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Public Guardianship In the Best Interests of
Incapacitated People 1st Edition Pamela B. Teaster
Digital Instant Download
Author(s): Pamela B. Teaster, Winsor C. Schmidt Jr., Susan A. Lawrence
Ph.D., Marta S. Mendiondo, Erica F. Wood
ISBN(s): 9780313378270, 0313378274
Edition: 1
File Details: PDF, 1.64 MB
Year: 2010
Language: english
             PUBLIC
      GUARDIANSHIP
     In the Best Interests of
     Incapacitated People?
Preface                                                                  vii
Acknowledgments                                                          ix
1.   Introduction                                                         1
2.   State Statutory Analysis: Adult Guardianship
     and Public Guardianship Law                                         15
3.   Case Studies                                                        31
Appendices
      Appendix A: State Public Guardianship Statutory Charts            173
          Table 1: Statutory Authority and Type of Program              173
          Table 2: Procedural Due Process Safeguards in Guardianship    183
          Table 3: Assessment; Civil Liberties; Selection of Guardian   194
          Table 4: Powers and Duties of Guardians; Costs                202
          Table 5: Additional Guardianship Provisions                   208
      Appendix B: State Public Guardianship Profiles                    213
      Appendix C: Classification of Models by State                     247
Bibliography                                                            249
Index                                                                   255
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                                                            PREFACE
T
        he purpose of this book, which is based on two phases of research con-
        ducted in 2004 and 2007, is to advance public understanding about the
        operation and impact of state public guardianship laws and programs,
including a comparison of public guardianship today with public guardianship in
1981. The anticipated audience is not only the aging public, but also attorneys,
judges, policy makers, public administrators, researchers, aging and disability ad-
vocates, social workers, long-term care facility staff, gerontology and social work
students, law enforcement officials, professional guardians, and family and friend
guardians. There are private, professional, and public guardians all over the coun-
try, and the number of persons performing this function is increasing in terms of
both size and national visibility. There is a growing body of research on this topic
and the related issues of elder abuse, elder rights, and ethics. For individuals who
are public and professional guardians, this text will serve as an essential tool for
the job. Our book is useful both as a primary and as a supplemental textbook in
law schools, and for undergraduate and graduate programs that focus on geron-
tology, disability, social work, psychology, public health, public administration,
nursing, and health care management and policy.
This page intentionally left blank
                             ACKNOWLEDGMENTS
T
         he views expressed herein have not been approved by the House of Del-
         egates or the Board of Governors of the American Bar Association and
         should not be construed as representing the policy of the American Bar
Association.
    Preparation of this book was supported in part by The Retirement Research
Foundation.
    The authors are grateful for the support they received throughout this project.
The public guardianship staff, judges, lawyers, adult protective services workers,
aging and disability advocates, and incapacitated persons who participated in our
site visit interviews contributed greatly to our findings.
    In particular, we thank the following people who assisted with the project:
Anita Royal, Pima County, Arizona, Office of the Public Fiduciary; Richard Van-
derheiden, Phoenix, Arizona, Maricopa County Office of the Public Fiduciary;
Jane Adams, San Bernardino County, California, Office of the Public Guardian;
Christopher Fierro, Los Angeles County, California, Office of the Public Guard-
ian; Robin Williams-Bruner, Delaware, Office of the Public Guardian; Michelle
Hollister, Florida, Florida Statewide Public Guardianship Office; John Wank,
Illinois, Office of the State Guardian; Patrick Murphy, Cook County, Illinois,
Office of the Public Guardian; and Valarie Colmore, Suzanne Lord, and Sue
Vaeth, the Maryland Adult Public Guardianship Program.
    We thank the Virginia Public Guardians for helping us with case examples.
    Our advisory committee offered valuable perspectives that improved our re-
port: Karen Roberto, Virginia Polytechnic Institute and State University; Joy
Duke, Virginia Guardianship Association; David English, University of Missouri-
Columbia School of Law; Naomi Karp, AARP Public Policy Institute; Sally
Hurme, AARP Financial Security; and Marty Ford of the Arc of the United
States.
    We appreciate the assistance of Julie Kaufman at The Retirement Research
Foundation and the grant from the Foundation that made this project possible.
    We acknowledge all of the incapacitated persons served by the public guard-
ians and hope this report will contribute to their quality of life.
X                              ACKNOWLEDGMENTS
   We thank Jamie Philpotts of the ABA Commission on Law and Aging for
her excellent editorial assistance. We gratefully acknowledge the help of Debra
Dunn and Francis Vorksy, graduate students at the University of Kentucky Grad-
uate Center for Gerontology, as well as that of Post-Doctoral Scholar, Dr. Tenzin
Wangmo.
   Finally, we thank our colleagues, friends, and families for supporting us as we
worked on this project.
                                                                 Pamela B. Teaster
                                                            Winsor C. Schmidt Jr.
                                                                Susan A. Lawrence
                                                             Marta S. Mendiondo
                                                                    Erica F. Wood
                                                               Chapter 1
INTRODUCTION
   Mrs. K, at age 89, has lived in a small group home for over 20 years. During
   early adulthood, Mrs. K was diagnosed with schizophrenia and depression,
   and her sister had served as her guardian, but has recently died. Mrs. K
   never married, and had no relatives except a distant cousin in another state
   who expressed little interest. Now she is slowly losing mobility, has sig-
   nificant hearing loss, and is at risk for a stroke. Mrs. K has fallen and
   broken her shoulder. Moreover, the group home where she resides has not
   been paid for many months due to a Medicaid problem. Social services
   recommended that Mrs. K be served by the state’s public guardianship
   program.
   This book aims to shed light on how governments are carrying out their basic
parens patriae role for those who have no one else. Parens patriae literally means
“parent of the country” and refers to the vital role of a state as the sovereign and
guardian of people with legal disabilities.1
                                   O VERVIEW
   This chapter provides an introduction and overview of adult guardianship
and public guardianship, including key studies, news stories, and cases affecting
the evolution of guardianship. It also briefly describes the design, methods, and
procedures used to collect the data that serve as the foundation for this book.
                                B ACKGROUND
   Noted bioethicist Nancy Dubler observes that:
   The single greatest category of problems we encounter are those that ad-
   dress the care of decisionally incapable [individuals] . . . who have no liv-
   ing relative or friend who can be involved in the decision-making process.
   These are the most vulnerable . . . because no one cares deeply if they live
   or die, no one’s life will be fundamentally changed by the death of the
2                               PUBLIC GUARDIANSHIP
    resident. We owe these [individuals] the highest level of ethical and medical
    scrutiny; we owe it to them to protect them from over-treatment and from
    under-treatment; we owe it to them to help them to live better or to die in
    comfort and not alone.2
promoting better public guardianship programs and, thus, more meaningful lives
for unbefriended incapacitated persons (IPs) under the care of the state.
