Age of Majority

Age of MajorityA Guide to Adult Decision-Making Supports

As your adolescent approaches the "age ofmajority" (age 18), it can be intimidating to

understand the various support options andchoose the best plan for your family.

This guide contains information about what eachoption means, what it will look like for your familyin the long-term, and what you need to do to put

the supports in place.

age of ma-jor-i-ty : the age at which a person is

granted by law the rights and responsibilities of an adult

- Merriam-Webster

Introduction........................................................1

Timeline.................................................................2

Identifying Skills & Support Needs.....3

Your Support Options.................................4

Full and Limited Guardianship.............5

Durable Power of Attorney......................7

Healthcare Proxy............................................8

Conservatorship.............................................9

Representative Payee................................10

School Decision-Making...........................11

Supported Decision Making.................12

Forms....................................................................13

Legal Assistance...........................................14

References........................................................15

Contents

Introduction

Age of Majority

Encouraging Independence Regardless of which support option is best for your

family, it is important for your young person to stayinvolved in making decisions and advocating for theirneeds and wants. The support put in place should bethere to make sure your young adult is protected andthat decisions are being made in his/her best interest.

Supports should not exist to be controlling orrestrictive to the young adult. Some supports involvea change in legal status for your adolescent, so it isimportant that they understand and agree with thesupport option to the best of their ability.

Age of Majority

Understanding Capacity

At age 18 in the United States, young peoplebecome legal adults and are responsible formaking all legal, medical, and financial decisions.

This means that their parent or guardian (as aminor) will not be able to make these decisions forthem anymore.

For individuals who are not able to make thesedecisions independently, supports are available.However, these supports require a setup processand paperwork. Some options also require goingto court.

The right decision-making support doesn’tautomatically depend on your adolescent’s diagnoses orIQ score. The right option depends on your adolescent’scapacity or ability to make his/her own decisions. There is no standard legal definition of capacity. Aperson has capacity when they can understand all partsof a situation and make a decision based on thisknowledge. Having capacity doesn’t mean that a person alwaysmakes good choices or needs to make decisionswithout advice or support from others. It does meanthat the person can legally handle the responsibility andconsequences of their decisions.

It can be helpful to think about:

What can my young adult do independently?What can my young adult do with some help?What does my young adult need someone else to do?

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TimelineAge of Majority

If you're pursuing ...

Guardianship and/orConservatorship

Power of Attorneyand/or Healthcare Proxy

Supported Decision-Making Agreement

Begin identifying professionalswho will complete the paperworkat age 17. Depending on theperson’s diagnoses, paperworkmay not be filled out more than30-180 days before the personturns 18. However, the earlier youplan, the easier the paperworkprocess will be.

Paperwork can becompleted on or afteryour adolescent’s 18thbirthday, as it requiredhis/her legal signature.

Your adolescent shouldbegin identifying his/hersupporters and speakingwith them at age 17. Theagreement can be set upand signed on or after theadolescent’s 18th birthday.

It is important to start thinking about support options for youradolescent around age 16.

Start to become familiar with thevarious options and consider youradolescent’s individual needs forsupport.

Discuss the options with youradolescent to get his/her input.

It can be helpful to also discuss yourthoughts with other family members,school staff, and/or medicalprofessionals involved in youradolescent’s care.

You may want to consult a lawyer todiscuss legal options and/or tocustomize paperwork for your family.

General Tips

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Identifying Skills & Support NeedsAge of Majority

Adapted from the Exceptional Lives Guardianship Guide: What can your family member do, and what do they need help with?

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Self-care and SafetyUse basic safety skills: stayingaway from dangerous areas,locking doors, not talking tostrangers, being careful aroundfires, stoves, candles, etc.

Get help during emergencies likefires or accidents

Living ArrangementsTake care ofthemselves, physically

Buy food, clothing, andshelter

Live in a group settingand respect others'needs for quiet, privacy,and cleanliness

Understand their learningissues and the servicesthey need at school

Advocate to get theservices they need

FinancesApply for a credit card/opena bank account and managethese accounts

Apply for and manage SSIbenefits

Keep money safe so it's notlost or stolen

Keep a monthly spendingbudget

Pay for expenses

Seek medical care when they aresick or injured

Weigh the risks and benefits ofmedical procedures

Understand the need for routinemedical care

Understand that they may stillneed a medical procedure, even ifit is painful or unpleasant

