Geriatric Care Management for Adults with Schizophrenia

Drawing on our firsthand experience with the effects of mental health issues on a family, we focus our efforts on maximizing every support resource available.

Our first step toward achieving and Living Life With Dignity is recognizing what role mental health plays in a client’s life.

During an initial assessment with a client, the family and doctors, we learn which issues have been resolved and where struggles continue to occur. Following that meeting, an assessment is developed based on the results of that collaboration. We provide an assessment document highlighting recommendations for a life/care plan, as well as an affordable fee structure.

A life/care plan is then developed through additional, very specific client interviews and outreach to our network of community resources. Our associates work hand-in-hand with clients, their families and/or caregivers to make sure the plan works in everyday situations.

Case Study

Supporting adults with schizophreniaThis case study involves a 62-year-old female diagnosed with Schizophrenia. At the time, Alice* was living in a nursing home with outside advocacy. Alice’s father was appointed as her guardian after her mother’s death; however, health issues prevented him from assisting in her care.

Alice believes that her mother is still alive and that her family has faked her mother’s death. She was oppositional at first but is now compliant, although still delusional after a year of treatment. She suffers from mild paranoia and does not maintain activities of daily living unless prompted.

She was in a secure environment; however, her Attorney was concerned that she was not getting proper care. She needed clothes, toiletries and reading materials, and her father needed to be removed as guardian due to his competency issues.

  • Living Life with Dignity stepped in and provided the following services:
  • We were appointed as Alice’s Guardian;
  • We attended to all of her care plans;
  • We advocated for her legal rights;
  • We accessed her current mental health status to acquire a more appropriate living environment and facilitated her change in residence;
  • We secured outside professionals for additional evaluations; and
  • We visited regularly to ensure proper care and to provide companionship.

*Not her real name.

Do you have any questions about support and advocacy for adults suffering from schizophrenia? Post a comment below!

What is the difference between Guardianship and Power of Attorney?

Healthcare Power of Attorney, Living Will, Estate Plan

Often times when I have to call a corporation for a custodial account, I am asked, “Are you the Power of Attorney.” My response is, “no, I am the Guardian.” To which they reply, “I am sorry I cannot divulge any information unless you are the Power of Attorney.” Then I have to go into an explanation as to why they can give me information. Then they will say, “Oh, so you are the Power of Attorney then.” Oy vey.

On paper they look somewhat the same; you are basically making the decisions for someone who is not capable of making decisions for themselves. However, they are not interchangeable.

Here are a few points to understand the difference.

Power of Attorney (POA)

  • A proactive decision made by an individual when they are of sound mind.
  • A designation of someone known and trusted to carry directives.
  • Can be for Healthcare or of the Property.
  • Two types of POA: one that is effective immediately and the other that requires proof of capacity.
  • A Power of Attorney for healthcare can be revoked at any time.
  • A Mental Health Directive is separate from the Power of Attorney and is needed in cases where the health issue is behavioral vs. clinical (IE: Bi-polar disorder).
  • Is not a judicial order.
  • No oversight for a Power of Attorney.
  • Cost effective.

Also see What is a Power of Attorney?

Guardianship

  • A judicial decision made when an individual has not designated a POA.
  • It is a request by someone other than the individual it is for.
  • Can be of the Person or of the Estate.
  • Can be Temporary, Limited or Plenary.
  • Is only revocable when an individual can produce proof that they have regain capacity.
  • The Mental Health Directive is included in the Guardianship.
  • It is a judicial order.
  • Judicial oversight and guidelines for Guardianship.
  • Expensive.

It is always better to be proactive than reactive. Planning for your future needs can keep you independent longer and be more cost effective. If you put a Power of Attorney in place with someone you trust and you provide them with a detailed account of what you want (or don’t want), you are more likely to be cared for the way that you want and your money will go further. Our Life with Dignity service offering can help you plan your future the way you envision it should be.

If you don’t have a Power of Attorney or a Mental Health Directive and you become incapacitated then anyone who has a vested interest in your welfare, whether family or friend, can petition the court for Guardianship. This gives you less choice of care givers and puts you at higher risk of not having your choices honored, potentially jeopardizing your independence and financial well-being. In many cases, when someone gets Guardianship, the wishes of the individual cannot be determined, and the ward is subject to what the guardian feels is in the individual’s best interest. Guardianship proceedings in themselves can be very costly. A contested Guardianship is even more costly.