                           A DULT G UARDIANSHIP
Overview of Reform
   Guardianship is a relationship created by state law in which a court gives one
person (the guardian) the duty and power to make personal and/or property deci-
sions for another (the ward or legally incapacitated person).8 The appointment of
a guardian occurs when a judge decides that an individual lacks the legal capacity
to make decisions on his or her own behalf. Adult guardianship protects legally
incapacitated individuals and provides for their decisional needs while simultane-
ously removing fundamental rights.9 Guardianship can “unperson” individuals
and make them “legally dead.”10 Guardianship can be a double-edged sword,
“half Santa and half ogre.”11
   Early studies of protective proceedings, including guardianship, found little
benefit for the legally incapacitated person (IP) and concluded that many peti-
tions were filed for the benefit of third parties, or based on well-meaning but
ineffective motivations to aid vulnerable groups.12 Despite the initial reform ef-
forts of the 1970s and 1980s, state guardianship remained an unexamined area
governed by archaic terms, inconsistent practices, drastic paternalistic interven-
tions, little attention to rights, and meager accountability.13
   In 1986, the Associated Press undertook a one-year investigation of adult
guardianship in all 51 jurisdictions, including more than 2,200 randomly se-
lected guardianship court files and multiple interviews with a range of infor-
mants. The resulting six-part national series presented in 1987, Guardians of
the Elderly: An Ailing System, described a troubled process: “a crucial last line
of protection for the ailing elderly, [that] is failing many of those it is designed
to protect.”14 In quick response, the U.S. House Select Committee on Aging
convened a hearing,15 which, in turn, triggered an interdisciplinary National
Guardianship Symposium in 1988 (the Wingspread Conference) that resulted in
recommendations covering procedural issues, capacity assessment, and guardian
accountability.16
   These events precipitated a rush to reform state guardianship laws, highlighted
by five marked trends: (1) enhanced procedural due process in the appointment
of a guardian; (2) a more robust determination of capacity based not only on
medical condition, but also on functional ability, cognitive impairments, risks,
and values; (3) an emphasis on limited orders that were more tailored to the
specific capacities of the individual; (4) bolstered court monitoring of guardians;
and (5) the development of public guardianship programs.17 A Uniform Guard-
ianship and Protective Proceedings Act (UGPPA) was developed in 1982 and
updated in 1997.18
4                                PUBLIC GUARDIANSHIP
Empirical Research
   Few empirical studies of guardianship exist. In 1972, Alexander and Lewin
studied over 400 guardianships and concluded that as a device of surrogate man-
agement, third parties use it to protect their own interests:
Recent Developments
    Significant events over the past several years have refocused public attention
on the nation’s adult guardianship system. In 2001, seven national groups con-
vened a second national guardianship conference (the Wingspan Conference) to
assess progress on reform. The conference resulted in recommendations for ac-
tion on mediation, the role of counsel, the use of limited guardianship, fiduciary
and lawyer liability, and guardian accountability.24 In 2004, many groups recon-
vened to develop specific steps for the implementation of selected Wingspan
recommendations.25
    Meanwhile, in 2002, a District of Columbia court of appeals overturned a
lower court decision, In re Orshansky,26 that highlighted critical guardianship is-
sues. This case and other guardianship rumblings prompted a U.S. Senate Com-
mittee on Aging hearing in 2003, “Guardianships Over the Elderly: Security
Provided or Freedoms Denied,”27 which, in turn, prompted a study by the U.S.
Government Accountability Office (GAO). The GAO study, Guardianship: Col-
laboration Needed to Protect Incapacitated Elderly People, included findings on
variations in guardianship oversight, lack of data on guardianship proceedings
and IPs, problematic interstate guardianship issues, and lack of coordination
between state courts handling guardianship and federal representative payment
programs.28
    In 2005, Quinn produced a comprehensive text about guardianship for com-
munity health and social services practitioners.29 Also in 2005, the Los Angeles Times
published a comprehensive series titled Guardians for Profit, highlighting problems
with professional conservators in Southern California,30 which sparked state legis-
lative action in 2006. A survey by Karp and Wood in 2006 found continued wide
variation in guardianship monitoring practices, a frequent lack of guardian report
and accounts verification, limited visitation of individuals under guardianship, and
minimal use of technology in monitoring.31 In 2007, the National Conference of
Commissioners on Uniform State Laws produced the UGPPA.32 States continued
to make changes in their laws, with at least 14 states passing a total of 27 adult
guardianship bills in 2007, and 15 states passing 18 adult guardianship bills in
2008.33
                           P UBLIC G UARDIANSHIP
DeÞnition and Overview
   An important subset of guardianship is public guardianship, which provides
a last resort when there is no one willing or appropriate to help—usually for
some at-risk, low-income incapacitated adults. A public guardian is an entity
that receives most, if not all, of its funding from a governmental entity. Public
guardianship programs are funded through state appropriations, Medicaid funds,
county monies, legislated fees from the IP, or some combination of these. Public
guardianship programs may serve several distinct populations: (1) older IPs who
6                               PUBLIC GUARDIANSHIP
have lost decisional capacity, (2) individuals with mental retardation and/or devel-
opmental disabilities who may never have had decisional capacity, and (3) adults
of all ages with mental illness or brain injury.
   State public guardianship programs are operated from a single statewide of-
fice, or have local or regional components. They are either entirely staff-based
or may operate using both staff and volunteers. Public guardians may serve as
guardian of the property, guardian of the person, and sometimes as a representa-
tive payee or other surrogate decision-maker. They can also provide case man-
agement, financial planning, public education, social services, adult protective
services (APS), or serve as guardian ad litem (GAL), court investigators, and/or
advisors to private guardians.
Empirical Research
    As with private guardianship, few published studies exist on the need for
public guardianship and on the operation of public guardianship programs. In
1987, Schmidt and Peters studied the unmet need for guardians in Florida and
found over 11,000 individuals in need, typically female, elderly, and predomi-
nantly white, with many having both medical and psychiatric conditions.34 In
1990, Hightower, Heckert, and Schmidt assessed the need for public limited
guardianship, conservator, and other surrogate mechanisms among elderly nurs-
ing home residents in Tennessee and found over 1,000 residents needing a surro-
gate decision maker.35 A 2000 report by Florida’s Statewide Public Guardianship
Office stated that the need for public guardianship was approaching crisis pro-
portions and estimated that 1.5 guardianships were needed per 1,000 people in
the population.36
    In comparison, Schmidt reported that the overall guardianship annual filing
rate ranged from 1 of every 1,785 (.056 percent) for Florida in 1977, to 1 of
every 1,706 (.059 percent) for 6 states (Delaware, Minnesota, North Carolina,
Ohio, Washington, and Wisconsin) in 1979,37 and half a million people total
under guardianship in the United States in 1995.38 Kroch most recently reported
the ratios of the international population adjudicated with guardianship and
trusteeship orders ranging from 0.444 in Alberta, Canada in 2003, to 0.459 for
Israel, 0.625 for Austria, 0.721 for Ontario, Canada, 0.850 in Switzerland, and
1.345 in Germany.39
    Schmidt and colleagues conducted the landmark national study of public guard-
ianship, published in 1981. The study sought to “assess the extent to which pub-
lic guardianship assists or hinders older persons in securing access to their rights,
benefits, and entitlements.”40 The study reviewed existing and proposed public
guardianship laws in all states and focused intensively on the most active and ex-
perienced states (Arizona, California, Delaware, Maryland, and Illinois), as well as
one state without public guardianship (Florida, which has since enacted a public
guardianship statute). Using Regan and Springer’s taxonomy, Schmidt classified
                                  INTRODUCTION                                     7
public guardianship programs into the following models: (1) court, (2) indepen-
dent state office, (3) division of a social service agency, and (4) county.
