A Massachusetts public health department report found hospital discharge bottlenecks linked to a shortage of guardians for incapacitated patients, WBUR reported Aug. 18.
Here is what to know.
1. Unrepresented individuals are typically people experiencing homelessness, have serious mental illnesses, lack a “willing or appropriate” healthcare surrogate and/or have outlived their loved ones and friends. These patients are at high risk for inappropriate medical care, including overtreatment, undertreatment and delayed discharges from hospitals, a Massachusetts Department of Public Health report found.
2. The report estimates roughly 3,100 to 4,950 unrepresented individuals could require public guardianship services every year. Services cost an average of $10,000 to $11,000 per client annually.
3. Guardians are typically family members, but they can also be social workers, therapists, psychiatrists, medical professionals, attorneys and retired judges.
4. If a decision maker is not assigned, these patients cannot be discharged until a court appointed guardian is found — an even narrower bottleneck for most facilities. The report found inadequate or nonexistent pay is driving the guardianship shortage, and cases are also often complex and require considerable time investments on the guardian’s behalf. This discourages many guardians from taking cases.
5. Attorneys searching for pro bono guardians on behalf of acute care hospitals contacted four to 13 guardians before finding someone willing to take on the case, according to the report.
6. In Massachusetts, three state agencies help clients find guardianship services: Department of Developmental Services, Department of Mental Health, and the Executive Office of Aging and Independence. Of these, AGE pays the highest at about $893 monthly per client. Other agencies like MassHealth pay $50 an hour, with an annual payment cap of $1,200.
7. Massachusetts is one of four states without a default surrogate statute, allowing close family members and friends to make medical decisions without needing to seek a court-appointed guardian.
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