When referring to Power of Attorney for the Person or of the Property vs the different types of Guardianship, you are basically referring to managing an individual personally and financially. So let’s look at the differences:

Difference between Power of Attorney for Healthcare and Plenary, Limited & Temporary Guardianship

In a POA for Healthcare your designee can make any decision for you without a court order. Once an individual has been declared by a physician to lack competency you simply have to present your Power of Attorney paperwork. However, with a Guardianship you have to follow the court order. Both types of Guardianship give certain or all power to act on the individual’s behalf; however, anything outside of the court order has to be approved by the court. For instance: if someone has a stroke, becomes dependent on life support and it is not in the court order, it is always a best practice to go to court to make the decision whether to end life or not. This protects the Guardian as well as the Ward. In addition, the Guardian of the Person has to file an annual report with the court as a status update affirming continuation of the Guardianship.

Difference between Power of Attorney for Property and Guardian of the Estate

It is a known fact that our ability to reason becomes compromised as we get older. In fact, studies suggest in some people it can be as early as 65. Having someone you trust to manage your financial affairs can prevent you from being exploited, provided the person you choose is of sound integrity. Sadly, I have seen many cases where individuals have been exploited by the Power of Attorney. Transparency and proper accounting are two ways a POA can avoid these issues. I recommend when choosing the POA for property, to pick someone that is good with their own finances if you want to ensure the safety of your financial future. See This Job Sucks! Choosing the right Power of Attorney is imperative

A Guardian of the Estate has little room to exploit anyone

They have to account for every penny that is spent of your money. The court requires the Guardian of the Estate to produce a yearly report and to provide the court with an annual budget. The court will readily pick a family member or close friend over a Corporate or Public Guardian. It is standard practice for family members to contribute to the welfare of their loved one, while a Corporate Guardian or the Public Guardian charge for their services. For this reason, when the court determines someone is not of sound mind, the court will default for family or a loved one to be the Guardian if appropriate.

Mental Health Directive

The state of Illinois requires a Mental Health Directive in addition to a Power of Attorney for Healthcare for treatment of a Mental Health Disorder. I won’t go into the why’s or the politics around it, that is fodder for another blog (next month). Nonetheless, please note that if you are preparing your estate, this should be a consideration when putting your directives in order, regardless of whether you suffer from a mental illness or not. See What is a Health Directive for Dementia?

Your Power of Attorney should know where you keep all of your important documents, and above all, be transparent. This way, if ever anyone wanted to challenge your POA’s intentions or abilities, you have everything documented. NOTE: POAs for Healthcare can easily be revoked, however, Power of Attorney for Property cannot.

Guardians are mandated to do all of the things a Power of Attorney does and are appointed by and accountable to the court. A physician’s report as to whether or not the individual is capable of making their own decisions is a requirement of a petition for Guardianship but ultimately the court, not the medical professional, makes the determination and the designation.

Digital LifeCloud

When Living Life with Dignity is appointed as a Guardian or a Power of Attorney we store all of our clients’ records on digitallifecloud.com. It is a HIPAA compliant cloud that allows you to share documents with doctors, caregivers or anyone that may need to help your POA. You can have everything from family pictures to your final arrangements stored and shared.

Read the latest press release about Digital LifeCloud and get a free gift package: Digital LifeCloud Press Release 120617

Ensure your future

Put a Healthcare Directive and Power into place.

Get a sound estate plan done and share the documentation with your designated Power of Attorney. You don’t have to give them access to everything just let them know where you keep it in case of an emergency. You’ll save money, time and most of all heartache.

For more information on Power of Attorney and Plenary Guardianship, read the following :

Do you have any questions about the difference between Plenary Guardianship and Power of Attorney? Post a comment to get the conversation started or contact us for more information.

8 Questions About Plenary Guardianship Answered

What is a Plenary Guardian?

When it comes to Plenary Guardianship, there are a lot of factors that need to be considered and processes that need to be executed before the plenary guardianship is actually granted. Who will be the guardian? How much does it cost? What are the duties and responsibilities of the guardian and how do Illinois courts decide who to appoint as guardian? Is there already a health care directive in place? Equip yourself with knowledge and let us help you every step of the way before making drastic decisions. Living Life with Dignity offers the assistance of knowledgeable, certified professional guardians who exceed industry standards. We are deliberate, thorough and ethical advocates who prioritize our client’s best interests. Prior to making any legal decisions, we work with the family to ensure sensitive issues are thoughtfully considered and appropriately communicated.

What is plenary guardianship?

Plenary Guardianship, also, referred to as conservatorship, is a legal process, utilized when a person can no longer make or communicate safe or sound decisions about his/her person and/or property or has become susceptible to fraud or undue influence. Because establishing a guardianship may remove considerable rights from an individual, it should only be considered after alternatives to guardianship have proven ineffective or are unavailable.

How do I set up a plenary guardianship in Illinois and how long does it take?

It is best to seek the advice and assistance of a guardianship attorney. You can represent yourself Pro Se, but it is not recommended. However, if you don’t have the money to hire a lawyer there are places like Prairie State Legal or Administer Justice that may be able to help with the plenary guardianship or walk you through the process depending on your individual circumstances. Get in touch with us if you need assistance finding the right people to help.

