A new study reveals that 60 percent of family members who were taking care of loved ones with Alzheimer’s disease exhibited symptoms of depression that worsened over time.

Researchers tracked symptoms of depression in family caregivers from the time when their loved ones were diagnosed with Alzheimer’s disease until five years later. A third of the caregivers – usually women caring for their spouse – showed increased symptoms of depression over the course of the study.

Interestingly, the trajectory or severity of their loved one’s Alzheimer’s disease did not appear to be related to the seriousness of caregivers’ depressive symptoms.

In addition to recommending a need for additional research on why some caregivers show increased symptoms of depression, the leaders of the study emphasize that clinicians should be taking their patients’ caregiver into account when planning support services.

“Assessment and continuous monitoring of family caregivers’ health and well-being should be included in the treatment of memory disorders,” said Tarja Välimäki, the study’s lead author, in a news release.

Find Support

If you are a caregiver for a loved one with Alzheimer’s disease or another form of dementia, be sure to check out the assortment of online resources, activities, and technological devices available to support you.

Access the study in the online September 2022 issue of Clinical Gerontologist.

Doctors, nurses, and hospital staff work hard to care for their patients when they are sick or hurt. However, even when a procedure is done to save a patient’s life, a hospital cannot act without patient consent. If a patient cannot speak for themselves and express their wishes, the hospital relies on what is known as a health care proxy form.

If you have ever been admitted to the hospital, you have likely been asked to sign a health care proxy form. Hospitals use proxy forms to obtain consent in advance from patients in case they become incapacitated and medical professionals need to administer medication, perform surgery, or otherwise treat the patient. However, the generic version used by most hospitals can fall short for many patients and may infringe upon their autonomy. Always be cautious when you sign a boilerplate document.

What Is a Health Care Proxy?

A health care proxy is a form that a patient uses to name an agent who will carry out their wishes regarding medical care if the patient cannot speak for themselves. Having a health care proxy specifically tailored to your needs can be important. For example, you can outline what kind of treatment you do — or do not want — if you become terminally ill or are in a coma; at the same time, you can indicate other wishes, such as whether you would want pain medication administered or your organs donated.

The agent only has the power to make decisions on the patient's behalf once a doctor confirms that the patient requires medical attention but cannot advocate for themselves. The agent's power ends when the patient can once again state their treatment preferences. Appointing an alternate agent is a good idea, too.

What Is the Problem with Signing a Generic Health Care Proxy?

A health care proxy is important because it instructs your agent to speak for you and, if well-written, it will give specific instructions about what medical treatments you want and which treatments you refuse. An estate plan is not complete unless it includes a health care proxy form.

The problem with relying on the generic health care proxy form the hospital provides is that, in some cases, these forms will not take your individual wishes into account. Every person treated at the emergency room or admitted into the hospital signs the same health care proxy form. Anything that could have a life-or-death consequence should be tailored to you and specifically address your needs.

If you have a health care proxy, inform the hospital staff so they can make the document a part of your medical record.

How Can I Complete My Own Health Care Proxy?

Part of creating an estate plan is having a health care proxy drafted. If you have not created an estate plan or health care proxy, contact your attorney to draft the estate planning documents that you need.

Many senior citizens may need the services of a nursing home or at-home care at some point in their life. You might assume that government assistance or health insurance will step in and cover the cost if you cannot afford these services. Unfortunately, neither health insurance nor Medicare covers long-term care. Because obtaining long-term care insurance can be very expensive, Medicaid could become your only option.

Medicaid coverage is not a given, however. If you have assets or recently transferred assets, Medicaid may determine you do not qualify for coverage until a certain amount of time has passed. If this happens, you and their family can face significant medical bills. If you cannot pay, nursing homes may take you to court to get reimbursed.

What steps can you take to avoid this? First, before applying for Medicaid, get a better understanding of the timelines in your state – known as lookback periods – that can affect your eligibility. Then you can engage in proper Medicaid or asset protection planning in advance of these timeframes. A good age to begin planning is around age 65, although everyone’s situation is different.

Individual states run Medicaid programs, and every state has different rules regarding Medicaid eligibility. These programs were designed as a payor of last resort — in other words, to qualify, you must meet strict requirements. There are two primary types of Medicaid benefits: home care and skilled nursing home care.

Lookback Periods

You must submit an application to your local Medicaid office to qualify for these benefits. As part of this process, the state will look at any money or property you may have transferred within a certain lookback period. In New York, for example, this period of time will soon be 30 months for home care and 60 months for skilled nursing care.

