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NGA’s mission is to advance the nationally recognized standard of excellence in guardianship. NGA believes that those appointed to the care of guardians, conservators, and fiduciaries deserve quality services and that every person should be provided respect, due process, rights, and dignity in guardianship. NGA represents more than 1000 guardians, conservators, and fiduciaries from across the United States who share this vision. They are professionals, volunteers, and family guardians. NGA seeks to protect adults under guardianship by ensuring that their guardians receive quality education and access to resources. The association is recognized as the leading national resource for professional development. NGA set the standard for quality in guardianship by establishing national practice standards for individuals in 2000 and for agencies in 2008. These standards have been, and continue to be, reviewed, and revised to ensure that the most current standards are promoted.


Established in Iowa Code (Chapter 231E), the Office of Public Guardian may act as an individual’s guardian; conservator; attorney-¬in-fact under a health care power of attorney document; agent under a financial power of attorney document; personal representative; or representative payee. The mission of the Office of Public Guardian is to preserve individual independence through a person-centered process by:

• Providing education;
• Providing assistance to public and private substitute decision makers;
• When necessary, assisting in substitute decision-making proceedings; and
• Providing substitute decision-making services in the least restrictive manner.

The Office of Public Guardian will only be appointed by the court as the substitute decision maker in a last resort.


Since 2012, the Guardianship Association of Iowa Network (GAIN) has been focused on the practice and issues of substitute decision-making in Iowa. Through education and advocacy for its members and the community, GAIN promotes best practices and the provision of ethical services to vulnerable persons in the least restrictive manner possible.


Download the GAIN Fact Sheet for more information about our organization.



ADVANCE DIRECTIVES – Legal documents stating a person’s wishes for medical treatments in case the individual is not able to make their own decisions. This includes a Durable Power of Attorney for Health Care and a Living Will.

AGENT – An individual designated in a power of attorney document to make decisions on behalf of the principal.

ATTORNEY-IN-FACT – an individual who is designed by a durable power of attorney for health care as an agent to make health care decisions on behalf of a principal and has consented to act in that capacity.

CONSERVATOR –  A person appointed by the court to have custody and control of the property of a protected person under provisions of the probate code.

COURT VISITOR – Court visitor is a neutral person who is appointed by the court to make a thorough investigation, evaluation, and recommendation of all information relevant to a guardianship or conservatorship proceeding. The court visitor does not represent any party in the proceeding and makes a recommendation to the judge as to whether a guardianship and/or conservatorship is necessary.

DO-NOT-RESUSCITATE (DNR) – a medical directive that requests that doctors do not attempt cardiopulmonary resuscitation (CPR) if a person’s heart or breathing stops. A do not resuscitate (DNR) order is placed on the individual’s medical chart.

DURABLE – A document becomes effective or remains effective upon the disability of the principal.

DURABLE POWER OF ATTORNEY FOR HEALTH CARE – A document authorizing an agent to make health care decisions for the principal if the principal is unable, if the judgment of the attending physician, to make health care decisions.

FEDERAL FIDUCIARY – An individual or entity that has been appointed by VA to receive VA funds on behalf of a beneficiary for the use and benefit of the beneficiary and their dependents.

FIDUCIARY – is responsible of acting in confidence and trust and includes a personal representative, executor, administrator, guardian, conservator, trustee of any trust and a representative payee and federal fiduciary.

FINANCIAL POWER OF ATTORNEY – Written document in which one-person (the principal) gives another (the agent) the authority to act on the principal’s behalf in financial matters.

GUARDIAN – a person appointed by the court to have the custody of a protected person under the provisions of the probate code.

INCAPACITY – the inability of an individual to manage property or business affairs and/or make health care decisions.

LEAST RESTRICTIVE ALTERNATIVES – A least restrictive alternative is one that allows a person to make as many decisions and be as independent as possible. Some examples of alternatives are: representative payees for government benefits, joint bank accounts, power of attorney appointments for health care, or finances.

LIMITED GUARDIANSHIP – a guardianship that grants the guardian less than all powers available or otherwise restricts the powers of the guardian.

LIVING WILL – A document directing the declarant’s doctor to withhold or withdraw certain treatments (life sustaining procedures) that serve only to prolong the dying process.

OUT OF HOSPITAL DO NOT RESUSCITATE ORDER – means a written order signed by a physician, executed in accordance with the requirements of section 144A.7A and issued consistent with this chapter, that directs the withholding or withdrawal of resuscitation when an adult patient in a terminal condition is outside the hospital.

PHYISICAN ORDERS FOR SCOPE OF TREATMENT – Physician orders for scope of treatment form or “IPOST form” means a document containing medical orders which may be relied upon across medical settings that consolidates and summarizes a patient’s preferences for life-sustaining treatments and interventions and acts as a complement to and does not supersede any valid advance directive.

POWER OF ATTORNEY – a writing that grants authority to an agent to act in the place of the principal, whether or not the term power of attorney is used.

PRINCIPAL – a person age 18 or older who has executed a durable power of attorney for health care.

PROTECTED PERSON – a person subject to guardianship or a person subject to conservatorship, or both.

REPRESENTATIVE PAYEE – An individual appointed by a government entity to receive funds on behalf of a beneficiary.

SUBSTITUTE DECISION MAKER – A guardian, conservator, representative payee, agent, or personal representative.