2019 -- S 0031 | |
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LC000076 | |
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STATE OF RHODE ISLAND | |
IN GENERAL ASSEMBLY | |
JANUARY SESSION, A.D. 2019 | |
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A N A C T | |
RELATING TO PROBATE PRACTICE AND PROCEDURE -- SUPPORTED DECISION- | |
MAKING ACT | |
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Introduced By: Senators Satchell, Seveney, Lawson, Nesselbush, and Cano | |
Date Introduced: January 15, 2019 | |
Referred To: Senate Judiciary | |
It is enacted by the General Assembly as follows: | |
1 | SECTION 1. Title 33 of the General Laws entitled "PROBATE PRACTICE AND |
2 | PROCEDURE" is hereby amended by adding thereto the following chapter: |
3 | CHAPTER 15.3 |
4 | SUPPORTED DECISION-MAKING ACT |
5 | 33-15.3-1. Short title. |
6 | This chapter shall be known and may be cited as the "Supported Decision-Making Act." |
7 | 33-15.3-2. Purpose. |
8 | (a) The purpose of this chapter is to achieve all of the following: |
9 | (1) Provide assistance in gathering and assessing information, making informed |
10 | decisions, and communicating decisions for adults who would benefit from decision-making |
11 | assistance; |
12 | (2) Give supporters legal status to be with the adult and participate in discussions with |
13 | others when the adult is making decisions or attempting to obtain information; |
14 | (3) Enable supporters to assist in making and communicating decisions for the adult but |
15 | not substitute as the decision maker for that adult; and |
16 | (4) Establish the use of supported decision-making as an alternative to guardianship. |
17 | (b) This chapter is to be administered and interpreted in accordance with all of the |
18 | following principles: |
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1 | (1) All adults should be able to choose to live in the manner they wish and to accept or |
2 | refuse support, assistance, or protection; |
3 | (2) All adults should be able to be informed about and participate in the management of |
4 | their affairs; and |
5 | (3) The values, beliefs, wishes, cultural norms, and traditions that adults hold, should be |
6 | respected in supporting adults to manage their affairs. |
7 | 33-15.3-3. Definitions. |
8 | For the purposes of this chapter: |
9 | (1) "Adult" means an individual who is eighteen (18) years of age or older. |
10 | (2) "Affairs" means personal, health care, and financial matters arising in the course of |
11 | activities of daily living and includes all of the following: |
12 | (i) Those health care and personal affairs in which adults make their own health care |
13 | decisions, including monitoring their own health; obtaining, scheduling, and coordinating health |
14 | and support services; understanding health care information and options; and making personal |
15 | decisions, including those to provide for their own care and comfort; and |
16 | (ii) Those financial affairs in which adults manage their income and assets and its use for |
17 | clothing, support, care, comfort, education, shelter, and payment of other liabilities of the |
18 | individual. |
19 | (3) "Good faith" means honesty in fact and the observance of reasonable standards of fair |
20 | dealing. |
21 | (4) "Immediate family member" means a spouse, child, sibling, parent, grandparent, |
22 | grandchild, stepparent, stepchild, or stepsibling. |
23 | (5) "Person" means an adult; health care institution; health care provider; corporation; |
24 | partnership; limited liability company; association; joint venture; government; governmental |
25 | subdivision, agency, or instrumentality; public corporation; or any other legal or commercial |
26 | entity. |
27 | (6) "Principal" means an adult who seeks to enter, or has entered, into a supported |
28 | decision-making agreement with a supporter under this chapter. |
29 | (7) "Supported decision-making" means a process of supporting and accommodating an |
30 | adult to enable the adult to make life decisions, including decisions related to where the adult |
31 | wants to live, the services, supports, and medical care the adult wants to receive, whom the adult |
32 | wants to live with, where the adult wants to work, and how the adult wants to manage finances, |
33 | without impeding the self-determination of the adult. |
34 | (8) "Supported decision-making agreement" or "the agreement" means an agreement |
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1 | between a principal and a supporter entered into under this chapter. |
2 | (9) "Supporter" means a person who is named in a supported decision-making agreement |