These lookback periods can have serious consequences. If you have not engaged in appropriate asset protection planning, you may not be able to qualify for home care or nursing home care for many months. The result is that many elderly individuals must then spend down their savings and liquidate their assets to pay privately for their home care before Medicaid starts covering anything. If a person no longer has resources and is subject to a disqualification penalty period, family members may have to step in and bear these costs on their own.

So, what can you do? The answer is to start planning as soon as is practical.

Options to Explore

Speaking with an elder law attorney can help you and your loved ones explore options available to avoid you or them being personally responsible for the costs of your care.

• Medicaid Asset Protection Trust — One common approach is placing assets in a Medicaid Asset Protection Trust. You may be able to use this to shelter various assets such as stock accounts, savings, a home with unprotected equity, and much more.
• Pooled Income Trust — Another option you may explore is contributing income that exceeds Medicaid allowances to a Pooled Income Trust. This can allow you to qualify for Medicaid while diverting excess income to a trust that pays qualified expenses on your behalf. This will enable you to benefit from the income and not spend it on things Medicaid could have otherwise covered.
• Spousal Refusal — Your spouse may also have options that can help you qualify for Medicaid. One such option includes exercising a right of spousal refusal — a process available in some states by which the income and assets of your spouse can be removed from consideration in your Medicaid eligibility analysis.

Finally, an attorney can help you understand if certain transfers are permissible under Medicaid rules without triggering a penalty period.

Without proper planning, individuals with assets and income exceeding specific state-set thresholds would have to spend this income and their assets on their care or exempt items before they can receive Medicaid benefits. For assistance in planning, consult with your attorney.

Each year, 36 million older adults fall, with one out of every five falls resulting in physical trauma, the Centers for Disease Control and Prevention report. Injuries from falls, such as hip fractures, can lead to hospitalizations, surgeries, and nursing home stays. Experiencing a fall or living in fear of falls can reduce your quality of life and separate you from family and friends.

AginginPlace.org provides a freely available, medically reviewed guide on preventing falls, with lifestyle, mobility, and home improvement recommendations to help you avoid falls, maintain independence, and assuage any fears you may have of falling.

Lifestyle Changes

Lifestyle modifications can prevent falls.

• Having the proper footwear is essential. Although slippers and socks can be comfortable to wear inside the home, use supportive shoes with nonskidding soles indoors.
• Wear properly fitted clothing. You could trip over oversized, baggy clothing.
• Maintain a well-organized, clutter-free living space. Items in the home, such as cords and surplus furniture, can be a tripping hazard. Decluttering can keep the interior of your living space safer.
• Vision problems can cause falls, so visit your eye doctor regularly.
• Talk to your primary care physician to learn more about any medications or health conditions that may make your gait unsteady.
• When you move about your home, do not rush. Take your time, moving slowly and carefully. Use short steps to avoid slipping.

Mobility Exercises

Staying active and physically fit is an essential element of fall prevention.

• Engage in exercises such as walks, tai chi, and water aerobics regularly to maintain your fitness.
• Practice balance exercises that improve lower body strength and help you stay on your feet three days a week for 10 to 15 minutes at a time.
• Use mobility aids, such as canes and walkers, to help you stay steady.
• Be aware of your surroundings.

Home Modifications

As you age, you can adapt your home to your needs.

• Keep your home well-lit. Install lighting into dark areas, such as hallways and stairways. Nightlights can illuminate your home in the dark, allowing you to see your surroundings and avoid tripping.
• Place grab bars and handrails around your home in locations where you might lose your balance, such as bathrooms, hallways, and stairways.
• Keep everyday items within your reach. Avoid storing items in high or hard-to-access places. If you choose to keep things in high places, use a sturdy step ladder with a safety bar or a reach extender — a tool for retrieving out-of-reach objects.
• To stop falls before they happen, look for hazards in your home and remove them.

To learn more about reducing your fall risk, read the Comprehensive Guide to Fall Prevention from AginginPlace.org.

In an alarming number of instances, private Medicare Advantage plans are denying coverage for medical services that would be covered under original Medicare, according to a federal investigation.  These denials are likely preventing or delaying medically necessary care for tens of thousands of Medicare Advantage beneficiaries each year.

