Family and Caregiver Schizophrenia Discussion Forum

Durable Medical Power of Atty/HIPPA vs. Guardianship? My role?

So we are working out the fine details of discharge for my son, and although I have temporary Guardianship (hearing for permanent Guardianship is April 12th), I am trying to decide what I want to be in this relationship with him going forward.

I will be his care provider initially and will provide him with a place to stay, but he/we both desire for him to get independent again. I am contemplating letting Guardianship go and instead working on our relationship going forward with only Durable Medical Power of Atty (DMPoA), and HIPPA auth in place. He is willing to sign DMPoa/HIPPA for us to have access…but he feels very violated about Guardianship and the Involuntary Hospitalization process we went through to get him hospitalized. Does anyone have any thoughts on this?

After nearly 60 days in the hospital, we are starting to make gains in his recovery. We are looking at the end of the month for D/C. He still has little insight, but he does state that he “feels better”. He still is not completely convinced he needs medication, but he does acknowledge that he is clearer having been in the hospital. After another change in medication dosing last week, I actually saw a glimpse of him for the first time in over a year. Because we struggled to get him to take any medication in this journey after his initial diagnosis and first-break psychosis, we are seeking a 6 month CTO/AOT following discharge, and will likely have that in place before he will discharge home.

For those of you that don’t know our story, we are extremely rural (100 people in town, a handful his age, no work opportunities, 70 miles from a grocery store, 1.5 hours from case management/therapist/etc.), so our goal is to get him into a location where he can have some independence and support services as quickly as possible. There is an option to D/C him to a community instead…but he is not set up financially with SSI (we are working on that), and we cannot afford to get him an apartment or maintain him elsewhere.

So…as we approach this…and without knowing what level of independence he will be able to maintain, and with the relationship in a state of necessary repair, would you press Guardianship with it’s court date in the two weeks after discharge?

Our need for Guardianship initially was due to him not being willing to allow us any information/access about his care, with the DMPoA/HIPPA, we accomplish access related to him being ill. I just am not sure what to consider, but our goal is to have access when he is ill, preserve the relationship overall with clear boundaries…but I do not necessarily want to police his decision making.


Depending on the state where you live, guardianship can’t do much more than durable medical power of attorney (DMPA for now) plus HIPPA release.

If your son objects to guardianship, there is a possibility in some states of a limited guardianship for medical purposes only, which could be accomplished by a well written DMPA.

Where we live, a guardian cannot force a person to take medication. That is done only by the court.

It seems the use of guardianship is mainly to be able to talk to doctors and access records. Also to make and change appointments and to get information about prescriptions. Also maybe oversee finances depending on state. If he has a tendency to run away, could be useful in trying to find him.

If he does receive SSI, try to get a separate agency (not you) to be his representative payee so he has to talk to them and work with them. That will help him manage money and preserve your relationship.

The more choices he has, the better. If he doesn’t want guardians, unless he truly needs them, then no. I personally wouldn’t go for guardianship unless I believed there would be a better outcome for my family member’s health and independence. Relationship-wise for your family, it sounds like a good idea not to pursue. What do the doctors and treatment team think would be best for your son’s health? They would probably be good people to ask about it.

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We have a POA because we wanted to foster our son so he could achieve some level of independence and have use this to talk with doctors and it has worked well for us

Regardless of the legal rights you have, you only have to do as much as you think is necessary to keep your family member healthy and safe. You may have the right to make certain decisions, but that in no way means you are required to leave the person out of the decision-making as they become more stable. You have the legal right to make the final decision, but of course you can include your son in any decision process.

It is correct that the guardian cannot force the person to take medication, however, the decision to hospitalize remains one of the guardian and the doctor. This has been what has been most helpful for me as guardian of my son.

My son was also unhappy about my guardian status, but has come to accept it. I am going to be slow to let it go. I would be happy if my son can make more responsible decisions, but without insight, I am not counting on it. I seek his input whenever appropriate.

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