Document Type

Capstone Experience

Graduation Date


Degree Name

Master of Public Health


Health Promotion

First Committee Member

Dr. Brandon Grimm, PhD, MPH

Second Committee Member

Ann Mangiameli, J.D.

Third Committee Member

Dr. Hongmei Wang, PhD


Unbefriended patients often experience an extended length of stay in the hospital while their medical providers await legal appointment of a public guardian to make their medical decisions. The medically unnecessary days the unbefriended patient spends in the hospital equates to high costs for the hospital, but more importantly, negative health outcomes for the patient. The purpose of this study is to provide literature and data to support recommendations for possible changes in Nebraska’s public guardianship appointment process. A literature review seeks to answer: (1) What is the median hospital length of stay for an unbefriended patient without a guardian compared to the unbefriended patient with a guardian? (2) What are the health outcomes for unbefriended patients without a guardian compared to those with a guardian? (3) What are the cost savings for a hospital when an unbefriended patient receives a public guardian? The literature review findings will also inform an outline for a future cost savings study of the unbefriended patient population in a Nebraska hospital.