The investigation by the Department of Health and Human Services’ Office of Inspector General found that 13 percent of Medicare Advantage plan denials should have been covered under Medicare.  The findings were based on a review by doctors and coding experts of service denials by 15 of the largest Medicare Advantage plans during the first week of June 2019.   Extrapolating from their findings, investigators estimate that nearly 85,000 beneficiary requests for medical care — everything from MRIs to skilled nursing facility care — could have been wrongly denied in 2019.

In an even higher proportion of cases, plans are incorrectly refusing to pay claims. Nearly one-fifth of claims that Medicare Adantage plans initially declined to pay were for services that met Medicare coverage and plan billing rules.  This translates to an estimated 1.5 million refused payments for all of 2019, which delayed or prevented payments for services that providers had already delivered.

Hidden Barriers to Care

Some 26 million Medicare beneficiares were in Medicare Advantage plans as of 2021, more than double the figure a decade ago.  The Congressional Budget Office projects that by 2030 more than half of Medicare beneficiaries will be in a private Medicare plan. Unlike original Medicare, where the federal government is the insurer, Medicare Advantage plans are run by private insurance companies. The government pays the plans a fixed monthly fee to provide services to each Medicare beneficiary under their care. The less money the plans spend on patient care, the more they and their investors make. In this way, plans have an incentive to keep costs down.

For many beneficiaries, Medicare Advantage plans’ most disagreeable cost-cutting strategy is “preauthorization” — the common requirement that doctors and other medical providers obtain the plan's approval before a beneficiary can receive certain medical services. If the plan administrators disagree that a procedure is medically necessary, the plan may refuse to pay for it.

Medicare Advantage plans often look attractive because they offer the same basic coverage as original Medicare at a seemingly lower cost, plus some additional benefits and services like vision and dental care that traditional Medicare doesn't offer. (One reason Medicare Advantage plans can offer such enhanced services is because the federal government gives them additional payments compared to original Medicare.) The inspector general’s report highlights one of Mediccare Advantage’s downsides.

“[B]eneficiaries enrolled in Medicare Advantage may not be aware that there may be greater barriers to accessing certain types of health care services in Medicare Advantage than in original Medicare,” the report states.

One example highlighted in the report tells of a Medicare Advantage plan that refused to approve a followup MRI to find out whether an adrenal lesion was malignant because the lesion was allegedly too small. In fact, Medicare’s rules do not restrict the use of followup MRIs based on the the size of a lesion. (The plan reversed its initial denial on appeal.)

Denial Appeals Can Work

The report identified two common causes of service denials. First, even though Medicare Advantage plans’ clinical criteria cannot be “more restrictive” than Medicare’s coverage rules, plans often used tighter clinical criteria, such as requiring an x-ray before approving more advanced imaging. Second, plans often claimed that the request for services lacked sufficient documentation, even though investigators who reviewed the denied claims found that the existing medical records were sufficient to support the request.

When a Medicare Advantage plan denies a preauthorization or payment request, the beneficiary can file an appeal with the plan.  The inspector general found that when a beneficiary or provider appealed or disputed the denial of a service that met Medicare’s coverage rules, plans sometimes reversed the denial.  And in certain cases, Medicare Advantage plans corrected their own errors.

The inspector general’s report offers several recommendations for the Centers for Medicare and Medicare Services, which oversees Medicare Advantage plans, including better auditing of plans.   

To read the inspector general’s report, “Some Medicare Advantage Organization Denials of Prior Authorization Requests Raise Concerns About Beneficiary Access to Medically Necessary Care,” click here.  

For more on Medicare Advantage plans, click here.

When a married couple applies for Medicaid, the Medicaid agency must analyze the couple’s income and assets as of a particular date to determine eligibility. The date that the agency chooses for this analysis is called the “snapshot” date and it can have a major impact on a couple’s financial future. 

In order to be eligible for Medicaid benefits a nursing home resident may have no more than $2,000 in “countable” assets (the figure may be somewhat higher in some states). Medicaid law also provides special protections for the spouses of Medicaid applicants to make sure they  have the minimum support needed to continue living in the community while their husband or wife is receiving long-term care benefits. 

In general, the community spouse may keep one-half of the couple's total “countable” assets up to a maximum of $137,400 (in 2022). This is the community spouse resource allowance (CSRA), the most that a state may allow a community spouse to retain without a hearing or a court order. The least that a state may allow a community spouse to retain is $27,480 (in 2022). Some states are more generous to the community spouse. In these states, the community spouse may keep up to $137,400 (in 2022), regardless of whether or not this represents half the couple's assets. 

