Q&A: Patients Who Lack Decision-Making Capacity

Q: What should case managers do when a patient lacks decision-making capacity but has no guardian or power of attorney (POA)?

A: When a patient lacks decision-making capacity and there is no court-appointed guardian or POA for healthcare decision-making, the case manager must communicate with the appropriate decision-maker for the patient. Since decisions about postacute care treatment and placement often involve finances, the patient’s family will sometimes ask the case manager to assist them with notarizing documents giving a family member authority over the patient’s financial affairs. Unfortunately, if a patient lacks the capacity to fully understand the impact of what he or she is signing, it is too late to execute this type of financial POA document. The last resort is asking the court to appoint a guardian or conservator over the patient’s financial affairs.

For more information about screening and assessments, see the Case Management Patient Communication Toolkit.

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