Healthcare decision-making alternatives
Health Care Proxy
A Health Care Proxy is a legally enforceable document made by an adult. It designates an agent to make health care decisions for an adult. A Health Care Proxy does not go into effect until a physician activates it by certifying that the adult cannot make their own health care decisions. The adult does not need a guardian to make healthcare decisions if there is an activated Health Care Proxy. Even if a guardian is appointed, the agent makes the adult’s health care decisions unless the Court orders otherwise.
Learn more about Health Care Proxies.
Medical Orders for Life Sustaining Treatment (MOLST) or Portable Medical Orders (POLST)
MOLSTs or POLSTs are not Court Orders. They are standardized medical order forms. They document an adult’s decisions about life-sustaining treatment. They are completed by the adult’s medical provider and the adult together.
A MOLST or POLST is suitable for adults of any age with an advanced illness. A MOLST or POLST is voluntary and can be modified and revoked. A MOLST or POLST goes into effect right away.
Learn more about MOLSTs and POLSTs.
Financial decision-making alternatives
Social Security’s Representative Payment Program
The Social Security Administration (SSA) may appoint a representative payee to manage benefits for an adult who cannot do it. This applies to Social Security Disability Insurance or Supplemental Security Income. The local SSA appoints representative payees. They do so based on medical proof that the adult cannot manage their own funds. The SSA monitors the representative payee’s activities.
Veterans Administration’s Fiduciary Program
If an adult is entitled to benefits through the U.S. Department of Veterans Affairs (VA) and they can’t manage their benefits, the VA may appoint a fiduciary. The fiduciary manages the adult’s VA benefits. This is similar to the Social Security’s Representative Payment Program.
Trust
A trust can be created to manage the adult’s finances. A trust is a legal entity able to hold property and assets for the benefit of the adult. The trust is managed by a person or organization, called the trustee. The trustee must manage the trust property for the adult’s benefit, as instructed in the trust document.
Durable Power of Attorney
A Durable Power of Attorney is a legal document. It lets an adult appoint a trusted person, called an “attorney-in-fact” or “agent,” to make decisions for them. The document details the types of decisions the agent is authorized to make. The decisions can be both personal and financial. A Durable Power of Attorney allows the agent to act for the adult even if they become incapacitated.
Protective Arrangement, Single Transaction or Special Conservator
Without appointing a conservator, the Court may approve a Protective Arrangement or Single Transaction regarding the adult’s finances. For example, the Court may authorize a one-time payment, deposit, contract, or settlement. The Court may also authorize the creation of a trust for the benefit of the adult.
A Special Conservator may be appointed for a short time to assist in carrying out the approved protective arrangement or single transaction.
Additional alternatives
Supported Decision-Making
Supported Decision-Making (SDM) is a written agreement for an adult. It allows an adult to make their own life choices with help from a trusted team. It can be used with a guardianship or conservatorship or as an alternative to it. A Supported Decision-Making agreement lets an adult identify areas where they need help, like:
- education
- employment
- housing
- health care
- finances
The adult’s Supported Decision-Making team helps them in the areas the adult has identified.
For example, at 18, students can make their own education choices. A Supported Decision-Making agreement may help students with an Individualized Education Program (IEP). It lets them share or delegate educational decisions with parents or other adults.
Resources to help you
To learn more about alternatives to guardianship and conservatorship, watch:
Alternatives to Guardianship and Conservatorship
If you have questions, the OAGCO is here to help you. You may reach out to the OAGCO by email at OAGCO@jud.state.ma.us or attend one of our monthly virtual Zoom sessions. Zoom sessions are held on the third Wednesday of each month from 12–2:00 p.m.