Medicaid agencies must pick a date to use to analyze the applicant’s assets. The date that the agency chooses can affect how much money the applicant must spend down before qualifying for benefits and how much a spouse is able to keep. It is called the “snapshot” date because Medicaid is taking a picture of the applicant’s assets as of this date.

The snapshot date is usually the date of “institutionalization,” the day on which the Medicaid applicant enters either a hospital or a long-term care facility in which he or she then stays for at least 30 consecutive days. States use as the snapshot date either the first day of the month the applicant entered the facility or the actual date of entry. If the applicant enters a hospital or nursing home, stays for 30 days, goes home, and then reenters a hospital or nursing home, the snapshot date is the date the applicant entered the hospital or nursing home for the first stay. 

Not all Medicaid long-term care applicants are in an institution. If the applicant is applying for Medicaid home care through a waiver program, the snapshot date is usually either the date of the application or the date the applicant is determined to need a nursing home level of care.  

On the snapshot date, the Medicaid agency counts up all of an applicant’s and his or her spouse’s assets, excluding the couple’s house. Then depending on the state’s CSRA, the agency determines how much the community spouse can keep. If any assets above $2,000 remain, then that money must be spent down before the applicant will qualify for benefits. 

Example: If a couple has $100,000 in countable assets on the snapshot date and the state allows the spouse to keep half the couple’s assets up to the maximum CSRA, the Medicaid applicant will be eligible for Medicaid once the couple's assets have been reduced to a combined figure of $52,000 — $2,000 for the applicant and $50,000 for the community spouse. If the state allows the spouse to keep the entire amount of the maximum CSRA, then the community spouse could keep the entire amount and the applicant would not be required to spend down assets. 

Proper planning can help a couple determine when the best time to apply for benefits based on the snapshot date and maximize the assets the couple can keep. Consult with your attorney for advice. To find an attorney near you, click here.

The Biden administration is hearing mounting calls to end a program that advocates warn will radically transform Medicare.  At the same time, the administration is getting counter-pressure from the health care industry that sees sudden threat to the potentially lucrative plan.  A decision may be coming soo

As recently as early December 2021 the program, known as Direct Contracting, wasn’t on the radar of most Medicare beneficiaries or members of Congress.  Rep. Pramila Jayapal (D-WA) called it the “biggest threat to Medicare you’ve never even heard of.”

But by early January, 54 lawmakers had joined Rep. Jayapal in signing a letter urging Health and Human Services Secrectary Xavier Becerra to permanently end the controversial program.  Direct Contracting, the letter said, would maximize the profits of new fiscal intermediaries while limiting the care options of the 38 million beneficiaries of traditional Medicare, which now offers free choice of any doctor or hospital. 

In early February, in response to the growing opposition to the program, the National Association of ACOs sent Secretary Becerra a letter imploring him to simply “adjust the model” rather than cancel it.  Abandoning Direct Contracting, the industry group warned, would undermine efforts to “achieve the triple aim of better patient satisfaction, higher quality care, and more affordable care.”   

Quickly responding to Becerra with its own letter, Physicians for a National Health Program (PNHP), which represents 25,000 health professionals and has spearheaded the opposition to Direct Contracting, said that immediately pulling the plug on the program would be in the best interests of Medicare beneficiaries. 

Introducing Middlemen into Medicare

Initiated under President Trump but continued by President Biden, Direct Contracting would insert middlemen — Direct Contracting Entities (DCEs) — between traditional Medicare beneficiaries and their medical-care providers. Like Medicare Advantage plans, DCEs — most of which are investor-owned with ties to commercial insurers — would receive a monthly payment for a specific group of patients. 

As is the case with Medicare Advantage, the less money the plans spend on patient care, the more money they and their investors pocket.  But while Medicare Aadvantage insurers are required to spend 85 percent of their revenues on patient care, DCEs are allowed to keep up to 40 percent of the taxpayer dollars they receive as profit and overhead. (By contrast, traditional Medicare spends 98 percent of its budget on patient care.)

The Direct Contracting “pilot” program affects Medicare beneficiaries in 38 states, Washington, D.C., and Puerto Rico, potentially covering 30 million of those in traditional Medicare. Fifty-three DCEs have already signed contracts to be the fiscal intermediaries between patients and their providers.

“Direct contracting is nothing more than privatizing Medicare,” charged Alex Lawson, Executive Director of the advocacy group Social Security Works. “It inserts a corporate bureaucrat between a patient and their doctor in order to deny care and make Wall Street money. The Biden administration must completely eliminate Direct Contracting — nothing less than that is acceptable.”