3 | and is not prohibited from acting pursuant to § 33-15.3-6(b). |
4 | (10) "Support services" means a coordinated system of social and other services supplied |
5 | by private, state, institutional, or community providers designed to help maintain the |
6 | independence of an adult, including any of the following: |
7 | (i) Homemaker-type services, including house repair, home cleaning, laundry, shopping, |
8 | and meal-provision; |
9 | (ii) Companion-type services, including transportation, escort, and facilitation of written, |
10 | oral, and electronic communication; |
11 | (iii) Visiting nurse and attendant care; |
12 | (iv) Health care provision; |
13 | (v) Physical and psychosocial assessments; |
14 | (vi) Financial assessments and advisement on banking, taxes, loans, investments, and |
15 | management of real property; |
16 | (vii) Legal assessments and advisement; |
17 | (viii) Education and educational assessment and advisement; |
18 | (ix) Hands-on treatment or care, including assistance with activities of daily living such |
19 | as bathing, dressing, eating, range of motion, toileting, transferring, and ambulation; |
20 | (x) Care planning; and |
21 | (xi) Other services needed to maintain the independence of an adult. |
22 | 33-15.3-4. Presumption of capacity. |
23 | (a) All adults are presumed to be capable of managing their affairs and to have legal |
24 | capacity. |
25 | (b) The manner in which an adult communicates with others is not grounds for deciding |
26 | that the adult is incapable of managing the adult's affairs. |
27 | (c) Execution of a supported decision-making agreement may not be used as evidence of |
28 | incapacity and does not preclude the ability of the adult who has entered into such an agreement |
29 | to act independently of the agreement. |
30 | 33-15.3-5. Supported decision-making agreements. |
31 | (a) A supported decision-making agreement must include all of the following: |
32 | (1) Designation of at least one supporter; |
33 | (2) The types of decisions for which the supporter is authorized to assist; and |
34 | (3) The types of decisions, if any, for which the supporter may not assist. |
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1 | (b) A supported decision-making agreement may include any of the following: |
2 | (i) Designation of more than one supporter; |
3 | (ii) Provision for an alternate to act in the place of a supporter in such circumstances as |
4 | may be specified in the agreement; and |
5 | (iii) Authorization for a supporter to share information with any other supporter named in |
6 | the agreement, as a supporter believes is necessary. |
7 | (c) A supported decision-making agreement is valid only if all of the following occur: |
8 | (1) The agreement is in a writing that contains the elements of the form contained in § |
9 | 33-15.3-11; |
10 | (2) The agreement is dated; and |
11 | (3) Each party to the agreement signed the agreement in the presence of two (2) adult |
12 | witnesses, or before a notary public. |
13 | (d) The two (2) adult witnesses required by subsection (c)(3) of this section may not be |
14 | any of the following: |
15 | (1) A supporter for the principal; |
16 | (2) An employee or agent of a supporter named in the supported decision-making |
17 | agreement; |
18 | (3) A paid provider of services to the principal; and |
19 | (4) Any person who does not understand the type of communication the principal uses, |
20 | unless an individual who understands the principal's means of communication is present to assist |
21 | during the execution of the supported decision-making agreement. |
22 | (e) A supported decision-making agreement must contain a separate declaration signed |
23 | by each supporter named in the agreement indicating all of the following: |
24 | (1) The supporter's relationship to the principal; |
25 | (2) The supporter's willingness to act as a supporter; and |
26 | (3) The supporter's acknowledgement of the role of a supporter under this chapter. |
27 | (f) A supported decision-making agreement may authorize a supporter to assist the |
28 | principal to decide whether to give or refuse consent to a life sustaining procedure pursuant to the |
29 | provisions of chapters 4.10 and 4.11 of title 23. |
30 | (g) A principal or a supporter may revoke a supported decision-making agreement at any |
31 | time in writing and with notice to the other parties to the agreement. |
32 | 33-15.3-6. Supporters. |
33 | (a) Except as otherwise provided by a supported decision-making agreement, a supporter |
34 | may do all of the following: |
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1 | (1) Assist the principal in understanding information, options, responsibilities, and |