    The study findings focused on the individuals served, program characteris-
tics (staff size and qualifications), funding, legal basis, due process safeguards,
oversight, and other areas. The study confirmed the need for public guardian-
ship. However, it stated that “public guardianship offices seem to be understaffed
and underfunded, and many of them are approaching the saturation point in
numbers.”41 The study found that, consequently, many IPs received little per-
sonal attention, and noted that there were identified instances of abuse. A core
conclusion for the extent to which public guardianship assists or hinders legally
incapacitated people in securing access to their rights, benefits, and entitlements
was expressed as follows:
characteristics, and needs. The study determined that the programs were per-
forming reasonably well and recommended an extension of the geographic reach
to cover all areas of the state. Other recommendations addressed the need for
rigorous standardized procedures and forms for client assessment, care plans,
guardian time accounting, regular program review of these documents, the need
for an established guardian-to-client ratio, increased fiscal support, and greater
attention to meeting the needs outlined in the care plans. Importantly, the
study determined that the public guardianship program saved the state a total
of over $2,600,000 for each year of the evaluation period through placements
in less restrictive settings and the recovery of assets (at a total program cost of
$600,000).48 Fourth, when the Utah legislature created a public guardian office
in 1999, it required an independent program evaluation by 2001. The evaluation
included on-site visits, interviews, and case file reviews. The study recommended
additional resources and staff, a continued location within the Department of
Human Services, the development of a unified statewide system, and a system in
which the office would not act as petitioner, as well as additional record-keeping,
and educational suggestions.49
                                 J USTIFICATION
   As this national public guardianship study was being proposed, there was
widespread agreement among experts in the aging and disability fields regarding
the need for increased attention to guardianship practices in general and public
guardianship in particular. The 2001 national Wingspan Conference on guardian-
ship50 recommended that “research be undertaken to measure successful practices
and to examine how the guardianship process is enhancing the well-being of per-
sons with diminished capacity.” Specifically concerning public guardianship, the
recommendations urged that “states provide public guardianship services when
other qualified fiduciaries are not available;” that “the public guardianship func-
tion [should] include broad-based information and training; ” that “guardianship
agencies [ . . . ] should not directly provide services, such as housing, medical care,
and social services to their own wards, absent court approval and monitoring;”
and that “funding for development and improvement of public [ . . . ] guardian-
ship services should be identified and generated.”
   Despite substantial social and demographic changes since the 1981 Schmidt
study, only a handful of state and local studies had examined the institution of
public guardianship until the 2005 national study.
                            R ESEARCH M ETHODS
   A detailed elaboration of the research methods used for the first national study
of public guardianship in 25 years is beyond the scope of this book. Specific de-
scriptions of the research methods are available elsewhere.51
                                      INTRODUCTION                                         9
    The purpose of the 2005 national public guardianship study was to update the
1981 study conducted by Schmidt and colleagues, which assessed the extent to
which public guardianship assists or hinders older persons in securing access to
their rights, benefits, and entitlements. Like its 1981 predecessor, this study used
multiple case studies to clarify the face of public guardianship. To improve the
science of the study, the original data-gathering instruments (i.e., surveys) were
refined, and disciplines from which the pool of informants was gathered were
increased. This approach is consistent with the iterative nature of qualitative in-
quiry.52 Using Schmidt’s 1981 effectiveness criteria as a baseline against which to
measure, this study attempted to discover how public guardianship had changed
since the original study.
    To replicate the original study, the public guardianship programs in Arizona
(Maricopa and Pima counties), California (Los Angeles and San Bernardino
counties), Delaware, Florida, Illinois, and Maryland were investigated. Devia-
tion from the original study occurred in one instance; the original study included
Alameda County in California. Although letters of support were obtained from
the public guardianship program in Alameda County, Alameda withdrew after
funding was awarded.53
    Before presenting the examination of the individual states, Chapter 2 ana-
lyzes the legal basis for public guardianship and the state public guardianship
statutes.
                                         N OTES
      1. Parens patriae is the alleged authority of a sovereign to act as “the general guard-
ian of all infants, idiots and lunatics” (English common law terminology). Hawaii v.
Standard Oil Co. of California, 405 U.S. 251, 257 (1972) (quoting three W. Blackstone,
Commentaries *47). For a more detailed note on the etiology for parens patriae, ranging
from a 17th-century printer’s error, to a rationalization to exclude juveniles from con-
stitutional protection, to the confinement of persons with mental illness and protective
services for the elderly, see, for example, Winsor Schmidt, “A Critique of the American
Psychiatric Association’s Guidelines for Legislation on Civil Commitment of the Mentally
Ill,” New England Journal on Criminal and Civil Confinement 11, no. 1 (1985): 14–15,
note 20. Cf. O’Connor v. Donaldson, 422 U.S. 563, 583–584 (1975) (Burger, C. J., con-
curring) (“The existence of some due process limitations on the parens patriae power does
not justify the further conclusion that it may be exercised to confine a mentally ill person
only if the purpose of the confinement is treatment”).
      2. Nancy Dubler quoted in Naomi Karp and Erica Wood, Incapacitated and Alone:
Health Care Decision-Making for the Unbefriended Elderly (Washington, DC: American
Bar Association Commission on Law and Aging, 2003), 1.
      3. Cf. Peter Conrad and Joseph Schneider, Deviance and Medicalization: From
Badness to Sickness (Philadelphia: Temple University Press, 1992); Nicholas Kittrie, The
Right to Be Different: Deviance and Enforced Therapy (Baltimore: Johns Hopkins Press,
1971). See also Sandra Reynolds, “Guardianship Primavera: A First Look at Factors As-
sociated with Having a Legal Guardian Using a Nationally Representative Sample of
10                                   PUBLIC GUARDIANSHIP
Community-Dwelling Adults,” Aging and Mental Health 6, no. 2 (2002): 109 (“Particu-
larly for older adults, increasing age, having physical or emotional limitations, a small
family network, and not living with a spouse are associated with having a guardian”).
       4. Annina Mitchell, “Involuntary Guardianship for Incompetents: A Strategy for
Legal Services Advocates,” Clearinghouse Review 12, no. 8 (1978): 466. See also Kent
Miller, Managing Madness: The Case Against Civil Commitment (New York: Free Press,
1976).
       5. Winsor Schmidt et al., Public Guardianship and the Elderly (Cambridge, MA:
Ballinger Publishing Company, 1981).
       6. Pamela Teaster et al., Wards of the State: A National Study of Public Guardianship
(Lexington, KY: University of Kentucky Graduate Center for Gerontology, 2005). The
data for the study were collected in 2004.
       7. Ibid.
       8. Portions of this section are based on Pamela Teaster et al., “Wards of the State:
A National Study of Public Guardianship,” Stetson Law Review 37, no. 1 (2007): 193–241
(describes the Phase I national study and results). Courtesy of the Stetson Law Review.
       9. In most states, a finding of legal incapacity restricts or takes away the right to:
make contracts; sell, purchase, mortgage, or lease property; initiate or defend against suits;
make a will, or revoke one; engage in certain professions; lend or borrow money; appoint
agents; divorce, or marry; refuse medical treatment; keep and care for children; serve on
a jury; be a witness to any legal document; drive a car; pay or collect debts; and manage
or run a business. Robert Brown, The Rights of Older Persons (New York: Avon Books,
1979), 286.
      10. Fred Bayles and Scott McCartney, Guardians of the Elderly: An Ailing System (As-
sociated Press Special Report, Sept. 1987). See also Winsor Schmidt, “Guardianship of
the Elderly in Florida: Social Bankruptcy and the Need for Reform,” in Winsor Schmidt,
ed., Court of Last Resort for the Elderly and Disabled 6 (Durham, NC: Carolina Academic
Press, 1995), 6: “The loss of any one of these rights can have a disastrous result, but taken
together, their effect is to reduce the status of an individual to that of a child, or a nonper-
son. The process can be characterized as legal infantalization.”
      11. John Regan and Georgia Springer, U.S. Senate Special Committee on Aging,
Protective Services for the Elderly: A Working Paper. (Washington, DC: GPO, 1977), 27.
      12. George Alexander and Travis Lewin, The Aged and the Need for Surrogate Man-
agement (Ithaca, NY: Cornell University Press, 1972); Margaret Blenkner, Martin Bloom,
and Margaret Nielsen, “A Research and Demonstration Project of Protective Services,”
Social Casework 52, no. 8 (1971): 483–499; Margaret Blenkner et al., Final Report: Protec-
tive Services for Older People: Findings from the Benjamin Rose Institute Study (Cleveland,
OH: Benjamin Rose Institute, 1974). Cf., for example, “Experience should teach us to
be most on our guard to protect liberty when the Government’s purposes are beneficent.
