” sort, (2) relationship map, and (3) “working/not working” analysis, are effective tools for incorporating person-centered planning into the guardianship construct.

1. Doing an Important To/Important For Sort

We ultimately want all people to have a meaningful and balanced life. For people who receive structured services, the system has focused heavily on ensuring that people are healthy and safe; but has disregarded in many situations if people are happy. So we have a lot of people who are healthy, safe, and miserable.

By implementing person-centered practices, specifically by implementing the tools and skills of person-centered thinking, we can help find a balance in people’s lives between what is important to them and what is important for them. Distinguishing important to from important for is the foundational concept of person-centered philosophy, and is a necessary first step before implementing any person-centered tool or other type of problem solving mechanism. This helps by engaging the individual, offering a way of checking that any recorded goals for the individual make sense to them, identifying changes in the individual’s situation, and in making a sensitive assessment of an individual’s personal needs.

If we can effectively do this, we help people move from healthy, safe, and miserable to healthy, safe, and happy.

Important To includes what people are saying with words and behavior. When words and behavior are in conflict, we must listen to the behavior. Important To concepts include the things that make individuals happy, comforted, content, and satisfied.

Important For includes what keeps individuals safe and healthy and a valued member of community.

Case Study 1: Gilbert J.

Gilbert J. is a common sight on the streets of Greensboro. When he was younger he worked for a landscaper for several years and then at various other minimum wage jobs. Gilbert, who was diagnosed with bipolar disorder at age twenty-three is now thirty-seven. Gilbert received treatment and medication for the bipolar diagnosis from a community mental health provider for three years with good results. His great work ethic and easy-going personality allowed him to easily find work and he could afford a small rental house. In the mid-1990s a friend introduced him to crack cocaine, and he became addicted. Since then, he has been arrested many times for petty theft and possession of drugs, spent time in jail, and passed through several rehabilitation programs for both drug and alcohol abuse. When clean and sober, he has been employed sporadically, but the symptoms of his bipolar disorder are unpredictable and have cost him his job on several occasions. He now lives in a run-down rented trailer just out of town, but he spends most days on the streets.

One day he passed out near the Veterans’ Memorial Park. The police took him to the emergency room and was admitted to the hospital with dehydration, malnourishment, alcohol poisoning, and diabetes. He is also having hallucinations that medication cannot subside. His landlord says he cannot return to his home. The Department of Social Services (DSS), in conjunction with the area mental health agency, has adjudicated Gilbert as incompetent. A DSS social worker is assigned to be Gilbert’s Guardian. She has not met him, but she has begun to secure housing for Gilbert because he is going to be released next week.

The Learning Community for Person Centered Practices (TLC) in 2009 stated: “If individuals are to get a good balance of what is important to them (what makes them happy, satisfied, content, and fulfilled) and what is important for them (health, safety, and being valued), then everyone in a support role with the individual has to understand and be skilled at sorting important to and important for.”

An Important To/Important For Sort

Important To Gilbert: Important For Gilbert:
Being called Gil
Knowing he is not being judged 
Living in his own place 
Hanging out with friends
Having a job and working hard
Making his own decisions
Being safe

Managing the symptoms of his bi-polar
disorder

Avoiding illicit substances
Getting proper nutrition
Having access to consistent mental and physical health care

What do we need to learn/know:

When Gilbert has been clean and sober in the past, what elements lead to his success?

Does Gilbert have any friends who have been important in helping him stay off substances? Have they supported him in other ways?

2. Creating the Relationship Map

The Relationship Map offers an effective way of finding out who to talk to and who to listen to when a guardian is making decisions. It depicts emotional distance and connectedness and reflects strength and depth of feeling between individuals versus how much time they spend together. Relationship maps capture information about who is most important to an individual and in what way, identifies networks of relationships that an individual has, and gives a fuller picture of relationships that must be strengthened and supported in the individual’s life. Placement of the names on the map can be determined based on “how” the person is in the individual’s life, not how close the “blood” relationship is. Thus the map develops a picture of who is in an individual’s life in a meaningful way and who they care about. This is an important distinction because we can get a good idea about who we should talk to in order to develop a clear picture of what is important to the individual.

Case Study 2: Thalia L.

Thalia is eighty-seven years old. She has lived alone in a small house that she owned in a friendly neighborhood in North Central North Carolina for forty-eight years. Her neighbors admire her for her great stories and her ability to remember everyone by name. Thalia never married and has always had an independent spirit. She is a “social butterfly” and is known by many in her community. Since her retirement, she has lived on her social security benefit and an educator’s retirement account, which has been sufficient to cover all of her expenses and allow her to live comfortably and take a few extended trips. She had siblings and cousins in the area, but most have passed away and Thalia has never had close relationships with them or their surviving children who now live in California and Tennessee.

