What is a substitute decision maker?
There are different types of substitute decision-makers including:
Guardians
Conservators
Power of Attorneys
Trustees
Representative Payees

What is a guardianship?
A guardianship is one form of substitute decision-making which is established through a legal proceeding. A guardianship is established to manage an individual’s care.

Difference between voluntary and involuntary guardianship?
A voluntary guardianship is a legal proceeding that occurs when the proposed ward files a petition to establish a guardianship. Iowa Code §633.557.

An involuntary guardianship is a legal proceeding in which someone other than the proposed ward files a petition to establish a guardianship. Iowa Code §633.552.

Why is a legal proceeding necessary?
To protect an individual’s constitutional rights a legal proceeding must determine, by clear and convincing evidence, that an individual does not have the decision-making capacity to care for themselves physically.  Iowa Code §633.551(1). In other words an individual must be adjudicated incompetent.

What does incompetent mean?
In Iowa, an individual is considered incompetent if he meets at least one of the following criteria:

a) Decision-making capacity which is so impaired that the individual is unable to care for their own personal safety or to attend to or to provide for necessities for themselves such as food, shelter, clothing or medical care, without which physical injury or illness will occur.

b) Decision-making capacity so impaired that the individual is unable to make, communicate or carry out important decisions concerning their own financial affairs.

c) Decision-making capacity is so impaired that both "a" and "b" are applicable to the individual.

What kind of guardianships can be established by the court?

Limited Guardianship
The district court must consider whether a limited guardianship is appropriate when determining whether to establish, modify or terminate a guardianship. Iowa Code §633.551(4). A limited guardianship is restricted to certain functions. Iowa Code §633.635 (See also Hedin stating that the District Court’s finding of fact should support the powers conferred on the guardian).

Stand-by Guardianship Iowa Code §633.560
A stand-by guardianship is only effective if a certain event occurs.

Temporary Guardianship Iowa Code §633.558
A temporary guardianship is limited to a specific period of time. This type of guardianship is usually created during the pendency of an involuntary guardianship proceeding.

What qualifications must an individual have to be a guardian?
Any natural person of full age who is a resident of Iowa except those mentally incompetent or those the court determines unsuitable.

A natural person who is a nonresident if a resident is also appointed. However, for good cause shown, the court may appoint a nonresident to serve alone.

Banks and trust companies if otherwise authorized to act in a fiduciary capacity.

Private nonprofit corporations organized under IC Chapters 504 or 504A. Iowa Code §633.63-.64

For children preference is given to a parent(s) if qualified and suitable otherwise it is up to the court to appoint an individual who is qualified, suitable and willing to serve in that capacity. Iowa Code § 633.559
and Iowa Code § 633.571. (See also Guardianship and Conservatorship of D.D.H., 538 N.W.2d 881(1995) stating that the determinative factor in deciding guardian for a minor is "best interests of child.")

What are the responsibilities of the guardian?
Duties which may be exercised without prior court approval: Iowa Code §633.635(1)

Provide for the care, comfort and maintenance of the ward, including the appropriate training and education to maximizes the ward’s potential.

Care for the ward’s clothing, furniture, vehicle & other personal effects.

Assist ward in developing maximum self-reliance & independence.

Ensure the ward receives necessary emergency medical services.

Ensure the ward receives professional care, counseling, treatment or services as needed.

Any other powers or duties the court may specify.

Changing ward’s resident, at the guardian’s request, if it is more restrictive of the ward’s liberties then the current living arrangement.

Arranging major elective surgery or any other nonemergency major medical procedure.

Consent to the withholding or withdrawal of life-sustaining procedures.

What is a more restrictive environment?  
The doctrine of least restrictive environment provides that restrictions on liberty should be limited to the minimum necessary to accomplish the asserted government purpose. This is a key concept to support placements in smaller, more home-like facilities. Such placements are aimed at improving the residents’ quality of life and increasing their chance of maximizing their independence. Zuckerman, Deborah and March Charmatz, Mental Disability Law, Fourth Edition 1991.

When can a guardian be removed? Iowa Code §633.65
Failure to qualify as a fiduciary.
Failure to perform any duty.
Termination of Iowa residency.

When can a guardianship be terminated?
A guardianship shall cease upon the occurrence of any of the following circumstances:

If the ward is a minor; when the ward reaches full age.

The death of the ward

A determination by the court that the ward is competent and capable of managing the ward’s property and affairs and that the continuance of the guardianship would not be in the ward’s best interests.

Upon determination by the court that the guardianship is no longer necessary for any other reason.

Does the guardianship terminate when a minor turns 18?
YES. Guardianships cease and conservatorships terminate at the age of 18. If it is necessary to continue a guardianship/conservatorship after a minor turns 18 a new petition must be filed. Iowa Code § 633.672.

Who must receive notice of a guardianship proceeding?
Effective July 1, 2000, House File 2240 requires that notice must be served on the parents of the proposed ward if the proposed ward is a minor; the spouse of the proposed ward, if the proposed ward is an adult. If the proposed ward has no spouse than notice must be served upon the proposed ward’s adult children.

Does the ward have the right to refuse medication?
This question has never been definitively answered in Iowa. Currently the courts are split. It appears that all courts would at least require the individual to be incompetent. In addition, some courts would also require
that the individual be a danger to self or others without the treatment and/or that there is no less intrusive treatment available. Under Iowa law you must obtain a court order to forcibly administer medications in non-emergency situations. Zuckerman, Deborah and March Charmatz, Mental Disability Law, Fourth Edition 1991.