Nancy Doty

What can we do?

For individuals who are able to make their own decisions, we may be asked by family members, a trust officer, a conservator, or another agency to help. This may include services as an Attorney in Fact under a Power of Attorney for Health Care.

If another surrogate decision-maker is named, we may provide case management and care coordination services.

What is Guardianship?

In a court appointed role, the guardian (of the person) is responsible for safe and appropriate housing. The Guardian may request or approve the professional care or treatment of the protected person, and may request the conservator (of the estate) to expend funds necessary to provide for the overall well being of the protected person.

It is the role of the Guardian to assure safety and security of a protected person. This must be balanced with the unique need and values of the individual. The Guardian must also respect the dignity of that protected person, while maintaining their highest level of functioning.

Inherent in this process is the establishment of communication and availability of all parties to consult with one another. The support within a community is a vital element of successful and responsible guardianship, but the Guardian holds the ultimate responsibility for the overall care of the protected person. Care coordination is one system in which the guardian may employ other professional “eyes and ears” to be kept apprised of the status of the protected person, his functional abilities, and other support systems provided to a ward. This ancillary care coordinator is to a Guardian as the nurse to a doctor, the teacher to a principal, or the legal assistant to an attorney. The care coordinator is a necessary and desirable assistant in the best possible team effort for the best result. When is Guardianship necessary?

Some individuals can no longer receive or evaluate the information they need to make good decisions, or they cannot communicate good decision-making or demonstrate appropriate judgment to remain safe and healthy. Their need for assistance is brought to the attention of the court through a legal process. After an objective evaluation of the situation, a court visitor makes a recommendation to the court, and the proposed guardian is then approved and appointed by the court. The court visitor will evaluate several areas of concern: health care, adequate nutrition, safe shelter, appropriate clothing, management of finances and assets (if no conservator has been appointed), and the ability of the individual to protect him- or herself from general harm or exploitation.

What are some examples of decisions made by a Guardian?

Medical Care (including, but not limited to):

Consent to any invasive treatment
Surgery
IV’s for fluid balance or administration of medication
Mechanical heart/lung treatment
Feeding tube
Suctioning
Dialysis
Transfusions
Injections
Medications (especially antibiotic, chemo-therapeutic, mood altering, and psychoactive medications)
Diagnostic testing (including x-rays)
Change in level of care (behavioral or physical)
Admission to hospital or other facility in response to an acute change in level of care
Changes representing shifts in nutritional status
Procuring safe and supportive housing, including necessary change of residence
Financial management (if no Conservatorship is in place) to assure that the assets of the protected person are prudently used for their needs, and collecting income and assets to be carefully marshaled to provide for the care, comfort and safety of the ward. In addition, the guardian may apply for or seek additional benefits to which the ward may be entitled, establish a budget with necessary respect to the needs of the ward and prior obligations or dependents. The guardian may also be responsible for the payment of all costs relevant to the care of the ward (whether private pay or on public assistance).
Personal needs, such as clothing and personal care items.

What is Care Coordination?

Care coordination is a systematic approach to organizing a multitude of services, which may be required for the continuity of care and overall well being of specific individuals. Sometimes a “brokerage approach” is necessary to provide the best level of care, a variety of services, and the most cost-effective approach. Nancy Doty and her team are very versatile and highly skilled at finding the necessary resources and services to best meet the needs of the client for almost anything they may require, whether it is health related personal care services, or household assistance.

What are Care Coordination Expectations?

Participate in a team approach to identify, engage, and monitor services that enhance the overall well being of clients
Exhibit the professional knowledge and judgment necessary to address client needs as prioritized by acuity, client based values, service and resource availability, and cost effectiveness.
Respect the confidentiality, privacy, and rights of all clients at all times! When judgment (or requests not in the best interest of the client) might jeopardize client safety {or guardianship rights and responsibilities}, surrogate decision makers must overrule client desires.
Demonstrate responsibility for care planning, careful accounting of services provided, efficacy, and the time required for provision of those services.
Conduct at all times in a professional manner when representing the office to clients, other professionals and service providers, family members, and interested parties.
Document time spent and services rendered in such a way that will withstand program or financial audits. Honesty and accuracy are the by-words.
Abide by professional ethics, codes of conduct and standards including (but not limited to) the avoidance of conflicts of interest, professional boundary issues, and recognition of limitations of professional scope of practice.
Agree to maintain or upgrade skills and knowledge by attending appropriate and relevant workshops, seminars, and professional peer activities in the community.
Participate in routine opportunities for supervision and performance review.

What is Conservatorship?

Through a process similar to establishing a guardianship, a conservator may be appointed to manage the financial affairs of the protected person when they can no longer manage on their own. This may include such assets as income, real property, investments, and other intangible assets that must be protected from inappropriate wasting, exploitation, or other mismanagement.

The court demands that all assets are secured for the benefit of the protected person. Even though another individual is named as Conservator, they cannot spend or liquidate the assets except to provide for the best interest of the original owner—the protected person.

The court requires strict record keeping, and court personnel review an annual report.

What is Power of Attorney?

Durable Power of Attorney and Power of Attorney for Health Care are methods by which an individual (the principal) can give power to another (the Attorney in Fact) to conduct particular types of business or make health care decisions when the principal is incapable. It is specifically designed so the principal can identify a known and reliable family member, friend, or other trusted person to help*. All paperwork is done in advance of the incapability of the principal, and while the individual is still of sound mind (and under no duress). No one else has the right to designate an Attorney in Fact; only the principal can do it for himself or herself.

* It is important for the principal to select a reliable Attorney in Fact since there is no court involvement, no independent court visit, and no record-keeping or review requirements.

What is a Special Needs Trust?

In general, a Special Needs Trust is formed to allow a person to retain any public entitlements or benefits (such as Social Security) while setting aside any additional funds (such as an inheritance) for their long-term care and future needs. The funds are carefully managed for the individual’s enhanced quality of life.

What is an Income Cap Trust?

An Income Cap Trust is set into place when an individual receives too much income to qualify for Medicaid but not enough to cover their monthly care expenses. An Income Cap Trust allows a payment schedule for professional fees (trustee, guardianship, and care fees), and outstanding medical bills with any remaining monthly funds paid to the care facility. The Income Cap Trust is established via a cooperative plan with the State (Medicaid) and the Probate Court.

After the client is deceased, the Income Cap Trust is liquidated and paid to the state to offset any funds that were paid out by Medicaid during the individual’s care.

What is Conflict Resolution and Mediation?

Conflict resolution can be used to help resolve almost any type of dispute. Mediators may assist with parent/adult child or sibling conflicts, elder care issues, family concerns, care facility disputes, or estate dissolution and distribution. Other types of conflicts that respond well to alternative dispute resolution include health care disputes, fiduciary/client conflicts, and many others.

Mediation is a voluntary and confidential process in which a neutral/impartial person (the mediator) helps discuss difficult issues and concerns and assists in the resolution of a dispute and reaches a voluntary agreement. The mediator helps identify individual needs and interests, clarify differences, and find familiar ground. When parties enter into mediation, they are responsible for creating solutions. The mediator is the facilitator, not the decision maker, and does not have any power over the outcome.

The use of mediation in estate planning, guardianships, conservatorships, and intricate family relationships can reduce the probability of litigation, bring a swift answer to contentious issues, and increase the likelihood of a more satisfactory outcome.