DHR public guardianship manual

GEORGIA DEPARTMENT OF HUMAN RESOURCES
5t
DHR GEORGIA DEPARTHENT OF HU].IAN RESOURCES
DHR PUBLIC GUARDIANSHIP MANUAL
Georgia Department of Human Resources Division of Aging Services
Two Peachtree Street, N.W., 9th Floor Atlanta, Georgia
February 1,2008

GEORGIA DEPARTMENT OF HUMAN RESOURCES Division of Aging Services

Department of Iluman Resources
Online Directives Information System

Index: Revised: Review:

MANSSOO 0210u2008

Subject: DHR Public GuardianshiP

Table of Gontents

Definitions

5

PUBLIC GUARDIANSHIP

s101

lntroduction

8

s102

Public Guardianship and the Law

8

s103

Guardian of Last Resort in Georgia

9

s104

DHR Public GuardianshiP

9

s105

Adult Guardianship Authority and DHR

10

DOCUMENTATION

s201

Documenting Guardianship Activities

12

s202

Guardianship Ghanges

12

s203

Gonfidentiality

13

DHR Adult Public Guardianship Manual Geolgia Department of Human Resources, Division of Aging Services February 2008

GEORGIA DEPARTMENT OF HUMAN RESOURCES Division of Aging Services

CHAPTER 3OO

GUARDIANS AND WARDS

s301

Rights of the Ward

14

s302

Guardian's Duties

14

s303

Personal Status RePort

16

s304

Special Assistant Attorney General

17

s401 s402 s403 5403(a) s403(b) 5403(c) s4o3(d)
S403(e) s403(f)

DECISION MAKING

Guidelines in Decision Making

18

Medical Consent

18

Special Situations and Guidelines

20

Refusal of Medication and/or Treatment

20

HIV Status

21

Do Not Resuscitate

21

Responsibilities of Guardian During a Natural Disaster

or National Crisis

22

Allegations of Abuse, Neglect and Exploitation

22

Critical lncident RePorting

23

END OF GUARDIANSHIP

s501

Terminating GuardianshiP

24

s502

Transfer of GuardianshiP

25

s503

Death of Ward

27

DHR Adult Public Guardianship Manual Georgia Department of Human Resoulces, Division of Aging Services Febluary 2008

GEORGIA DEPARTMENT OF HUMAN RESOURCES Division of Aging Services

APPENDICES

Appendix A:

Checklist for Guardians

Appendix B:

Guardianship Reporting Form

Appendix C:

DHR Medical Consent Authorization Form, DAS/MC AF 911512007

AppendixD: CardiopulmonaryResuscitationStatute

DHR Adult Public Guardianship Manual Georgia Department of Human Resources, Division of Aging Servicea February 2008

GEORGIA DEPARTMENT OF HUMAN RESOURCES Division of Aging Services
DEFINITIONS
Caregiver: A caregiver is a person who has the responsibility for the care of a
disabled adult or elder person as a result of family relationship, contract,
voluntary assumption of that responsibility, or by operation of law.
Conservator: a person given the legal right to be responsible for the assets and
finances of a person deemed fully or partially incapable of providing these necessities for himself or herself. In Georgia law, "conservator" includes a
"guardian of the property" appointed prior to July 1,2005.
Department: means the Department of Human Resources
DHR Representative: individual who has been assigned case management duties and responsibilities for DHR public guardianship when the Department of
Human Resources has been appointed as guardian.
Director: means the director of the Division of Aging Services of the Department
of Human Resources
. Division: means the Division of Aging Services of the Department of Human
Resou rces.
r Guardian: means an individual or entity appointed by a probate court to be
legally responsible for the care and management of an individual adult who
lacks sufficient capacity to make or communicate significant responsible
decisions concerning his or her health or safety. Within Georgia law, "guardian" includes a "guardian of the person" appointed prior to July 1,2005.
r Guardian ad Litem: means an individual appointed pursuant to the provisions of
O.C.G.A. S 29-9-2. The probate court in its discretion may at any time appoint a guardian ad litem to represent the interests of a minor, a proposed ward, or a
ward in proceedings relating to the guardianship or conservatorship of that
individual. However, the appointment of a guardian ad litem does not supersede any specific requirement that an individual be served by personal service and the guardian ad litem may not waive personal service for that individual.
. Guardian of Last Resort: a guardian appointed by the probate court when no
other person or entity is qualified, suitable or available to serve.
r Guardianship: is a probate court appointment of guardian to make decisions for
an adult who has lost sufficient capacity to make or communicate significant responsible decisions concerning his or her health or safety. The power of a
guardian over the person of his or her ward is like that of a parent over his child, but only to the extent necessary for the adult's actual limitations and in the least
DHR Adult Public Guardianship Manual Georgia Department ot Human Resources, Division of Aging Services February 2008

GEORGIA DEPARTMENT OF HUMAN RESOURCES Division of Aoi Services
restrictive manner possible while observing that adult's individual rights and dignity. Refer to Guardianship of Adults, O.C.G.A. $$ 29-4-1, et seq.
Incapacitated: an adult whose ability to receive and evaluate information effectively and communicate decisions in any way is impaired to such a
significant extent that he or she is partially or totally unable to manage his
financial resources or to meet essential requirements for his physical health and safety.
Letters of Guardianship: legal document that gives the guardian authority and
duties to act on behalf of the ward.
PASRR: means Preadmission Screening and Resident Review. PASRR is a
federally mandated screening process for individuals with serious mental illness
and/or Developmentally Disabled related diagnosis who apply or reside in
Medicaid Certified beds in a nursing facility regardless of the source of payment. The federal regulations, 42 CFR SS 483.100 through 483.138, governing PASRR can be found at: www.access.qpo.qov/nara/cfrlwaisidx 03/42cfr483 03.html
PASRR requirements are found in the State Operations Manual (SOM),
Appendix P Survey Protocol for Long-Term Care Facilities and Appendix PP Interpretive Guidance for Long-Term Care Facilities. State Survey Agency
Directors guidance from CMS regarding PASRR, September 27, 2007 from the Centers for Medicare and Medicaid Services (CMS): http://www.cms.hhs.qov/SurvevCertificationGenlnfo/downloads/SCLetter0T38.pdf
Personal Status Report (PSR): report submitted to and required by the probate court to update the court on the physical, emotional and mental condition of the
ward.
Public Guardian: an individual or private entity, including a nonprofit entity, who
meets the qualifications required in O.C.G.A S 29-10-1, et seq. and has
registered with and been duly approved by the probate court to serve as a public guardian of an adult pursuant to Code Section 29-4-3.
Public Guardianship: the appointment and responsibility of a public official or publicly funded organization to serve as legal guardian in the absence of willing and responsible family members or friends, or in the absence of resources to employ, a private guardian. Since the 1960s, states and localities
have developed a variety of mechanisms to address this "unbefriended"
population, often serving as "guardian of last resort."
DHR Adult Public Guardianship Manual Georgia Department ot Human Reaources, Division of Aging Services Febluary 2008

GEORGIA DEPARTMENT OF HUMAN RESOURCES

Division of

Services

In Georgia, public guardianship would include public guardians, the Department of Human Resources when appointed as guardian oi last resort, and in certain circumstances, county guardians.

