There are ways to make health care and financial decisions that do not involve a guardianship. Some are legal tools while others involve government programs, social services, and community supports. There are decisions you can make for yourself now while you understand your situation and in case you become unable to make decisions for yourself. Those decisions can take effect now or in the future. There are also decisions other people can make for you if you have not made any plans.

What’s right for one person and situation is not right for another. You can choose the way you prefer. Each option has advantages and disadvantages. Although it’s hard to think about the possibility of becoming unable to make your own decisions, if you make plans you will have more peace of mind about the future and so will your family and friends.

There are community supports you can call on to help you make decisions. You can start researching your options by exploring how community resources, as well as family and friends, can help you live most independently.

Community Supports and Supported Decision-Making

Family and Friends

Family and friends know you best. Sometimes they want to help you but they don’t know what to do. They may be waiting for you to ask them for assistance. They can help with paying your bills and coordinating your medical and social services. They may not have all the knowledge or expertise you might need for your situation but they can help you find it. You could form a circle of people who will help you with decisions about your health or finances. Some states provide for “supported decision-making agreements” in which an individual designates one or more persons to help in making and communicating decisions, which are recognized by third parties.  See National Resource Center for Supported Decision-Making. Keep in mind that some people, even family members, can be trusted more than others.

Care Managers

Care managers are professionals who come to your home and help you figure out what services you need to continue living in your home. Your family and friends are involved if you wish. Care managers are familiar with the services available in your community and will help you make a plan. Then the care manager will introduce services to you and coordinate them. Such services might include arranging for medical, dental and podiatry care, retaining in-home help for grocery shopping and meal preparation, and if needed, personal care such as bathing and dressing. Care managers may make referrals to adult day care programs, or arrange for assistive equipment to be installed in your home. They can also help you make medical or therapy appointments. They are aware of other services that can help you such as home delivered meals, homemaker assistance, transportation, counseling services and the various services at senior centers.

The largest no-fee care manager service in the country is Adult Protective Services (APS) which exists in every state and is funded by the federal government. APS will come to your home but only if you want them to do so. They can perform all the functions of a care manager but usually can help you only for short periods of time. APS staff also receives and investigates complaints about mistreatment of elders or adults with disabilities. In most states, the law requires them to investigate such complaints.

Private fee care managers are also available in some areas and can help for longer periods of time. The National Association of Case Management is a voluntary member organization for private care managers. More information about the organization can be found at the NACM website.

Money Management Assistance

Daily money management programs offer assistance to people who have problems managing their personal financial affairs. You still make the decisions about your money. Money management programs provide a wide variety of services for people with various disabilities. They can assist with bill paying, prepare checks for signature, make deposits to the bank, and dispense cash to their clients. They can also help by educating you about managing money, acting as debt managers, serving as coaches regarding handling money, as well as paying your bills. They may manage more complex tasks such as maintaining payroll records for home attendants and preparing documents for accountants for annual federal and state tax preparation. Some programs are non-profit but there are an increasing number of for-profit money management programs.

Money management programs are valuable for people who have disabling arthritis or visual disabilities, those who have little experience managing money or are unfamiliar with banking practices, and those who have limited ability to read and write. They are also helpful for people with mild to moderate cognitive impairments.

Some programs ask their clients to sign a power of attorney for finances that allows them to continue providing services if you lose the ability to make the best decisions for yourself. This is called a durable power of attorney. Find out more information about the durable power of attorney. 

Advantages

• The programs are usually flexible and can adapt to your needs as they arise.

• No court process is involved.

• There may be no charge for services if the program is not for profit.

Disadvantages

• Money management programs do not manage or handle investments or real estate transactions.

• The field is unregulated. You don’t have to have a license to be a money manager. However, there is a professional organization you can consult. The American Association of Daily Money Managers has standards of practice and a code of ethics.

• Qualifications of the people doing money management vary considerably.

• The person helping you with your money is not insured (“bonded”) against making mistakes or using your money for themselves.

• There is no oversight.

Mediation to Resolve Family Issues

If there is conflict among members of your family, or between you and your family, you might want to think about mediation as a way to reach solutions that everyone agrees on. It is a process in which a trained professional mediator helps people in conflict state their opinions and concerns and then work through open conversations to come up with solutions. The outcomes of the mediation are the responsibility of the participants. They are the ones who find and agree on the solutions. The mediator cannot impose decisions. Using mediation standards and communication techniques geared toward problem-solving and settlement of the dispute, the mediator helps the parties understand their issues, become sensitive to each other’s point of view, and work towards mutually acceptable solutions. For instance, one person may need only an apology from another person to resolve a dispute. The goal is a win-win solution for everyone. Mediation can strengthen relationships and create understanding, rather than leaving a problem to fester or going to court as adversaries.

A special form of dispute resolution is called “eldercaring coordination.”  It focuses on high conflict disputes between or among family members, often in the context of a guardianship petition. In eldercaring coordination a trained coordinator is appointed by the court in cases of aggravated family conflict. The coordinator uses techniques of mediation, calming, identification of community resources, and limited coordinator decision-making authority if conferred by the court.  The Association for Conflict Resolution has approved eldercaring coordination guidelines.

Advantages

• Mediation is more flexible in time and process than court procedures which are more formal.

• Everyone who is in the conflict can have their say and then go on to develop solutions that fit their situation. It can be a very empowering process.

• It is usually less expensive than court proceedings.

• It can be less damaging to your relationships than court proceedings which can pit people against each other.

• It is a private process.

Disadvantages

• Finding mediators who are trained in the issues affecting people with disabilities and elders can be a challenge.

• Some people are uncomfortable with this form of dispute resolution. They want a judge to make the decision.

• Not all conflicts are suitable for mediation. For instance, in cases of elder mistreatment, mediation may not be appropriate.