Is there already a health care directive in place?

Is a Healthcare Directive in place?Each case is different. Given that there are different types of guardianship and 3 types of directives, (health, mental health and property), you need to establish what the need is. If there are directives for health and property but not for mental health and it is the mental health that is the cause for the individual’s lack of capacity, then you may need to consider plenary guardianship. In most cases, if a directive is in place, guardianship should not be necessary provided that there is a physician’s statement declaring that the individual does NOT have capacity. If you do not have that statement, then it is best to consult an attorney. My rule of thumb is when in doubt defer to someone who can give you a definite answer. You may have to pay for that advice but in the long run it will be worth it.

Who will be the guardian?

In most cases the court prefers to appoint a family member or close friend. Guardianship with a corporate guardian or public guardian can be costly to the individual’s estate. In addition, if the individual doesn’t have the means they will end up with the office of state guardianship. While this appointment is free to the individual, it is not the best means of support simply because of the ratio of client to state guardian.

If there is no one willing or able to be the guardian, and the individual has assets of $25,000 or more, a private corporate guardian such as Life with Dignity can be appointed, or the public guardian will be appointed.

What are the costs?

In any guardianship there are costs, which can be as little as $3,000. Let’s use the example of a parent of a disabled adult who seeks guardianship to continue care for their child. In most cases the adult child wants to stay at home and be taken care of by their family so they would not contest the guardianship and the court would see this favorably. The costs in this example would be for the guardian’s attorney and the guardian ad litem (GAL). A GAL is a person the court appoints to investigate whether the guardianship is appropriate. See Living Life with Dignity’s costs here.

In the case of a contested guardianship, whether it is contested by the individual or another friend or family member, the cost can be catastrophic.

Who is responsible for payment?

Living Life with Dignity can assist you secure a financial plan for the future.If you are the petitioner requesting the court to grant guardianship, responsibility for payment will depend on whether you are appointed or not. If you are appointed guardian, the estate of the Ward is responsible for all fees, including those of the GAL and all attorney’s fees. If, however, you are not appointed and it is determined that the individual does not need guardianship then you are responsible for all costs. In some cases, the individual may be expected to pay for their attorney but the GAL and your own attorney fees and any other fees such as medical testing bills would be the petitioners responsibility.

What are the duties and responsibilities of the plenary guardian?

If you are the guardian of the person only, then your duties are limited to making healthcare and mental healthcare, end of life decisions, and residential placement.

If you are guardian of the estate as well you are responsible for all financial matters. Including bill paying, benefits management and bookkeeping.

Regardless of what type of guardian you are each requires you to file an annual report. The county in which the guardianship is in has a form to be filled out annually that walks you through the healthcare portion of it. Annual reporting for guardian of the estate is a bit more intense and requires the guardian to report all expenditures for the Ward and account for any assets that were spent.

In addition, as guardian of the estate you will have to provide an inventory of assets to the court when you are first appointed. You will also have to provide an annual budget. It is important when creating the budget, that all of the ward’s needs are reflected in that budget. As guardian you are also expected to see your ward at least once per month.

What do courts consider when deciding who to appoint as guardian or conservator?

You cannot have a felony when applying to be a guardian and you must be over 18. The court requires the petitioner to prove evidence that the guardianship is necessary. Part of that evidence is a Physician’s report which is a form filled out by a doctor that states the individuals physical or mental health status.

The court will also examine the relationship and personal history of the person petitioning to determine the appropriateness. The GAL will interview the Petitioner and others in the respondent’s life and make a recommendation to the court. I have been involved in cases where the person that petitioned was not the person appointed.

The final verdict is disposed of by the Judge.

Is a guardianship forever?

It doesn’t have to be. If a ward is ill, say in a car accident or because of a mental illness, gets treatment and recovers, the ward can petition the court to have the guardianship removed or at the very least, limited. Again, this can be a costly process without considerable documentation as to the person’s progress. It helps if all parties agree to the guardianship removal.

Glossary of terms:

  • Petition: Formal written request to the court.
  • Petitioner: the person that files the petition.
  • Respondent: the person the petition is filed regarding.
  • Ward: the individual under guardianship
  • Conservator: Interchangeable term for guardian
  • Guardianship: The position of protecting or defending something or someone.
  • Guardian: Protector or Defender
  • Annual Report: A report written to the court on a yearly basis to inform the court of the ward’s status and to reinforce the continued need for the guardianship.
  • Residential Placement: Where the Ward is to live. This can be at his/her home, a group home or support living or nursing home. Most important is that it be appropriate and the least restrictive allowable.
  • Guardian Ad Litem: (GAL): An attorney appointed by the court to represent the court in determining the appropriateness of the guardianship.
  • Felony: a crime, typically one involving violence, regarded as more serious than a misdemeanor, and usually punishable by imprisonment for more than one year or by death.