Men born to freedom are naturally alert to repel invasion of their liberty by evil-minded
rulers. The greatest dangers to liberty lurk in insidious encroachment by men of zeal, well-
meaning but without understanding.” Olmstead v. United States, 277 U.S. 479 (1928)
(Brandeis, J., dissenting).
      13. Peter Horstman, “Protective Services for the Elderly: The Limits of Parens
Patriae,” Missouri Law Review 40, no. 2 (1975): 215–236; Mitchell, 451–468; Roger
Peters, Winsor Schmidt, and Kent Miller, “Guardianship of the Elderly in Tallahassee,
Florida,” The Gerontologist 25, no. 5 (1985): 532–538; Regan and Springer, op. cit.; Win-
                                      INTRODUCTION                                       11
sor Schmidt, “Guardianship of the Elderly in Florida: Social Bankruptcy and the Need
for Reform,” Florida Bar Journal 55, no. 3 (1981): 189–195; Erica Wood, Statement of
Recommended Judicial Practices on Guardianship Proceedings for the Aging (Washington,
DC: American Bar Association Commission on Legal Problems of the Elderly and Na-
tional Judicial College: 1986); National Conference of Commissioners on Uniform State
Laws, Uniform Guardianship and Protective Proceedings Act (1982); The Center for Social
Gerontology, Guidelines for Guardianship Service Programs (Ann Arbor, MI: Center for
Social Gerontology: 1986).
      14. Bayles and McCartney, Guardians of the Elderly.
      15. U.S. House of Representatives, Select Committee on Aging, Abuses in Guard-
ianship of the Elderly and Infirm: A National Disgrace (GPO Committee Publication No.
100-641: 1987).
      16. American Bar Association Commission on the Mentally Disabled and Commission
on Legal Problems of the Elderly, Guardianship: An Agenda for Reform—Recommendations of
the National Guardianship Symposium and Policy of the American Bar Association (Washing-
ton, DC: American Bar Association: 1989).
      17. See state statutory charts on adult guardianship, as well as the annual update, on
the Web site of the ABA Commission on Law and Aging at http://www.abanet.org/aging/
legislativeupdates/home.shtml.
      18. National Conference of Commissioners on Uniform State Laws, http://www.
law.upenn.edu/bll/archives/ulc/ugppa/guardsh2.htm.
      19. For example, Frank Johns, “Guardianship Folly: The Misgovernment of Parens
Patriae and the Forecast of Its Crumbing Linkage to Unprotected Older Americans in the
Twenty-First Century—A March of Folly? Or Just a Mask of Virtual Reality,” Stetson Law
Review 27, no. 1 (1997): 1–93.
      20. Alexander and Lewin, The Aged and the Need for Surrogate Management, 136.
      21. Blenkner, Bloom, and Nielsen, “A Research and Demonstration Project”; Blenk-
ner, Bloom, Nielsen, and Weber, Protective Services for Older People.
      22. Mark Lachs, Christianna Williams, Shelly O’Brien, and Karl Pillemer, “Adult
Protective Service Use and Nursing Home Placement,” The Gerontologist 42, no. 6 (2002):
734–739 (“[I]t is remarkable that controlled studies of differential outcomes of APS have
not been conducted. A review of the literature shows no systematic attempt to evaluate
program outcomes or to examine unintended consequences of APS intervention”). See
also Sandra Reynolds and L. Carson, “Dependent on the Kindness of Strangers: Profes-
sional Guardians for Older Adults Who Lack Decisional Capacity,” Aging and Mental
Health 3, no. 4 (1999): 301–310 (“Wards with family guardians were more likely to be
living in the community than those with professional guardians”).
      Cf., for example, Robert Davis and Juanjo Medina-Ariza, Results from an Elder Abuse
Prevention Experiment in New York City (National Institute of Justice: Sept. 2001) (“New
incidents of abuse were more frequent among households that both received home visits
and were in housing projects that received public education”) at http://www.ojp.usdoj.
gov/nij. See also Winsor Schmidt, “Quantitative Information About the Quality of the
Guardianship System: Toward a Next Generation of Guardianship Research,” Probate
Law Journal 10 (1990): 61–80.
      23. Lauren Lisi, Anne Burns, and Kathleen Lussenden, National Study of Guardian-
ship Systems: Findings and Recommendations (Ann Arbor, MI: Center for Social Gerontol-
ogy: 1994).
12                                PUBLIC GUARDIANSHIP
      39. Uri Kroch, “The Experience of Being A Dependent Adult (Ward)-A Hermeneu-
tic Phenomenological Study” (Ph.D. thesis, University of Calgary, 2009), 57.
      40. Schmidt et al., Public Guardianship and the Elderly, 3.
      41. Ibid., 172.
      42. Schmidt, “Guardianship of the Elderly in Florida,” 192. See also Schmidt et al.,
Public Guardianship and the Elderly, 16–17, 34, 38, 170, 174–175, 183–184, 193.
      43. Schmidt, Guardianship: Court of Last Resort.
      44. Pamela Teaster, “When the State Takes Over a Life: The Public Guardian as
Public Administrator,” Public Administration Review 63, no. 4 (2003): 396–404.
      45. Winsor Schmidt et al., “A Descriptive Analysis of Professional and Volunteer
Programs for the Delivery of Guardianship Services,” Probate Law Journal 8, no. 2 (1988):
125–156 (1988); Winsor Schmidt, “The Evolution of a Public Guardianship Program,”
Journal of Psychiatry and Law 12, no. 3 (1984): 349–372.
      46. Winsor Schmidt et al., Second Year Evaluation of the Virginia Guardian of Last
Resort and Guardianship Alternatives Demonstration Project (Memphis: The University of
Memphis Center for Health Services Research, 1997).
      47. Pamela Teaster et al., “Staff Service and Volunteer Staff Service Models for Pub-
lic Guardianship and ‘Alternatives’ Services: Who Is Served and With What Outcomes?”
Journal of Ethics, Law, and Aging 5, no. 2 (1999): 131–151.
      48. Pamela Teaster and Karen Roberto, Virginia Public Guardian and Conservator
Programs: Summary of the First Year Evaluation (Virginia Department for the Aging,
2002). See also Pamela Teaster and Karen Roberto, Virginia Public Guardian and Conser-
vator Programs: Evaluation of Program Status and Outcomes (Blacksburg: The Center for
Gerontology, Virginia Polytechnic Institute and State University, 2003), pp. 11–16; Pa-
mela Teaster, et al., The Florida Public Guardian Programs: An Evaluation of Program Sta-
tus and Outcomes (Lexington: University of Kentucky Graduate Center for Gerontology,
2009)(cost savings to Florida of over $1.8 million in one year from public guardianship),
http://www.panhandleparade.com/index.php/mbb/article/study_public_guardianship_
programs_save_florida_taxpayers_1.9_million/mbb7718858/.
      49. Center for Social Gerontology, Utah Office of Public Guardian: Program Evalua-
tion (Ann Arbor, MI: Center for Social Gerontology, 2001).
      50. Symposium, Wingspan Conference.
      51. Teaster et al., Wards of the State (2005): i–ii, 6, 61–62; Teaster et al., Public
Guardianship After 25 Years: 5, 21–26.
      52. John Creswell, Research Design: Qualitative and Quantitative Approaches (Thou-
sand Oaks, California: Sage Publications, 1994); Matthew Miles and A. Michael Hu-
berman, An Expanded Sourcebook: Qualitative Data Analysis, 2nd ed. (Thousand Oaks,
California: Sage Publications, 1994).
      53. The following is the verbatim e-mail response from Alameda County. “I’m sorry,
but our County Counsel indicated to you previously that Alameda County will not be
participating in this survey. Sorry the information did not reach you!” The research team
never received such information from the county counsel. Subsequent entreaties by the
principal investigator and project manager to conduct a limited version of the site visit
went unanswered.
