Jan212026
Guardianship Q&A Series

How do I get general guardianship for a relative with severe dementia who can’t manage medical or financial decisions? – North Carolina

Short Answer

In North Carolina, “general guardianship” (guardian of the person and the estate) usually requires two court steps in front of the Clerk of Superior Court: (1) an incompetency case where the court decides the person cannot manage personal or financial affairs, and (2) an appointment case where the court names a general guardian. The process starts by filing a verified petition and giving required notice to the respondent and family members, followed by a hearing. If there is an urgent medical or financial risk before the full hearing, the clerk can appoint an interim guardian with limited powers for a short period.

Understanding the Problem

In North Carolina, a family member often asks: can a relative be placed under a general guardianship when severe dementia prevents safe medical decisions and basic money management? The decision point is whether the Clerk of Superior Court can adjudicate the relative incompetent and then appoint one person to handle both personal decisions (care and medical coordination) and financial decisions (paying bills and managing assets). The question commonly arises when the relative already lives in a long-term care facility and someone needs clear legal authority to communicate with providers, consent to care, and manage finances while keeping the relative in the current placement.

Apply the Law

North Carolina treats adult guardianship as a court-supervised process. The Clerk of Superior Court in the county with jurisdiction handles incompetency and guardianship appointments. A “general guardian” is a guardian of both the person and the estate, meaning the guardian may be responsible for care decisions and for managing property and money, subject to court oversight and reporting requirements. The case generally begins with a verified petition to adjudicate incompetence, followed by an application to appoint the appropriate type of guardian.

Key Requirements

  • Jurisdiction in the right forum: The matter is filed and heard before the Clerk of Superior Court, who has original jurisdiction over adult guardianship appointments in North Carolina.
  • Incompetency determination first: A court process must adjudicate the adult as incompetent using North Carolina’s exclusive procedure for incompetency cases.
  • Proper guardianship request and information: The application for appointment must identify the respondent, next of kin, and a general overview of assets/liabilities, and must specify that a general guardian (person and estate) is requested.

What the Statutes Say

Analysis

Apply the Rule to the Facts: Here, the goal is a general guardianship for an elderly relative with severe dementia who lives in a long-term care facility and cannot manage medical or financial decisions. Those facts typically align with seeking an incompetency adjudication first, because the court must formally determine incapacity before appointing a general guardian. If staffing changes at the facility create immediate concerns about consent for care, coordination with providers, or protecting funds used to pay for care, an interim guardianship request may be appropriate while the full case moves toward a hearing.

Process & Timing

  1. Who files: A relative or other interested person. Where: The Clerk of Superior Court in the appropriate North Carolina county. What: A verified petition to adjudicate the adult incompetent, and an application to be appointed as general guardian (person and estate). When: Filed as soon as decision-making authority is needed; if an interim guardian is requested, the clerk must set a prompt hearing and the hearing is generally held no later than 15 days after the motion is served on the respondent.
  2. Evaluation and notice steps: The clerk typically requires current information about the respondent’s condition and functioning and ensures required notice goes to the respondent and other interested persons. The respondent’s rights and representation issues (including whether a guardian ad litem is needed) are addressed as the case proceeds.
  3. Hearing and appointment: At the incompetency hearing, the clerk decides whether the respondent is incompetent. If the clerk adjudicates incompetence, the clerk then appoints the appropriate guardian (here, a general guardian if both personal and financial authority is needed) and issues letters or an order reflecting the guardian’s authority, along with any bond and reporting requirements for estate authority.

Exceptions & Pitfalls

  • Guardianship may be broader than necessary: North Carolina can appoint different types of guardians (person, estate, or general). Requesting a general guardian can trigger more oversight and financial reporting than a narrower appointment, so the requested scope should match the actual needs.
  • Existing documents can change the strategy: If the relative previously signed a valid durable power of attorney or health care power of attorney, the court may still proceed with guardianship, but the existence of agents and their authority can affect what powers are needed and whether any authority should be suspended by court order.
  • Facility placement expectations: A guardianship can provide authority to make care and placement decisions, but it does not guarantee a particular facility will keep a resident if the facility’s policies, level-of-care capabilities, or regulatory requirements change. Planning should include communication with the care team and documentation supporting why the current placement remains appropriate.
  • Interim guardianship is limited and temporary: An interim guardian order must be narrowly tailored and ends quickly (often before the full case finishes). It is not a substitute for completing the incompetency and permanent appointment steps.
  • Financial authority triggers bond and reporting: When estate authority is involved, the clerk may require a bond and ongoing accountings. Delays and compliance problems often come from incomplete asset information or missed reporting deadlines set by the clerk.

Conclusion

In North Carolina, getting “general guardianship” for a relative with severe dementia usually requires filing a verified incompetency petition and then an application to appoint a general guardian with the Clerk of Superior Court. The clerk must first adjudicate incompetence and then appoint the guardian of the person and estate, with court supervision over the guardian’s duties. If an urgent risk exists before the full hearing, an interim guardian may be requested, with a hearing generally required within 15 days after service. The next step is to file the verified petition with the clerk in the proper county.

Talk to a Guardianship Attorney

If a family member has severe dementia and a court order is needed to manage medical decisions and finances while maintaining stability in a long-term care facility, a guardianship case can move quickly and has strict procedural requirements. Our firm has experienced attorneys who can help explain options, prepare filings, and track timelines. Call us today at [919-341-7055].

Disclaimer: This article provides general information about North Carolina law based on the single question stated above. It is not legal advice for your specific situation and does not create an attorney-client relationship. Laws, procedures, and local practice can change and may vary by county. If you have a deadline, act promptly and speak with a licensed North Carolina attorney.

Category: Guardianship Q&A Series

Author: Pierce Law

Pierce Law Group is a North Carolina law firm focused on probate administration, real estate partition matters, and surplus funds claims across North Carolina. We know these situations often come with stress, family dynamics, and time-sensitive decisions—so we prioritize clear communication, steady guidance, and a practical plan from day one. Our goal is to make a complicated process feel manageable, while protecting what matters most to you.