The Mission of the Washoe County Public Guardian is to serve as Guardian, by court appointment, to vulnerable individuals who are unable to manage their personal and financial affairs, by orchestrating provision of services, providing informed consents on their behalf, and protecting, preserving and managing their assets.
It is the policy of the Washoe County Public Guardian's Office to serve as guardian in such appropriate circumstances in accordance with NRS 253.200 and other relevant provisions of the Nevada Revised Statutes.
It is the policy of the Washoe County Public Guardian's Office to consider in the management of all guardianship cases the National Guardianship Association's Model Code of Ethics and Standards of Practice, which are understood to be aspirational in nature. http://www.guardianship.org/
CASE MANAGER CERTIFICATION
It is the preference of the Washoe County Public Guardian's Office for those positions within the Guardian Case Manager classification series to be certified as Registered Guardians by the National Guardianship Foundation. The Public Guardian is certified as a Master Guardian by the National Guardianship Foundation. All staff in the Case Manager classification series: the Supervising Guardian Case Managers, Guardian Case Managers, Guardian Case Manager Investigators and the Community Nurse are certified as Registered Guardians by the National Guardianship Foundation.
DUTIES OF THE GUARDIAN
Pursuant to NRS 159.079, the Washoe County Public Guardian's Office will monitor the care, custody and control of the person of the ward, and will perform the duties necessary for the proper care, maintenance, education and support of the ward provided the ward's estate can afford the expenditure of funds to accomplish these tasks.
PROCESS FOR DECISION-MAKING
The process of decision-making includes, but is not limited to:
Informed Consent -- Any decision made will be on the Informed Consent Standard based on a full disclosure of facts needed to make the decision intelligently.
Substituted Judgment -- Substituted Judgment promotes the underlying values of self-determination and well being of the ward. Substituted Judgment requires that decision be based on the decision the guardian believes the ward would make based on the ward's previously expressed and/or current wishes. However, the Substituted Judgment Standard should not be utilized if following the ward's wishes would cause substantial harm to the ward, or when the guardian is unable to establish the ward's prior or current wishes.
Best Interest -- If the Substituted Judgment standard cannot be utilized, decisions should be made based on a determination of the best interest of the ward.
INDIVIDUAL GUARDIANSHIP PLAN
Upon appointment as Permanent Guardian of the Person, and upon completion of the Initial Client Assessment, the Public Guardian or the Public Guardian's designee will develop an Individual Guardianship Plan, which will incorporate relevant elements of the Initial Client Assessment/Investigation of Person and Estate into the Individual Guardianship Plan. The purpose of the Individual Guardianship Plan is to determine the goals and objectives for the ward from the date of appointment to the anniversary of the appointment, and annually thereafter. The Individual Guardianship Plan will state specific measurable objectives. The Public Guardian or the Public Guardian's designee on no less than an annual basis will review the Individual Guardianship Plan. Additionally, the Guardianship Plan will be reviewed in Staffing when there is a change in the ward's status and at the time of termination.
MONTHLY VISIT REPORT/QUARTERLY ASSESSMENTS
The Public Guardian's designee will conduct monthly visits on all locally placed wards. The monthly report will document the ward's status and progress as it relates to the guardianship/care plan. Starting the first month, then every third month thereafter, the assigned case manager will use the Quarterly Assessment Form. The Quarterly Assessment will, at a minimum, document the ward's: Psycho-Social Functioning, Mental Status, Medical Status, Medication Compliance, Functional Status, Socialization, Financial Status, Current Needs, Status of Attainment of Previously Identified Short-Term and Long-Term Goals as established in the Individual Guardianship Plan.
LEAST RESTRICTIVE ALTERNATIVE
It is the policy of the Washoe County Public Guardian's Office to carefully evaluate the alternative placements available and to choose the placement option that best meets the needs of the ward while placing the least restrictions on the ward's freedoms, rights, and ability to control his/her environment. In determining appropriate placement, the Washoe County Public Guardian's Office will weigh the advantages and disadvantages, the risks versus benefits, and develop a balance between maximizing the growth potential of the ward and maintaining the ward's safety and security.
PLACEMENT OUT OF COUNTY
It is the policy of the Washoe County Public Guardian's Office to provide guardianship services to residents of Washoe County, Nevada, as provided by the Nevada Revised Statutes. If the Washoe County Public Guardian's Office determines that a placement outside of Washoe County may be necessary, and upon consultation with the Public Guardian or the Public Guardian's Deputy, the following protocol will be followed:
The Public Guardian or the designee of Washoe County will advise the appropriate Court of the recommendation of placement outside of the County, and will seek Court intervention to arrive at a resolution in compliance with this policy while ensuring the ward's best interest are met.
If it is determined that the Washoe County Public Guardian's Office must, due to lack of local placement alternatives, manage the ward's affairs with the placement outside of Washoe County, the Public Guardian's Office will work with the jurisdiction of the necessary placement and attempt to secure regular visits and monitoring, as sufficient as resources will allow. The Public Guardian's designee will make visits as frequently as resources will allow, and will make at least monthly telephone contact with care providers.
If it is determined that the Washoe County Public Guardian's Office will not be discharged as guardian and the ward's placement remains outside Washoe County, the Public Guardian will confer with the appropriate authorities within the placement jurisdiction and attempt to trade cases and/or visits to improve the monitoring of Washoe County wards.
COMPLIANCE WITH DISTRICT ATTORNEY OPINION
The Washoe County Public Guardian does not have authority to engage in end-of-life decisions on behalf of the ward as directed in Deputy District Attorney Margaret M. Crowley`s Memorandum Opinion Letter on "Withdrawing/Withholding Life Sustaining Treatment" dated May 3, 1994. In a situation where an end of life decision must be made for a ward, the Public Guardian or the Public Guardian's designee should engage in all efforts to have a properly authorized person make the decision on behalf of the client. In the event the Public Guardian or the Public Guardian's designee is unable to obtain such consent, the Public Guardian or the Public Guardian's designee will determine the proper course of action, including but not limited to seeking judicial intervention.
To the extent the Washoe County Public Guardian's Office is involved in issues related to withholding or withdrawing medical care and treatment, it will be guided by the provisions of NGA Standards 6 (Informed Consent), 7 (Decision-Making) and 15 (Decision-Making About Withholding and Withdrawal of Medical Treatment).
Specifically, the Washoe County Public Guardian's Office will utilize ethical, legal, and medical advice as appropriate with particular attention to utilization of Ethics Committees.
DETERMINATION OF ABILITY OF ESTATE TO PAY
Pursuant to NRS 253.220 and 253.230, the Washoe County Public Guardian will investigate the financial status of any proposed ward. Upon appointment, the Washoe County Public Guardian will seek a determination from the Court as to whether the ward's estate is financially able to pay all or part of the costs of the proceeding. Factors in determining the ability of the ward's estate to compensate a guardian include: The nature, extent and liquidity of the ward's estate; the ward's disposable income; the nature of the guardianship; the type, duration and complexity of the services required; and any other foreseeable expenses.