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                                                              Chapter 2
T
        wo adult daughters clashed over the care of their mother. One claimed
        that her sister drained the mother’s bank account and neglected her care.
        Without checking with anyone, she brought her mother to live with her.
The second daughter disputed the allegations and contended that the move
was abusive. APS filed a petition naming the public guardianship program as
the proposed guardian. What would be the process for appointment? Would
the mother receive notice? Have an attorney? Have rights at the hearing? What
would be the court’s criteria for determining whether the mother is incapaci-
tated and requires a guardian? What would be the criteria for selecting the public
guardianship program? If appointed, what accountability would the program
have to the court? If the mother receives insufficient care and services, to what
extent can the program challenge care providers and zealously advocate for her
interests?
                                  O VERVIEW
   This chapter provides a summary analysis of state adult guardianship statutes,
highlighting public guardianship provisions. It includes eligibility, scope, peti-
tioners, investigation and examination, due process protections, rights, powers,
costs, and review and monitoring, and outlines key statutory changes over time.
                                B ACKGROUND
   As with the 1981 study, one of the first tasks of the national public guardian-
ship study was to research state statutes to identify jurisdictions with provisions
for public guardianship. In addition, the new study’s practitioners conducted
statutory research and analysis, constructing a table matching the one established
in the original 1981 work.1 (The 2007 table is broken into five sub-tables for ease
of reading.) The tables (Appendix A), as well as the commentary below (updated
to 2007 unless otherwise indicated), generally use the framework of the 1981
table, thus providing two directly comparative snapshots across 26 years. (How-
ever, the 1981 Schmidt table includes only the 34 states with statutory provisions
16                                PUBLIC GUARDIANSHIP
for public guardianship, whereas the current table includes all states.) Both tables
integrate basic elements of state adult guardianship and conservatorship statutes
with more specific provisions concerning public guardianship, as an understand-
ing of public guardianship statutes requires a close look at the state guardianship
codes on which they are based. Indeed,
     the public guardian, and the public guardian process, do not exist in isola-
     tion . . . [but are] an end point in the process of guardianship, which itself
     seems to exist in a continuum of protective services and civil commitment.
     In fact, the success of a public guardian seems to be quite dependent upon
     the quality of the state’s guardianship statute.2
   Public guardianship programs are shaped by the overall contours of the state
guardianship codes that determine the procedures for appointment, the defini-
tion of incapacity, the powers and duties of guardians, and the mechanisms for
judicial oversight. For updated state adult guardianship tables with citations for
each provision, see the Web site of the ABA Commission on Law and Aging at
http://www.abanet.org/aging/guardianship/lawandpractice/home.html.
                            S TATUTORY P ROVISIONS
   Adult guardianship is a state, rather than a federal, function. All states have a
general guardianship code. These laws have undergone significant change in the
past two decades, with particular emphasis on procedural protections, the deter-
mination of capacity, limited guardianship, and court oversight.3 These state laws
provide the foundation for public guardianship.
   As of 2007, a total of 44 states4 had specific statutory provisions on public
guardianship. Seven states included no such reference in their code. Public guard-
ianship provisions are most frequently included as a section of the state guardian-
ship code. But in some states, the public guardianship provisions are located in
separate statutory sections, such as, for example, services for the aging, APS, or
services for individuals with disabilities.5
   In 1981, Schmidt distinguished between “explicit” and “implicit” public
guardianship provisions:
     One can distinguish between explicit public guardianship statutes that spe-
     cifically refer to a “public guardian” and implicit statutes that seem to pro-
     vide for a mechanism equivalent to public guardianship without actually
     denominating the mechanism as “public guardian.” The distinction is often
     nominal at best. Although an explicit scheme often indicates a progressive
     trend in this field, this is not always true. Indeed, several of the implicit
     schemes are even more progressive than the typical explicit statute.6
                             STATE STATUTORY ANALYSIS                               17
designee may serve as the conservator for patients of mental health facilities
whose fees do not exceed $10,000 per year.
   In addition, a number of state statutes specify services for persons with fi-
nancial limitations. Connecticut limits services to those with assets that do not
surpass $1,500. Florida indicates that services are primarily for those of “limited
financial means.” In Indiana, services are for indigent adults, as defined adminis-
tratively. In Illinois, one scheme serves individuals with estates of $25,000 or less
and another serves individuals whose estates are over $25,000. In Virginia, the
public guardianship program serves IPs whose resources are insufficient to fully
compensate a private guardian or pay court costs and fees. In the state of Wash-
ington, under a law enacted in 2007, the office of public guardianship serves
individuals whose incomes do not exceed 200 percent of the federal poverty level
and who are receiving Medicaid long-term care services. On the other hand,
Mississippi law specifies that the appointment of a clerk as guardian is only for “a
ward who has property.”
                       D UE P ROCESS P ROTECTIONS
                     IN G UARDIANSHIP P ROCEEDINGS
   In the quarter century since the Schmidt study, state procedural protections
for respondents in guardianship proceedings have undergone a paradigm shift,
with virtually all states bolstering the requirements for due process protections.
Schmidt discovered that 5 of the 34 states studied made no provision for a hear-
ing. Today, all states provide for a hearing. In 1981, 29 of the states studied
required notice to the respondent, as well as to family members and other inter-
ested parties. Today, all states require notice. Moreover, many state notice provi-
sions now require large print and plain language, as well as information about
hearing rights and the rights potentially lost as the result of the hearing. In ad-
dition, states generally maintain that the respondent has a right to be present at
the hearing. An increasing number go beyond this entitlement to require the
respondent’s presence unless it would be harmful or there is other good cause for
his or her absence. Courts today are subject to the provisions of the Americans
with Disabilities Act, which call for reasonable accommodations at the person’s
request.
Free counsel for indigents. In 1981, 17 states made counsel available free
of charge to indigent persons. Today, over 20 states provide for such free counsel
in their guardianship statutes, and there may be additional states with relevant
provisions in other parts of the code.
Right to jury trial. Eleven of the states studied in 1981 gave the individual the
opportunity to have a trial by jury. Today, 27 states provide for trial by jury if the
respondent requests it. It is particularly notable that Kentucky makes a jury trial
mandatory in every adult guardianship case.
Today, 35 state guardianship statutes provide for this important right, and there
are probably additional states with relevant provisions in the rules of evidence or
civil procedure.
Standard of proof. The Schmidt study found only a couple of states that used
a “clear and convincing evidence” standard of proof. Today, a total of 36 states
require clear and convincing proof that the respondent lacks decisional capacity
and requires a guardian. One state (New Hampshire) uses a standard of “beyond
a reasonable doubt”; two (North Carolina and Washington) use a standard of
“clear, cogent, and convincing evidence”; one (Wyoming) uses a mere “prepon-
derance of the evidence”; two (Idaho and South Carolina) state that the court
must be “satisfied” that a guardian is necessary; and the remaining eight states
provide no statutory standard.
Appeal/review. In 1981, only three of the states provided a direct and immedi-
ate review of the findings of a guardianship proceeding. Today, some 29 states
refer to an appeal or review within their guardianship statutes. However, there
may be additional states with relevant provisions in the rules of civil procedure.
right to vote) are personal in nature and not delegable to the guardian. Thus,
they are either retained or lost under guardianship, but not transferred. Other
fundamental rights are delegable, but state law may include a presumption that
the individual retains them unless they are specifically removed in the court
order (see the section on limited guardianship below). Schmidt found that only
10 state statutes explicitly preserved the civil liberties of IPs.
   Today, 27 state laws include a provision designed to preserving basic rights.
