When a Client in Unable to Care for Self

When a client becomes incapable of making medical decisions and has not completed an advance directive, a surrogate must be assigned (ex. a parent, spouse, adult son or daughter, domestic partner, adult brother or sister, close friend, or two physicians who may choose to consult a medical ethics committee) to make medical decisions. If a client chooses, due to mental or physical incapability, a court may appoint a conservator to handle the client's financial affairs; this conservator must annually report allocation of client finances. After outside petition, if a court determines a person incapable of making financial decisions (an inability to provide for food, clothing, and shelter, or inability to protect against loss of property) a client may be assigned a conservator involuntarily. The conservator is still required to report annually to the court. With the assignment of conservator, the client may no longer sign checks, use credit cards, buy or mortgage property, or sign a lease or any contract involving finances; these functions may instead be performed by the conservator.

A guardian may be appointed by the court if a client is unable to care for him/herself. A guardian manages a client's financial affairs, as well as necessary personal management (food, clothing, shelter, medical care, etc.). Once appointed a guardian, the client may not vote, make contracts, choose a residency, choose medical treatment, travel at will, or sign checks. Court consent must be obtained for any decision involving institutional commitment, treatment with antipsychotic drugs, or subjection to intrusive medical procedures. In such cases, a case manager is responsible for documenting objective facts only (avoid subjective descriptions or opinions), avoiding derogatory comments, maintaining good communication with client and family, maintaining an understanding of diagnosis, allowing the client to be decision-maker, and maintaining consent and release forms.