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American Journal of Alzheimer's Disease and Other Dementias logoLink to American Journal of Alzheimer's Disease and Other Dementias
. 2001 Mar-Apr;16(2):89–96. doi: 10.1177/153331750101600208

Legal guardianship and other alternatives in the care of elders with Alzheimer's disease

Michael N Kane 1
PMCID: PMC10833914  PMID: 11302077

Abstract

This paper discusses planned instructional and proxy interventions for incapacity, legal guardianship, and supplements to care for people with Alzheimer's disease (AD). Service providers are encouraged to identify and initiate care decisions that are consistent with the client's care preferences. Case examples are discussed. Practitioners are encouraged to educate clients, particularly those in the early stages of Alzheimer's disease, to create evidence for care preferences through planning. Service providers' concerns for liability are briefly discussed.

Keywords: advance directives, Alzheimer's disease, durable power of attorney, guardianship, health care proxy, instructional directives

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References

  1. Kapp MB : Geriatrics and the Law. New York: Springer, 1999. [Google Scholar]
  2. Sirmon M , Kreisberg R: The invisible patient. NEJM. 1996; 334: 908-911. [DOI] [PubMed] [Google Scholar]
  3. Sabatino CP : Competency: Refining our legal fictions. In Smyer M, Warner Schaie K, Kapp MB (eds.): Older Adults' Decision-Making and the Law. New York: Springer, 1996: 1-28. [Google Scholar]
  4. Brakel SJ : Historical trends. In Brakel SJ, Parry J, Weiner BA (eds.): The Mentally Disabled and the Law, 3rd Ed. Chicago: American Bar Foundation, 1985: 9-20. [Google Scholar]
  5. Peters R , Schmidt WC, Miller KS: Guardianship of the elderly in Tallahassee, Florida. The Gerontologist. 1985; 25(5): 532-538. [DOI] [PubMed] [Google Scholar]
  6. Iris MA : Guardianship and the elderly: A multi-perspective view of the decision-making process. The Gerontologist. 1988; 28 (suppl.): 39-45. [DOI] [PubMed] [Google Scholar]
  7. Scogin F , Perry J: Guardianship proceedings with older adults: The role of functional assessment and gerontologists. Law & Psychology Review. 1986; 10: 123-128. [Google Scholar]
  8. Kane MN : Consent and competency in elders with Alzheimer's disease. American Journal of Alzheimer's Disease. July/August 1998; 13(4):179-188. [Google Scholar]
  9. Meisel A : The Right to Die. New York: John Wiley & Sons, 1989. [Google Scholar]
  10. Hennessy CH : Autonomy and risk: The role of client wishes in community-based long-term care. The Gerontologist. 1989; 29(5): 633-639. [DOI] [PubMed] [Google Scholar]
  11. Kapp MB : Alternatives to guardianship: Enhanced autonomy for diminished capacity. In Smyer M, Warner Schaie K, Kapp MB (eds.): Older Adults' Decision-Making and the Law. New York: Springer, 1996. [Google Scholar]
  12. Kelly TB : Paternalism and the marginally competent: An ethical dilemma, No easy answers. Journal of Gerontological Social Work.1994; 23(1/2): 67-84. [PubMed] [Google Scholar]
  13. Reamer FG : The concept of paternalism in social work. Social Service Review. 1983; 57: 254-271. [Google Scholar]
  14. Beauchamp TL , Childress JF: Principles of Biomedical Ethics, 3rd Ed. New York: Oxford University Press, 1989. [Google Scholar]
  15. Beall C , Baumhover LA, Novak DA, et al.: Educating about Alzheimer's disease: Curricular implications for health professionals. Gerontology & Geriatric Education. 1992; 11(3): 85-95. [Google Scholar]
  16. Carmel S , Cwikel J, Galinsky D: Changes in knowledge, attitudes, and work preferences following courses in gerontology among medical, nursing, and social work students. Educational Gerontology. 1992; 18: 329-342. [Google Scholar]
  17. Intrieri RC , Kelly JA, Brown MM, Castilla C: Improving medical students' attitudes toward and skills with the elderly. The Gerontologist. 1993; 33: 373-378. [DOI] [PubMed] [Google Scholar]
  18. Kane MN : Factors affecting social work students' willingness to work with elders with Alzheimer's disease. Journal of Social Work Education. 1999; 35(1): 71-85. [Google Scholar]
  19. Gatz M , Pearson CG: Ageism revised and the provision of psychological services. American Psychologist. 1988; 43(3): 184-188. [DOI] [PubMed] [Google Scholar]
  20. Gubrium JF , Holstein JA: Constructionist perspectives on aging. In Bengston VL, Warner Schaie K (eds.): Handbook of Theories of Aging. New York: Springer, 1999: 287-305. [Google Scholar]
