Maryland Cerebral Palsy Guardianship Options and Alternatives

Why Cerebral Palsy Cases Are Different

Cerebral palsy is primarily a motor disorder. Many adults with cerebral palsy have full cognitive capacity — they understand their options, can evaluate consequences, and can communicate decisions, even if that communication requires assistive technology. A person who needs help physically signing a document or who uses a communication device is not the same as a person who lacks the capacity to make decisions.

This distinction matters enormously under Maryland law. Guardianship requires clear and convincing evidence that the individual cannot make or communicate responsible decisions. Physical difficulty with communication is not the same as inability to communicate. If an adult with cerebral palsy can understand and communicate responsible decisions through any means — speech, AAC device, eye-tracking, assisted typing — physical communication difficulty alone does not establish incapacity or justify a guardianship petition.

The Most Common Mistake

Families, doctors, and even some attorneys default to guardianship when they see significant physical disability. An adult with severe cerebral palsy who uses a wheelchair, needs assistance with daily care, and communicates through a device may look like they "need" a guardian. But the legal question is not whether they need physical assistance — it is whether they can make and communicate responsible decisions.

Filing an unnecessary guardianship petition strips a capable person of their constitutional rights. Maryland law explicitly requires courts to exhaust less restrictive alternatives before granting guardianship.

Alternatives That Fit

Supported Decision-Making

An SDMA under Maryland's 2022 statute is often the right fit for adults with cerebral palsy who have full or near-full cognitive capacity but need help with the mechanics of decision-making — gathering information, reviewing documents, communicating choices to third parties. The supporter assists; the individual decides.

The Appellate Court's 2025 Pughsley decision confirmed that supported decision-making is a valid court-recognized support. Third parties — including banks, hospitals, and government agencies — cannot refuse to let a supporter accompany or assist the adult when the supporter acts within the agreement's documented scope.

Financial Power of Attorney

An adult with cerebral palsy who has the cognitive capacity to understand the document can execute a durable financial POA under Estates and Trusts Title 17. The agent handles banking, bill-paying, and property management while the individual retains ownership and decision-making authority. Maryland law requires third parties to accept a statutory POA or notify the agent of a refusal within strict timelines.

Advance Health Care Directive

A healthcare directive designates a medical decision-maker who steps in when the attending physician and a second independent physician certify incapacity; if the patient is unconscious, a second physician's certification is not required. For adults with cerebral palsy, this provides a safety net for medical emergencies without removing any current authority over healthcare decisions.

Representative Payee

If the individual receives SSI or SSDI and needs help managing those specific payments, a representative payee handles benefit funds without any court involvement. This is a common arrangement for adults with physical disabilities who find it difficult to manage banking logistics.

When Guardianship Is Appropriate

Some adults with cerebral palsy do have co-occurring intellectual disability or cognitive impairments that affect decision-making capacity. When the clinical evidence demonstrates that the individual cannot make or communicate responsible decisions even with assistive technology and supported decision-making, a limited guardianship may be warranted — limited to the specific areas where incapacity is documented.

The clinical certificates (two required for filing) should address whether communication barriers have been appropriately accommodated. If the clinicians did not attempt to use the individual's established communication method, the assessment may not reliably measure capacity.

Practical Considerations

• Assistive technology matters in court. If your family member uses AAC or other communication tools, ensure these are available during clinical examinations and at the guardianship hearing. A capacity determination made without the individual's established communication method may not reliably measure capacity.
• DDA services do not require guardianship. Access to Maryland DDA waiver services, community pathways, and self-directed services is based on eligibility, not guardianship status. An adult with cerebral palsy can sign their own service contracts, with a supporter helping them understand and communicate decisions under an SDMA.
• IEP rights stay with parents until exit. Under Maryland's non-transfer rule, parents hold educational decision-making rights until the student leaves school, unless a documented transfer condition applies — regardless of the student's physical disability status.

The Maryland Adult Guardianship & Alternatives Guide includes a capacity evaluation framework that distinguishes between physical assistance needs and decision-making capacity, helping families and clinicians avoid the common error of conflating the two.

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