What is a Plenary Guardian?

Plenary Guardianship for aging adult with dementia.Jim was becoming increasingly confused and estranged, and his actions were unpredictable. One day his wife asked him to put the kettle on for a cup of tea; he replied ‘yes’. When his wife came back into the kitchen a short while later, he was just standing there staring at the kettle as if it were a foreign object. It seemed he had lost interest in life, his financial affairs were in disarray, and he could no longer find the words to communicate it. He had forgotten how to drive, read, or perform any normal daily tasks, to the point where he was unable to dress himself in the morning. His aging and unwell wife was finding it impossible to manage his dementia and their estate any longer, and he clearly could not care for himself. Jim’s wife took him to the doctor and her worst fears were realized – the doctor declared him incapable of making decisions for himself. It was time to consider plenary guardianship, as Jim was not competent to enter into a Power of Attorney, the document in which a competent person grants authority to another individual to act on his/her behalf. See Dementia and Guardianship

Plenary guardianship is when the court finds an individual incapable of caring for themselves, and therefore gives a legal guardian rights over and responsibilities towards that individual or “ward”. Plenary guardianship must be appointed by the court. This kind of petition would include the name of the person in need of guardianship, their date of birth and address, and a report by a doctor stating the physical and mental incapability of the person. See What is the Difference between Guardianship and Power of Attorney?

Types of Guardianship

Other less restrictive types of guardianship do exist and the court will decide which is suitable for the individual in question. Illinois law permits several different types of adult guardianship:

Limited Guardianship

A limited guardianship permits the guardian to make some, but not all, decisions for the person under the guardianship.

Guardian of the Person and Guardian of the Estate

There are different types of plenary guardianship – it may be as to the person (personal care, education, and medical services) or as to the estate (financial affairs and property) or as to both.

Temporary Guardianship

In emergencies, the court may appoint a temporary guardian for up to 60 days to protect a person with special needs’ interests.

Successor Guardianship

A successor guardian takes over the guardianship when the initially appointed guardian no longer can serve.

Testamentary Guardianship

Parents of children with special needs use testamentary guardianships to protect their children who are living under guardianships in case of the parent’s death.

Duties of the Plenary Guardian

A Plenary Guardian has legal rights by the court to make all decisions for the person that is found to be incompetent. It is important to note that this is a legal appointment, not a medical appointment. The medical report presented to the court is only part of what a judge will consider in making a decision for a potential ward. Once someone is under guardianship they will not be able to engage in certain activities. This is including, but not limited to, their estate. While someone is under the care of a guardian they may not:

  • Determine residence
  • Consent to medical treatment
  • Make end-of-life decisions
  • Possess a driver’s license
  • Manage, buy, or sell property
  • Own or possess a firearm or weapon
  • Contract or file lawsuits
  • Marry
  • Vote

The plenary guardian is responsible for managing the needs of that person. If proper housing needs to be secured, it is the responsibility of the guardian. If medical needs have to be addressed, it is the responsibility of the guardian. The guardian is also to manage the client’s financial and insurance needs, including applying for Medicare or Medicaid or Social Security if necessary. Some additional things a plenary guardian can be responsible for include the following:

  • Determine and monitor residence
  • Consent to and monitor medical treatment
  • Consent and monitor non-medical services such as education and counseling
  • Consent and release of confidential information
  • Make end-of-life decisions
  • Act as representative payee
  • Maximize independence in least restrictive manner
  • Report to the court about the guardianship status at least annually
  • Marshall and protect assets
  • Obtain appraisals of property
  • Protect property and assets from loss
  • Receive income for the estate
  • Make appropriate disbursements
  • Obtain court approval prior to selling any asset
  • Report to the court or estate status

Plenary Guardian Requirements

It is required by Illinois law that a plenary guardian be 18 years or older without a felony and capable of the responsibility. It also states that you cannot be in service to the ward other than to provide guardianship services and that there may not be any debt owed to you by the ward. These simple requirements come with much responsibility. Often a well-intended family member is willing to take on this role without fully understanding the magnitude of what they are getting into. Knowing all there is to know to help someone in need of a guardian is challenging. The impact of being the caregiver can be tremendous. See Recognizing the Signs of Caregiver Burnout

If you find yourself in this situation, we suggest you sit down with a good estate and probate attorney experienced in these matters to learn what is involved before you decide to take it on. If you have already accepted an appointment then your attorney might be able to help you manage and understand the requirements.

As advocates and professional guardians we can help you put a plan in place that is easy to follow and maintain. You don’t have be in this alone. With professional expertise you will have the support you need to be the best guardian for your loved one and know you are making the right decisions.

If you have any questions regarding guardianship, please post them below so we can raise awareness and help others who might be facing similar issues.