Gibson (2011) provided a retrospective analysis of adult guardianship cases in two Kentucky counties. The goal of the analysis was to determine if the information provided to the courts during these cases was comprehensive, if least restrictive intervention alternatives were considered, and if the limited guardianship option was utilized. Gibson (2011) concluded with recommendations for improvements in these areas of guardianship cases with particular attention to the role social workers could play.
The article reported an estimate from 2006 that 1.5 million people were under private or public guardianships. However, the article also noted that the US Government Accountability Office stated that neither state governments nor federal governments keep track of how many elderly individuals have guardians or the incidences of abuse of those individuals with guardians. While Gibson (2011) highlighted many intended benefits of guardianships such as protecting people from abuse, neglect, and exploitation, the article also highlighted potential pitfalls of guardianships and the current system.
Autonomy appeared to be the biggest concern once an individual was determined to need a guardian. Gibson (2011) discussed a case from 1966, Lake v. Cameron, which highlighted the importance of the least restrictive intervention. In the case, a 60-year-old woman was reported to wander the streets and was involuntarily hospitalized. She was diagnosed with dementia, but not deemed to be a danger to herself or others. The court found that the woman could not be indefinitely hospitalized without considering less restrictive forms of treatment. Gibson (2011) mentioned a previous study of guardianship cases noting that 94% of petitions were granted and only 13% of those granted were limited guardianships. Gibson (2011) also cited a review of court practices that concluded that reports with more thorough testimony were more likely to result in limited guardianships being awarded.
The article examined 40 randomly selected disability cases of 813 disability cases in two Kentucky counties from a three-year period (2004, 2005, 2006). The study used a modified Guardianship Evaluation Recording Instrument (GERI Mod) to examine information for the cases and collected demographics, social workers’ reports, psychologists’ reports, physicians’ reports, and the audio recording of court testimony, if available. The analysis looked at over 300 items and determined whether the item was present or not. The items looked at information that included, but was not limited to, clinical examination procedures, medical history, cognitive symptoms, functional abilities, social functioning, consideration of least restrictive interventions, diagnoses, and final recommendations.
Gibson (2011) found that 97% of the guardianship cases examined were granted, 82% of those were awarded full guardianships and 18% were limited guardianships (partially disabled in Kentucky). The study utilized seventeen of the items that were consistent with Kentucky law as well as current best practice and provided a score of adherence to these seventeen items. Gibson (2011) found that psychologists scored a mean of 11.98 with a standard deviation of 3.21, social workers scored a mean of 11.45 with a standard deviation of 1.62, and physicians scored a mean of 8.35 with a standard deviation of 2.65. Based on these findings, Gibson (2011) determined that there was a significant difference between the adherence score of the physicians and the other two disciplines. Although the mean score of psychologists was slightly higher than that of the social workers, the smaller standard deviation indicates that the social workers were more consistently adhering to the items. Gibson (2011) determined that medical history, effect of medications on behaviors, adaptive behaviors, and strengths were frequently lacking from the reports of psychologists, social workers, and physicians alike.
Gibson concluded with a discussion of how social workers could be useful in providing more information to courts in guardianship cases. The suggestion was to have a court visitor, a social worker who would come in to ensure that all areas were being address properly, that the least restrictive alternative was being considered, and that clients were empowered to seek clarification and ask questions. Even though social workers provided similar amounts of information in the cases examined for this article, Gibson (2011) expressed that social workers are uniquely primed for this role, given that they have a history of advocacy, are familiar with other professional disciplines, and have the opportunity to educate clients and their families. Gibson (2011) concluded that more thorough information from social workers and other professionals would better help the courts make decisions about guardianships and may prepare a court to award limited guardianships when the individual is still capable of maintaining some of their basic rights and autonomy.
Gibson, L. (2011). Giving courts the information necessary to implement limited guardianships: Are we there yet?. Journal of Gerontological Social Work, 54(8) 803-818. doi: 10.1080/01634372.2011.604668
Brittany Best, BA
WKPIC Doctoral Intern