Guardianship in Hospitals: A Health Services/OPA Pilot Project

Dr Rob Hoffman1, Sally Costar1, Tass Kostopoulos2, Justine Little3, Aaron Livingstone4, Fiona McAlinden3, Paul Newland4, Jacinta Re3, Dina Watterson1, Prof Terry Haines5

1Alfred Health, Melbourne, Australia, 2Eastern Health, Melbourne, Australia, 3Monash Health, Melbourne, Australia, 4Office of the Public Advocate (Victoria), Melbourne, Australia, 5Monash University, Melbourne, Australia


This collaborative project between three metropolitan health services and the Office of Public Advocate Victoria (OPA) explores the impact of increased availability of advocate guardians delegated by the Public Advocate on healthcare system sustainability and outcomes.

The pilot targets a particularly-vulnerable group: hospital-based recipients of VCAT guardianship orders, made on evidence of a cognitive impairment indicating a lack of capacity to make important lifestyle and personal decisions.

The primary aim of the pilot is to reduce the time these patients spend waiting for allocation of a guardian, decreasing patient risk and releasing healthcare system resources.

A multi-institutional, cross-sectional pilot program created a dedicated hospital guardian team within OPA, funded by the partner health services, to reduce the time to guardian allocation for patients within these services.

The impact of the pilot was measured through an historical control group design, with initial data collection over 12 months, followed by yearly cohorts of post-implementation patients.

Under this pilot the time from guardianship order lodgement to guardian allocation has significantly decreased from 46.5 to 23.1 days, halving the average time hospital-based patients spend waiting for a guardian. Estimated cost savings are $15,355 per patient, or over $5 of healthcare system resources released per $1 spent on increased staffing.

Significance of the findings to allied health:
These findings demonstrate how collaboration and investment by healthcare providers in non-health areas can deliver substantial benefits for healthcare system sustainability in an area of patient vulnerability and growing demand.


Dina Watterson is Associate Director of Allied Health at Alfred Health in Melbourne, Victoria.

Tass Kostopoulos is Director of Social Work and Associate Program Director of Allied Health at Eastern Health in Melbourne, Victoria.

Fiona McAlinden is Director of Sub Acute Care and Community Health at Monash Health in Melbourne, Victoria.

Paul Newland is Manager of Advocacy and Guardianship at the Office of the Public Advocate in Melbourne, Victoria.