Representative social security,

Payee: a
ssl and

person or other entity that manages an individual's
or Railroad Retirement benefits when an adult is

determined unable to manage this function without assistance. (Also called

"Payee")

serious Injury: bodily injury to a DHR ward that involves a substantial risk of death, unconsciousness, extreme physical pain, sexual assault, violence,
protracted and obvious disfigurement or impairment.

State Office: generally in the context used herein refers to the Division of Aging
Services' physical office location at Two Peachtree Street, N.W., nttanta,
Georgia.

Unbefriended adults or elders: those who do not have capacity to give informed consent, have not executed advance directives, have no legllly
authorized surrogate and no family, friends or interested persons to help with
decision-making.

Unexpected Death: a death of a DHR ward of that occurs as a result of
homicide, suicide, accident or suddenly when in apparent good health.
Ward: A person placed under the care and protection of a guardian or
conservator.

DHR Adult Public Guardianship Manual Georgia Department of Human Resources, Division of Aging Services February 2008

GEORGIA DEPARTMENT OF HUMAN RESOURCES Division of Aging Services
CHAPTER 1OO

s101. TNTRODUCTTON

The Georgia Department of Human Resources Division of Aging Services is the State

Act. Agency on
Americans

Aging

(commonly named State Unit on
lt has organizationally been

Aging) pursuant to the federal Older assigned public guardianship case

management duties for adults that are traditionally performed by its Adult Protective

Services staff. This manual seeks to define the unique role assigned by Georgia law for

those adults who have no one qualified, suitable or available to serve as a guardian.

"Unbefriended" elders and disabled adults are a vulnerable population that the Older

Americans Act, the Aging Network, and Law and Aging experts have separately found

there is an importance to adequately address.l

s102. PUBLTC GUARDIANSH|p AND THE LAW
Guardianship is a judicial procedure, primarily handled in the Probate Court, to
intervene in the life and affairs of persons who need help and protection in using and controlling their person and their property. The Guardianship Law and procedures are found in "GUARDIANS OF ADULTS", Chapter 4, Title 29; O.C.G.A. g 29-4-1 , et seq.
Public Guardianship: Published in April 2005, Wards of the State: A National Study of Public Guardianship, is the first major national study of public guardianship since the
seminal publication, Wards of the State: A National Study of Public Guardianship, Teaster, P., S., Wood, E., Hurme, S., et al., American Bar Association and the University of Kentucky (April 2005). [Public Guardianship and the Elderly, Winsor
Schmidt (1981)l In the 2005 study, public guardianship is defined as 'the appointment and responsibility of a public official or publicly funded organization to serve as legal guardian in the absence of willing and responsible family members or friends, or in the
absence of resources to employ, a private guardian. Since the 1960s, states and localities have developed a variety of mechanisms to address this "unbefriended"
population, often serving as "guardian of last resort."
Guardianship is a last resort. As mandated by guardianship law, lesser restrictive
alternatives and interventions to guardianship are pursued prior to the probate court's
decision to appoint a legal guardian. lf a guardianship is necessary, a qualified

rRefer to the American Bar Association Commission on Law & Aging at htto://www.abanet.org/agins,/ and Karp,

Naomi and Wood, Erica, Incqpacitated and Alone: Health Cqre Decision-Making for the {Jnbefriended Elderly,

ABA Commission on Lcrw and Aging tJuly 2003).

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February 2008

GEORGIA DEPARTMENT OF HUMAN RESOURCES

individual or public guardian should be appointed only when no other person is available
to serve as the guardian for the ward. A guardian of last resort is appointed only when
no other person is suitable and available to serve as the guardian.

s103. GUARDTAN OF LAST RESORT tN GEORGTA
Hastory of Guardian of Last Resort in Georgia: From 1974 and until July 1, 2005, certain individuals of a Department of Human Resources division or office performed guardian of last resort functions. ln 1974, the Commissioner of the Department of
Human Resources served in this capacity. Subsequently, in 1979, the directors of the county department of family and children services of the Division of Family and Children
Services served as guardian of last resort for incapacitated adults. Adult Protective Services was created in 1981 and organizationally assigned to the county DFCS
directors and under their supervision, performed guardianship duties and functions for county DFCS directors. The transfer of Adult Protective Services from the Division of Family and Children Services to the Division of Aging Services and the restructuring of DFCS in 2004, led to the Department requesting legislative changes for guardian of last resort. Effective July 1, 2005, with the enactment of HB 394, Committee Substitute, the Georgia General Assembly removed county department of family and children services
directors as guardians of last resort and designated the Department of Human
Resources as the entity to serve in that capacity. The Division of Aging Services is primarily assigned the public guardianship oversight and case management on behalf of the Department of Human Resources. The Division's Adult Protective Services Section
is primarily assigned case management duties.

sl04. DHR pUBL|C GUARD|ANSH|p OF ADULTS
Appointment of the Department of Human Resources, as guardian: When
appointed, the Department of Human Resources serves as Guardian of an adult when there is no one qualified, suitable and available to serve. Guardianship experts refer to this as "guardian of last resort." Under Georgia law, "guardian" is what was formerly called "guardian of the person."' The Department is appointed as an entity.
Alternatives to public guardianship should be pursued through the court to ensure the continued protection and preservation of the rights of the ward. Alternatives may include appointment of a successor guardian or restoration of the ward's rights.
The probate court determines the guardian pursuant to O.C.G.A. S 29-4-3. The
Department of Human Resources does not serve as a conservator.
Georgia law provides an order of preference in the selection of guardians, as follows:

2 The Departrnent ofHuman Resouces is not statutorily authorized to serve as a Consewator.

DHR Adult Public cuardianship Manual

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Georgia Department of Human Resources, Division of Aging Services

February 2008

GEORGIA DEPARTMENT OF HUMAN RESOURCES Division of Aqinq Services
S 294-3. Order of preference in selection of guardians; written request
nominating guardian; requirements of writing
(1) The individual last nominated by the adult... (2) The spouse of the adult or an individual nominated by the adutt's spouse ... (3) An adult child of the adult or an individual nominated by an adutt chitd of the adult . -. (4) A parent of the adult or an individual nominated by a parent of the adutt. . . (5) A guardian appointed during the minority of the adutt (6) A guardian previously appointed in Georgia or another state; (7) A friend, relative, or any other individual;
(8) Any other person, including a volunteer to the coutt, found suitable and appropriate who is willing to accept the appointment; and (Emphasis added)
(9) The county guardian.

s105. ADULT GUARD|ANSH|P AUTHOR|TY AND DHR
Requirements'.

O.C.G.A. S29-4-3(b. 1 ) provides:

(b.1) lf no other person is available to serve as guardian of the ward, the judge may appoint a public guardian in accordance with Chapter 10 of this title. ln the event the couft determines that there is no pubtic guardian
registered in accordance with Chapter 10 of this tiile appropiatety
available to serve as guardian for a ward, the couri may appoint the Depaftment of Human Resources as guardian. If so appointed, the
depaftment shall designate a representative of the depaftment to provide guardian serylces who shall take the oath of guardianship. lf, after having
been so appointed, the depaftmenf presenfs to the court a pubtic guardian
registered in accordance with Chapter 10 of this tiile or some other person suitable and appropiate to serve as guardian of a ward and witting to so serve, the couri shall allow the department to resign and shatt appoint such public guardian or such other person. lf the depaftment is appointed
pursuant fo thls subsection, it shall be bound by all the requirements of this chapter, except that it shall not be required to post bond or pay any
cost or fee of court associated with the guardianship proceeding. tf the depaftment is appointed pursuant fo fhls subsection and enters into a contract with an independent contractor for the provision of guardianship serylces, the expense of providing such servlces may be paid for from state funds appropiated for public guardians under Chapter 10 of this titte or, upon approval of the coutt, from the estate of the ward.