2 | consequences of the principal's life decisions, including those decisions relating to the principal's |
3 | affairs or support services; |
4 | (2) Help the principal access, obtain, and understand any information that is relevant to |
5 | any given life decision, including medical, psychological, financial, or educational decisions, or |
6 | any treatment records or records necessary to manage the principal's affairs or support services; |
7 | (3) Assist the principal in finding, obtaining, making appointments for, and implementing |
8 | the principal's support services or plans for support services; |
9 | (4) Help the principal monitor information about the principal's affairs or support |
10 | services, including keeping track of future necessary or recommended services; and |
11 | (5) Ascertain the wishes and decisions of the principal, assist in communicating those |
12 | wishes and decisions to other persons, and advocate to ensure that the wishes and decisions of the |
13 | principal are implemented. |
14 | (b) Any of the following are disqualified from acting as a supporter: |
15 | (1) A person who is an employer or employee of the principal, unless the person is an |
16 | immediate family member of the principal; |
17 | (2) A person directly providing paid support services to the principal, unless the person is |
18 | an immediate family member of the principal; and |
19 | (3) An individual against whom the principal has obtained an order of protection from |
20 | abuse or an individual who is the subject of a civil or criminal order prohibiting contact with the |
21 | principal. |
22 | (c) A supporter shall act with the care, competence, and diligence ordinarily exercised by |
23 | individuals in similar circumstances, with due regard either to the possession of, or lack of, |
24 | special skills or expertise. |
25 | 33-15.3-7. Recognition of supporters. |
26 | A decision or request made or communicated with the assistance of a supporter in |
27 | conformity with this chapter shall be recognized for the purposes of any provision of law as the |
28 | decision or request of the principal and may be enforced by the principal or supporter in law or |
29 | equity on the same basis as a decision or request of the principal. |
30 | 33-15.3-8. Limitations of liability. |
31 | (a) A person, who in good faith acts in reliance on an authorization in a supported |
32 | decision-making agreement, or who in good faith declines to honor an authorization in a |
33 | supported decision-making agreement, is not subject to civil or criminal liability or to discipline |
34 | for unprofessional conduct for any of the following: |
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1 | (1) Complying with an authorization in a supported decision-making agreement based on |
2 | an assumption that the underlying supported decision-making agreement was valid when made |
3 | and has not been revoked; |
4 | (2) Declining to comply with an authorization in a supported decision-making agreement |
5 | based on actual knowledge that the agreement is invalid. |
6 | 33-15.3-9. Access to information. |
7 | (a) A supporter may assist the principal with obtaining any information to which the |
8 | principal is entitled, including, with a signed and dated specific consent, protected health |
9 | information under the Health Insurance Portability and Accountability Act of 1996 [Pub. L. 104- |
10 | 191], educational records under the Family Educational Rights and Privacy Act of 1974 [20 |
11 | U.S.C. § 1232g], or information protected by 42 U.S.C.A. § 290dd-2, 42 C.F.R Part 2. |
12 | (b) The supporter shall ensure all information collected on behalf of the principal under |
13 | this section is kept privileged and confidential, as applicable; is not subject to unauthorized |
14 | access, use, or disclosure; and is properly disposed of when appropriate. |
15 | 33-15.3-10. Reporting of suspected abuse, neglect, or exploitation. |
16 | If a person who receives a copy of a supported decision-making agreement or is aware of |
17 | the existence of a supported decision-making agreement has cause to believe that the principal, |
18 | who is an adult with a developmental disability or an elder, is being abused, neglected, or |
19 | exploited by the supporter, the person shall report the alleged abuse, neglect, or exploitation |
20 | pursuant to §§ 40.1-27-02, and 42-66-8. |
21 | 33-15.3-11. Form of supported decision-making agreement. |
22 | A supported decision-making agreement may be in any form not inconsistent with the |
23 | following form and the other requirements of this chapter. Use of the following form is presumed |
24 | to meet statutory provisions. |