Four months ago, Thalia fell and broke her shoulder. Her best friend and neighbor, Millie, looked after her home and her cat while she was hospitalized for the shoulder surgery and rehabilitation. Thalia’s physician believed she would be able to return to her own home in two to three weeks. However, Thalia had a major stroke the week after the surgery while she was still in the hospital. She is now severely physically and cognitively impaired and her physician is unsure of how much she will improve, or how long any recovery will take. The hospital contacted Lucus, Thalia’s cousin and only nearby family member. Lucus agreed to serve as a guardian for Thalia. Lucus arranged for Thalia to be moved from the hospital to a long-term care facility where she receives skilled nursing care. Lucus wants to sell Thalia’s home and a piece of land that she owns in a neighboring county even though her monthly income plus her retirement savings cover the cost of her room and care. Thalia has not done any advanced planning, but she has told Millie for years that she does not ever want to enter a long-term care facility.

The Relationship map identifies who is important to a person.

3. Using the Working/Not Working Analysis

The Working/Not Working Analysis provides a picture of how things currently are across multiple perspectives and is a negotiation tool that can be used when there are disagreements between parties. To negotiate for a meaningful and desired goal, all involved must feel listened to and their perspectives must be accurately reflected. This tool starts with common ground, remains unconditionally constructive, and is done in partnership. This analysis reflects current reality only and serves as a bridge to action planning. It can help us determine what needs to change, what needs to stay the same, and what should be enhanced.

This analysis helps resolve problems and concerns and can be used to develop goals and objectives that help people move toward the lives that they want. It can also assist with negotiation where there are disagreements. Additionally, this analysis engages people who are important in the individual’s life and allows those people to contribute to improving the individual’s life.

To help with action and goal planning:

  • The left hand column helps with identifying those things that you wish to maintain or enhance.
  • The right hand column shows things that need to change.
  • Disagreements often turn up on the diagonals.

This has two of the core principles of negotiation built into it:

  • If you have carefully written down everyone’s perspective, they feel listened to.
  • If you point out where the same items appear in the same column, but different perspectives you have started with common ground.

Case Study 3: Sam S.

Four months ago, Sam S., fifty-nine years old, lost control of his car and went through the front windshield. He suffered a moderate traumatic brain injury, and has been at the hospital’s rehabilitation facility ever since. Sam, a talented craftsman carver, is known for his great sense of humor and the beautiful Christmas ornaments he carves for a local gift shop. He has physically recovered enough to be discharged, but it is not clear where he should go. His cognitive injuries have not significantly improved since the accident.

He was married when he was younger, but he has been divorced for about ten years. He has dated a few women, but nothing serious has developed in his relationships. His sister lives twenty miles away and their relationship has never been good. Sam lived alone in a small apartment in Mt. Airy, but his sister put his things in storage after the accident and let the lease lapse. Sam has begun learning to speak again and seems to understand everything that is communicated to him, but he is somewhat slower in his progress toward regaining the ability to do selfcare activities. His behavior has changed and he is often moody and irritable. His sister does not want to take Sam into her home. She believes he should move into a long-term care facility. Sam becomes loud and strikes out at the hospital social worker when she discusses long-term care options with him.73

Working/Not Working Analysis for Sam S.

  What works/makes sense? What doesn’t work/make sense?
Sam’s Perspective

Living independently

Having a means to pay for things he wants and needs

Having his own things

Having difficulty expressing his wishes to live independently

Having to depend on others for care

Having his things taken away when the lease on the storage facility lapsed

Having no home to go to

Sister’s Perspective

Arranging for Sam to move to a long-term care facility

Feeling responsible for making decisions for Sam
The hospital wants her to take Sam into her home
 

The working/not working analysis provides a picture of how things are right now and analyzes issues and situations across perspectives.

IV. PERSON-CENTERED PLANNING CONCEPTS IN THE CURRENT GUARDIANSHIP PROCESS

In order to understand how person-centered planning could fit into the guardianship process, doctrines74 relating to how guardians exercise authority require attention. This Part describes (A) the doctrines by which guardians exercise authority and how person-centered planning concepts can be incorporated into those doctrines and (B) some of the necessary steps for this incorporation.

A. The Doctrines by which Guardians Exercise Authority

Most state statutes, codes, and laws are silent when it comes to how guardians exercise authority.75 When doctrines are statutorily expressed, there is no data or research reflecting whether or not the guardians actually exercise their authority based on that doctrine. Doctrines specifically prescribed are doctrines of (1) best interest,76 (2) substituted judgment,77 or (3) a hybrid consisting of a blend of the two.78 Even though doctrines for exercising the guardian’s authority do not exist in most states, and it cannot be determined how the doctrines are applied in the other states, these doctrines are well known in American jurisprudence.79 It is through these doctrines that person-centered planning has the best possibility of becoming policy, regulation, or a standard by which guardians will exercise their powers and duties.