Additionally, o.c.G.A. 929-a-2(a) distinguishes the Department of Human Resources and public guardians as exceptions to the requirement that an individual must be

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Georgia Department of Human Reaources, Division of Aging Services

February 2008

GEORGIA DEPARTMENT OF HUMAN RESOURCES

Division of

Services

appointed as guardian. The Department, when appointed as guardian, serves as an entity. An individual is not appointed.
. The DHR, assumes the role of "guardian" based on Georgia Law.
. The DHR Representative shall take the "Oath of Guardianship" and obtain the
"Letters of Guardianship" from the Court.
o When appointed by the court, the guardian shall be listed as the',Department of Human Resources" or the "Georgia Department of Human Resources".
o The DHR Representative, acting on behalf of the Department as guardian, is fully
authorized to exercise all the powers and duties of the guardianship from the
date of the Letters of Guardianship.

DHR Representatives who have been assigned with case management duties and
responsibilities for public guardianship are the Adult Protective Services section within the Division of Aging Services, Guardianship Services Providers under contract with
DHR to provide public guardianship services to adults, and any Division of Aging
Services staff as assigned specifically by the Director. The Department or DAS may
authorize any personnel of the Department to carry out the entity's authority as
guardian. The Division of Aging Services is primarily assigned public guardianship
oversight and case management on behalf of the Department of Human Resources
when appointed as guardian. The Division's Adult Protective Services Section primarily
is assigned case management duties. Responsibility for activities related to case
management and meeting the ward's basic needs shall be assigned to a responsible
employee, contractor or volunteer of DHR.

DHR Adult Public cuardianship Manual

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Georgia Department of Human Resources, Division of Aging Services

February 2008

GEORGIA DEPARTMENT OF HUMAN RESOURCES Division of Aging Services CHAPTER 2OO DOCUMENTATION

s201. DOCUMENTING GUARDIANSHIP ACTIVITIES

Requirement:

All DHR adult guardianship
documentation. Originals or

cases copies

shall of all

have an open case
related letters, reports

record with ongoing
and court documents

should be inserted into the case record.

GuardianshiP Checklist:

Requiremenb:

o A "Checklist for Guardian" shall be used with each Guardianship case and filed in
the client's case record.

r

The Checklist is a tool to help ensure all areas of Guardianship responsibility are

addressed. (Refer to Appendix A for "Checklist for Guardian")

s202. GUARDIANSHIP CHANGES

Requirements:

oA||nttfoeehrfrrfweifmc"eganinciu-gatoiatn"oitonrtnhod1oesi.rasdopnhfiufuaiscirl"lhisiaobuilpnei;n'sGttD",puicior'aoehrtacdta"ntiOaonynrg.stsieuhTtbnishpseiiesnRqtOieunhpnefeoSnorwtrmtSiranaetatgvritodiesFn'iosOoni|sfrifvmioctiofen",p.bgowe(aliRitchrsyeruinafbbenmy5r gittcthotaeeeldemAAnptdPeopaSnert.htndsaedeanicysxdtstiaoBtone)f
Guardianshiplawrequiresthataguardianreportsignificantchangestothe
Probate Court.

oAwardcannotbep|acedoutofstatewithouttheprobatecourt'sadvance
permission. Additionll[, the APS State Office, Division Director and DAS Legal
must be notified if placement is considered out-of-state'

o

AASldtladdtiteeioaOnthafslfliyca,enadfllo/odllroesawetihrnsioguatsnhdien/ojurDrsieeepsraioorutfmsaeiwnnjaiurrodiefssHhoauf lmal bwaenarrRedpeaosrreoteutdorctbeoestrhceerpitosicrttaaetdleinbocyfifdtihceeen't

reporting policy or as iequired by subsequent policies of the DHR/DAS/APS.

oftn Aoutt Public Guardianship Manual C"orgii O"p"tttent of Human Resoulces'

Division

of

Aging

services

l2

February 2008

GEORGIA DEPARTMENT OF HUMAN RESOURCES Division of Aoi Services
Notifications of Guardianship
Requiremenb:
o DHR representatives shall notify significant agencies, caregivers and others of the appointment or termination of guardianship. (Social Security Administration, Nursing Home, Home Health Agencies, etc.)
r DHR representatives shall give After Hours Emergency contacts to caregivers, care providers and facilities for all adult guardianship clients.
o DHR representatives shall contact the Conservator, when one is appointed, for
the purpose of having a joint meeting to share information, coordinate
plans/activities related to meeting the client's monthly needs and making future
plans (including burial).
s203. coNFTDENT|AL|TY
The Department of Human Resources shall protect the sensitive and confidential
information obtained regarding public guardianship cases in accordance with the Health Insurance Portability and Accountability Act and state and federal laws and regulations. Additionally, state law protects the confidentiality of adult protective services records, as defined in O.C.G.A. S 30-5-7 of the Disabled Adult and Elder Persons Protection Act.

DHR Adult Public Guardianship Manual

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Georgia Department of Human Resources, Division of Aging Services

February 2008

GEORGIA DEPARTMENT OF HUMAN RESOURCES Division of I Services

GUARDIANS AND WARDS

s3or. RTGHTS OF THE WARD
O.C.G.A S 29-+20. Righb of the ward; impact on voting and testamentary
capacity.
(a) ln every guardianship, the ward has the right to:
(1) A quatified guardian who acts in the best interest of the ward;
(2) A guardian who is reasonably accessible to the ward;
(3) Have the ward's propefty utilized to provide adequately for the ward's support, care, education, health, and welfare;
(4) Communicate freety and privately with persons other than the guardian, except as otherwise ordered by a court of competent iuisdiction;
(5) Individuatty, or through the ward's representative or legal counsel, bring an action retating to the guardianship, including the nght to file a petition alleging that the ward is
being unjustly denied a ight or privilege granted by this chapter and chapter 5 of this title bnd including the ight to bing an action to modify or terminate the guardianship
pursuant to the provisions of Code Seclions 29-4-41 and 29-4-42;
(6) The least restrictive form of guardianshrp asslslan ce, taking into consideration the ward's functional limitations, personal needs, and preferences; and
(7) Be restored to capacity at the earliesf possible time ...
Note: Letters of Guardianship or other orders of the court may give the ward additional rights. An appointment of a guardian is not automatically a determination of the right of the ward to vote and is not a determination that the ward lacks the capacity to make a will (testamentary capacity).

s302.,GUARDIAN'S DUTIES
In Georgia, all guardianships of adults are designed to encourage the development of maximum self-reliance and independence in the adult and are ordered only to the extent necessitated by the adult's actual and adaptive limitations after a determination that less restrictive alternatives to the guardianship are not available or appropriate. [O.C.G A. S 2s4-1(f).1

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Georgia Department of Human Resources, Division of Aging Services

February 2008

GEORGIA DEPARTMENT OF HUMAN RESOURCES Division of Aqin Services

The duties of a guardian are listed in O.C'G.A. S 29-4-22' as follows:

O.C.G.A. S 29-+22. Decisions on ward's well'being; obligations of guardian;
liability of guardian.