Guardrails vs. Bigger Trucks

Health care companies and providers that are banking on Direct Contracting’s continued rollout don’t see things quite that way.  “This is not the end of traditional Medicare, as advocates have falsely claimed, but is a way to provide additional beneficiary and provider tools as part of a whole-person care approach,” they said in their letter to Becerra.  The letter's signatories urge Becerra to “make necessary refinements” to Direct Contracting rather than scuttle it. 

“For example,” the group writes, “you can limit participation to certain types of DCEs, such as provider-led DCEs, and place additional guardrails and add more beneficiary protections.”

PNHP countered that as long as the program provides a profit motive for DCEs, they will find a way around proposed “guardrails.” “Our experience from Medicare Advantage (MA) shows that when regulators install new guardrails that threaten profits, the industry will simply build a bigger truck to run them over,” the advocacy group told Becerra.

Profits are clearly being threatened: The morning e-letter of the news site Modern Healthcare warns: “Direct Contracting uncertainty may hurt startups betting on it: Stocks for startups banking on Direct Contracting fall as regulators prepare an announcement about the model's future.”

Now it is up to Becerra and the Biden administration to decide whether Direct Contracting is a path to better and more affordable care, as its backers claim, or an exit ramp for the Medicare program most beneficiaries know and love.

For the National Association of ACOs’ letter to Becerra, click here.

For Physicians for a National Health Program’s letter, click here.

For the Congressional sign-on letter on Direct Contracting, click here.

For our earlier coverage of Direct Contracting, click here.

When loved ones pass away, there are lots of considerations, including what happens to their Social Security. The decedent’s payments need to be stopped, but survivor’s benefits may be available to the spouse or, in certain cases, children. 

Social Security benefits stop at death. If a loved one who was receiving Social Security dies, you need to notify the Social Security Administration as soon as possible. Often the funeral home does this as one of its services, but if not, you can notify Social Security by calling 1-800-772-1213 or contacting your local Social Security office. Benefits are not paid for the month the recipient dies and are not prorated. So, even if the recipient dies in the middle or end of the month, Social Security will not pay any benefits for that month. If the Social Security Administration is not notified on time and makes a payment, that payment will have to be returned. 

Death Benefit
Regardless of age or eligibility for survivor’s benefits, surviving spouses are entitled to a one-time lump-sum payment of $255 if they were living with the decedent or collecting benefits on the decedent’s record. If there is no surviving spouse, the payment can be made to a child who qualifies for benefits on the decedent’s record. 

Survivor’s Benefits
In addition to the lump-sum death benefit, certain family members may be eligible to receive monthly survivor’s benefits, including:

• A widow or widower age 60 or older (age 50 or older if they have a disability).
• A surviving divorced spouse, under certain circumstances.
• A widow or widower at any age who is caring for the deceased’s child who is under age 16 or has a disability and is receiving child’s benefits.
• An unmarried child of the deceased who is younger than age 18 (or up to age 19 if they are a full-time student in an elementary or secondary school) or age 18 or older with a disability that began before age 22.
• Parents, age 62 or older, who were dependent on the deceased for at least half of their support.

If the spouse has reached full retirement age when the decedent died, then the spouse begins receiving the decedent’s actual benefits. This is true even if the decedent and spouse were divorced, so long as they had been married for at least 10 years. 

While a spouse can claim survivor's benefits as early as age 60, the benefits will be permanently reduced. If the surviving spouse claims benefits between age 60 and full retirement age, he or she receives a reduced percentage of the decedent’s benefits. At age 60, the spouse will receive 71.5 percent of the actual benefits. If the spouse waits to collect, this percentage increases each year until the spouse reaches full retirement age, at which point he or she can receive 100 percent of the actual benefits. A surviving spouse who is age 50 to 59 also receives 71.5 percent of the actual benefits. Spouses caring for a child and the decedent’s dependents receive 75 percent of the decedent’s actual benefit. Dependent parents receive 75 percent each or 82.5 percent if there is only one parent.

If a surviving spouse, including a divorced spouse, remarries before turning age 60, then the spouse is no longer eligible for benefits unless the new marriage ends. Spouses who remarry after age 60 are still eligible for survivor’s benefits. 

For more information about Social Security survivor’s benefits, click here.

For information on how to maximize your Social Security survivor’s benefits, click here. 

For information about Social Security benefits for spouses and children, click here.

