Guardianship

Decision-making and Guardianship

Some people have difficulty making decisions about their medical care and daily life. This can happen due to serious problems with thinking or memory caused by health conditions, such as:

  • A type of dementia, such as Alzheimer’s disease
  • Intellectual disabilities, such as Down syndrome
  • Being in a coma or having other serious medical conditions

Older adults with these or other conditions should plan ahead and decide who will help with financial and medical decisions if they become unable to make them independently. One option is to choose a healthcare decision-maker. This person can speak on the older adult’s behalf about medical decisions.

The legal document that names a healthcare decision-maker may have different titles, including:

  • Health Care Proxy

  • Durable Power of Attorney for Health Care

  • Health Care Representative

Appointing a Guardian

In some cases, an older adult cannot make important decisions and has not chosen someone to act for them. If there is also no available or appropriate surrogate decision-maker under state law, a court may appoint a guardian to help. The guardian may assist with:

  • Managing finances

  • Arranging food and housing

  • Making medical decisions

Establishing Guardianship

The guardianship process usually requires the person requesting guardianship to hire an attorney.

The person or organization asking the court to appoint a guardian is called the petitioner. If family members are not available, social service agencies or healthcare providers may serve as petitioners.

The petitioner must show that the older adult cannot safely manage their own affairs. If the court agrees, a guardian will be appointed.

Types of Guardianship

All states allow courts to establish limited guardianships (also called conservatorships) and unlimited guardianships (also called committeeships).

  • A limited guardianship gives the guardian authority over specific areas that the older adult can no longer manage, such as finances or medical care.
  • An unlimited guardianship gives the guardian authority over all decisions in the older adult’s life.

Most states prefer limited guardianships because unlimited guardianship removes all decision-making authority from the older adult.

Guardianship should occur only if:

  • No less restrictive option is available.
  • The person’s safety or well-being is at risk.

Alternatives to Guardianship

There are alternatives to guardianship, including:

  • Supported decision-making, which provides assistance so the older adult can continue making their own decisions.
  • Medical and ethical review boards, which offer guidance about treatment decisions when family decision-makers are not available.

Information about legal issues and guardianship is often available through state departments of aging and social services. 

You can find your State Unit on Aging (SUA) by visiting eldercare.gov or calling 1-800-677-1116.  

 

Last Updated April 2026

 

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