  21. Wilderom CPM , Press EG, Perkins DV, et al.: Correlates of entering medical students' attitudes toward geriatrics. Educational Gerontology. 1990; 16: 429-446. [Google Scholar]
  22. Kane MN : Mental health issues and Alzheimer's disease. American Journal of Alzheimer's Disease. March/April 1999; 14(2): 102-110. [Google Scholar]
  23. Roth LH , Meisel JD, Lidz CW: Tests of competency to consent to treatment. American Journal of Psychiatry. 1977; 143(3): 279-284. [DOI] [PubMed] [Google Scholar]
  24. Watts DT , Cassell CK, Howell T: Dangerous behavior in a demented patient: Preserving autonomy in a patient with diminished competence. Journal of the American Geriatrics Society. 1989; 37: 658-662. [DOI] [PubMed] [Google Scholar]
  25. Mahler JC , Perry S, Miller F: Psychiatric evaluation of competency in physically ill patients who refuse treatment. Hospital & Community Psychiatry. 1990; 41: 1140-1141. [DOI] [PubMed] [Google Scholar]
  26. Rabins PV , Mace NL: Some ethical issues in dementia care. Clinical Gerontologist. 1986; 5(3/4): 503-512. [Google Scholar]
  27. McCullough L : Medical care for elderly patients with diminished competence. Journal of the American Geriatrics Society. 1984; 32:150-150. [DOI] [PubMed] [Google Scholar]
  28. Kane MN : Ethnoculturally-sensitive practice and Alzheimer's disease. American Journal of Alzheimer's Disease. March/April 2000;15(2): 80-86. [Google Scholar]
  29. High DM : Planning for decisional incapacity: A neglected area in ethics and aging. Journal of the American Geriatrics Society. 1987; 35(8): 814-820. [DOI] [PubMed] [Google Scholar]
  30. Molloy DW , Clarnette RM, Braun EA, et al.: Decision making in the incompetent elderly: “The daughter from California syndrome.” Journal of the American Geriatrics Society. 1991; 39(4): 396-399. [DOI] [PubMed] [Google Scholar]
  31. Bowers VJ : Advance directives: Peace of mind or false security? Stetson Law Review. 1996; 26: 677-723. [Google Scholar]
  32. Darr K : Ethics in Health Services Management, 3rd Ed. Baltimore: Health Professions Press, 1998. [Google Scholar]
  33. Morris V : How to Care for Aging Parents. New York: Workman Publishing, 1996. [Google Scholar]
  34. Parry, J : Incompetency, guardianship and restoration. In Brakel SJ, Parry J, Weiner BA (eds.): The Mentally Disabled and the Law, 3rd Ed. Chicago: American Bar Foundation, 1985. [Google Scholar]
  35. Coleman N , Dooley J: Making the guardianship system work. Generations. 1990; (Suppl.): 47-50. [Google Scholar]
  36. Keith PM , Wacker RR: Guardianship reform: Does revised legislation make a difference in outcomes for proposed wards? Journal of Aging and Social Policy. 1992; 4(3/4): 139-155. [DOI] [PubMed] [Google Scholar]
  37. Petrila J , Otto RK: Law and Mental Health Professionals—Florida. Washington, DC: American Psychological Association, 1996. [Google Scholar]
  38. Quinn MJ : Everyday competence and guardianship: Refinements and realities. In Smyer M, Warner Schaie K, Kapp MB (eds.): Older Adults' Decision-Making and the Law. New York: Springer, 1996: 128-141. [Google Scholar]
  39. Willis SL : Assessing everyday competence in the cognitively challenged elderly. In Smyer M, Warner Schaie K, Kapp MB (eds.): Older Adults' Decision-Making and the Law. New York: Springer, 1996: 87-127. [Google Scholar]
  40. Congress EP , Chernesky RH: Representative payee programs for the elderly: Administrative, clinical, and ethical issues. Journal of Gerontological Social Work. 1993; 21(1/2): 77-93. [Google Scholar]
  41. Houston-Vega MK , Nuehring E, Daguio ER: Prudent Practice: A Guide for Managing Malpractice Risk. Washington, DC: NASW Press, 1997. [Google Scholar]
  42. Madden RG : Legal Issues in Social Work, Counseling and Mental Health: Guidelines for Clinical Practice in Psychotherapy. Thousand Oaks, CA: SAGE Publications, 1998. [Google Scholar]
  43. Wilber KH : Alternatives to guardianship revisited: What's risk got to do with it? In Smyer M, Warner Schaie K, Kapp MB (eds.): Older Adults' Decision-Making and the Law. New York: Springer, 1996: 213-224. [Google Scholar]
  44. Stiegel LA : Barriers to the development and use of alternatives to guardianship. Smyer M, Warner Schaie K, Kapp MB (eds.): Older Adults' Decision-Making and the Law. New York: Springer, 1996: 202-212. [Google Scholar]

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