25 | SUPPORTED DECISION-MAKING AGREEMENT |
26 | Appointment of Supporter |
27 | I, .....................................(insert your name), make this agreement of my own free will. |
28 | I agree and designate that: |
29 | Name:............................... |
30 | Address: ............................................. |
31 | Phone Number: ................................... |
32 | E-mail Address: .................................... |
33 | is my supporter. My supporter may help me with making everyday life decisions relating to the |
34 | following: |
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1 | Y/N Obtaining food, clothing, and shelter |
2 | Y/N Taking care of my health |
3 | Y/N Managing my financial affairs |
4 | Y/N Other (specify): |
5 | ______________________________________________________________________________ |
6 | ______________________________________________________________________________ |
7 | I agree and designate that: |
8 | Name: ................................................ |
9 | Address: ................................... |
10 | Phone Number:.................................... |
11 | E-mail Address: ........................................... |
12 | is my supporter. My supporter may help me with making everyday life decisions relating to the |
13 | following: |
14 | Y/N Obtaining food, clothing, and shelter |
15 | Y/N Taking care of my physical health |
16 | Y/N Managing my financial affairs |
17 | Y/N Other (specify): |
18 | ______________________________________________________________________________ |
19 | ______________________________________________________________________________ |
20 | My supporter(s) is (are) not allowed to make decisions for me. To help me with my decisions, my |
21 | supporter(s) may: |
22 | (1) Help me access, collect, or obtain information that is relevant to a decision, including |
23 | medical, psychological, financial, educational, or treatment records; |
24 | (2) Help me gather and complete appropriate authorizations and releases; |
25 | (3) Help me understand my options so I can make an informed decision; and |
26 | (4) Help me communicate my decision to appropriate persons. |
27 | Effective Date of Supported Decision-Making Agreement |
28 | This supported decision-making agreement is effective immediately and will continue |
29 | until.................................(insert date) or until the agreement is terminated by my supporter or me |
30 | or by operation of law. |
31 | Signed this ..................day of .................., 20............. |
32 | Consent of Supporter |
33 | I, ...................................... (name of supporter), consent to act as a supporter under this agreement, |
34 | and acknowledge my responsibilities under chapter 15.3 of title 33. |
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1 | ..................................................................................................................................................... |
2 | (Signature of supporter) (Printed name of supporter) |
3 | My relationship to the principal is: ................................................. |
4 | I, ........................................... (Name of supporter), consent to act as a supporter under this |
5 | agreement, and acknowledge my responsibilities under chapter 15.3 of title 33. |
6 | ....................................................................................................................................................... |
7 | (Signature of supporter) (Printed name of supporter) |
8 | My relationship to the principal is: .......................................................... |
9 | Consent of the Principal |
10 | ....................................................................................................................................................... |
11 | (My signature) (My printed name) |
12 | Witnesses or Notary |
13 | ........................................................................................................................................................... |
14 | (Witness 1 signature) (Printed name of witness 1) |
15 | ........................................................................................................................................................... |
16 | (Witness 2 signature) (Printed name of witness 2) |
17 | Or |
18 | State of ..................................... |
19 | County of .................................. |
20 | This document was acknowledged before me on (date) by |
21 | ...................................................................... and ............................................................................. . |
