Supported Decision-Making Service

Supported Decision-Making Service for Persons with Disabilities | Service Model

The Human Rights Center for People with Disabilitis

illnesses – are in a dynamic, changing and relative condition. Gradual loss of abilities occurs over

time – sometimes a very long time (decades); it occurs in different contexts, to different extents

and with respect to different functionality areas; it is neither linear nor "binary" in the sense that

until very advanced stages, senior citizens still maintain functional and decision-making abilities

in specific and different areas.

To conclude this section, in the context of guardianship, senior citizens undergo an experience

partially similar (but consisting of unique characteristics) to the experience of the population

of persons with disabilities, resulting in excessive revocation of their personal liberty and

disproportionate violation of their rights. Therefore, the vision of developing a supported decision-

making service model as an alternative to guardianship, whose implementation would prevent

unnecessary violation or revocation and/or disproportionate restriction of the legal capacity of

senior citizens – is a vision which is definitely shared by persons with disabilities and senior

citizens.

However, considering the unique nature of the population of senior citizens – namely, the fact that

throughout the years they had built an independent and autonomous "life course" (usually without

disabilities), and that throughout their life they "made" personal and family choices – the supported

decision-making service model should be "one of the alternatives" rather than an exclusive and/

or preferred "alternative", over the current institution of guardianship. Many senior citizens

may (and this assumption should be empirically substantiated in the future) prefer or choose the

alternative of "advance directives" or the alternative of "enduring power of attorney" – over a

"supported decision-making service", for different personal reasons and motives. Moreover, due

to the progressive nature of diseases such as dementia, a supported decision-making service could

become limited in its ability to provide a solution to the real needs at a certain point of time, and

other alternatives which were mentioned above, will prove to be more effective in securing senior

citizens' wills and preferences. In this context, it should be remembered that the last amendment

to the law has significantly expanded the scope of enduring powers of attorney and the areas to

which they may be applied (such funds and property management) which did not exist in the past.

Target population

As noted above, in practice most older adults placed under guardianship in the State of Israel are

senior citizens. The characteristics of this population, at least those placed under guardianship,

are different from those of the population of persons with disabilities. At least according to

currently available data (which are limited in scope), this population is characterized as having a

larger female majority ; advanced in age; single (in the sense of absence of spouse); and living in

institutional settings for the elderly (senior citizens' homes and nursing homes). According to this

data, a significant part of the above population experiences different types of dementia, but mostly

Alzheimer's dementia, entailing (in the more advanced stages of the disease) profound cognitive

impairment.

Similar to the pilot project conducted with persons with disabilities, it is advisable an identical

pilot project be conducted with the population of senior citizens – in general, and with senior

citizens suffering from dementia (of different types) – in particular.