Assess whether taking a certainmedicine is important, eventhough it may have unpleasantside effects

Provide accurate informationabout their medical condition

Follow medical advice andtreatment plans

Medical Care

Communicate effectively(verbally or by other means)

Understand that they havechoices

Express their preferences

Communication

Understand what it meansto sign documents

Make sound decisions inimportant life areas likehousing, school, and work

Legal/Decision-Making

Vocational/Adult ServicesApply for services fromgovernment agencies(DDS, MRC, DMH)

Access the services theyneed, like job training, jobsupport, or day programs

Advocate for themselves toget the best possibleservices

Before You BeginIt is always important to involve your adolescent and/or those closest to them inimportant life decisions like making a plan for support. Think about what youradolescent can do and where they need help, for either the short or long term. Examples of these skills are provided here.

Education

Your Support Options

Durable Power ofAttorney

Age of Majority

# 2

Legally appoints someone tomake decisions in some or all

areas for an individual

Can be combined with 4, 5

Handles financial and legalmatters for someone.

Can be combined with 3, 4, 5, 6

Makes an individual's healthdecisions if they are unable to.


Makes decisions about anindividual's property or

business affairs.

Can be combined with ALL

Makes financial decisionsregarding Social Security

benefits for someone.

Can be combined with ALL

Makes educational decisionsfor or with individual.

Can be combined with 2,3,4,5,7

A network that helps anindividual make their own

decisions. Legal power remainswith the individual.


Healthcare Proxy# 3

Conservatorship# 4

Representative Payee# 5

School Decision-Making# 6

Supported Decision-Making# 7

Guardianship# 1

What type ofsupport is this?

4

Financial Legal Medical Education Property Well-being

GuardianshipAge of Majority

A guardian is a person whomakes personal, legal, and/ormedical decisions for someone.A guardian can be theindividual's parent(s) oranother trusted adult. Legalpower transfers from theindividual to the guardian.

What is Guardianship? What will this look like for my family?

GlossaryIncapacitated person:individuals with a clinicallydiagnosed condition wholack the ability to make andcommunicate decisions

Notice: providinginformation to those whomay attend the proceeding

Return of Service: showingthe court that all interestedparties have received notice

A full guardianship grants theguardian the authority tomake decisions for a personin all life areas.

Full Guardianship

A Rogers order is required before aguardian can consent to"extraordinary medical treatment"of a person, such as anti-psychoticmedication, electroshock therapy,sterilization, etc. This requiresadditional medical paperwork andreporting, and is reviewed each year.

Rogers Order

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The guardian will have legal power to make decisions for youradolescent, similar to when they were aminor. The guardian should be makingdecisions in the best interest of youradolescent and encourage him/her toparticipate in making decisions. Your adolescent will still have thefreedom to do things like have a job,travel independently (taking publictransportation or learning how to drive),have friends, run errands, go to college,vote, etc. However, the power to makemajor decisions moves from youradolescent to his/her guardian – he/shedoes not keep any legal rights orresponsibilities for making thesedecisions.

Managing basic financesExamples of Decisions

Medical care/treatmentApplying for health insuranceSigning paperwork

Limited GuardianshipLimited guardianship restrictsthe guardian’s powers to only the areas in which the personneeds help (e.g., medicaltreatment decisions orlegal/financial decisions).

Obtaining Guardianship: The ProcessAge of Majority

1. Download a Clinical TeamReport (CTR) Form.

2. Obtain signatures from ALLTHREE of the following:Physician, Psychologist ANDSocial Worker within 180 daysof filing guardianship petition.

3. Download andcomplete Petition to File forGuardianship.

4. Go to the clinic at your localcourthouse or consult anattorney to make sure youhave the correct forms.

5. File Petition forguardianship with thecompleted CTR at your localFamily and Probate court.

6. Get a notice from the courtand ask a non-family memberto give it to the individualshowing that you are seekingto be made his/her guardian.

7. Get an updated CTR form ifthe signatures are signedbeyond 180 days of the courtdate.

8. Attend the courtproceedings with theindividual unless explainedotherwise.

9. File a plan for the individualwithin 60 days after the courtsgrant guardianship. Completeannual reports each year.

If your adolescentDOES have anintellectual disability...

1. Download a MedicalCertificate Form.

2. Obtain signatures fromONE of the following:Physician, Psychologist ORClinical Nurse Specialist within30 days of filing guardianshippetition.