22 | (Name of adult with a disability) (Name of supporter) |
23 | ....................................................................... |
24 | (Signature of notarial officer) |
25 | (Seal, if any, of notary) |
26 | ....................................................................... |
27 | (Printed name) |
28 | My commission expires: ................................................ |
29 | SECTION 2. Section 33-15-47 of the General Laws in Chapter 33-15 entitled "Limited |
30 | Guardianship and Guardianship of Adults" is hereby amended to read as follows: |
31 | 33-15-47. Forms. |
32 | The following forms shall be used for the purposes of this chapter: |
33 | STATE OF RHODE ISLAND PROBATE COURT |
34 | OF THE COUNTY OF ______________________ __________________ |
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1 | No. ________________ |
2 | ESTATE OF ____________________________ |
3 | PERSONAL ESTATE ESTIMATED AT $________ CITY/TOWN OF |
4 | ________________ |
5 | 19 _____________ |
6 | PETITION FOR LIMITED GUARDIANSHIP OR GUARDIANSHIP |
7 | ______________________hereby petitions the Probate Court of the city/town of _____________ |
8 | Petitioner |
9 | to appoint a limited guardian/guardian for ______________ who currently resides at |
10 | ________________________, in the city/town of __________________, and whose date of birth |
11 | Address |
12 | is __________________. |
13 | Based upon an assessment conducted by __________________ on______________________, |
14 | Date |
15 | which functional assessment reflects the current level of functioning of __________________, it |
16 | Respondent |
17 | has been determined that _____________ lacks decision-making ability in one or more of the |
18 | Respondent |
19 | following areas as indicated: |
20 | ____ health care |
21 | ____ financial matters |
22 | ____ residence |
23 | ____ association |
24 | ____ other |
25 | Regarding each area indicated, please describe the specific assistance needed: |
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31 | Indicate which of the following less restrictive alternatives to guardianship have been |
32 | explored and deemed inappropriate as indicated: |
33 | ____ Durable Power of Attorney for Health Care |
34 | ____ Living Will |
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1 | ____ Power of Attorney |
2 | ____ Durable Power of Attorney |
3 | ____ Trusts |
4 | ____ Joint Property Arrangements |
5 | ____ Representative Payee |
6 | ____ Money Management |
7 | ____ Single Court Transactions |
8 | ____ Government Benefit and Social Service Programs |
9 | ____ Housing Options |
10 | ____ Supported Decision-Making Agreement |
11 | ____ Other |
12 | Please describe the basis for the determination that the alternative will not meet the needs |
13 | of the respondent for each alternative explored and deemed inappropriate: |
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29 | The following individual/agency is willing to serve as guardian: |
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33 | Upon information and belief the above individual/agency has: |
34 | □ No conflict of interest that would interfere with guardianship duties. |
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1 | □ No criminal background that would interfere with guardianship duties. |
2 | □ The capacity to manage financial resources involved. |
3 | □ The ability to meet requirements of law and unique needs of individual. |
4 | □ Demonstrated willingness to undergo training. |
5 | The Respondent has the following heirs at law: |
6 | NAME: RESIDENCE: |
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13 | ___________________________________ |
14 | Signature |
15 | ___________________________________ |
16 | Name |
17 | ___________________________________ |
18 | Address |
19 | _____________________________ |
20 | Telephone |
21 | Subscribed and sworn to before me this as to the truth of the above facts by ________ in |
22 | ________ on the ________day of ________, 19____. |
23 | ___________________________________ |
24 | Notary Public |
25 | ___________________________________ |
26 | Print Name |
27 | DECREE |
28 | __________________ |
29 | Dated __________________________ |
30 | PROBATE JUDGE |
31 | This notice should be served at once and returned to the clerk of the court. |
32 | NOTICE |
33 | STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS |
34 | BY THE PROBATE COURT OF THE __________ OF ____________ |
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1 | BY THE COUNTY OF ______________ AND STATE AFORESAID |
2 | To ________________________ |
3 | Estate or ______________ |
4 | Docket No. _____________ |
5 | GREETING: |