(a) Except as othewise provided by law or by the coutt, a guardian shall make

decisions regarding the ward's suppott, care, education, health, and welfare. A guardian

shalt, to the-extent
,ard'" o*n behatf,

afenadsidbetev,eelonpcoourrareggeatihnethweacrdaptaocpitayfttiocipmaatenaignedtehceisiwonasr,d'.sacpteorsnonthael

affairs- To the extent known, a guardian, in making decisions, shall consider the

expressed desfe s and personal values of the ward. A guardian shall at all times act

as a fiduciary in the ward's best interest and exercise reasonable care, diligence, and

prudence.

(b) A guardian shall:

(1) Respect the rights and dignity of the ward;
(2) Become or remain personalty acquainted with the ward and maintain sufficient contact with the ward to know of the ward's capacities, limitations, needs, oppot'tunities, and physical and mental health;

(3) If necessary, petition to have a conservator appointed; (4) Endeavor to cooperate with the conservator, if any;

(5) Take reasonable care of the ward's personal effects;
(6) Anange for the support, care, education, health, and welfare of the ward,
considering the ward's needs and available resources;
(7) Expend money of the ward that has been received by the guardian for the ward's current needs for support, care, education, health, and welfare;
(8) Conserve for the ward's future needs any excess money of the ward received by the guardian; provided, however, that if a conseruator has been appointed for the ward, the guardian shall pay to the conservator, at least quafteily, money to be conserved for the ward's future needs; ...
(9) Provide Personal Status Report (PSR) as required by the probate court; (Refer to Personal Status Report section below at S 303.)
(10) Promptty notify the couri of any change in the ward's condition that in the opinion of the guardian might require modification or termination of the guardianship;
(11) Promptly notify the coutt of any conflict of interest between the ward and the guardian when the conftict aises or becomes known to the guardian and take any
action as is required by Code Section 29-4-24; and
(12) Keep the couft informed of the guardian's cunent address.

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Georgia Department of Human Reaources, Division of Aging Services

February 2008

GEORGIA DEPARTMENT OF HUMAN RESOURCES Division of Aqin Services
Liabilitv of Guardian
-- Pursuant to Georgia guardianship law, O.C.G.A. g 29a-22 (c\
(c) A guardian, solely by reason of the guardian-ward relationship, is not personally
liable for:
(1) The ward's expenses or the expenses of those persons who are entitted to be
suppofted by the ward; (2) Contracts entered into in the guardian's fiduciary capacity; (3) The acts or omissions of the ward; (4) Qbligations aising from ownership or control of propefty of the ward; or (5) Other acts or omrsslons occuning in the course of the guardianship. IO.C.G.A.S
29-a-22 (c).1
Generally speaking, there is no liability if the guardian acts reasonably and uses good judgment.
Least Restrictive Environment
A ward has a right to the least restrictive form of guardianship assistance considering the ward's functional limitations and disability, personal needs, preferences and values. The guardian must also balance the rights with health and safety issues facing the
ward. DHR Representatives are encouraged to consult with the Division of Aging
Services State Office for advice on utilizing resources for assessment available to the Department, as an entity. lt is important to assess dlsability issues, language access, program resources, health and safety issues, and compliance with federal and state
laws and regulations through consultation with supervisors, the Adult Protective
Services section, and the Division State Office.

s303. PERSONAL STATUS REPORT (pSR)
Requiremenb:
r The Personal Status Report, required of the Guardian by the probate Court, shall
be completed and submitted to the Probate Court, on behalf of the Department of Human Resources by a DHR representative for the ward.
o Based on requirement of law, the Personal Status Report must be submitted to
the Probate Court within sixty days from the date of the appointment and within sixty days after each anniversary date of appointment.

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Georgia Department of Human Resources, Division of Aging Services

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GEORGIA DEPARTMENT OF HUMAN RESOURCES Division of tn Services
O.C.G.A S 29-+22(bxg) peftaining to Personal Sfatus Reports" (9) Within 60 days after appointment and within 60 days after each anniversary date
of ippointment, tite with the court and provide to the ward and to the conservator, if any,
a peisonal status repoft conceming the ward, which shall include: (A) A desciption of the ward's general condition, changes since the last report, and
needs;
(B) Ail addresses of the ward duing the repofting peiod and the living anangements
of the ward for a// addresses,'
(c) A desciption of the amount and expenditure of any funds that were received by
the guardian pursuant to paragraph (7) of this subsection; and (D) Recommendations for any alteration in the guardianship order; ...
s304. SPECIAL ASSISTANT ATTORNEY GENERAL (SAAG)
When there is litigation after the appointment of the Department of Human Resources,
DAS Legal shalf be contacted immediately. Special Assistant Attorneys General
(SAAGsf represent the agency in litigation. Since the Department of Human Resources as an entity serves as guardian, DHR Representatives are responsible for coordinating decisions ior wards with their supervisors, District Managers, the APS Section, DAS
Legal and other Division leadership as each situation warrants. The DHR
Representative is not the sole decision-maker for the agency.
Note: Filing for a guardianship petition is solely authorized under Adult Protective
Services investigation law when there is no other means to protect^a person in need of
protective services and is not part of DHR Public Guardianship.' Process for filing
petition under APS authority of the Disabled Adults and Elder Persons Protection Act is found in the Adult Protective Services Manual. The Department of Human Resources,
as guardian, does not file guardianship petitions in its case management or
guardianship role.
3 Disabled Adults and Elder Persons Protection
DHR Adult Public Guardianship Manual Georgia Department of Human Resources, Division of Aging Seryices February 2008

GEORGIA DEPARTMENT OF HUMAN RESOURCES Division of tn Services
CHAPTER 4OO DECISION MAKING
s401. GUIDELINES lN DECISION-MAKING Requiremenb:
The Department of Human Resources shall:
. act to protect and preserye the ward's life; r follow established guidelines in Decision Making; and o seek the assistance and services of professionals for consultation purposes, as
needed.
s402. MEDICAL CONSENT
lf there are any questions or concerns about a particular medical treatment, DAS policy is that DHR Repiesentatives consult with the APS Section and obtain legal advice from
the Director's office (DAS Legal). Appropriate documentation must be completed. In
the event of an emergency or disaster, DHR Representatives performing public
guardianship duties and functions on behalf of Department of Human Resources, as luardian of last resort, may not have sufficient time to consult with DAS staff and obtain
ill documentation. DHR Representatives will make a reasonable assessment of the factors required for a decision on medical treatment in order to achieve informed
consent in emergency situations, and consult with supervisors and DAS as soon as
possible.
To the extent known, representatives of DHR, in making decisions on behalf of DHR as guardian of last resort, shall consider the expressed desires and personal values of the ward. A guardian shall at all times act as a fiduciary in the ward's best interest and exercise reasonable care, diligence and prudence, pursuant to O.C.G.A. 529'4-22,

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Georgia Department of Human Resources, Division of Aging services

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GEORGIA DEPARTMENT OF HUMAN RESOURCES Division of Aging Services

Levels of Approval for Medical Consent:a
Routine medical consent involves medical treatment such as medical, vision, dental
care that does not administer general anesthesia, and general admittance into hospice (except when client is entering hospice with life expectancy of 30 days or less)' A case manager is permifted to approve medical treatment involving routine medical consent.
Although routine medical consent does not require a supervisor's approval; the
supervisor should be fully briefed in advance, when possible, and in a timely manner.