For example, such a provision may state that the individual under guardian-
ship “retains all legal and civil rights except those which have been expressly
limited by court order or have been specifically granted by order to the guard-
ian by the court.” Florida has one of the most extensive provisions, setting out
the rights retained by the individual (such as the right to retain counsel, to
receive visitors and communicate with others, to privacy); rights that may be
removed by court order, but not delegated to the guardian (such as the right to
marry, vote, have a driver’s license); and rights that are removable and delega-
ble to the guardian (such as the right to contract, to sue, and to defend against
lawsuits).
                       W HO S ERVES        AS   G UARDIAN
    Guardians are family members, other individuals, professionals, private non-
profit or for-profit agencies, or public guardianship entities. In 1981, Schmidt
found that about one-third of the states used “the usual probate priority scheme,”
that is, a hierarchy that provides for the appointment of a spouse, adult child,
parent, or other relative. Such a list often states that any suitable person or insti-
tution may serve, and that the court should make the selection in the best interest
of the incapacitated individual.
    Today, most states continue to offer such a hierarchical scheme, building suf-
ficient court discretion to act in the IP’s best interest. In addition, 43 states in-
clude a mechanism for the input of the IP in the form of advance nomination
of a guardian, the most recent nomination of an agent under a durable power
of attorney “in accordance with the IP’s stated wishes,” or the “person preferred
by IP.”
    A recent examination of APS laws found that approximately 11 states specifi-
cally allow the APS agency to serve as the guardian of an APS client, either on a
temporary or permanent basis.13
1981 study and the project’s national survey. As explained above, an important
distinction evident in comparing the statutory schemes is between states that
merely name a state agency or employee as a last resort guardian (generally, im-
plicit schemes) and states that establish an office with the sole mandate of serv-
ing as public guardian (generally, explicit schemes). States that establish a public
guardianship office (such as Delaware, Florida, Virginia, New Jersey, Utah, and a
number of others), have detailed statutory provisions on powers and duties, staff-
ing, funding, record keeping, and review.
   Schmidt relied on an earlier classification by Regan and Springer using four
models: (1) a court model; (2) an independent state office; (3) a division of a
social service agency; and (4) a county agency. He noted, however, that while the
four models “at first appeared to provide a useful classification,” upon further
analysis, there were “many exceptions and variations” and that “few states fit the
exact organization described in the models.” This study uses the same classifica-
tion, with the same caveat.
Court model. The court model establishes the public guardianship office as an
arm of the court that has jurisdiction over guardianship and conservatorship.
In 1981, there were six states with a court model for public guardianship. In
2007, statutory provisions revealed five. In Delaware, Hawaii, Mississippi, and
Washington, the public guardian is located in the judiciary. In Georgia, recent
legislation created a public guardianship program in which qualified and trained
individuals are approved and registered by the county probate court to serve as
public guardians, yet the training, administration, and funding of the program
is conducted through the Division of Aging in the Department of Human Re-
sources, which must maintain a master list of registered public guardians.
     The agency’s primary priority may be expedient and efficient dispersal of its
     various forms of financial and social assistance. This can be detrimental to
     the effectiveness of the agency’s role as guardian. If the ward is allocated in-
     sufficient assistance, if payment is lost or delayed, if assistance is denied alto-
     gether, or if the ward does not want mental health service, it is unlikely that
     the providing agency will as zealously advocate the interests of that ward.14
    Schmidt found that over one-half of the states studied configured the public
guardianship function in a manner that presented a conflict of interest between
the role of guardian (deciding on, monitoring, and advocating for services) and
the role of the social services agency (providing services). That is largely still true
today. The percentage of states with statutes providing a potential for conflict
appears to have increased. More than half of the 44 states with public guard-
ianship statutory provisions name a social service, mental health, disability, or
aging services agency as guardian, or as the entity to coordinate or contract for
guardianship services. For example, Connecticut names the Commissioner of So-
cial Services. New Hampshire authorizes the Department of Health and Human
Services to contract for public guardianship services. Vermont, Virginia, Florida,
and other states charge the Department on Aging with the administration of the
public guardianship program.
    Schmidt noted that some of the states with potential conflicts of interest had
sought to alleviate the problem within the statutory scheme, for example, by stat-
ing that the agency is not to serve unless there is no other alternative available.
The majority of statutes include such language today. Moreover, most specify
that a key duty of the public guardian is to attempt to find suitable alternative
guardians. In Florida, the statewide Office of Public Guardian must report on
efforts to find others to serve within six months of appointment. A few statutes
include more specific language addressing conflict of interest. For instance, the
Illinois Office of State Guardian may not provide direct residential services to le-
gally IPs. North Dakota allows the appointment of any appropriate government
agency, unless the agency provides direct care and has custody of the IP (except
if the court offers the specific finding of no substantial risk). Indiana requires
that regional guardianship programs have procedures to avoid conflict of inter-
est in providing services. Montana prohibits the appointment of guardians who
provide direct services to the IP, but makes an exception for the agency serving in
the public guardianship role.
   Every state guardianship code sets out an array of duties and powers for the
guardians of the person and the estate. In some states, guardians have a great deal
of flexibility in their authority to sell property, invest assets, make major health
care or end-of-life decisions, or relocate the individual, while in other states,
guardians must obtain a court order to take some of these actions.
   Public guardianship statutes generally provide that the public guardian has
the same duties and powers as any other guardian. However, many of the stat-
utes list additional duties and powers for public guardianship programs. For
example, mandatory duties may include specifications about visits to the IP.
At least eight states dictate the frequency of public guardianship IP visits or
contacts. A few states require the public guardianship program to take other
actions, such as developing individualized service plans, making periodic reas-
sessments, visiting the facility of proposed placement, and attempting to secure
public benefits.
   Most of the additional listed duties, though, are programmatic in nature. Stat-
utes may require the public guardianship entity to maintain professional staff;
contract with local or regional providers; assist petitioners, private guardians,
or the court; provide public information about guardianship and alternatives;
contract for evaluations and audits; and maintain records and statistics. Public
guardianship statutes frequently set out additional powers, as well as duties, for
example, the authority to contract for services, recruit and manage volunteers,
and intervene in private guardianship proceedings, if necessary.
                         E MERGENCY P ROCEDURES
   The Schmidt study also referred to the need for emergency procedures when
the “needs of an individual may be so acute as to require immediate aid.” This is
particularly relevant for public guardianship, as frequently vulnerable individuals
without societal contacts (candidates for public guardianship appointment) ex-
perience crises that put them in jeopardy. Schmidt discovered that in 1981, only
28                              PUBLIC GUARDIANSHIP
“a handful of states” had emergency procedures, and that these were outlined in
APS legislation and emergency guardianship procedures in “some states.”
    Currently, as reported above, all states have APS legislation and programs in
place, which frequently funnel cases to public guardianship programs. In addi-
tion, virtually all states have provisions for emergency guardianships. One issue
is that due process safeguards for emergency guardianship are typically less strin-
gent than for permanent guardianship, yet emergency guardianship often func-
tions as a gateway to the more permanent status. Thus, some individuals may end
up in a guardianship with less than full due process protection.17
                          L IMITED G UARDIANSHIP
    In 1981, the Schmidt study touched on the issue of limited guardianship,
which at that time was “becoming more prevalent of late.” The principle under-
lying limited guardianship is that there is no “bright line” of capacity; incapacity
is not all or nothing. A limited guardian has powers only in those areas in which
the person lacks capacity, allowing the IP to retain as much independence and
autonomy as possible. This is in accordance with the principle of using the “least
restrictive alternative.”
