Barriers Beyond Clinical Control Affecting Timely Hospital Discharge for a Patient Requiring Guardianship

The Burden of Guardianship: A Matched Cohort Study

“…The results of this study reflect the Massachusetts’ experience, with no public guardianship program or hierarchy statute. That being said, while this presumably causes the need for more guardianships in Massachusetts, the mechanisms for guardianship are broadly similar nationwide and are likely to result in excessive length of stay and cost similar to those in our population, as demonstrated in studies from other states 7,15‐17 …”

“…To our knowledge, this is among the first studies to investigate healthcare costs and harm to the patient in the form of hospital‐associated complications as a result of guardianship proceedings. Other studies 15,16 have also demonstrated excessive length of stay attributed to nonclinical factors such as guardianship, though they did not quantify the excess stay or compare guardianship cases with a matched control. One study 17 demonstrated total charges of $150,000 per patient requiring guardianship, which are similar to our results.…”

“…That being said, while this presumably causes the need for more guardianships in Massachusetts, the mechanisms for guardianship are broadly similar nationwide and are likely to result in excessive length of stay and cost similar to those in our population, as demonstrated in studies from other states. 7,[15][16][17] Implications At a time where medical systems are searching for opportunities to reduce the length of stay, prevent unnecessary hospitalization, and improve the quality of care, reevaluating the guardianship process is ripe with opportunity. In this single academic center, the process of guardianship was associated with 58% excess length of stay and 23% higher total hospital charges.…”