6 | A petition for Limited Guardianship/Guardianship has been filed in the Probate Court of |
7 | the city/town of _______________________. ________________________ has requested that |
8 | the Probate Petitioner |
9 | Court appoint a limited guardian/guardian for you. |
10 | A hearing regarding this Petition shall be held |
11 | On: ____________________________________ |
12 | date |
13 | At: ____________________________________ |
14 | time |
15 | at the Probate Court for the town of . |
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17 | Address |
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19 | The Petition requests that the Probate Court consider the qualification of the following |
20 | individual/agency to serve as your limited guardian/guardian: |
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23 | A guardian ad litem will be appointed by the Probate Court to visit you, explain the |
24 | process and inform you of your rights. |
25 | You have the right to attend the hearing to contest the petition, to request that the powers |
26 | of the guardian be limited or to object to the appointment of particular individual/agency limited |
27 | guardian/ guardian. If you wish to contest the petition, you have the right to be represented by an |
28 | attorney, at state expense, if you are indigent. |
29 | If the Petition is granted and a limited guardian/guardian is appointed, the Probate Court |
30 | may give the limited guardian/guardian the power to make decisions about one or more of the |
31 | following: |
32 | Your health care; your money; where you live; and with whom you associate. |
33 | Copies of this Notice will be mailed to: |
34 | The administrator of any care or treatment facility where you live or receive primary |
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1 | services; |
2 | your spouse, and heirs at law; any individual or entity known to petitioner to be |
3 | regularly |
4 | supplying protection services to you. |
5 | CERTIFICATION OF SERVICE |
6 | I certify that I hand-delivered and read this Notice to __________________ on the |
7 | ________ day of________, 19____. |
8 | ___________________________________ |
9 | Signature |
10 | ___________________________________ |
11 | Print Name |
12 | ___________________________________ |
13 | Address |
14 | CERTIFICATION OF NOTICE |
15 | I certify that, as required by Rhode Island General Laws § 33-15-17.1(e), I mailed a copy |
16 | of this Notice to the following persons, at the addresses listed, on the ________ day of ________, |
17 | 19____. |
18 | ___________________________________ |
19 | Signature |
20 | ___________________________________ |
21 | Print Name |
22 | ___________________________________ |
23 | Address |
24 | Subscribed and sworn to before me this ________ day of ________, 19____. |
25 | ________________________________ |
26 | Notary Public |
27 | WITNESS |
28 | Judge of the Probate Court of the ________ of ________ this ________ day of |
29 | ________, 19____. |
30 | __________________________________ |
31 | Clerk |
32 | DECISION-MAKING ASSESSMENT TOOL |
33 | Name of Individual being assessed: Current Address: |
34 | _________________________ _____________________________ |
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1 | Date of Birth: Permanent Address (if different): |
2 | _________________________ _____________________________ |
3 | Instructions for Completion |
4 | This document will be used by a Probate Court to determine whether to appoint a |
5 | guardian to assist this individual in some or all areas of decision-making. |
6 | This document has two parts. Please first complete the part which is right after these |
7 | instructions, titled Assessment. Then complete the second section, titled Summary. |
8 | To a physician completing this document: The individual's treating physician must |
9 | complete this document. If there is any information of which the treating physician completing |
10 | this document does not have direct knowledge, he or she is encouraged to make such inquiries of |
11 | such other persons as are necessary to complete the entire form. Those persons might include |
12 | other medical personnel such as nurses, or other persons such as family members or social service |
13 | professionals who are acquainted with the individual. If the physician has received information |
14 | from others in completing the form, the names of those individuals must be listed on the |
15 | Summary. |
16 | To a non-physician completing this document: Professionals or other persons acquainted |
17 | with the individual being assessed may also complete this document. If there is information of |
18 | which a non-physician completing this document does not have knowledge, such non-physician |
