Abstract
Few things are as important as where you live, where you call home. “Home is where the heart is.” “There is no place like home.” Home can be place where one has “deep-seated ties with family members and close friends” and “a harbor of family traditions.” For a frail, older person or an individual with disabilities, “home” can be a long-standing family residence, but might also be a room in assisted living, a nursing home, group home, or other option where support and services can be provided. Where you live conjures up fundamental values of independence, safety, comfort, and community engagement. A guardian with responsibility for determining where a person with diminished capacity will live takes on a charge that goes to the core of quality of life. Of course, a guardian’s “choice” of where a person will live is set in a constellation of factors that bear on or even dictate the outcome—the person’s expressed preferences, the availability of optimal settings, the financial resources available, the risk involved, the kinds of care and supervision needed, the applicable law and court order, the process of hospital discharge planning, and more. The guardian’s residential decision is set against a backdrop of federal and state long-term care policy. Without available and affordable options, a guardian will be in a bind. The extent to which these settings are readily available is influenced by federal and state priorities and budgets for institutional versus community-based care. The recent recession has put a crimp in available options, especially for low- and moderate-income individuals—which squeezes guardians into making that daunting determination of where “home” will be. By making surrogate residential decisions and providing consent for transitions from one setting to another, guardians are a key piece in the puzzle for policy-makers in designing a workable system for long-term supports and services, and in facilitating the drive toward community-based options.
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