When the State Takes Over a Life: The Public Guardian as Public Administrator

Abstract

Public guardians are appointed by the state to meet the needs of incapacitated citizens when no other willing or responsible surrogate decision maker exists. These public administrators, who live the decisional life of another citizen, need meaningful controls and accountability because of the great private and public authority that is entrusted to them. A review of program documents, interviews with public guardians and their program supervisors, and participant observations revealed complex roles for the public guardian: service monitor, service broker, client advocate, surrogate decision maker, and relationship architect. Because of the multiplicity of roles and few controls on their actions, public guardians' accountability should first be drawn from mechanical mechanisms (for instance, thorough audits and sanctions for infractions), but a second and necessary control is the principles of public administration, which are grounded in normative values and democratic governance.

Incapacitated and Alone: Prevalence of Unbefriended Residents in Alberta Long-Term Care Homes

“…In most cases, the individual who takes over legal guardianship is a family member or friend (Bayles & McCartney, 1987; Bulcroft, Kielkopf, & Tripp, 1991). However, public guardians may be called upon to serve when an individual has been adjudicated as incapacitated and no one is willing or able to assume guardianship (Teaster, 1997). In the Province of Alberta, capacity is defined as an individual’s mental ability to make decisions and it is based on an assessment of the individual’s ability to understand information that is relevant to a decision and to appreciate the foreseeable consequences of a decision (Government of Alberta, 2009).…”

Going it Alone: A Scoping Review of Unbefriended Older Adults

“…They are more likely to be single, childless, have fewer siblings, and limited financial resources when compared to older adults with a family or friend guardian (Reynolds & Carson, 1999 ; Reynolds & Wilber, 1997 ). Unbefriended older adults often have a diagnosis of a dementia or related cognitive impairment and multiple chronic diseases (Janofsky & Rovner, 1993 ; Reynolds, 1997b ; Teaster, 1997 ).…”

“…Our findings reveal an alarming lack of data on those residents who are unbefriended and living in institutional settings such as long-term care. Public guardianship imposes significant limitations on the older adult’s ability to decide location of residence, and when coupled with mental and physical limitations, means these individuals are likely to live in a long-term care facility (Reynolds, 1997b ; Teaster, 1997 ). Although research reports indicate that once older adults are placed under public guardianship they are more likely to be transferred to long-term care (Menio, Halperin, Campbell, & Reever, 2013 ; Reynolds, 1997b ; Reynolds & Carson, 1999 ), we found only one study specifically examining long-term care residents (Janofsky & Rovner, 1993 ).…”

Rethinking the education potential of older adults to delay the onset of dementia

“…As the number of older adults continues to rise, so does the cost of healthcare. In this case, an increased portion of the federal budget will be allocated to Medicare and Medicaid for which states must provide matching funds (Teaster, 2003). Additionally, the projected 2020 healthcare costs for long-term care and hospice services for those 65 and older with dementia are estimated to be $305 billion (Alzheimer's Association Report, 2020).…”