VOA MN 2017 All Rights Reserved 1 - Minnesota ... VOA MN 2017 All Rights Reserved 1 Supportive Decision Making –An Emerging Alternative to Guardianship Anita Raymond, MSW, Program

1/10/2018

VOA MN 2017 All Rights Reserved 1

Supportive Decision Making

– An Emerging Alternative to

Guardianship

Anita Raymond, MSW, Program Manager, Protective

Services and Care Management & Consultation Programs,

Volunteers of America MN & WI

Handouts:

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January 16, 2018

12 – 1 pm

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1/10/2018


Supported Decision Making:

An Emerging Alternative to

Guardianship

Minnesota Gerontological Society

January 16, 2018

Anita L. Raymond, LISW, CMC

Objectives

• Explore the tension guardianship presents

between helpful tool and infringement on civil

rights.

• Understand the person-centered approach of

SDM and how it protects individual rights while

still protecting those who are vulnerable to

maltreatment.

• Learn about Minnesota initiatives to address

these issues on individual and systems levels,

including the Guardianship Information Line, the

Center for Excellence in Supported Decision

Making, and WINGS MN

1/10/2018


The Paradox of Guardianship

Valuable tool to

protect Vulnerable

Adult?

Or

Heavy-handed tool

which strips

constitutional right to

self-determination?

● Court appointed substitute decision-maker

● Guardianship / Guardian / Ward = Personal

and Care Decisions

● Conservatorship / Conservator / Protected

Person = Money and Assets

● Process for appointment is identical

● Voluntary or involuntary (most common)

Guardianship & Conservatorship:

What is This?

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● Time Consuming: due process protections to

ensure justifiable intrusion of government

● Potential emotional devastation

● Expensive: individual, society

● Potential loss: dignity of risk

Is Guardianship the Best

Solution?

Making Bad Choices or

Experiencing the Dignity of Risk?

8

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● “Older adults with more self-determination

have improved psychological health

including better adjustment to increased

care needs” O’Conner & Vallerand,

Canadian Journal on Aging, 1994

● “Women with intellectual disabilities

exerising more self-determination are less

likely to be abused.” Khemka, Hickson, and

Reynolds, 2005

Self-Determination

.

Vulnerable Citizens’ Rights to

Protection

From harm

From exploitation, abuse, neglect

From personal dignity

being robbed by

incapacitating illness

or condition

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~ Robert Perske

To deny the right to make choices in an effort to protect the person with disabilities from risk is to diminish their human dignity.

Finding the Balance

Self-Determination Safety

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Person Centered Interventions

2 4

Important TO

the Person:

• Relationships

• Hobbies

• Residential

choices

• How to spend

day

• Providers

• Personal

expression:

clothing,

makeup, etc

Important FOR

the Person:

• Health

• Safety

• Policy/law

compliance

• Etc.

Supported Decision Making

Supported Decision Making is a

recognized alternative to guardianship

where people with disabilities use

trusted friends, family members, and

professionals to help them understand

the situations and choices they face, so

they may make their own decisions

without the need for a guardian (Blanck & Martinis, 2015)

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Guardianship & SDM Position

Statements


A philosophical approach

A legal tool in Texas, Delaware; British Columbia,

Australia…more jurisdictions every year

Another less restrictive alternative

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Just because a

person cannot make

decisions independently,

does that mean person is

incapacitated and in need of

legal decision maker?

Supported Decision Making:

An Emerging Model

• A way people can make their own decisions,

stay in charge of their lives while receiving

help they need to do so.

• Person making decisions with support of

others vs. others making decisions for the

person: …cutting through the jargon to

understand what’s going on and what you

need to do…

~ Jonathan Martinis, Esq.

1/10/2018



[J]ust a fancy way of describing how we all

make choices. We all need help making

decisions, every single day.

~ Jonathan Martinis, Esq.

I don’t need a guardian. I just need a little help!

~ Jenny Hatch

How Does Supported Decision

Making Work?

• Understand we all have the right to

make choices, and need help to

make choices.

• Remember: needing help ≠ needing

guardianship

• Work with person to identify team of

“supporters” for current or future

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How Can I Use SDM?

• Confront own assumptions about:

• Capacity & Diagnosis

• Need for legal decision maker

• Ability of “family” (however imperfect)

to play significant and positive role

• Recognize risk factors re: family, but sort

out reality vs. perception

• Confront own and other professionals’

lack of comfort with ambiguity

No SDM Law in MN (yet): Is it still

applicable?

We need a culture change, to move away from current model of (too often) defaulting to guardianship

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FAQ ABOUT SDM

What indicators suggest

that SDM may be

appropriate?

Person May Be a Candidate for SDM

• Recognizes needs help

• Has trusted others to form team

• Cooperative and/or open to trusted

others’ ideas

• Ideally, able to also complete HCD/POA

1/10/2018


Person Likely Not a Candidate for SDM

• Does not recognize need for

help/refuses

• Resistiveness cannot be overcome

• Person sabotages others’ efforts

(and this can’t be overcome)

• No trusted supporters

• Supporters not able to act per

wishes/best interests (and can’t be

“trained”)

FAQ ABOUT SDM

Is there a formal process

to use in making

decisions utilizing SDM?

Is it recognized by

others?

1/10/2018


Formal Processes?

