title: Wishard Volunteer Advocates Program: an intervention for at-risk, incapacitated, unbefriended adults.
abstract: Unbefriended, incapacitated individuals who lack surrogates to make medical decisions present a complex problem to the healthcare providers who treat them. Adults without surrogates are among the most vulnerable in the community and are often alone and estranged from family, neglected and abused, and at risk of receiving inappropriate medical treatment. This article describes the program model and outcomes for the first 2 years of the Wishard Volunteer Advocates Program (WVAP), a guardianship program using trained, supervised volunteers as surrogates for unbefriended, incapacitated individuals. Of the 50 individuals enrolled during the study period, 20 were female, and 39 were Caucasian and 11 African American. Their average age was 67. Nineteen were insured with Medicare as primary and Medicaid as supplementary insurance. Ninety-eight percent had four or more comorbid conditions at the time of the index hospitalization. Before program referral, many lived alone in unsafe conditions. Adult Protective Services was involved in almost half of the cases at the time of the index hospitalization. Approximately half of the participants required some type of property management. Healthcare usage data demonstrated that most were not receiving medical care before WVAP enrollment; the data indicated a decrease in emergency department visits and hospitalization after WVAP enrollment. The WVAP completed Medicaid applications for 12 participants, resulting in $297,481.62 in reimbursement for the index hospitalization and a payer source for subsequent hospitalization and long-term care. The volunteer advocate model provides an efficient and quality mechanism for providing unbefriended individuals with surrogates.
authors.affiliation: Charles Warren Fairbanks Center for Medical Ethics, Indiana University Health, Indianapolis, Indiana; Division of General Internal Medicine and Geriatrics, School of Medicine, Indiana University, Indianapolis, Indiana.
authors.forename: Robin
authors.initials: R
authors.lastname: Bandy
authors.forename: Greg A
authors.initials: GA
authors.lastname: Sachs
authors.forename: Kianna
authors.initials: K
authors.lastname: Montz
authors.forename: Lev
authors.initials: L
authors.lastname: Inger
authors.forename: Robert W
authors.initials: RW
authors.lastname: Bandy
authors.forename: Alexia M
authors.initials: AM
authors.lastname: Torke
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000628:therapy; D003142:Communication; D015897:Comorbidity; D003362:Cost-Benefit Analysis; D003657:Decision Making; D006233:Persons with Disabilities / Q000523:psychology*; D004552:Elder Abuse / Q000517:prevention & control / Q000523:psychology; D005260:Female; D016330:Frail Elderly / Q000523:psychology*; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand / Q000191:economics / Q000458:organization & administration; D006801:Humans; D007196:Indiana; D007872:Legal Guardians / Q000193:education / Q000523:psychology*; D008297:Male; D016743:Mental Competency / Q000523:psychology*; D008875:Middle Aged; D010344:Patient Advocacy / Q000191:economics / Q000193:education / Q000523:psychology*; D015397:Program Evaluation; D012189:Retrospective Studies; D012847:Single Person / Q000523:psychology*; D012946:Social Welfare / Q000191:economics / Q000523:psychology; D014600:Utilization Review / Q000191:economics; D014838:Volunteers / Q000193:education / Q000523:psychology*; D035862:Vulnerable Populations / Q000523:psychology*
keywords: guardian; incapacitated; unbefriended