3. Download andcomplete Petition to File forGuardianship.

4. Go to the clinic at yourlocal courthouse or consultan attorney to make sure youhave the correct forms.

5. File Petition forguardianship with thecompleted MC at your localFamily and Probate court.

7. Get an updated MC form ifthe signatures are signedbeyond 30 days of the courtdate.

8. Attend the courtproceedings with theindividual unless explainedotherwise.

9. File a plan for the individualwithin 60 days after the courtsgrant guardianship. Completeannual reports each year.

If your adolescent DOES NOT have anintellectual disability...

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6. Get a notice from the courtand ask a non-family memberto give it to the individualshowing that you are seekingto be made his/her guardian.

Durable Power of AttorneyAge of Majority

What will this look like for my family?

GlossaryPrincipal: Theindividual transferringpower of attorney.

Agent: The personreceiving power ofattorney

Signing paperworkExamples of Decisions

Financial transactionsBuying life insurance

Durable power of attorney is establishedthrough paperwork and no courtappearance is required.The power of attorney form must besigned and notarized.Either party can choose to stop thepower of attorney at any time.

What do I have to do?

The agent has power of attorneyabilities as soon as thepaperwork is signed and comesinto effect. Even if the individualbecomes legally 'incapacitated',the agent will keep decisionmaking power.

Durable Power of Attorney

The agent only has power ofattorney abilities if theprincipal is deemed legallyincapacitated by a physician.

Springing Durable Power ofAttorney

Managing bank accounts

7

A power of attorney is whensomeone can make legal andfinancial decisions on a person'sbehalf. Having this responsibilitydoesn't require taking care ofanother person physically, butrather handling their legaldecisions. The person also keepstheir own power to make decisions.

What is Power of Attorney?

Both your adolescent andhis/her agent will be able tolegally make decisions and signdocuments regarding legal orfinancial matters. This providesyour adolescent with someindependence along withsupport.

Healthcare ProxyAge of Majority

A Health Proxy is someonewho is allowed to makemedical decisions on anindividual's behalf only whenthe person becomes medically unfit.

What is a Healthcare Proxy?

A health proxy can only be namedby someone who is considered"competent". An individual can stillotherwise make their ownhealthcare decisions, but familymembers may provide advice andsupport. Additionally, the individualcan end the health proxyagreement at any point.

Remember

The proxy can makehealthcare decisions for youradolescent if a physiciandetermines they becomeunable to do so on their own.

What will this look like for myfamily?

GlossaryProxy: the authority torepresent someoneelse or act on theirbehalf

In a coma

A proxy would step in if anindividual is...

Temporarily unconsciousUnable to communicate needsUnable to make healthcaredecisions

An individual appoints a healthcareproxy and an alternate, in case the proxycan't perform their duties.A healthcare proxy form must becompleted and signed with twowitnesses, not including the individual,proxy, or alternate. A copy of the form must be given to theindividual's healthcare provider.


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ConservatorshipAge of Majority

An individual is appointed tomake all financial and businessdecisions on behalf of someoneelse. This is an arrangement forindividuals with significantmeans or property.

What is a Conservatorship?Conservatorship allows you toensure financial care andprotection of your adolescentand prevents property in theirname from being wasted.


GlossaryProtected Person:patient who needssupport

Conservator: personappointed to helpthem

Inventory:comprehensive list ofProtected Person'sestates and assets

Annual Account: asummary of spendingand assetmanagement withSchedules A, B, C

Paying Bills Examples of Decisions

Mortgage or rent paymentsMedical expensesManaging property

There are different degrees ofcontrol, ranging from verylimited to full (also calledplenary conservatorship).This is determined by thecourt and is dependent onthe individual.

Levels of Control

Prior to court hearing, the protectedperson should submit a nomination fortheir conservator.Medical proof of incapacity must beobtained and provided to the court.

File an inventory (list of estates andassets) to the court within 90 days.


File a financial plan.Contact all institutions with protectedperson's assets and claimconservatorship roleFile an annual account.

Officially appointed by Probate & FamilyCourt based on Protected Person'snomination and nominee's ability toensure care of Protected Person

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Representative PayeeAge of Majority

What will this look like for my family?Your adolescent's payee will be ableto use their benefits to pay for anyneeds they may have and place anyleftover benefits into savings. Thepayee is also responsible for keepingrecords and reporting to the SSA.

