Lessons Learned

Caring for the Patient with an LPS Conservatorship

Recently, CHPSO hosted a safe table, Care of the Conserved Patient, focused on patients with a Lanterman-Petris-Short [LPS] conservatorship that is patients with a psychiatric diagnosis resulting in grave disability. It became abundantly clear during the discussion that caring for patients with an LPS conservatorship is often challenging and complex.  Good communication both within and among facilities is key. It is also essential that organizations have a plan in place for the early identification of patients with a conservatorship. Due to nuances in LPS conservatorship from county to county, organizations should develop a good working relationship with the appropriate entities within their county. 

To minimize the risk of an untoward outcome, it is critical that the care team understands what an LPS conservatorship means for the patient, and how that may impact the plan of care. It is helpful to begin with a basic understanding of conservatorships in general. In California, conservatorship types include:

  • The probate conservatorship, which can mean the conservatorship of a person, an estate, or both a person and their estate. Within the category of probate conservatorship are specific rules that should be considered in the event that a patient has dementia.
  • The limited conservatorship, which is designated for developmentally delayed individuals and should be tailored to meet the patient’s needs.
  • The LPS conservatorship, which is specifically for patients with a psychiatric diagnosis resulting in grave disability, defined in the Lanterman-Petris-Short Act as “a condition in which a person, as a result of a mental health disorder, is unable to provide for his or her basic personal needs for food, clothing, or shelter.”

The conservator for a patient with an LPS conservatorship may be public (appointed by the county) or private. A private conservator may be a friend or family member, or may be obtained through an agency or professional conservator service.

Irrespective of whether the conservator is private or public, an LPS conservator does not have absolute decision-making power. If the conservator has been granted physical health medical decision-making authority, beyond decisions related to the treatment of the identified psychiatric disorder, it must be specified in the court papers.

Caring for a patient with an LPS conservatorship can be complicated. To decrease the complexity and ensure that care is of the highest possible quality, organizations should confirm that staff know and understand the requirements and potential barriers for the care and placement of such a patient. In addition, staff should be knowledgeable about the resources available in their community, how to access them and the level of involvement required to maintain those resources.

Resources and References:

The Lanterman-Petris-Short Act

Markkula Center for Applied Ethics Medical Decision Making for Publicly Conserved Individuals