Unrepresented Adults Face Adverse Healthcare Consequences: The Role of Guardians, Public Guardianship Reform, and Alternative Policy Solutions

Catlin, Casey; Connors, Heather; Teaster, Pamela B.; Wood, Erica; Sager, Zachary; Moye, Jennifer

doi:10.1080/08959420.2020.1851433

Cited by 13 publications

(8 citation statements)

References 27 publications

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“…Additional articles without detailed descriptions of capacity determination did still note a lack of capacity to be an explicitly temporary state ether due to acute illness or in the context of a specific pressing medical question. Those few articles that referred to incapacity as a long-term state due to chronic mental or cognitive illnesses all lacked a detailed discussion of capacity determination and were largely found in discussions specifically addressing guardianship ( Björkstén et al, 2014 ; Catlin et al, 2021 ; Coker & Johns, 1994 ).…”

Section: Resultsmentioning

confidence: 99%

Adults Without Advocates and the Unrepresented: A Narrative Review of Terminology and Settings

Brenner

Cole

Towsley

et al. 2023

Gerontology and Geriatric Medicine

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Socially isolated adults, including those with and without the ability to make medical decisions, are encountered in clinical practice and are at risk for adverse health outcomes. Consensus is lacking on appropriate terminology to describe subpopulations of these patients. In addition, little is known about the settings in which they present. These gaps prevent clinicians and policymakers from identifying and understanding these populations and deploying appropriate resources to meet their complex needs. We conducted a narrative review of literature on socially isolated adults aged 50 and older to assess and integrate the available evidence regarding the terminology used to describe unrepresented patients and adults without advocates to inform consensus on terminology. We also identified the settings in which unrepresented patients and adults without advocates are described in the literature, including both within and outside health care settings. Our results indicate that there is heterogeneity and inconsistency in the terminology used to describe socially isolated adults, as well as heterogeneity in the settings in which they are identified in the literature. Our findings suggest that future work should include achieving consensus on terminology and integrating proactive interdisciplinary interventions across health systems and communities to prevent adults without advocates from becoming unrepresented.

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Section: Resultsmentioning

confidence: 99%

Adults Without Advocates and the Unrepresented: A Narrative Review of Terminology and Settings

Brenner

Cole

Towsley

et al. 2023

Gerontology and Geriatric Medicine

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“… 5 , 6 While the default surrogacy mechanism can be of value to individuals who have not completed an advance directive, as of 2017, there were 4 states without this legal mechanism. 7 …”

Section: Introductionmentioning

confidence: 99%

“…However, a recent qualitative study found that on average it took 17 days and 6 attempts before a guardian was found. 7 …”

Section: Introductionmentioning

confidence: 99%

The Cost of Medically Unnecessary Days Due to Waiting for Guardianship in a State Acute Hospital System

Brierley-Bowers

Connors²,

Tompkins³

et al. 2022

INQUIRY

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Hospitals must do more with less, making efficiency a priority. Discharge delays create challenges for acute care hospitals. Some delays are due to patients waiting for a guardian—a person appointed to assist an adult who lacks decision-making capacity. Previous studies examine the burden of excess days in a single academic medical center (AMC); however, these institutions do not represent the entire hospital system. This descriptive study expands upon previous analyses by calculating the financial implications of medically unnecessary days in a state’s hospitals to payers. Two models are presented: one calculates the gross patient service revenues required to support excess days; the other calculates the expense to hospitals. Results suggest that substantial funds are required to support excess days. Funds may be better allocated to support the health and well-being of people needing medical care or to address the cause of delays due to waiting for guardianship.

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“…In the U.S., adults without surrogates are characterized as white, male, 65 years or older, and as having a family member, but not having a proxy, because they are not cooperative in decision-making [24]. Adults without surrogates experience longer hospital stays and delays in receiving palliative care and treatment [25]. Further, one study in a Canadian long-term care facility found that social support for these individuals was limited, and even basic personal items were difficult to 4 obtain [18].…”

Section: Introductionmentioning

confidence: 99%

Current situation of the hospitalization of persons without family in Japan and related medical challenges

Yamazaki¹,

Tamiya

Muto

et al. 2022

Preprint

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This study aims to determine the approximate number of hospitalizations of persons without family and the medical challenges they encounter in hospitals across Japan. Self-administered questionnaires were mailed to 4,000 randomly selected hospitals nationwide to investigate the actual conditions and problems, decision-making processes, and use of the government-recommended Guidelines for the hospitalization of, and decision-making support for, persons without family. To identify the characteristics of each region and hospital function, chi-square tests were used to make separate group comparisons by hospital location and type. Responses were received from 1,271 hospitals (31.2% response rate), of which 952 hospitals provided information regarding the number of admissions of persons without family. The mean (SD) and median number of hospitalizations (approximate number per year) of patients without family was 16 (79) and 5, respectively. Approximately 70% of the target hospitals had allowed the hospitalization of a person without family. The most common difficulties encountered during the hospitalization were collecting emergency contact information, decision-making related to medical care, and discharge support. In the absence of family members and surrogates, the medical team undertook the decision-making process, which was commonly performed according to manuals and guidelines and by consulting an ethics committee. Regarding the use of the government-recommended Guidelines, approximately 70% of the hospitals that were aware of these Guidelines responded that they had never taken any action based on these Guidelines, with significant differences by region and hospital type. To solve the problems related to the hospitalization of persons without family, the public should be made aware of these Guidelines, and measures should be undertaken to make clinical ethics consultation a sustainable activity within hospitals.

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Unrepresented Adults Face Adverse Healthcare Consequences: The Role of Guardians, Public Guardianship Reform, and Alternative Policy Solutions

Cited by 13 publications

References 27 publications

Adults Without Advocates and the Unrepresented: A Narrative Review of Terminology and Settings

Adults Without Advocates and the Unrepresented: A Narrative Review of Terminology and Settings

The Cost of Medically Unnecessary Days Due to Waiting for Guardianship in a State Acute Hospital System

Current situation of the hospitalization of persons without family in Japan and related medical challenges

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