Collateral Damage
One thing soldiers with recent combat experience say is that frequently it's the non-combatants who suffer the worst in battle. This is something like the observation my daughter, a pediatrician, makes about working in the ER: it's the innocent bystanders that are always hurt the worst.
The same is true when end-of-life issues clash with expectancies arising from a parent's wealth. Issues usually arise in one of several ways: either (1) a family member believes that another person, acting under a durable power of attorney, is looting the estate of the elder; (2) the family members bicker over how care should be provided but no one has the power to made decisions; or (3) one family member or another decides that their parent needs a guardian or conservator, often fearing that without such action the estate will be looted by others. In these cases it is often hard to tell who the good guys really are.
A guardianship is a court-ordered takeover of a person's right to make decisions about their life and health. A guardian has a ward. The guardian can confine that ward in a nursing home, make decisions about what care is to be provided and what care is to be withheld, and if they also have the power of the conservator, they can say how the ward's money is to be spent. These are awesome powers and the guardian can become, and in some cases actually does become the ward's jailer.
In most states a guardianship is declared only where a person is not competent to make their own decisions. Usually medical testimony is used to determine competence, although sometimes a protectee may simply be examined by the Court. Where the Court feels that the protectee cannot function so as to protect himself or herself, the Court appoints a guardian (to manage the health care and living decisions) and a conservator to look after the finances.
As health care providers its normal to have opinions about whether a client is competent to manage his or her affairs. It is never a good idea, however, to share those opinions with family members because sometimes this results in being called by one side or another to testify about a person's competence. And worse, it is often difficult to determine if a person acting under a guardianship actually intends to help or harm the elder.
Consider the case from the Dallas area where local media jumped on a local court and health care providers after a former producer form the television station was "incarcerated" in a nursing home. Although the use of the synonym for jailed indicates some strong feelings on the part of the media, it also indicates that nursing homes are perceived to be in some cases worse than jails. In that case after the ward called his former employers and begged for help, new lawyers and new doctors were called in to undo the guardianship.
The danger for the nursing home is in siding with one party or another in a guardianship proceeding. If a family member obtains guardianship and thereafter loots the estate or makes decisions contrary to the best interests of the ward, the nursing home may have a duty to report this to the Court. If the guardian is later alleged to have been working in sync with the nursing home staff, liability for any financial losses might be shared by the nursing facility.
As a general rule the smartest approach is to stay out of the line of fire in a guardianship where multiple parties think they know what is best. Until the matter is decided by the courts, the nursing home may have trouble complying with multiple requests by multiple parties, and may want to consider asking the Court for the appointment of a temporary guardian (often called a public administrator) so that care issues can be properly managed while the family fights out the guardianship battle. Having an interim source for the resolution of conflicts about care can help keep caregivers from becoming collateral damage in a family war.