GlossaryBeneficiary: The personbeing represented.

Payee: personappointed to representthem

Buying foodExamples of Decisions

Housing expensesDental and medical careAny personal expenses

A payee primarily manages SocialSecurity Benefits, including SSI andSSDI. The Social SecurityAdministration (SSA) determineswhich areas the payee has power overand can conduct random checks toensure benefits are handled properly.

Payee Duties

An individual must apply to have a reppayee by contacting their local SocialSecurity office.In person, the payee applicant completesform SSA-11 and provides identification.

Priority of representation is given to theindividual's legal guardian, family, andthen any agent with custody.


The individual can then appeal thedecision to be represented or the choiceof representative.

The Social Security Administrationdetermines an individual's eligibility for apayee and appoints their representative.

Someone who managesSocial Security benefits onbehalf of another person,called a beneficiary.

What is a RepresentativePayee?

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School Decision MakingAge of Majority

Accepting or rejecting an IEPExamples of Decisions

Requesting assesmentsDeciding to continue specialeducation programmingDeciding how long to stay inschool

In delegated decisionmaking, a parent willkeep making educational decisions after the individualturns eighteen.

Delegated Decision Making

In shared decision making,a parent will shareeducational decisionmaking power with theindividual. If there is adisagreement, the student'sdecision will stand.

Shared Decision Making

School districts inform student of age ofmajority rights at 17 and document in IEP.Age of Majority is discussed among teammembers leading up to the student's 18thbirthday. The student must agree to shareor delegate decision making.The individual’s choice to use one of theseoptions is documented by representativesof the school district.School must obtain consent from studentto continue existing special educationservices once the student turns 18.


GlossaryIEP: Individualized

Education Program

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If approved, you would beable to stay involved in youradolescent's educationbeyond age 18, until theyleave school.

What will this look like formy family?

School decision makingallows a parent (or otheradult) to be involved ineducational decisions foran individual.

What is School Decision Making?

Supported Decision MakingAge of Majority

Supported Decision Making,or SDM, involves an individualidentifying a team of peopleto support them in makingimportant life decisions. Asupport network can consistof friends, family, mentors, orother community members.

What is Supported Decision Making?

SDM maximizes an individual'sindependence and promotes selfadvocacy, because no decisionmaking power is taken away fromthem. Rather, the individualreceives support and is empoweredto make their own decisions.

Why SDM?

Your adolescent would keeptheir legal right to makedecisions, but would have asupport network to helpadvise them.


GlossarySelf-advocacy: theaction of representingoneself of one's viewsor interests

Notary public: anofficial authorized bythe government towitness the signing ofimportant documents

Living arrangementsExamples of Decisions

Job opportunitiesFinancial MattersHealthcareRelationships

Individuals create RepresentationAgreements, where they specify areasthey need help making decisions in andappoint people to their support network.Network supporters can signdocuments agreeing to respect theindividual's choices and decisions. Representation Agreements can besigned before a notary public, thoughthis is not required.


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FormsAge of Majority

Guardianship:www.mass.gov/files/documents/2016/08/nc/mpc402-clinical-team-report-fill.pdfwww.mass.gov/files/documents/2016/08/xn/mpc400-medical-certificate-guardianship-or-conservatorship-fillable-2010.pdfwww.mass.gov/files/documents/2016/08/vf/mpc120-petition-for-appointment-of-guardian-adult-fill.pdf

Durable Power of Attorney:

www.powerofattorney.com/massachusetts Healthcare Proxy:

www.massmed.org/Patient-Care/Health-Topics/Health-Care-Proxies-and-End-of-Life-Care/Massachusetts-Health-Care-Proxy---Information,-Instructions-and-Form-(pdf)

Conservatorship:

www.mass.gov/lists/probate-and-family-court-forms-guardianship-and-conservatorship

Supported Decision Making:

www.supportmydecision.org/assets/tools/ACLU-how-to-make-a-SDM-Agreement.pdf

www.supporteddecisions.org/wp-content/uploads/2015/09/SDM-Representation-Agreement-pdf.pdf

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Legal AssistanceAge of Majority

The following Probate & Family Courthouses offer free legal clinicson guardianship to families who qualify. Lawyers and law studentscan help with completing, reviewing, and submitting applicationsfor guardianship. Families should have all supplemental paperwork(assessments, medical reports, etc.) completed before attending theclinic and should bring these with them to the courthouse.