Not Officially. But…

• Person-centered interventions /

philosophy informs process

• As part of HCD, language making it

effective now regardless of “capacity”

• Sample agreements available

SDM Relationship Recognized

by Others?To be determined…

• As we use, talk about, advocate,

produce agreements, we will

“normalize” with providers as familiarity

increases

• If part of HCD or POA, providers more

likely to honor

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SDM Relationship Recognized

by Others?Advocacy required…

Patient Self-Determination Act, ADA,

Older American's Act, Olmstead Act:

recognize person’s right to self-

determination, entitlement to receive

support to accommodate disabilities, and

maximize independence

But What About….?

Doctors won’t talk to family without guardianship?

• Community Standards

• Health Care Directive

• Consent for Release of Information

• Communication

30

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But What About….?

Person may be taken advantage of?

• Power Of Attorney

• Representative Payee

• Banking Tools

• Communication

31

But What About….?

Person can’t make own medical / housing / other decisions?

• POA / HCD / Rep Payee

• Authorized Rep

• Supported Decision Making & Communication

32

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But What About….?

Isn’t Guardianship required when

person is “incapacitated”?

• Guardianship is NOT required by MN law:

• to receive County Services

• to sign IEP when person turns 18

• Residential and Care Facilities cannot mandate

appointment of Guardian as condition of

admission

33

But What About….?

Person may make a bad decision?

• What happens when people without

disabilities make bad decisions?

• Communication

34

1/10/2018


MN Initiatives: Center for Excellence in


A Program of VOA MN, funded by

DHHS Administration for Community Living

CESDM: Impacting Individuals

GUARDIANSHIP INFORMATION LINE

952-945-4174

1-844-333-1748

[email protected]

1/10/2018


CESDM: Impacting Individuals

Supporting “family” in need of

consultation for

support/technical assistance in

role of supported or surrogate

decision maker

CESDM & WINGS MN: Impacting

Communities• Supporting individuals, providers, families

through education

• Building systems prioritizing supported

decision making and alternatives to

guardianship

• Sustaining conversations with stakeholders:

improve outcomes, increase self-

determination

1/10/2018


CESDM & WINGS MN: Impacting

Communities

• 4th Annual WINGS MN Summit: 1/26/18

• Quarterly newsletters with local and

national news

• Community and Professional Education &

Training: Guardianship, SDM, etc.

Join our efforts to promote alternatives to

guardianship and expand networks of people

addressing maltreatment of vulnerable adults:

Become a WINGS MN community member!

[email protected]

www.wingsmn.org

mailto:[email protected]

http://www.wingsmn.org/

1/10/2018


RESOURCES: SDM TOOLS

• Brainstorming Guide

www.supporteddecisionmaking.org/sites/default/file

s/sdm-brainstorming-guide.pdf

• MO Guardianship Stoplight Tool

www.moguardianship.com/Alternatives%20to%20G

uardianship%20Tool%20Revised%2011-2015.pdf

• ABA’s PRACTICAL Tool

www.americanbar.org/groups/law_aging/resources/

guardianship_law_practice/practical_tool.html

RESOURCESVOA MN www.voamnwi.org

•Legal Services: HCD forms and more

•CESDM & Protective Services: links to

articles, G&C FAQ and more

WINGS MN www.wingsmn.org

•National Resource Center on Supported

Decision Making

www.supporteddecisionmaking.org

http://www.supporteddecisionmaking.org/sites/default/files/sdm-brainstorming-guide.pdf

http://www.moguardianship.com/Alternatives to Guardianship Tool Revised 11-2015.pdf

http://www.americanbar.org/groups/law_aging/resources/guardianship_law_practice/practical_tool.html

1/10/2018


RESOURCES

• American Association on Intellectual and

Developmental Disabilities

and The Arc Joint Position Statementhttp://aaidd.org/news-policy/policy/position-

statements/autonomy-decision-making-supports-

and-guardianship#.WH_huOkiy70

• National Guardianship Association SDM

Position Statementhttp://guardianship.org/documents/NGA_Policy_Stat

ement_052016.pdf

RESOURCES

Supported Decision Making in Later Life, by David

Godfrey

https://www.americanbar.org/content/dam/aba/administ

rative/law_aging/Supported%20Decision%20Making%

20in%20Later%20Life%20(003)%20(002).authcheckda

m.pdf

Supported Decision-Making: What, Why, & How by

Morgan Whitlatch

http://supporteddecisionmaking.org/sites/default/files/e

vent_files/MD-Arc-2016-Convention.pdf

https://www.americanbar.org/content/dam/aba/administrative/law_aging/Supported Decision Making in Later Life (003) (002).authcheckdam.pdf

http://supporteddecisionmaking.org/sites/default/files/event_files/MD-Arc-2016-Convention.pdf

1/10/2018


RESOURCES

https://www.youtube.com/

playlist?list=PLKdIRbjdmx

geDSVBZhEFyrzIIi9zjO3

Mc

CESDM

Team

Amanda Hudson952-945-4177

[email protected]

Anita RaymondProgram [email protected]

John [email protected]

Kathleen [email protected]

GUARDIANSHIP INFORMATION LINE 952-945-4174 1-844-333-1748

https://www.youtube.com/playlist?list=PLKdIRbjdmxgeDSVBZhEFyrzIIi9zjO3Mc

1/10/2018


Questions?

contact

[email protected]

Arts, Health, and the Aging Brain

By: Catherine Sullivan, PhD, St. Catherine University

NEXT WEBINAR

February 22, 2018

noon – 1:00 pm

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VOA MN 2017 All Rights Reserved 1 - Minnesota ... VOA MN 2017 All Rights Reserved 1 Supportive Decision Making –An Emerging Alternative to Guardianship Anita Raymond, MSW, Program