    In 1982, the UGPPA incorporated limited guardianship provisions, giving a
major boost to the adoption of the concept in state law. Today, virtually all state
guardianship statutes include provisions for limiting or tailoring the court order
(in some cases, stating a preference for limited over plenary guardianship), and
most include language acknowledging the importance of “maximizing [the] self-
determination and independence” of the individual.18 Such language on limited
guardianship, however, is difficult to put into practice. A 1994 study found that
nationwide, the overall use rate for limited guardianships (excluding one high-
use state) was about 5 percent.19
    In nine states, statutory language specifically mentions that the public guard-
ianship program may serve as a limited guardian, thus emphasizing the legisla-
tive intent. In some of these states (such as California and Illinois), the public
guardianship program may petition to serve, and could thus petition for a lim-
ited order. The recent Washington legislation states that the public guardianship
providers must annually certify that they have reviewed the need for continued
public guardianship services and the appropriateness of limiting or further limit-
ing the scope of the order.
by the ABA Commission on Law and Aging statutory tables, state guardianship
law remains variable, causing particular problems when guardianship jurisdiction
issues arise. The Uniform Law Commission has developed the UGPPA, which is
being enacted by state legislatures. State statutes have reflected significant progress
in affording procedural protections, including a more functional determination of
incapacity, promoting limited orders, and bolstering court oversight procedures.
    State public guardianship statutes are markedly variable, as well. There is no
uniform public guardianship law. A now-and-then statutory comparison shows
that some nine additional states have adopted explicit public guardianship legisla-
tion. Explicit provisions provide for an actual program, rather than a governmen-
tal entity to serve as guardian of last resort, and can articulate standards with much
greater specificity. These explicit provisions are more likely to provide for budget-
ary appropriations and to establish greater oversight than that required for private
guardians. Finally, it is important to note that seven states now reference staffing
ratios. This is a great leap forward, which is probably attributable to the 1981
study’s emphasis on adequate staffing. However, a substantial portion of states still
place public guardianship programs in a governmental agency with the potential
for conflicts of interest. While some attempt to mitigate these potential conflicts
with statutory language, the conflicting agency roles remain problematic.
                                         N OTES
      Portions of this chapter are based on Teaster, Pamela, Erica Wood, Susan Lawrence,
and Winsor Schmidt. “Wards of the State: A National Study of Public Guardianship.”
Stetson Law Review 37, no. 1 (2007): 193–241. Courtesy of the Stetson Law Review.
      1. Schmidt et al., Public Guardianship and the Elderly.
      2. Ibid., 179.
      3. See state statutory charts on adult guardianship, as well as the annual update, on
the Web site of the ABA Commission on Law and Aging at http://www.abanet.org/aging/
legislativeupdates/home.shtml. See also Teaster et al., Public Guardianship After 25 Years,
33–37; and Erica Wood in Quinn, Guardianships of Adults.
      4. In mid-2007, Arkansas passed a public guardianship bill, S.B. 820, creating an
office of public guardian for adults within the Division of Aging and Adult Services. The
Act does not take effect until and unless the director of the division determines that ad-
equate appropriations or other funding are available and appoints a public guardian.
      5. This project did not include a systematic search of all state adult protective ser-
vices statutes, which might reveal additional guardianship provisions. See ABA Commis-
sion on Law and Aging, Adult Protective Services Agency Authority to Act As Guardian of
A Client: Guidance and Provisions from Adult Protective Services Law, By State, http://www.
abanet.org/aging/elderabuse.shtml. Throughout this chapter, the District of Columbia is
counted as a state.
      6. Schmidt et al., Public Guardianship and the Elderly, 26.
      7. National Conference of Commissioners on Uniform State Laws, Uniform Guard-
ianship and Protective Proceedings Act (1982).
      8. Cf. Washington Certified Professional Guardian Board, Ethics Advisory Opin-
ion 2005-001-Professional Guardian Petitioning for Appointment, http://www.courts.
30                                 PUBLIC GUARDIANSHIP
wa.gov/committee/?fa=committee.display&item_id=644&committee_id=127 (“The
practice of nominating oneself as guardian automatically raises the appearance of
self-dealing.”)
        9. Schmidt et al., Public Guardianship and the Elderly, 34.
       10. See http://www.ncea.aoa.gov/NCEAroot/Main_Site/Find_Help/APS/Analys
is_State_Laws.aspx. Cf. Winsor Schmidt, “Adult Protective Services and the Therapeutic
State,” Law and Psychology Review 10 (1986): 101–121; Winsor Schmidt and Kent Miller,
“Improving the Social Treatment Model in Protective Services for the Elderly: False Needs
in the Therapeutic State,” Journal of Comparative Social Welfare 1, no. 1 (1984): 90–106.
      11. See ABA Commission on Law and Aging, American Psychological Association,
and National College of Probate Judges, Judicial Determination of Capacity of Older Adults
in Guardianship Proceedings (ABA and APA, 2006).
      12. Michael Mayhew, “Survey of State Guardianship Laws: Statutory Provisions for
Clinical Evaluations,” BIFOCAL 27, no. 1 (2005): 1–2, 13–19. See also Jennifer Moye,
Stacey Wood, et al., “Clinical Evidence in Guardianship of Older Adults Is Inadequate:
Findings From a Tri-State Study,” The Gerontologist 47, no. 5 (2007): 604–612; Jennifer
Moye, Steven Butz, et al., “A Conceptual; Model and Assessment Template for Capacity
Evaluation in Adult Guardianship,” The Gerontologist 45, no. 5 (2007): 591–603.
      13. ABA Commission on Law and Aging, Adult Protective Services Agency Authority
to Act As Guardian of A Client: Guidance and Provisions from Adult Protective Services Law,
By State, http://www.abanet.org/aging/elderabuse.shtml.
      14. Schmidt et al., Public Guardianship and the Elderly, 38.
      15. U.G.P.P. A. section 318.
      16. Karp and Wood, Guardianship Monitoring: A National Survey of Court Prac-
tices; Karp and Wood, Guarding the Guardians: Promising Practices for Court Monitoring.
See also Sally Hurme and Erica Wood, “Guardian Accountability Then and Now: Trac-
ing Tenets for an Active Court Role,” Stetson Law Review 31, no. 3 (2002): 867–940.
A recent Guardianship Task Force report in the state of Washington not only recom-
mends that adequate public funding should be allocated to the guardianship system, but
also advocates that courts should actively, and not just passively, monitor guardianship
cases. Elder Law Section, Washington State Bar Association, Report of the Guardianship
Task Force to the WSBA Elder Law Section Executive Committee (Seattle, WA: Washington
State Bar Association, 2009), http://www.wsba.org/lawyers/groups/elderlaw/
      17. See Peter Barrett, “Temporary/Emergency Guardianships: The Clash Between
Due Process and Irreparable Harm,” BIFOCAL 13 (1992–1993): 3. See also Grant v.
Johnson, 757 F. Supp. 1127 (D. Or., 1991), ruling a state emergency guardianship statute
unconstitutional because it lacked sufficient due process protection.
      18. See the state-specific chart of statutory provisions on limited guardianship by
the AARP Public Policy Institute, on the Web site of the ABA Commission on Law and
Aging, http://www.abanet.org/aging/guardianship/lawandpractice/home.html.
      19. Lisi, et al., National Study of Guardianship Systems: Findings and Recommenda-
tions. See also Sally Hurme, “Current Trends in Guardianship Reform,” Maryland Journal
of Contemporary Legal Issues 7, no. 1 (1995–1996): 143–189; Lawrence Frolik, “Promot-
ing Judicial Acceptance and Use of Limited Guardianship,” Stetson Law Review 31, no. 3
(2002): 735–755; Winsor Schmidt, “Assessing the Guardianship Reform of Limited
Guardianship: Tailoring Guardianship or Expanding Inappropriate Guardianships?,”
Journal of Ethics, Law and Aging 2, no. 1 (1996): 5–14.
