A shortage of guardians, or those empowered to make medical decisions on behalf of incapacitated patients, is contributing to a hospital bottleneck in Massachusetts, according to a report published by the Massachusetts Department of Public Health (DPH) and Eastern Research Group, in collaboration with the Bureau of Health Safety and Quality.
The DPH estimates there are about 3,100 to 4,950 unrepresented patients who could require public guardianship services each year in Massachusetts alone. And services could cost on average $10,000 to $11,000 per client annually – a potential fiscal impact of $31 million to $54.5 million on MassHealth.
The hospital discharge process to the nursing home slows down considerably when a patient can’t make decisions for themselves and lacks a surrogate decision maker, guardian or advance directive, according to the report, which was also covered by Boston NPR, or WBUR.
“DPH finds there is a significant need for qualified professional guardians to give informed medical consent for persons who are unable to afford these services,” DPH said in the report. “Increasing payment to Qualified Professional Guardians, coupled with other recommended legislative changes, could substantially reduce delays in hospital discharges and expedite access to long-term and preventative care.”
Separately, Gov. Healy’s Health Care Affordability Work Group placed scrutiny on transitions of care and included recommendations that would move more than 2,000 patients along that are stuck in a hospital. That includes legislation allowing surrogates to make certain medical determinations and modernizing health care proxy laws.
Unrepresented patients are at risk of inappropriate medical care like overtreatment or undertreatment, or delayed discharges from the hospital to a different setting. These patients are oftentimes homeless or are dealing with a serious mental illness and lack a willing or appropriate surrogate or have outlived their loved ones and friends, according to the report.
In these cases, a guardian is appointed by the court; some are for hire or work pro bono, usually attorneys or retired attorneys. Guardians can also be family members, social workers, therapists, psychiatrists, medical professionals or retired judges. Compensation for guardians in the state is “inadequate or nonexistent,” DPH said, which drives guardianship shortage.
Guardians of Medicaid members in nursing facilities earn about $50 an hour with annual payments capped at $1200. Payments were established in 1999 and need to be increased for inflation, if paid out at all; such payments are a “bureaucratic nightmare” to secure, according to Wynn Gerhard, elder justice at the Massachusetts Guardianship Policy Institute. Gerhard spoke with WBUR.
Courts end up contacting four to 13 guardians before finding someone willing to take such cases, the report found.
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