When a patient becomes incapable of making medical decisions and has not completed any advance directive, a surrogate must be assigned (who may be a parent, spouse, adult son or daughter, domestic partner, adult brother or sister, close friend, or two physicians who may choose to consult a medical ethics committee) to make medical decisions. If a patient chooses, due to mental or physical incapability, a court may appoint a conservator to handle the patient’s financial affairs, who must annually report allocation of patient finances. If a court, after outside petition, determines a person incapable of making financial decisions (an inability to provide for food, clothing, and shelter, or inability to protect against loss of property), a patient may be assigned a conservator involuntarily. The conservator is still required to report annually to the court. With the assignment of conservator, the patient may no longer sign checks, use credit cards, buy or mortgage property, sign a lease or any contract involving finances- which may be performed by the conservator.
A guardian may be appointed by the court if a patient is unable to care for himself. A guardian manages a patient’s financial affairs, as well as necessary personal management (food, clothing, shelter, medical care, etc.) Once appointed a guardian, the patient may not vote, make contracts, choose residency, choose medical treatment, travel at will, or sign checks. Court consent must be obtained for any decision involving institutional commitment, treatment with antipsychotic drugs, or subjection to intrusive medical procedures. In such cases, a case manager is responsible for documenting objective facts only (avoid subjective descriptions or opinions), avoiding derogatory comments, maintaining good communication with patient and family, maintaining an understanding of diagnosis, allowing patient to be decision-maker, and maintaining consent and release forms.
http://casemanagerexam.com
