Choosing Between Guardianship and Medical Power of Attorney

 Posted on December 22, 2025 in Guardianship

As loved ones age, many families take steps to plan ahead by setting up powers of attorney and other advance directives. These documents ensure that someone can make important decisions if a loved one becomes unable to do so. 

However, there are situations where these estate planning tools are not enough. Sometimes, guardianship becomes necessary even when advance planning was done correctly.

Understanding when guardianship may be required can help families prepare for difficult decisions. If you are considering guardianship for someone you love in 2026, contact our San Antonio elder law attorneys today. 

The Difference Between Guardianship and Medical Power of Attorney

While a medical power of attorney only activates in specific situations defined by the document, guardianship provides ongoing authority. Guardianship authority begins after a court determines incapacity.

However, Texas law requires guardians to consider the elder's preferences and values. If the elder previously expressed wishes about medical treatment, the guardian should honor those wishes when possible. The guardian must always act in the elder's best interests.

Common Reasons Powers of Attorney Fail

A power of attorney allows an older adult to appoint someone they trust to make decisions on their behalf. However, several situations can make a power of attorney insufficient:

• The named agent is unavailable or unable to serve because they refuse to act, become incapacitated themselves, or pass away without an alternate agent.

• The agent abuses their authority by misusing funds, making decisions against the elder's best interests, or neglecting their duties. The National Council on Aging estimates that one in 10 Americans over age 60 has experienced some form of elder abuse. 

• Third parties refuse to honor the document because banks or healthcare facilities reject old powers of attorney or documents that do not meet their internal requirements.

• The authority is too limited for the elder's current needs, such as when a healthcare power of attorney does not cover financial matters or living arrangements.

Under Texas Estates Code Section 1002.001, guardianship may be established when a person no longer has the capacity to make decisions. This is true even when powers of attorney exist.

Is Limited Guardianship Available for Elders in Texas?

Texas law recognizes that not every elder requires a full guardianship. Limited guardianship allows courts to tailor a guardian's powers to match specific needs.

How Limited Guardianship Works

The court specifies exactly which rights transfer to the guardian while the elder retains all other rights. For example, a limited guardian might only be able to make financial decisions while the elder still makes healthcare choices.

The court can limit guardianship to specific tasks or time periods. An elder might need assistance during recovery from surgery but regain capacity afterward.

Texas courts must consider whether less restrictive options would be enough before appointing a guardian. Courts generally prefer limited guardianship when it can protect an elder.

Can Elder Guardianship Be Forced Against Someone's Will?

Guardianship can be established even if the elder objects. This is one of the most difficult aspects of guardianship proceedings for families.

The Legal Standard for Involuntary Guardianship

If evidence shows an elder lacks mental capacity to make informed decisions, a court can appoint a guardian over their objection. The elder has the right to an attorney and can contest the petition. But if medical evidence demonstrates incapacity, the court will prioritize protection.

When is Involuntary Guardianship Necessary?

This often happens when an elder has dementia or other conditions impairing judgment. The elder may not recognize their limitations and may resist help even when clearly needed.

The court requires clear and convincing evidence of incapacity. You will likely need to share medical evaluations or testimony from healthcare providers. If there is evidence your loved one cannot take care of themselves, this is important as well.

Even when guardianship is established over someone’s objection, they still have rights. This includes asking for restoration if capacity improves.

Court Oversight and Accountability

Guardians in Texas must file regular reports with the court detailing the elder's condition and decisions being made. If anyone believes the guardian is not acting in the elder's best interests, they can bring concerns to the court.

How Does Guardianship Affect an Elder's Medical Autonomy?

Guardianship significantly impacts an elder's ability to make medical decisions. When a guardian of the person is appointed, that guardian gains authority to make healthcare decisions on the elder's behalf.

A guardian is usually authorized to make decisions such as: 

• Where the elder will live

• What medical treatments they will receive and who will provide care

• Whether to consent to or refuse medical procedures

• Which healthcare providers to use

• The level of medical intervention, including end-of-life care

Contact a San Antonio, TX Estate Planning and Guardianship Attorney

Even careful advance planning cannot prevent every situation that may come up as we age. When powers of attorney and other planning tools are not enough, guardianship may be the necessary next step. 

Our San Antonio guardianship lawyer at The Law Office of Ryan C. Moe, PLLC can offer tailored guidance on whether guardianship is right for you. Contact The Law Office of Ryan C. Moe, PLLC at 210-861-6000 to learn more about guardianship and estate planning.