Suffolk County Probate & Family Court in Boston Tuesdays from 9 a.m. to 1 p.m. on the 2nd Floor of the BrookeCourthouse in the Court Services department.

Middlesex County Probate & Family Court in Cambridge Thursdays from 10 a.m. to 1 p.m. on the 2nd Floor of the Courthousein East Cambridge.

Brockton District Court (Plymouth County)

Contact Pilgrim Advocates at 508-583-6966 or the clerk's office at508-587-8000 for the clinic schedule.

Other Courthouses offer assistance through a Court Services orLawyer of the Day program - for more information, contact yourcounty's Probate Court clerk or visit:

www.mass.gov/service-details/lawyer-for-the-day-programs www.mass.gov/service-details/learn-about-court-service-centers

Volunteer Lawyers Project / Eastern Regional Legal Intake (ERLI)Helpline - Hotline providing residents of the Greater Boston areawith free legal information and referrals.

Phone: (617) 603-1700 | Website: www.vlpnet.org/need-legal-helpMass Legal Help - Database of legal services and information to helpindividuals find legal help.

Website: www.masslegalhelp.orgMLPB - Network of lawyers that work with medical providers toprovide free legal information/assistance to patients at participatinghealth care institutions, including BMC. MLPB can also connectpatients with pro-bono attorneys. Contact your provider for a referral.

Website: www.mlpboston.orgDisability Law Center - Provides legal advocacy on disability issuesthat promote the fundamental right of all people with disabilities toparticipate fully and equally in the social and economic life inMassachusetts.

Phone: (617) 723-8455 | Website: www.dlc-ma.org

Find Legal Help & Information

Courthouse Clinics/Resources

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References & Additional InformationAge of Majority

15

Guardianship:www.exceptionallives.org/guardianship-guidewww.bmc.org/sites/default/files/Patient_Care/Specialty_Care/AutismConsortiumTransitiontoAdulthoodManual.pdf [pages 12-19]www.masslegalservices.org/system/files/library/vlp_guardianship_adults_brochure.pdf www.massguardianshipassociation.org/information/guardianship-of-an-adult- 2www.massguardianshipassociation.org/pdf/FINALHandbookforGuardians.pdf www.mass.gov/courts/selfhelp/guardians/guardianship-ip.html

Durable Power of Attorney:

www.massguardianshipassociation.org/information/alternatives-to-guardianship-and-conservatorship/alternative-to-conservatorship-a-durable-power-of-attorneywww.info.legalzoom.com/durable-power-attorney-massachusetts-20314.html

Healthcare Proxy:

www.massmed.org/healthcareproxy/#.Wl5ccZM-euUwww.brighamandwomensfaulkner.org/about-us/patient-visitor-information/advance-care-directives/ma-health-care-proxy-faqs.aspxwww.ppal.net/wp-content/uploads/2011/01/Legal-guide-single-page-all-for-web.pdf

Conservatorship:

www.massguardianshipassociation.org/information/conservatorship/what-does-a-conservator-dowww.mass.gov/files/documents/2017/10/04/3-Conservators-HandbookforConservators-Version1.pdfwww.massguardianshipassociation.org/information/conservatorship/what-does-a-conservator-do

Representative Payee:

www.mhlac.org/Docs/Representative_payees.pdfwww.ssa.gov/payee/faqrep.htmwww.ssa.gov/pubs/EN-05-10076.pdf

School Decision Making:

www.doe.mass.edu/sped/advisories/11_1.htmlwww.fcsn.org/linkcenter/wp-content/uploads/sites/25/2017/08/dese_student_ieps_brochure_web-sm.pdf

Supported Decision Making:

www.supporteddecisions.org

This guide was developed by: Lia Hsu-Rodriguez, MIT '21

Roma Pradha, MIT '18 Coral Bays-Muchmore, MIT '18

Yichen Zhu, Tufts University MA '18Meghana Kamineni, MIT '21

Ohyoon Kwon, MIT '20 with Simone Dufresne, MA - Transition Navigator

For more information & resources, contact: The Autism Program at Boston Medical Center 617.414.3842 | [email protected]

www.BMC.org/autism

Special thanks: Kara Hurvitz, MLPB

Anne McDonald, BMC

Disclaimer: The content of this guide is intended to provideinformation only and does not constitute legal advice.

For further legal information/advice, please contact an attorney.

Documents

Age of Majority