A federal court has ruled that hospitalized Medicare beneficiaries who were switched from inpatient to observation status can appeal the decision, making it easier for them to receive coverage for subsequent nursing home care. The ruling appears to bring to an end more than a decade of litigation on behalf of Medicare recipients.

Medicare covers nursing home stays entirely for the first 20 days, but only if the patient was first admitted to a hospital as an inpatient for at least three days. In part due to pressure from Medicare to reduce costly inpatient stays, hospitals often do not admit patients but rather place them on observation to determine whether they should be admitted. Even if a hospital originally admits a patient, a hospital review board can switch the patient from inpatient to observation status, before or after the patient’s stay. If the patient does not have a full three days as an inpatient, Medicare will not cover a subsequent nursing home stay – potentially costing the Medicare recipient thousands of dollars. 

There are other consequences to being considered under observation. Instead of billing you under Medicare Part A, which covers inpatient services, the hospital will bill you under Medicare Part B. This means that you will owe a co-payment for every service offered. Your total co-payment could be much larger than the one-time deductible you have to pay under Part A.

In 2011, a group of Medicare beneficiaries sued the federal government in a class action lawsuit, arguing that they should have the right to appeal when their status is switched from inpatient to observation status. After making its way through the courts for 11 years, the U.S. Court of Appeals for the Second Circuit affirmed a lower court’s ruling in favor of the beneficiaries, noting that Medicare allows appeals of other decisions. According to the court, “the decision to reclassify a hospital patient from an inpatient to one receiving observation services may have significant and detrimental impacts on plaintiffs’ financial, psychological, and physical well-being.” The court ordered Medicare to set up a process to appeal for coverage as hospital inpatients and to notify people of their appeal rights. The class was represented by advocacy groups the Center for Medicare Advocacy and Justice in Aging and the law firm Wilson, Sonsini, Goodrich, and Rosati.  

Observation status has been controversial for years. Originally, hospitals didn’t have to give patients notice that they were in observation status rather than inpatients. That changed in 2017, when a federal law required hospitals to notify patients who are under observation for more than 24 hours of their outpatient status within 36 hours, or upon discharge if that occurs sooner. 

What Patients Can Do Now

If you are in the hospital and told you that you are under observation status, you can ask the hospital doctor to be admitted as an inpatient. You should also contact your primary care physician to ask if he or she can call the hospital and explain the medical reasons that you need to be admitted.

If you are kept in observation status and transferred to a nursing home and denied coverage by Medicare, you can appeal. In order to appeal, you must wait for your Medicare Summary Notice (MSN) to arrive. Copy the notice and highlight the disputed charges. The notice should provide information on where to send the notice to request an appeal. You can appeal both the hospital's denials of hospital admission as well as subsequent the nursing home charges. The appeal process can be very complicated and you may need the help of an attorney to navigate it. For more information about the Medicare appeals process, click here.

For more analysis of the decision by Kaiser Health News, click here.

If a loved one is experiencing memory loss or suddenly making poor decisions, you may want the court to appoint a guardian, which requires a declaration of incompetence. Determining whether someone is incompetent to make their own decisions is a complicated process. 

If a loved one is unable to make decisions for him or herself, the court may appoint a substitute decision maker, often called a “guardian,” but in some states called a “conservator” or other term. A guardian is only appointed as a last resort if less restrictive alternatives, such as a power of attorney, are not in place or are not working.

The standard under which a person is deemed to require a guardian differs from state to state. In some states the standards are different depending on whether a complete guardianship or a conservatorship over finances only is being sought. Generally, a person is judged to be in need of guardianship when he or she shows a lack of capacity to make responsible decisions or decisions that are in their best interests. 

The court usually looks at a number of factors in determining the need for a guardian or conservator, including the following: 

• Comprehension of important medical or financial information
• Appreciation of the importance of medical and financial decisions and understanding the effect of those decisions 
• Ability to make reasonable decisions using the information available 
• Capacity to communicate decisions in a consistent manner
• Ability to maintain a safe environment 

A person cannot be declared incompetent simply because he or she makes irresponsible or foolish decisions, but only if the person is shown to lack the capacity to make sound decisions. For example, a person may not be declared incompetent simply because he or she spends money in ways that seem odd to someone else. Also, a developmental disability or mental illness is not, by itself, enough to declare a person incompetent.

Keep in mind that the standard for whether someone is legally incompetent to care for themselves is not always the same as whether they have the capacity to make legal decisions. Proper execution of a legal instrument requires that the person signing have sufficient mental “capacity” to understand the implications of the document.