conservatorship

Introduction

A legal relationship, created by a state court (in most states in the probate division), between a subject declared incompetent (ward) & a conservator, appointed by the court to manage the subject's financial assets. It is appropriate when a physician determines that a patient lacks decision-making capacity, but the patient is not willing to give this up.

• Not standard terminology (state-specific).

• Alternatives:
  • health care proxies
  • durable power of attorney
  • shared bank accounts
  • trusts

• Conservatorship may result in loss of choice, regarding:
  • place of residency
  • health care
  • medications
  • relationships
  • marriage contracts
  • voting
  • voting
  • use of money

• Conservatorship process
  • capacity* declaration
  • hearing
  • appointment & monitoring of guardians

* Capacity based on function, rather than diagnosis.

• 4 categories of mental function
  • alertness & attention
  • information processing
    • memory, communication, planning, understanding, abstract reasoning
  • thought processes - hallucinations, delusion
  • modulation of affect

• Conservatorship Assessment:
  • VA guidelines (1997)
    • detailed clinical intervies with patient, family, including goals, preferences & mental health conditions
    • cognitive assessment
    • assessment of specific capacity in question
      • esp finances

• Functional component:
  • finances
    • managing assets
    • bill paying
    • writing will
  • health
    • medical decision-making
    • health-care management, including medications
  • independent living
    • household cleaning & maintenance
    • laundry
    • food shopping & meal preparation
    • communication
    • personal hygiene
  • transportation
    • driving
    • use of public transport

• Causal component:
  • all states require the establishment of a causal relationship between a medical or psychological condition &
  • a deficiency in abilities necessary to care for oneself &/or property

• Interactive Component:
  • situational demands (living situation, financial assets)
  • social supports & stressors

• Review of forensic assessment instruments
  • IADL rating scales
  • specific guardianship or conservatureship
  • neuropsychological or cognitive testing
  • mental health diagnostic interviews & scales

• IADL instruments based on interview or observation
  • adult functional adaptive behavior scale
  • multidimensional functional assessment questionnaire
  • Philadelphia Geriatric center Multilevel Assessment Inventory

• Performance-based instruments to assess IADLs
  • direct assessment of functional status
  • everyday problems test
  • KELS - used by occupational therapists

• Performance based instruments to assess need for conservator
  • decision-making instrument for guardianship
  • financial capacity instrument
  • Hopemont Capacity Assessment Interview
  • Independent Living Scales

More specific terms

• plenary guardianship

Additional terms

• guardianship