19 | may either leave portions of the document blank, or also make inquiries or do such investigation |
20 | as is necessary to complete the entire document. Again, the names of any individual from whom |
21 | information is derived should be listed on the Summary. |
22 | The document must be signed and dated by the person completing it. It does not need to |
23 | be notarized. |
24 | A. BIOLOGICAL ASSESSMENT |
25 | THE FOLLOWING IS BASED UPON A PHYSICAL EXAMINATION CONDUCTED |
26 | BY ME ON |
27 | __________________________ |
28 | (DATE) |
29 | 1. DIAGNOSIS and PROGNOSIS: |
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31 | 2. MEDICATION (PLEASE LIST): |
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3 | How do the above medications, if any, affect the individual's decision-making ability? |
4 | Please explain: |
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10 | 3. CURRENT NUTRITIONAL STATUS: |
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16 | B. PSYCHOLOGICAL ASSESSMENT |
17 | 1. MEMORY (CIRCLE ONE) |
18 | (A) Intact; (B) Mild Impairment; (C) Moderate Impairment; (D) Severe Impairment |
19 | 2. ATTENTION (CIRCLE ONE) |
20 | (A) Intact; (B) Mild Impairment; (C) Shifting/Wandering; (D) Delirium; (E) |
21 | Unresponsive |
22 | 3. JUDGMENT (CIRCLE ONE) |
23 | (A) Intact; (B) Able to Make Most Decisions; (C) Impaired; (D) Gross Impairment |
24 | 4. LANGUAGE (CIRCLE ALL THAT APPLY) |
25 | (A) Intact (B) Sensory Deficits (Hearing/Speech/Sight) |
26 | (C) Impairment In Comprehension/Speech: Mild/Moderate/Severe |
27 | (D) Completely Unresponsive |
28 | 5. EMOTION (CIRCLE ALL THAT APPLY) |
29 | (A) ANXIETY/DEPRESSION: (1) None (2) History of Anxiety/Depression |
30 | (3) Moderate Symptoms of Anxiety/Depression |
31 | (4) Severe symptoms with sleep/appetite/energy disturbance |
32 | (5) Suicide/Homicidal |
33 | (B) OTHER: (1) Suspiciousness/Belligerence/Explosiveness |
34 | (2) Delusions/Hallucinations (3) Unresponsive |
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1 | If you circled any of the above, other than (A) or (1) for any of the above categories, |
2 | please explain whether the situation is treatable or reversible, and if so, how: |
3 | C. SOCIAL ASSESSMENT |
4 | 1. MOBILITY (CIRCLE ALL THAT APPLY) |
5 | (A) Intact/Exercises (B) Drives Car Or Uses Public Transportation |
6 | (C) Independent Ambulation in Home Only; (D) Walker/Cane; (E) Requires Assistance |
7 | If you circled (C), (D), or (E), is situation treatable or reversible? If so, how? |
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13 | 2. SELF CARE (CIRCLE ALL THAT APPLY) |
14 | (A) No Assistance Needed; |
15 | (B) Requires Assistance with (1) Meals (2) Bathing (3) Dressing (4) Toileting/Feeding |
16 | If you circled any of (B), is individual aware that assistance is required? |
17 | ___________________ |
18 | Is individual willing to accept assistance? |
19 | Is individual able to arrange for assistance? |
20 | 3. CARE PLAN MAINTENANCE (CIRCLE ALL THAT APPLY) |
21 | (A) No Active Problem; (B) Initiates Problem Identification; (C) Actively Cooperative; |
22 | (D) Passively Cooperative; (E) Passively Uncooperative; (F) Actively Uncooperative |
23 | 4. SOCIAL NETWORK RELATIONSHIPS |
24 | (CIRCLE ONE IN (A) AND IN ONE IN (B)) |
25 | SUPPORT: |
26 | (1) Very Good Supportive Network; (2) Some Support From Family And Friends; (3) No |
27 | Or Limited Support From Family/Friends; (4) Needs Community Support; (5) |
28 | Isolated/Homebound |
29 | (B) SOCIAL SKILLS: |
30 | (1) Very Good Social Skills; (2) Good Social Skills; (3) Interacts With Prompting; (4) |
31 | Isolated |
32 | D. SUMMARY |
33 | I hereby certify that I have reviewed sections A, B, & C attached hereto and based on |
34 | such assessments that the individual's decision-making ability is as follows: |
| LC000076 - Page 16 of 22 |
1 | (1) PLEASE DESCRIBE AS FULLY AS YOU CAN THE INDIVIDUAL'S DECISION- |
2 | MAKING ABILITY IN EACH OF THE FOLLOWING AREAS: |
3 | A. FINANCIAL MATTERS |
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9 | B. HEALTH CARE MATTERS |
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15 | C. RELATIONSHIPS |
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21 | D. RESIDENTIAL MATTERS |
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27 | (2) PLEASE INDICATE YOUR OPINION REGARDING WHETHER THE |
28 | INDIVIDUAL NEEDS A SUBSTITUTE DECISION-MAKER IN ANY OF THE FOLLOWING |
29 | AREAS: (Circle one for each category. If you circle "limited" for any category, please explain.) |
30 | (1) FINANCIAL MATTERS Yes No Limited |
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| LC000076 - Page 17 of 22 |
