The Hospital to Guardianship Pipeline

• Date: 01 July 2023

Bifocal July - August 2023Vol. 44, No. 6

105

The Hospital to

Guardianship Pipeline

By Anita Raymond, LISW, CMC

“Hazel”, age 89, was recently hospitalized after a fall

at home and received surgery to repair her broken

hip. It has been determined that she is unable to

return home due to her increased care needs and the

condition of her home. She is now stabilized and

ready for discharge to long term care: the hospital

discharge planner has made referrals to the local

nursing homes, but all are refusing to admit her unless

she has a guardian.

This scenario, and others like it, is garnering

attention across the United StatesI, and is

often referred to as a “the hospital to guardianship

pipeline.”II Problematic as an inelegant solution to a

complicated problem, this approach pits healthcare

I See: Bifocal Vol. 43 Issue 5: Elder Jusce In-

novaons Prole: Maryland and The Use and Misuse

of Guardianship and Conservatorship by Nursing

Homes and Health Care Providers

II National Center on Elder Abuse: Anatomy of a

Guardianship: Case Study and Red Flags for Abuse

providers against advocates, families, and state law,

while leaving patients in legal and practical limbo:

stuck in acute care settings they no longer need or in

a long term care setting they don’t want following the

removal of their decision making rights.

Systems have historically

over-relied on guardianship,

leading to a loss of rights and

over-burdened courts. New

approaches are occurring

nationally, including adoption

of supported decision making

principles. More and more

states’ statutes are recognizing

Supported Decision Making as a

viable and necessary alternative,

as well as the importance of

supporting and protecting

the autonomy of people with

disabilities. There needs to be

a change in how and when we

turn to guardianship. This was

a focus of the Fourth National

Guardianship Summit in May

2021, where advocacy, legal,

judicial, scholar, and guardian attendees adopted 22

recommendations around the themes of maximizing

autonomy and ensuring accountability: “Six working

groups convened to address the rights of persons

subject to guardianship; supporting decision-making;

limited guardianship, protective arrangements,

and diverting guardianship pipelines; rethinking

monitoring and addressing abuse by guardians;

duciary responsibilities and tensions; and developing

guardianship court improvement programs.”III

Minnesota’s Guardianship Information Line annually

elds over a thousand inquiries from individuals

III Syracuse University College of Law: The

Fourth Naonal Guardianship Summit: Maximizing

Autonomy and Ensuring Accountability