Examples include:
. Vaccines . Dental Work . Diagnostic x-rays . Sutures/Removal of Sutures . Administration of local anesthesia o Mental health/mental retardation behavior support plans . Psychotropic medications (if ward does not refuse) o Hospice (where life expectancy is more than 30 days)
Intermediate medical consent (Superuisor's/Distict Managels Approval) requires the approval of the Supervisor and District Manager (or regional manager), and requires obtaining a second physician's wriften opinion. Supervisors must make this decision based upon what a reasonable supervisor making a medical consent decision in the particular situation would do in accordance with DHR/DAS training and policy.

o.... Examples include:

Administration of general anesthesia Minor surgery with little risk to ward Advanced diagnostic testing Emergency Surgery (if Division Director approval not required) Hospice (if life expectancy is 30 days or less)

Division Directols consent requires the approval or notification of the Division Director, Deputy Director or their designee when there is substantial risk to the ward, or end-of-
life care.

Examples include:
. Neurosurgery . Amputation or other similar surgeries o Sterilization, in accordance with state law

4 Refer to Appendix C, DHR Medical Consent Authorization Form, DAS,4\4CAF g/l5l2OO7 or a subsequently approved form.

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Georgia Department of Human Re6ources, Division of Aging Services

February 2008

GEORGIA DEPARTMENT OF HUMAN RESOURCES Division of Aging Services
. Court order required based on federal or state law . Organ transplant r Bypass surgery o Electro-Convulsive Treatment (ECT) o End-of-life care (e.9. Order not to resuscitate (DNR order), removal
of ventilator, etc.) (notification only)
The Department of Human Resources, as guardian of an
incapacitated adult, shall not authorize a "NO CODE" or "DNR" (Do Not Resuscitate) Order

s403. SPECTAL STTUATIONS AND GUIDELINES
The following guidelines provide clarification and direction in special situations. There are many factors that may need to be weighed in individual situations. Specific legal and programmatic consultation may be needed in order to address the uniqueness of
individual cases.
Example of when consultation is required:
.. The ward's religious beliefs prohibit the treatment or the family's wishes and the
guardian's plans conflict or the guardian is requested to considering "forcing"
medical treatment to prevent death against the ward's wishes.
** A ward wants an abortion or the physician is recommending an abortion.
** Request for organ transplant from ward to another or experimental
treatmenUresearch.
$403(a). Refusal of Medication and/or Treatment
While guardianship removes the right of a ward to consent to medical treatment, it does not necessarily mean that a guardian can consent to any and all types of treatment over the objection of a ward. A ward, generally speaking, cannot make an informed consent to medical treatment. A ward does, however, retain a liberty interest to object to certain
unwanted medical treatments and procedures, such as ECT, physical detention or involuntary commitment, and medications. A guardian will receive consultation and notification rights of a ward who has a mental illness as in O.C.G.A. S 37-3-164, regardless of the objection of a ward. However, if a ward objects, the Department of
Human Resources, as guardian, cannot force the ward to take medication before the
ward is considered an imminent risk to self or others (unsafe or emergency), or to stay in the hospital until completely well. (Refer to Heichelbech v. Evans,798 F.Supp. 708
(M.D.Ga. 09to1t1992).

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Georgia Department of Human Resources, Division of Aging Sewices

February 2008

GEORGIA DEPARTMENT OF HUMAN RESOURCES Division of linc Services

In reviewing screening and treatment options for DHR wards with mental illness or developmental disabilities who reside in Medicaid certified beds in a nursing facility,
determine if any behavioral support plans and/or Preadmission Screening and Resident Review (PASRR) progress documents are relevant.

S403(b). HIV Status

Example of when consultation is required:
** A ward is HIV positive and is sexually active. A ward that knows he/she is HIV positive and is sexually active must disclose to the sex partner that he/she is HIV
positive. O.C.G.A. S 16-5-60 relates to reckless conduct causing harm to or
endangering the bodily safety of another and the conduct by HIV infected persons. Such a person, failing to disclose, is guilty of a felony.
** Under O.C.G.A. S 24-947, when a HIV positive person's physician reasonably
believes that the spouse/sexual partner or any child is at risk of being infected by the HIV positive person... the physician may disclose to that spouse, sexual partner, or child. This is done after the physician attempts to tell the HIV positive person that disclosure must be done.

The Department of Human Resources may disclose to the board of health of the
county in which the HIV positive person resides or is located if reasonably
necessary to protect the health and safety ofthat person or others who may have come in contact with the body fluids of the HIV infected person, consistent with Department policy. DHR or the county board of health may contact any person at
risk of being infected with HIV by the HIV positive person.

S403(c). Do Not Resuscitate
A request that the guardian authorize a "NO CODE" or "Do Not Resuscitate"'

This specifically addresses the restarting of the heart and/or lungs should they
fail. When a person's heart and/or lungs cease working, procedures will be taken
to restart the hearVlungs - unless there is a DNR/No Code on file for that person.
People with Living Wills should have their stated wishes honored.

The Department of Human Resources, as guardian of an incapacitated adult shall not authorize a "NO CODE" or "DNR" (Do Not Resuscatate) Order.
r DHR shall not initiate legal action for the purpose of disconnecting life
support.
r DHR shall make the ward's treating physician aware when the ward has a
Georgia Advance Directive for Health Care or a prior Durable Power of Attorney

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Georgia Department of Human Resoulces, Division of Aging Services

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GEORGIA DEPARTMENT OF HUMAN RESOURCES Division of Aging Services
for Health Care. The guardian indicates to the physician that Guardianship does not alter those arrangements.
o The Department of Human Resources shall be informed when a patient is
determined to be a candidate for no resuscitation; however, DHR will leave this
medical decision in the hands of the family and/or physician.
o Physicians or hospital personnel can be directed to O.C.G.A. $ 31-39-4, the
Cardiopulmonary Resuscitation Statute for persons authorl not to resuscitate. DHR takes the position that the physician should follow the
requirements of 31-394(e) in issuing an order not to resuscitate. (Refer to
Appendix D.)
o The Department of Human Resources representative shall contact the
Ombudsman on behalf of the client, if a nursing home or hospital states that a ward's admission is contingent on the guardian signing an advance directive or "no code". Do not sign such a form.
r When consenting for Hospice Care for a DHR ward, it is important for Hospice to
understand that the Department of Human Resources, as Guardian is not able to authorize a DNR. This should not prevent the ward from benefiting from Hospice
Care. Any problems in this area should be discussed with ward's treating
physician.
S403(d). Responsibilities of Guardian During a Natural Disaster or National Crisis
The Department of Human Resources, as Guardian, will take appropriate
measures to ensure the safety and well-being of all wards in the event of a
crisis. DHR Representatives will document current addresses and other identifying information in case records. A list of DHR wards and current
whereabouts is also maintained at the State Office.
Sa03(e). Allegations of Abuse, Neglect and Exploitation
DHR wards should be free from abuse, neglect and exploitation. As a mandated
reporter, DHR representatives will report indications or allegations of abuse, neglect or exploitation as mandated by law. lf Adult Protective Services receives
a report of abuse, neglect and/or exploitation of a DHR ward, its investigation will use caution to use staff from another district for the APS investigation who is not involved in the day-to-day case management of the DHR ward. The assignment will be coordinated by APS Section staff at the State Office, with consultation as needed.