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2 | (2) HEALTH CARE MATTERS Yes No Limited |
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8 | (3) RELATIONSHIPS Yes No Limited |
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14 | (4) RESIDENTIAL MATTERS Yes No Limited |
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20 | (5) OTHER: If there are any other areas in which you think the individual lacks decision- |
21 | making ability or has limited decision-making ability, please explain. |
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27 | __________________________________ |
28 | Signature |
29 | _______________________________ |
30 | Name (Print or Type) |
31 | _______________________________ |
32 | Title |
33 | _______________________________ |
34 | Date |
| LC000076 - Page 18 of 22 |
1 | _______________________________ |
2 | Names and titles of others who assisted in Preparation of This Assessment. |
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8 | STATE OF RHODE ISLAND PROBATE COURT |
9 | OF THE |
10 | COUNTY OF ___________________ |
11 | Estate of ________________________ Docket No. ________________ |
12 | ANNUAL STATUS REPORT |
13 | (1) The residence of the ward is |
14 | (2) The medical condition of the ward is: |
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18 | (3) I perceive the following changes in the decision making capacity of the ward: |
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22 | (4) The following is a summary of the actions I have taken and decisions I have made on |
23 | behalf of the ward during the last year: |
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27 | (If more space is needed, please attach a supplement). |
28 | __________________________ |
29 | Guardian |
30 | __________________________ |
31 | Date |
32 | STATE OF RHODE ISLAND PROBATE COURT OF |
33 | COUNTY OF _____________ THE _______________________ |
34 | (Estate Name) |
| LC000076 - Page 19 of 22 |
1 | Probate Court No. ______ |
2 | REPORT OF THE GUARDIAN AD LITEM |
3 | Now comes (Name of Guardian Ad Litem) for (Name of Proposed Ward) and reports that |
4 | on (Date), I personally visited the proposed ward at (Address). I explained to (Name of Proposed |
5 | Ward) the following: |
6 | * The nature, purpose, and legal effect of the appointment of a guardian; |
7 | * The hearing procedure, including, but not limited to, the right to contest the petition, to |
8 | request limits on the guardian's powers, to object to a particular person being appointed guardian, |
9 | to be present at the hearing, and to be represented by legal counsel; |
10 | * The name of the person known to be seeking appointment as guardian: |
11 | Based on such visit and the respondent's reaction thereto, I make the following |
12 | determination regarding the respondent's desire to be present at the hearing, to contest the |
13 | petition, to have limits placed on the guardian's powers and respondent's objection, if any, to a |
14 | particular person being appointed as guardian. |
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19 | Based on my review of the petition, the decision making assessment tool, my interview |
20 | with the prospective guardian, my visit with the respondent, and interviews and discussions with |
21 | other parties, I made the following additional determinations: |
22 | Regarding whether the respondent is in need of a guardian of the type prayed for in the |
23 | petition: |
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28 | Regarding whether the guardian ad litem has, in the course of fulfilling his or her duties, |
29 | discovered information concerning the suitability of the individual or entity to serve as such |
30 | guardian: |
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| LC000076 - Page 20 of 22 |
1 | Respectfully submitted, |
2 | Date:________________________ _________________________ |
3 | (Name of Guardian Ad Litem) |
4 | SECTION 3. This act shall take effect upon passage. |
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LC000076 | |
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| LC000076 - Page 21 of 22 |
EXPLANATION | |
BY THE LEGISLATIVE COUNCIL | |
OF | |
A N A C T | |
RELATING TO PROBATE PRACTICE AND PROCEDURE -- SUPPORTED DECISION- | |
MAKING ACT | |
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1 | This act would establish the supported decision-making act which is a less restrictive |
2 | alternative to guardianship for utilization of the probate courts. |
3 | This act would take effect upon passage. |
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LC000076 | |
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| LC000076 - Page 22 of 22 |