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Clinical evidence in guardianship of older adults is inadequate: findings from a Tri-State study
- Authors:
- MOYE Jennifer, et al
- Journal article citation:
- Gerontologist, 47(5), October 2007, pp.604-612.
- Publisher:
- Oxford University Press
This preliminary study compared clinical evaluations for guardianship in three states with varying levels of statutory reform. Case files for 298 cases of adult guardianship were reviewed in Massachusetts, Pennsylvania, and Colorado, three states with varying degrees of statutory reform. The quality and content of the written clinical evidence for guardianship and the hearing outcome were recorded. The quality of the written clinical evidence for guardianship was best in Colorado, the state with the most progressive statutory reform, earning a grade of B in the ratings, and worst in Massachusetts, a state with minimal reform, earning a grade of D – with nearly two thirds of the written evidence illegible. Information on specific functional deficits was frequently missing and conclusory statements were common. Information about the individual's key values and preferences was almost never provided, and individuals were rarely present at the hearing. Limited orders were used for 34% of the cases in Colorado, associated with more complete clinical testimony, but such orders were used in only 1 case in either Massachusetts or Pennsylvania. Implications: In this study, states with progressive statutes that promote functional assessment are associated with increased quality of clinical testimony and use of limited orders. A continuing dialogue between clinical and legal professionals is needed to advance reform in guardianship, and thereby provide for the needs and protect the rights of adults who face guardianship proceedings.
A conceptual model and assessment temple for capacity evaluation in adult guardianship
- Authors:
- MOYE Jennifer, et al
- Journal article citation:
- Gerontologist, 47(5), October 2007, pp.591-603.
- Publisher:
- Oxford University Press
The authors present a conceptual model and associated assessment template that is usable across state jurisdictions for evaluating the independent-living capacity of older adults in guardianship proceedings. The model and template provide a structure for conducting and documenting a capacity evaluation in guardianship by using six assessment domains of interest to the courts: (a) medical condition, (b) cognition, (c) functional abilities, (d) values, (e) risk of harm and level of supervision needed, and (f) means to enhance capacity. The template also addresses the participation of the person in the guardianship hearing, confidentiality and privilege issues, and certification by the examiner. An online version of the template can be adapted to address specific jurisdictional requirements. A conceptual model and evaluation template provide a useful cross-jurisdictional format for conducting and documenting capacity assessments of older adults in guardianship proceedings. The template may be particularly useful to clinicians for providing courts with information to support limited guardianship orders. The article is written from an American perspective.