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Georgia Department of Human Resources, Division of Aging Services

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GEORGIA DEPARTMENT OF HUMAN RESOURCES Division of Aging Services
5403(0. Critical Incident Reporting
Reports to the Division of Aging Services State Office shall be made using: ApS
Death, Serious Injury and Reportable Critical Incidents Reporting Form or its
subsequently approved form in accordance with Division policy. Additionally, the
Division shall follow all Department policy on Reporting of Urgent Incidents,
Employee Misconduct, and Suspected Criminal Activities concerning serious
injury or death of consumers or its subsequently approved Department policy.

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Georgia Department ot Human Resources, Division of Aging Services

February 2008

GEORGIA DEPARTMENT OF HUMAN RESOURCES

Division of

Services

END OF GUARDIANSHIP

s501. TERMTNATING GUARDTANSHTP
Requiremenb:
DHR shall take actions to petition the Probate court to modifu or terminate the
Guardianship of Person when:
A) Someone on the preference order list is identified and willing to serve as
Guardian.
B) The condition of the ward has significantly changed to the extent that restoration
of some or all rights is indicated.

Additionally, the Department of Human Resources shall be removed as guardian in
accordance with O.C.G.A. g 29a-3 @.1):
"lf, after having been so appointed, the depaftmenf presenfs to the couft a
public guardian registered in accordance with Chapter 10 of this tiile or some other person suitable and appropriate to serve as guardian of a
ward and willing to so serye, the coutt shall allow the department to resign and shall appoint such public guardian or such other person."
Note: The Department of Human Resources, as guardian, does not vouch for the
qualifications, suitability or availability of a proposed successor guardian. The agency will present the name to the court in accordance with O.C.G.A. S 294-3
(b.'l ) for the probate court judge to determine suitability and appropriateness.
O.C.G.A. S 29-+42. Termination of guardianship; required evidence; burden of
proof; return of property.

(a) Upon the petition of any interested person, including the ward, or upon the
court's own motion, and upon a proper showing that the need for a guardianship is ended, the couft may terminate the guardianship and restore all personat and property rights to the ward. Except for good cause shown, the couti shalt order that notice of the
petition be given, in whatever form the couft deems appropiate, to the ward, the
guardian, the ward's legal counsel, if any, and the ward's conservator, if any. The couri
shall appoint legal counsel for the ward and may, in its discretion, appoint a guardian ad
litem.

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Georgia Department of Human Resources, Division of Aging Services

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GEORGIA DEPARTMENT OF HUMAN RESOURCES

(b) A petition for termination must be supported either by the affidavits of two

persons who have knowledge of the ward, one of whom may be the petitioner, or of a

physician licensed to practice medicine under chapter 34 of riile 43, a psychotogist

licensed to practice under chapter 39 of ritle 43, or a licensed clinicat social worker,

sefting forth the suppofting facts and determinations. If, after reviewing the petition and

the affidavits, the court determines that there is no probable cause to betieve that the

guardianship should be terminated, the court sha// dlsmr.ss the petition. tf the petition is

not
the

dismissed, the court shall order
provisions of subsection (d)

that
of

an evaluation be conducted, in accordance with
code section 29-4-1 1 . If, after reviewing the

evaluation repoft, the couft finds that there is no probabte cause to betieve that the

guardianship should be terminated, the couri sha// dlsmiss the petition. lf the petition is

not dismissed, the couti shall schedule a heaing, with such notice as the couft deems

appropriate.

(c) ln any proceeding under this Code section, the burden is on the petitioner to show by a preponderance of the evidence that there is no longer a need for the
guardianship.

(d) No petition for termination of a guardianship shall be altowed by the coutt within two years after the denial or dlsmissa/ on the meits of a petition for termination of the
guardianship unless the petitioner shows a significant change in the condition or
circumstances of the ward.
(e) The death of the ward automatically terminates the guardianship, except as
otherwise provided in Code Secfion 29-4-43.
(t) Upon termination of the guardianship, the guardian shail deliver any money or propefty to the ward or, if a conseruator has been appointed for the ward, to that
conservator or, if the ward is deceased, to the ward's personal representative.

s502. TRANSFER OF GUARDTANSHTP
O,C,G.A. S 29-+90. Transfer of guardianship following ward's permanent move;
determining status of ward's residence; petition for receipt and acceptance of
guardianship.
A foreign couri is a couft in another state or territory covered by the Constitution of the United States.)
(a) A guardian may petition the Georgia court that has juisdiction over the
guardianship to transfer the guardianship to a foreign court of competent juisdiction if
the ward has moved permanently to the foreign juisdiction. A DHR Representative must notify the APS section at the state office and DAS Legal if actions are considered that would move a ward out-of-state. DHR wards may not be moved out-of-state without prior approval of the Director. Therefore, a case manager
DHR Adult Public cuardianship Manual Georgia Department of Human Resources, Division of Aging Services February 2008

GEORGIA DEPARTMENT OF HUMAN RESOURCES Division of Aqinq Services
will fully apprise their supervisor, District Manager, or other regional supervision
(Guardianship Service Providers), and DAS Legal of any plans for the removal of a ward from Georgia. Additionally, notification must be given to the court prior to any process to remove a ward out-of-state. lf litigation or a hearing is required, then a Special Assistant Attorney General (SAAG), if available, and DAS Legal will be notified by the DHR Representative. [Note: Within guardianship law, the probate court must appoint an attorney for the ward. Additionally, if the ward is 60 years of age
or older, a DHR Representative may notify Elderly Legal Assista nce Program for
representation of the ward.l
O.C.G.A. S 29-+91. Requirements of petition to transfer guardianship.
The petition to transfer a guardianship to a foreign iuisdiction shall include the
following:
(1) The name and address of the foreign coutt to which the guardianship shall be transfened and an authenticated copy of the petition for receipt and acceptance of a
foreign guardianship if previously filed in the foreign court;
(2) A listing of any other guardianship petitions that are pending in any iuisdiction and the names and addresses of the courts where the petitions have been filed;
(3) The petitioner's name, address, and county of domicile;
(4) The name, age, and cunent address of the ward and the new or proposed
address of the ward;
(5) The names and addresses of the following, if living:
(A) The spouse of the ward; and
(B) All children of the ward; or
(C) lf there are no adult children, then at least two adults in the following order of
priortty:
(i) Lineal descendants ot the ward;
(ii) Parents and siblings of the ward; and
fii) Fnends of the ward; (6) The name and address of the person responsible for the care and custody of the
ward, if other than the petitioner, and of any other guardian currently serving;
(7) The name and address of any legal representative, other than the petitioner, including any legal counsel, guardian ad litem, or couti visitor appointed by the foreign
couri for the ward;
(8) The name and address of the ward's conservator, if any; and
DHR Adult Public Guardianship Manual Georgia Department of Human Resources, Division of Aging Services February 2008

GEORGIA DEPARTMENT OF HUMAN RESOURCES Division of rinc Services
(9) The reason for moving the ward and the reason the transfer of the guardianship is in the ward's best interest.
, (Code 1981, 29-4-91, enacted by Ga. L.2004, p. 161 1.)
o.c.G.A. 5 29-+94. Required findings prior to transfer of guardianship; orderly and coordinated transfer of guardianship.
(a) The court may grant a petition to transfer a guardianship to a foreign coutT of
competent jurisdiction if the court finds that: (1) The guardian is presently in good standing with the couft; and
(2) The transfer of the guardianship to the foreign iuisdiction is in the best interest of
the ward...

s503. DEATHOFAWARD

Requiremenb:

The death of the ward automatically terminates the guardianship authority of the
Department of Human Resources.