1. The Doctrine of Best Interest

The doctrine of best interest requires surrogates to act in the best interest of the AIP regardless of it being inconsistent with what the AIP declares should be done, or would have been done by the AIP when competent.80 Considered on the far end of the surrogate decision-making spectrum, the best interest doctrine is marked by determinations of the AIP’s welfare, in stark contrast to selfdetermination. 81 It is understandable that this doctrine does not harmonize well with person-centered planning, looking to sources and individuals other than the AIP to make choices and decisions. One practical application of best interest comes when decisions are being made for end of life or for significant acute medical choices, including ending life.82

2. The Doctrine of Substituted Judgment

The doctrine of substituted judgment is simple to define yet difficult to apply. Cases, texts, and encyclopedias describe substituted judgment as doing what a person would have wanted to do if he or she were able to communicate his or her wishes.83 Under substituted judgment, it is understood that whenever possible, decisions should be based on what the AIP has expressly declared, conveyed in some form of writing or conversation, and should be respected by the surrogate making those decisions whenever possible.84 This was also expressed in a case well known to elder law and estate and trust attorneys, In re Shah,85 citing and quoting from a lower court opinion in the same case:

[I]t is, or should be, clear that Mr. Shah, who had the unrestricted right to give his assets to his wife, or to his children, or to anyone else for that matter, at all times up to the moment of his terrible injury, did not, on account of that injury, lose that fundamental right merely because he is now incapacitated and financial decisions on his behalf must necessarily be made by a surrogate. The relief granted pursuant to Mental Hygiene Law article 81 is designed to permit an incapacitated person to do, by way of a surrogate, those essential things such a person could do but for his or her incapacity.86

Additionally, in some jurisdictions, several factors are mandated by which judges must be guided when entering a substituted judgment of their own in place of what the AIP would decide: the AIP’s expressed preferences; the AIP’s religious convictions related to a denial of treatment; the impact on the AIP’s family; the probability of adverse side effects to or on the AIP; and the prognosis with and without treatment.87

3. The Hybrid Doctrine of Substituted Judgment and Best Interest

The UGPPA merges the doctrines of substituted judgment and best interest,88 and many states have enacted the same or similar language in their guardianship statutes.89 Just how guardians implement the doctrines is not known, or whether they implement the doctrines at all.90 To the extent that such a hybrid of the doctrines actually works in reality, it may be a way by which person-centered decision-making could function.

B. How to Effectively Implement Person-Centered Guardianship

Person-centered planning is described in many ways, such as through steps and tools, systems and core concepts, and guides and processes by which those serving others interact with those they are serving.91 Examination of any number of articles and manuscripts by experts in person-centered planning quickly provides an understanding of how difficult it is to make such a seemingly simple concept a reality in any service, system, or process.92 As one writer suggests, the more individuals, agencies, and systems declare their approval of person-centered planning, the more they fall into the “same soup in a different cup syndrome,” announcing the launch of new labels for those things they have been doing all along.93

Person-centered planning has been developed in many different approaches or methods, including personal-futures planning, individual design sessions, getting to know you, and twenty-four hour planning.94 It will take a significant effort by those in the American guardianship network to gain even a beginner’s understanding of person-centered planning, to spread the person-centered planning philosophy to others, and to help AIPs realize the benefits of person-centered planning. In addition, effectively implementing person-centered planning into current guardianship standards will require (1) accountability and monitoring, (2) training and education. In addition, Michael Smull has offered an outline of other factors that should be considered and discussed.95

1. Accountability and Monitoring

Whether found in the UGPPA, in the state guardianship statutes reviewed later in this manuscript, or in any of the other state guardianship statutes, a high percentage of the state guardianship statutes have some form of required accounting or accountability;96 some of the statutes have some form of monitoring;97 but few of the statutes have any training.98 Guardianship accountability and monitoring of guardians have had published scrutiny over the last twenty years.99 In that period of time, the studies, surveys, and statutes reveal that there have been minimal to modest increases in statutory directives for guardians to make reports, or use guardianship care plans.100 Thus, it is reasonable to assert that the success of any created mandate of person-centered planning will require some form of accountability, monitoring, or enforcement.

