Professional Guardianship Standards
Series Two: Service Providers, Service Plan Development, and Monitoring
By Pamela D. Wilson, CSA, MS, BS/BA, CG
Almost anyone can be a professional guardian. Are the results the same from guardian to guardian or is there a difference between professional guardians who commit to implement the standards of membership organizations? How might wards benefit from guardians whose actions support a higher standard of care and oversight? Here are a few questions to ponder regarding visits, service providers, and service plan development.
- Is there a difference between a family member and a professional relative to experience that is beneficial to managing service providers?
- What is a service plan and why is this important relative to care and oversight for a loved one?
- Why is ongoing communication with all service providers beneficial to the individual needing care?
- What are the common pitfalls for family members serving as guardian that result in less than collaborative relationships with service providers?
The mission of the National Guardianship Association is to advance the nationally recognized standards of excellence in guardianship. NGA set the standard for quality in guardianship by establishing national practice standards for individuals. (www.guardianship.org)
If you are regularly involved with the role of guardianship through your position in a law practice, social or adult protective services, a county office, or a care team partner are you aware of the NGA standards? If so, are the professional guardians with whom you work visiting and establishing regular contact with service providers to develop and implement service plans?
According to NGA Standard 13: Guardian of the Person: Initial and Ongoing Responsibilities, Section IV, B. The guardian is required to maintain substantive communication with service providers, caregivers, and others attending to the person, and D. The guardian shall require that each service provider develop an appropriate service plan for the person and shall take appropriate action to ensure that the service plans are being implemented.
Service providers come in a variety of backgrounds:
- Companies providing in home caregivers in the roles of companion, home health aide, and certified nursing assistant
- Medical in home providers offering nursing, hospice, physical, speech, social workers, and occupational therapy
- Day program providers
- Communities: assisted living, memory care and skilled nursing
- Medical providers: primary care physicians and specialist physicians
- Mental health providers offering social workers, therapists and psychiatrists
Depending on the care need of the individual, one or more of the above service providers may be involved. When managing service providers it is important for the person managing to understand not only the services provided but the services that cannot be provided due to the scope and licensure of the business. For example, many families believe that assisted living communities provide medical care; this is not an accurate belief. Assisted living communities provide assistance – not medical care. Skilled nursing communities provide medical care due to state licensure and the employment of nurses and visiting physicians. An in home companion is a person wanting to be helpful to a particular population, for example the elderly. An in home companion usually does not have any special training, education, or licensure.
Because of a lack of general knowledge about services providers, many families have unrealistic expectations about the type of care and the skill level of the individuals providing care. The development of a service plan is a helpful tool in establishing a relationship with a service provider to ensure that there are no misunderstanding related to expectations for care. A service plan identifies the services and care to be received by the person requiring care. For example tasks like: medication reminding, assistance with incontinence, and daily exercise. The more specific the service plan the less opportunity for potential disagreement between the guardian and the service provider.
Ongoing communication is important with all service providers as changes in condition occur. One day an individual may require assistance in transferring and the next day the person may be a “2-person assist”. Another individual may have no issues eating, while another has swallowing difficulties that require thickened liquids or a pureed diet. It is important that all changes in condition be discussed so that the service plan may be modified to address the changes in care level.
A common pitfall for a family guardian is assuming that a service provider “knows what is needed’. It is the role of the guardian to determine needs and to direct the service providers in the provision of various types of services. Many family guardians lack the skill to manage service providers. Some family guardians are intimidated by service providers who may not be service-oriented but prevention oriented – the less the service provider is asked to do the easier the situation for the service provider’s staff.
In addition to development of service plans and monitoring the plans, guardian knowledge of insurance regulations, allowable services, red flags that indicate health and well-being may be at risk, information about medical conditions, the ability to identify a change in condition or a health decline, and knowledge in related areas is supportive of overall care. A guardian can never know too much, ask too many questions, or be too educated about service providers and the types of care and assistance available to a ward.
Pamela D. Wilson, MS, BS/BA, CG, CSA, Certified Senior Advisor specializes in working with family and professional caregivers to navigate healthcare and aging concerns. Wilson, an expert in the field of caregiving, has personally helped thousands of family and professional caregivers since 2000 in her career as an advocate, a care navigator, and an educator. Through her company, The Care Navigator, she is an advocate and service provider in the roles of guardian, power of attorney, care manager, and transition specialist. She was producer and host of The Caring Generation®, from 2009 to 2011, an educational radio program for caregivers on 630 KHOW-AM. In addition to her work at the Care Navigator, Pamela gives back to the community by serving as chairperson of the Community Ethics Committee in Denver, Colorado.
Her new book, The Caregiving Trap: Solutions for Life’s Unexpected Changes, is available through all major bookstores as well as on PamelaDWilson.com. You can follow Pamela on YouTube, Facebook, Twitter, and Linked In.