DHR, who was Guardian at the time of the ward's death, shall take actions to notify all known relatives, ne{-of-kin, other significant persons and agencies/care coordinators of the death.

Written notification of the death of the ward shall be made to the State Office within 5
calendar days. A report shall be made to the DAS APS Section, immediately upon
receipt of any such report of a ward's unexpected death no later than the close of the next business day (with copy to District Manager & supervisor). An "unexpected death" is defined as death that occurs as a result of homicide, suicide, accident or suddenly
when in apparent good health. (Refer to Definitions.)

Reports shall be made using: APS Death, Serious Injury and Reportable critical f ncidents Reporting Form (Revised 1119107) or its subsequently approved form. A final
personal status report shall be immediately filed with the probate court of jurisdiction.

Request for authorization for autopsy or donation of ward's body for research
o As guardianship authority ceases at the death of a ward, the Department of
Human Resources, as guardian, has no authority to authorize an autopsy or
donation of a ward's body for research and cannot give consent.

Note: The Coroner and/or Medical Examiner have the legal authority to require

or authorize an autopsy.

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Georgia Department of Human Resources, Division of Aging Services

February 2008

GEORGIA DEPARTMENT OF HUMAN RESOURCES Division of I Services

Request for Department from a hospitalinursing

of Human home to a

Resources to funeral home

sign or to

to release w-ard's body arrange and/or pay for

the ward's funeral

r The Department of Human Resources, as Guardian, has no authority to release a ward's body from a hospital/nursing home to a funeral home.

. The Department of Human Resources, as Guardian, has no authority to
authorize cremation of a body. The conservator, if one has been appointed,
should handle all necessary arrangements.

o The Division's Legal Services Officer and the Special Assistant Attorney General (if SAAG is involved) shall be consulted on matters of law, as needed, related to the death of a ward.

Paveeshio Funds held at time of Death WhenDFCS is Reprsentative Payee at the time of a ward's death, any outstanding debts/bills may be paid from the funds held in the payeeship account. DFCS may issue a check, from'client's funds, to the funeral home for burial. Any remaining funds held must be turned over to the Conservator or Probate Court.

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Geolgia Department of Human Resources, Division of Aging Seruices

February 2008

GEORGIA DEPARTMENT OF HUMAN RESOURCES Division of Aqinq Services
APPENDICES

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29

Georgia Department of Human Resources, Division of Aging Services

February 2008

December 31, 2007

Appendix A

GUARDIAI\SHIP CHECKLIST

nn!

Take the Oath and obtain Letters of Guardianship, Date appointed Guardian
Obtain names, addresses, phone numbers of ward's interested others.

ninn!l

Is there a Conservator/Guardian of property? name, address, phone Does the ward receive any funds under their name? From whom? How much? Are there funds in a patient account at a facility? How much? Obtain ward's Social Security, Medicaid, and Medicare numbers, Is ward eligible for veteran's benefits, ssA-D, ssl, Medicaid? Has anyone applied for

benefits?

Dn
tr

Obtain name of ward's physician and other treating professionals. Date of last known physicat exam? Last lab tests? X-rays? Schedule appointment with treating physician. Attend with ward,

Obtain list of ward's medicines and over-the-counter drugs.

n Does ward wear of need glasses? Date of last known eye exam?

tnnnD!nnr

Does ward wear or need dentures? Date of last known dental exam? Does ward wear or need hearing aid? Date of last known hearing exam? Does ward use or need walker? Wheelchair? Prosthesis?
Does ward need podiatry services?
Does ward need special exams? Mammogram? Pap test? Colo-rectal smear?
What is the medical diagnosis? Recommended course of treatments? Does ward require extended physical assessments from other professionals? Did ward have recent surgery? Diagnosis? Follow-up appointment needed?

nntnnnr

Obtain name of ward's psychiatrist or other mental health professional. Date oflast know mental exam? Should one be scheduled? What is mental diagnosis? Recommended course of treatment? What, if any, psychotropic medicines does ward take?
Does ward need counseling for a mental health problem?
Has the ward been hospitalized for mental probtems? Where? When?

n!n

Does ward's living environment provide basic needs met and safety? If not, why?
What does ward's physician recommend? Where does the ward wish to live?

tnnnr

Has ward's clothing and personal items been inventoried?
Has ward's clothing and personal items been marked?
Does the ward wish to have own furniture, TV, radio, mementos, photographs? can ward keep personal jewelry or other valuables? consider placing them in a secure

!

place.
consult with conservator/Guardian of Property or Bank trustee when considering change

in residence.

December 3l,200'7

U Attend care plan conferences.

n Is there a pre-arranged funeral or cremation? Is there a cemetery plot? Has it been pre-

paid?

nn!

Does ward have a will? Where is will located?
Did the ward dictate funeral arrangements in a Will? Make a list of individuats to be notified in the event of an emergency of the ward's death.

!

Include State Office. Advance directives? Living will?

n Complete Case Plan (involve ward and all ofher interested parties)

tr Maintain accurate records of ward's changes in address (dates and addresses)

tnr

Maintain records of all medical and psychiatric treatments, hospitalizations, surgery. Notify attorney of record, conservator/Guardian of Property or Bank trustee, ward's

family, friends, service provider of any changes in health or residence.

!nn

An APS case manager will see ward each month.
Have ward examined by a doctor at least once annually. Prepare and submit to the Probate Court Jhe Personal Status Report.

Appendix B

ffDHR

B. J. Walker. Commissioner

Gorgia Department of Human Rsources . Division of Aging Services o Maria Gren, Division Director

Two Peachtre Street, NW. Suit 9-398. Atlanta, Georgia 30303-3142 o Phone: 404-657-5258 o Fax: 404-657-5285

PLEASE SEND THIS FORM BY GROUPWISE ATTACHMENT TO:

Date:
Mary Martha Rugg, Section Manager Adult Protective Services Division of Aging Services Two Peachtree Street, N.W. 9s Floor Atlant4 Georgia 30303
RE: Name of Ward:
Birthdate: Social Security Number: Name of Facility: Type of Facility: Address of Faciliry:
Name of Guardian of Property (ifapplicable):
Dear Mrs. Rugg:
This is to inform you:
A. The above-named person became a ward of Adult Protective Services through DHR on
. Adult Prolective Services will monitor and provide
ongoing services to the ward.
The petition was filed by: This is a Permanent Guardianship. This is an Emergency Guardianship.
Comments:
B. Ward's address has changed to the above.
c. Guardianship was terminated on
Reason:
Submitted b!: APS Case Manager
Approved by: APS Supervisor

Seming Older Georgiqns qnd Their Fqmilies An Equal Opportunity Employer

NNEN N N E EE NNN EilN E E N N EE N E N

E

N APPendix C

N

MEDICAL CONSENT AUTHORIZATION T'ORM Georgia Department of Human Resources as Guardian of Last Resort

E

N

Represented by the Division of Aging Services/Adult Protective Services

lNt

N

N

N

Please indicate which type ofconsent is required:

N

E

_ Routine

Intermediate Division Director's Approval/Notification

E

E NAME

N

N

ADDRESS CLIENT SS#

DOB:

AGE:

E

N

E

E

PROCEDURE RECOMMENDED: Informed consent issues addressed Yes

N
E

-
Altematives and reasons why the alternatives are not being pursued:

E
N N

N

N

E

Goal of the treatment/Why is the treatment needed?

