Helping Vulnerable Patients Transition Safely: The Role of Guardianship in Discharge Planning

Helping Vulnerable Patients Transition Safely: The Role of Guardianship in Discharge Planning.

In hospital and nursing home settings, discharge planning often presents significant challenges when a patient lacks the capacity to make decisions and has no healthcare directive or available surrogate. In these cases, a court-appointed guardian can be a crucial tool for hospital social workers, discharge planners, and care teams seeking to ensure patient safety and continuity of care. Guardianship may provide a legal mechanism to facilitate discharge to a more appropriate (and less acute) setting when consent cannot otherwise be obtained.

Guardianship as a Discharge Planning Tool for Hospitals

Hospitals and long-term care facilities are increasingly encountering patients who are ready for discharge medically, but who cannot participate in care planning due to cognitive impairment or psychiatric illness. When no family member or agent is available to help, a hospital may petition the court for the appointment of a guardian. This may be especially necessary when:

  • A patient refuses discharge or placement recommendations but lacks decisional capacity;
  • There is no valid healthcare directive or power of attorney in place;
  • No willing or appropriate family member can assume decision-making responsibility.

Under Minnesota Statutes § 524.5-303(b), any "interested person" may petition for guardianship. Minnesota law defines this term broadly to include any person concerned with the respondent's welfare (Minn. Stat. § 524.5-102, subd. 7). In this context, hospital social workers, case managers, and discharge planners often qualify as interested persons when advocating for a patient’s health and safety. If no family member is suitable to serve, the hospital can seek the appointment of a professional guardian, helping to facilitate safe discharge and access to appropriate care services.

Emergency Guardianships When Discharge is Imminent

When a discharge is urgent and the patient is at imminent risk, a hospital may petition the court for the appointment of a temporary emergency guardian under Minn. Stat. § 524.5-311. This provision allows for the appointment of a guardian without notice or a full hearing, if the court finds — based on specific facts set out in a verified petition or affidavit — that immediate and irreparable harm will result to the person’s health, safety, or welfare if the appointment is delayed.

However, whether a situation meets this standard is highly fact-specific. If the patient is medically stable and safely housed in the hospital, courts are often reluctant to find an emergency, since immediate harm is not occurring. On the other hand, emergency guardianship may be appropriate when:

  • The hospital is actively pursuing discharge, but the patient lacks capacity and refuses to leave;
  • There is no surrogate or agent to assist, and the patient faces discharge to an unsafe setting or homelessness;
  • The patient is actively attempting to leave AMA, interfering with care, or placing themselves or others at risk;
  • Urgent medical decisions are required, but no one is legally authorized to consent.

In these circumstances, a court may issue a narrow, temporary order authorizing the necessary decisions until a general guardianship hearing can be held. Emergency appointments under this section are typically short in duration and tailored to the specific risks presented.

Guardian's Role in Preventing Unsafe Discharges

Once appointed, a guardian can:

  • Participate in discharge planning and advocate for the patient’s needs;
  • Consent to medical care and placement on behalf of the patient;
  • Challenge or delay discharges that are unsafe or premature;
  • Secure home care, services, or facility placement as appropriate;
  • Address environmental safety concerns at the patient’s proposed place of discharge.

Importantly, guardianships are tailored to the patient’s specific needs. Under Minn. Stat. § 524.5-310(d), courts must grant only the authority necessary to meet the individual’s needs and must consider less restrictive alternatives before appointing a guardian.

Alternatives to Guardianship

Guardianship should always be a last resort. Minnesota law strongly favors less restrictive alternatives that preserve the individual’s autonomy, consistent with the public policy in Minn. Stat. § 524.5-120. Alternatives may include:

  • Healthcare directives combining a power of attorney and living will (Minn. Stat. § 145C.01 et seq.);
  • Supported decision-making arrangements with family or trusted individuals;
  • Informal assistance with limited tasks where capacity is partially retained;
  • Community or residential service supports that reduce the need for substitute decision-making.

In cases where these alternatives are unavailable or inappropriate, guardianship may be the most practical legal path forward to ensure safe discharge and follow-up care.

Including Conservatorship When Financial Decision-Making is Also at Issue

In some situations, a guardianship alone may not be sufficient to address the needs of an incapacitated individual. When financial decisions must be made — such as applying for Medical Assistance, paying for long-term care, or managing income or property — a conservatorship may also be necessary.

A conservator is a person appointed by the court under Minn. Stat. § 524.5-401 to manage the financial affairs of someone who cannot do so on their own. The court must find that the individual is unable to manage property or financial matters, and that the person has assets that may be wasted or misapplied without protection.

Conservatorship is often appropriate when:

  • There is no durable power of attorney in place;
  • The person needs to apply for Medical Assistance (Medicaid) and lacks capacity to complete the application or submit financial documentation;
  • Funds must be accessed to pay for long-term care or facility placement;
  • Legal authority is needed to sign care contracts, manage benefits, or address bills.

Legal Support for Hospitals and Families

Hospitals, nursing homes, and care teams facing discharge barriers due to patient incapacity may benefit from legal guidance in evaluating whether guardianship is warranted and preparing the necessary court filings. This can be particularly useful when seeking the appointment of a professional guardian to serve in the absence of family.

At Dave Burns Law Office, I assist families and healthcare professionals in navigating the Minnesota guardianship process. I have professional relationships with several experienced guardians who may be available to serve when no suitable family member is able or willing to act. If you are working on a complex discharge or have questions about whether guardianship may be appropriate, I welcome the opportunity to consult with you. I represent clients throughout the Twin Cities metro area and am available to meet in both Minneapolis and St. Paul.

The Dave Burns Law Office hopes you find this article helpful. But please do not rely on it as legal advice. The law changes regularly and the outcome of any legal matter depends on its unique circumstances. View full disclaimer