In their report “Becoming a Person Centered System,”experts in the field of person-centered supports describe culture change efforts in a six state consortium and set forth the evolution of efforts they believe to underlie true culture change:

A variety of agencies in many different locations have engaged with us in a set of efforts that have evolved over time. At each location the goal has been consistent: to create person centered systems that support person directed services. The learning that has taken place from working toward that goal has changed the approach. Some of the central ideas of the effort are:

  • Changes in rules and practice should be driven by learning what is and is not working in supporting individuals.
  • Using a small set of value-based skills at all levels of the system will drive change throughout the system.

Using these skills in conjunction with selected quality management and organizational development tools will improve quality of life and increase organizational effectiveness and efficiency.101

2. Training and Education

There are a number of reasons for this. Teaching and supporting the use of person-centered thinking skills will mean that

  • it is more likely that plans will be used and acted on, that the lives of people who use services will improve; and
  • there will be options for a number of ways to get plans started.

If a proceeding is brought for reasons other than that the respondent is a minor, after a hearing on the petition, upon finding that a basis exists for a conservatorship or other protective order, the court shall make the least restrictive order consistent with its findings. The court shall make orders necessitated by the protected person’s limitations and demonstrated needs, including appointive and other orders that will encourage the development of maximum self-reliance and independence of the protected person.134 /INDENT

1. Statutes Identical to UGPPA—Arizona and Michigan

Arizona enacted the UGPPA in 2001.150 Arizona Revised Statute Section 14- 5312 substantially incorporates UGPPA Article 3.151 However, Arizona separately sets out the guardian’s powers and duties related to an AIP with developmental disabilities, imposing a “best interest” standard when the guardian exercises those powers.152 This infers that all persons labeled developmentally disabled are unable to communicate their wants, needs, and wishes, leaving it to their guardians to make those decisions in their “best interest.”153 Other than this distinguishing difference, the earlier analysis of the UGPPA applies as well to an analysis of the Arizona statute.

(b) Vermont’s Guardianship Statute

Vermont’s guardianship statute begins as an expressed prohibition against any authority, power, or control that does not promote “the well-being of the individual and to protect the individual from violations of his human and civil rights.”186 It follows with mandatory instruction that individual guardianships “encourage the development and maintenance of maximum self-reliance and independence in the individual and [only the least restrictive form of guardianship] shall be ordered to the extent required by the individual’s actual mental and adaptive limitations.”187 Vermont recognizes the fundamental right of an adult with capacity to determine the extent of health care the individual will receive, and to execute advance directives that would either circumvent the need for guardianship, or identify the person or entity that would serve as guardian.188

  1. Guardian’s responsibility to require information – what information?
  2. Guardian’s Meeting Obligations
  3. Understanding “Tools”
    1. Appreciation and application of person-centered “tools”
    2. Understanding Core Concepts - What is important to a person includes those things in life that help to gain satisfaction, contentment, comfort, and happiness.
  4. Training to Accomplish Reasonable Expectations
  5. Using the “Tools:”
    1. People to be with / Relationships
    2. Things to do
    3. Places to go; Rituals or Routines
    4. Rhythm or Pace of Life
    5. Things to Have
  6. What Matters the Most to the Person—Their Own Definition of Quality of Life
  7. What is Important for People—Includes Only Those Things that We Need to Keep in Mind Regarding:
    1. Issues of Health or Safety;
    2. Physical Health and Safety, Including Wellness and Prevention;
    3. Emotional Health and Safety, Including Support Needed;
    4. What Others See as Important to Help the Person be a Valued Member of Their Community;
    5. “Important to” and “Important for” Influence Each Other;
    6. No One Does Anything that Is “Important for” Them (Willingly) Unless a Piece of It Is “Important” to Them
  8. Information and Assessment Developed by Which the Guardian Makes Decisions
  9. What Do Guardians Need to Expect of Others?
TEST INFORMATION
A passing score is 75%. There are 100 possible points (multiple choice questions are worth 3.5, true/false questions are worth 3)
Payment of $50 for NGA members or $75 for non-members (Family or volunteer guardian fee is $25 for NGA member or $30 non-member) must accompany the test answers for scoring to occur.
You will be notified of your test score within two weeks by email. If you receive a passing score, a certificate will also be emailed.
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TEST QUESTIONS
1. Most court-appointed guardians never need to make health care decisions for the ward.
 
2. Which of the following is not included in health care decisions?
 


3. What information gathering action is most critical to a person-centered decision?
 


4. What is the primary goal of person-centered planning and decision-making?
 


5. What is the most important skill set in person-centered planning?
 


6. When should a guardian notify the court of a person’s improved cognitive health?
 


7. Which statement best describes the author’s message regarding person-centered decision-making?
 


8. Why is person-centered planning and decision making preferred over paternalistic protection?
 


9. Why are the majority of guardianship adjudications in the USA not person-centered?
 


10. What does the process of negotiating for a goal not require?