The Impact of a Guardianship Social Worker on Inpatient Time-To-Guardianship and Costs: Preliminary Findings.

Unrepresented patients who lack decision-making capacity can remain in hospitals for weeks awaiting guardianship and subsequent discharge, resulting in medically unnecessary and costly extended stays. The guardianship process is complicated and requires collaboration between the medical and legal systems. The Rocky Mountain Regional Veteran Affairs Medical Center created a guardianship social worker position to improve the guardianship process by developing subject matter expertise, infrastructure, and standardized procedures. In this brief report, we provide preliminary data on the impact of a guardianship social worker. Time to guardianship completion, mean lengths of stay (LOS), counts of completed guardianships, and cost estimates were compared before and after the guardianship social worker position was created. The mean time to complete guardianships decreased from 121.9 to 69.8 days (p = .13), the mean LOS for patients awaiting guardianship decreased from 129.8 to 117.2 days (p = .39), and the yearly counts of completed guardianships increased from 2 to 9 (p = .002). Estimated inpatient cost savings per patient was $56,244. While promising, these preliminary data are limited by small case numbers and the unknown impact of the COVID-19 pandemic on long-term placement. Creating guardianship-focused social work positions has the potential to create efficiencies in the guardianship process.