Woman in legal limbo at Mayo cleared to go home

A case closely watched by disability advocates appears to be coming to a close after a judge vacated a court-ordered guardianship and conservatorship for Cindy Hagen, who has been living in Mayo Clinic’s Austin, Minn. hospital since last summer.

Hagen, 49, is quadriplegic as a result of injuries sustained as a child in a car crash.

Earlier this year, a judge put Hagen under emergency guardianship and conservatorship after attempts to discharge her to an appropriate facility failed.

Blue Earth County Human Services petitioned the courts for the guardianship. According to court documents, the county was unable to find in-home care for Hagen, which she had previously had at her apartment in Mankato, Minn., in part due to wide-spread staffing shortages.

Meanwhile, Hagen was offered services in skilled nursing facilities or in an apartment in the Twin Cities but she did not agree to them, according to court documents.

Hagen declined an interview, but said in court documents she instead wanted to go home to her apartment where she lived for years until 2020.

Systemic challenges

Hagen’s situation highlights challenges in some of the systems that surround people living with disabilities, said David Dively, executive director of the Minnesota Council on Disability.

Recent legislative changes make it harder to put people living with disabilities under guardianship. But courts and families have been slow to embrace those changes, he said.

 “We want to move as far away from guardianship as realistically and practically possible, because it is so restrictive. And in Minnesota, we do it pretty heavy handedly,” he said.

Instead, disability advocates say the state — and nation — should be moving toward a process of “supported decision-making.”

That process recognizes that people with disabilities can make their own decisions, said Anita Raymond, program director of the Center for Excellence in Supported Decision Making at Volunteers of America MN. 

“Often when people can approach them and provide the support they need, help them understand the situation and the decisions they face in language they can understand, we are finding — and the research backs it up — that people can make decisions with the support of others without needing guardianship,” she said.

Lack of staff

A big challenge, however, are staffing shortages in assisted living facilities and in the profession of in-home care shortages made worse by the pandemic.

More and more, patients who no longer need acute care end up stuck in the hospital as a result, said Mayo Clinic Dr. Tamara Buechler, who works in Rochester. 

“In these past couple of years with the pandemic, the challenges have only increased,” she said. “In any given quarter we have over 900 delays related to post-acute care. On any given day, in our hospital 10 percent or more of the population are patients who are delayed in the hospital setting because we need to establish a next level of safe care for them.”

Buechler said that means there are fewer beds available for patients who are just coming into the hospital for care.

Still, Raymond said that guardianship doesn’t solve the problem of labor shortages. 

“Let's not use guardianship for a situation where we're basically setting a guardian up to fail because there's nothing they can consent to because there are no resources,” she said. 

Court documents say Hagen's guardianship and conservatorship will be reinstated if she doesn't move home within 45 days.