                                                              Chapter 3
CASE STUDIES
   Helen is an 87-year old woman with a history of mental illness. Two years
   ago, the group home sought the payment of fees that were six months in ar-
   rears. The courts found that there were no family members and no one able
   and/or willing to serve as guardian. As a result, Helen was made a ward of
   the state. ABC Services was named to provide guardianship services. ABC
   staff resolved the financial confusion and Helen was delighted to be able
   to stay in the place she calls her home. Several months later, Helen fell and
   broke her shoulder. Again, ABC stepped in and sought her input and was
   able to ensure that physical therapy services were provided and Helen was
   able to regain most of her mobility. Six months ago, Helen was diagnosed
   with inoperable cancer. Yet again, ABC stepped in and, with its knowledge
   of Helen’s values, ensured that she would be provided hospice care, in keep-
   ing with her wishes.
                                  O VERVIEW
    Chapter 3 presents information about and an assessment of site visits to nine
public guardianship programs in six states. Florida and Illinois were studied
using focus groups composed of key stakeholders, while individual interviews
were utilized in the other four states. Thus, the headings for Florida and Illinois
differ from those for California, Arizona, Maryland, and Delaware. Programs are
presented within the context of how stakeholders regard them, as well as consid-
eration of the programs’ strengths, weaknesses, opportunities, and threats. Cases
that either made the newspapers in each state or were described during the site
visit are also included.
Language: English
            LITTLE MISS
               MOTH
BY
AMY LE FEUVRE
By JOHN BUNYAN
   THE PILGRIM'S PROGRESS
By AMY LE FEUVRE
   LITTLE MISS MOTH
   TESTED
BY M. L. CHARLESWORTH
   MINISTERING CHILDREN
   THE BASKETMAKER'S SHOP
       (A SEQUEL TO MINISTERING CHILDREN)
BY CHARLOTTE MURRAY
   WARDLAUGH; OR, WORKERS TOGETHER
   THROUGH GREY TO GOLD
   STUART'S CHOICE
   MURIEL MALONE
   FROM SCHOOL TO CASTLE
BY PANSY
   A NEW GRAFT ON THE FAMILY TREE
BY M. E. DREWSEN
   GRACIE AND GRANT, A HIGHLAND TALE
   NEDDIE GARDNER; OR, THE OLD HOUSE
BY GRACE PETTMAN
   GIVEN IN EXCHANGE
BY J. GOLDSMITH COOPER
   HOPE GLYNNE'S AWAKENING
BY SYDNEY WATSON
   WOPS THE WAIF, A TALE OF REAL LIFE
CONTENTS
CHAPTER
I. A NEW HOME
V. THE PIRATE
X. STRAWBERRY PICKING
                 CHAPTER I
                        A NEW HOME
    Hope, next to her in age, had fair golden hair and blue
eyes; she was sweet tempered and rather apt to be an echo
of anyone with whom she was.
    There was silence. The little girls were busy eating their
bread and treacle, but their ears were taking everything in.
   "No, I don't think so. It lies just off a road. There's not
much passing, but, Mother dear, you will revel in the peace
and quiet after this!"
    Aunt Alice waved her hand out of the window. She was
smiling brightly. Granny looked at her rather wistfully. "And
you have quite made up your mind to give up your war
work and come with us? You don't think I could manage
with the children?"
    "And we'll all have a slice of bread and butter now," said
Aunt Alice briskly. Then she turned to the children, and
began to tell them of all that she had seen and heard since
she had left them two days ago.
    Mrs. Cox was a thin, gaunt woman who came every day
from eight o'clock to six in the afternoon. She cleaned, she
cooked, she washed and ironed, and was the children's
devoted friend. They were never tired of listening to her
stories, but Mrs. Cox always enjoyed very dismal subjects.
Funerals and illnesses were her chief topics; and her friends
seemed to the children to have had the most marvellous
diseases, and the most miraculous cures that they had ever
heard.
     Charity left her. Mrs. Cox would not understand the joy
of looking forward to a move into an unknown country.
   Two hours later, the three little girls were in bed in one
room upstairs. Aunt Alice and Granny always slept together.
    "No," said Charity; "it was when Faith was so ill the
other day. The doctor said Granny must take her to the
country, and Granny shook her head. And I heard her say to
Aunt Alice after:
    "And I shall sit on the well," said Faith, "and draw water
up and down in a bucket all day long!"
    "It's our names," she confided to her aunt; "why did our
father and mother give us such names? The girls all laugh
at us, 'specially me! 'Charity' means everything nasty. If
you live on people's charity, it means you're a nobody, and
Charity schools are for the very lowest. I hate my name!
I'm glad we're going to the country. Mrs. Cox says we shall
have nobody there to notice what we're called."
     "I like your names," said Aunt Alice laughing. "Don't be
a little goose. Your Mother was a saint, and she got your
names from the Bible, and so far from 'Charity' being a
name to be despised, it is the greatest of all other names.
We are told so, you read the chapter about Charity and see
all you ought to do if you're worthy of your name."
    Granny and Aunt Alice packed day after day. Mrs. Cox
asked how they were going to manage in the country if they
had no one to clean for them, and Hope asked her aunt
anxiously about it, but she was laughed at.
   "I love scrubbing," said Hope happily. "I hope you'll let
me do that. Are we as poor as Mrs. Cox is?"
    Granny put her arm round her. Faith was very delicate,
and she was continually in her grandmother's thoughts.
Granny often said to Aunt Alice that Faith lived at Heaven's
gates, and she was afraid that any day she might slip inside
them.
     At last they reached the Cottage. It had a white gate
which had been freshly painted, and the door stood open;
and kind Mrs. Horn had lighted a fire, and put a kettle on to
boil and was standing outside the door, ready to welcome
them.
    "I think I see some trees over there," she said, pointing
to the corner of a field a short distance off. They were going
to set off immediately in search of it, when they heard their
aunt call them in.
    "Yes, we've taken over the furniture left here, but we'll
make this kitchen quite pretty with nice curtains, and some
cushions and some of Granny's pretty things."
                      CHAPTER II
                     FIRST ADVENTURES
    THE next day came, and Aunt Alice gave her small
nieces permission to go off for the morning anywhere they
liked.
   "I don't think you can get into any mischief," she said.
"Charity has a wise little head of her own, and if you like to
go to the wood, and bring back some sticks for the fire, I
shall be very glad."
   "Oh, what is it?" asked Faith with big eyes. "Is it a wild
beast, do you think? It may be a wolf or a fox!"
    He put his foot on the gin, and with a wriggle and a cry,
the dog was free. He stopped whining and stood before his
master trembling from head to foot. The old man knelt
down and with his handkerchief began to bind up the poor
torn leg. Charity and Hope watched the proceeding with the
greatest interest, Faith shut her eyes tight. She was as
white as a sheet, and, like Sandy, trembled from head to
foot.
   But Charity began to talk, she asked the old man his
name.
"Oh, yes."
Faith stretched out her little hand and took hold of his.
   "No, no, 'tis just the boys who will trap rabbits, but they
oughter open them by day, an' I'll have a word to say to
'em on that score. Come along, and your sisters will find us
when they get through the copse."
    "What's a copse?"
    "What you call a wood."
    Charity, seeing her walk off with the old man, came
running back, but Timothy told her he was taking Faith to
his cottage to rest.
    "It's all right," said Charity gravely. "I see you've a good
face, and if Faith likes to go with you she can; but we want
to pick up firewood for Aunt Alice, and find some more
adventures!"
    "She looked white and sick," said Charity; "I think that
trap frightened her, and the sight of Sandy's bleeding leg!"
    "We've just come here, and we're picking wood for Aunt
Alice."
    "No, Granny is too poor, and since the war she says it's
wicked to buy sweets; for they take the sugar."
He laughed again.
   Sir George was then told about the dog, and the old
man.
Charity beamed.
   "It's quite near," said Hope, "but we can't carry all this
wood up there. Let her find her way home herself."
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