E

E

N

N

Treatment needed no later than

N

E

Outcome ifno action is taken

N

E

N

N

Risk/consequencevside effects of the treatmenV involved

N

N
E

N

E

E

Is Court order required

N

E

E

N

State/Include any preferences the ward has previously stated both verbally and through advance

E

directives
N

E

N

N

N

Decision Making Capacity of the ward

N

N

DASA4CAT' 9/15/2007

N

N E NN EilN EI N E N N N E N E N E N N NE N N

N N N N N N N N N N N N N N N N N Eil N N EI tr EI

N

N

_#1 Medical Opinion, physician's name and organization,s name lsee attached)

N

_#2 Medical Opinion, if applicable, physician's name and organization,s name (see attached)

N N N

E

Physician's Information:

N

N

E

N

N

(Print Name)

N

(Print Facility & Address)

N
N
E

N

(Print Name)

N

N
E

(Print Facility & Address)

N N

N

N

Medical Consent Approved by:

Case manager approval

N N

N

N

Supervisor approval, if applicable

N

DAS/APS Section staff approval, if applicable

E

District Manager's approval, if applicable

N

Division Director/Deputy Director/Designee approval, if applicable

N
N N N
E

E

N

N

To the extent known' representatives of DIrRr in making decisions on behalf of DHR as

N

guardian of last resort, shall consider the expressed desires and personal values ofthe ward. A guardian shall at all times act as a fiduciary in the ward's best interest and

N

exercise reasonable as an addendum to

care,
Adult

dPilrigoetenccteiveanSdeMprcuedsenpcoel,icpyuMrsaunaunat l,toCOh.aCp.tGer.A2,0$0209, -$42-20027a.1n0d.

N
E E

N

N

N
N
N
E

If there are any questions or concerns about a particular medical treatment, DAS policy is that staff consults with the APS Section and obtain legal advice from the Director's Office. In the event ofan
emergency or disaster, DHR staff handing duties and functions on behalf of DHR as guardian of last resort may not have sufficient time to consult with DAS staff and obtain all documentation. DHR reprsentatives (DAS staff) will make a reasonable assessment of the factors required for decision on
medical heatment in order to achieve informed consent.

N
N
E E

NNN E

DASA4CAF 9/15/2007

NN N Eil NN NN EN N NN E NN N N

N NN

Eil N N N N N N Eil EI N Eil tr N N N N N N N N N N N

N

N

N

Levels of Approval for Medical Consent:

E

N

Routine medical consent involves medical treatment such as medical, vision, dental care that does not administer general anesthesia, and general admittance into hospice (except when client is entering hospice

N

N

reilh life expectancy of 30 days or /ess). Although routine medical consent does not require a supervisor's approval; the supervisor should be fully briefed in advance, when possible, and in a timely manner.

N

E

Examples include:

E

N Vaccines

Administration oflocal anesthesia

N

N

Dental Work Diagnostic x-rays

Mental health/mental retardation behavior support plans Psychotropic medicttions (if ward does not refuse)

N

N

SutureVRemoval of Sutures

Hospice (where life expectanq/ is more than 30 days)

N

N

Intermediate medical consent (Supenisor's/District Manager's Approval) requires the approval of the Supervisor and District Manager, and obtain a second physician's opinion. Supervisors make this

N

tr

decision based upon what a reasonable supervisor making a medical consent decision in the particular situation would do in accordance with DAS/APS training and policy.

E

N Examples include:

N

N

o Administrationofgeneralanesthesia o Minor surgery with little risk to ward

N

N N

o Advanced diagnostic testing . Emergency Surgery (if Division Director approval not required) . Hospice (if life atpectancy is 30 days or less)

N N

N

Division Director's consent requires the approval or notification of the Division Director, Deputy

E

E

Director or their designee when there is substantial risk to the ward, or end-oflife care.

E

E

Examples include:
. Neurosurgery

N

N

. Amputation or otler norneversible surgeries o Sterilization, in accordance with state law

N

N

. Court order required based on federal or state law . Organ transplant

E

N

o Blpass surgery r Electro-ConvulsiveTreatment(ECT)

N

N

. End-ofJife care (e.g. Order not to resuscitqte (DNR order), removql ofventilotor, etc.)

E

N

N

N

N

N

N

E

N

N

E

N

E

E

DASA,ICAF 9/15/2007

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Appendix D
O.C.G.A $ 3f-39-4. Persons authorized to issue order not to resuscitat.
(a) It shall be lawful for the attending physician to issue an order not to resuscitate pursuant to the requirements of this chapter. Any written order issued by the attending physician using the term "do not resuscitate," 'DNR," 'order not to resuscitate," "no code," or substantially similar language in the patient's chart shall constitute a legally sufficient order and shall authorize a physician, health care professional, or emergency medical technician to withhold or withdraw
cardiopulmonary resuscitation. Such an order shall remain effective, whether or not the patient is
receiving treatment from or is a resident of a health care facility, until the order is canceled as provided in Code Section 31-39-5 or until consent for such order is revoked as provided in Code Section 31-39-6, whichever occurs earlier. An attending physician who has issued such an order and who transfers care of the patient to another physician shall inform the receiving physician and the health care facility, ifapplicable, ofthe order.
(b) An adult person with decision-making capacity may consent orally or in writing to an order not to resuscitate and its implementation at a present or future date, regardless of that person's mental or physical condition on such future date. If the attending physician determines at any time that an order not to resuscitate issued at the request of the patient is no longer appropriate because the patient's medical condition has improved, the physician shall immediately noti$ the patient.
(c) The appropriate authorized person may, after being informed of the provisions of this
Code section, consent orally or in writing to an order not to resuscitate for an adult candidate for nonresuscitation; provided, however, that such consent is based in good faith upon what such authorized person determines such candidate for nonresuscitation would have wanted had such candidate for nonresuscitation understood the circumstances under which such order is being
considered.
(d) Any parent may consent orally or in writing to an order not to resuscitate for his or her minor child when such child is a candidate for nonresuscitatioh. If in the opinion ofthe attending
physician the minor is of sufficient maturity to understand the nature and effect ofan order not to resuscitate, then no such order shall be valid without the assent ofsuch minor.
(e) If none of the persons specified in subsections (b), (c), and (d) of this Code section is
reasonably available or competent to make a decision regarding an order not to resusciiate, an attending physician may issue an order not to resuscitate for a patient, provided that:
(1) Such physician determines with the concurrence of a second physician, in writing in the
patient's medical record, that such patient is a candidate for nonresuscitation;
(2) An ethics committee or similar panel, as designated by the health care facility, concurs in the opinion ofthe attending physician and the concurring physician that the patient is a candidate for nonresuscitation; and
(3) The patient is receiving inpatient or outpatient treatment from or is a resident of a health care facility other than a hospice or a home health agency.