Feb62026
Guardianship Q&A Series

How do I get guardianship over an adult family member who is mentally unable to make medical and financial decisions and refuses to sign a power of attorney? – North Carolina

Short Answer

In North Carolina, when an adult cannot understand or communicate decisions and will not (or cannot) sign a power of attorney, the usual path is a court guardianship. A family member (or other interested person) files an incompetency petition with the Clerk of Superior Court, and if the clerk finds the person incompetent, the clerk can appoint a guardian to make medical and/or financial decisions. The process is designed to protect the adult’s rights, so it requires notice, evidence, and a hearing.

Understanding the Problem

In North Carolina, the key question is: can a family member get legal authority to make medical and financial decisions for an adult who is mentally unable to make those decisions and refuses to sign a power of attorney? The decision point is whether the adult must first be found “incompetent” by the Clerk of Superior Court before anyone else can step into a decision-making role. In a hospital setting, this issue often comes up when discharge planning requires consent for placement, services, or access to funds, but the adult will not sign documents or cannot reliably understand what is being signed.

Apply the Law

North Carolina uses a court process (handled by the Clerk of Superior Court) to decide whether an adult is legally incompetent and, if so, what type of guardian should be appointed. The incompetency case and the guardian appointment are related steps: first, the clerk adjudicates incompetence; then the clerk appoints a guardian (if needed) with authority limited to the areas the adult cannot manage. Guardianship can be tailored—medical decision-making usually falls under a guardian of the person, and money/property decisions usually fall under a guardian of the estate. In some cases, the clerk appoints a general guardian to handle both.

Key Requirements

  • A proper incompetency filing: A verified petition must be filed with the Clerk of Superior Court to start the incompetency case.
  • Proof of decision-making incapacity: Evidence must show the adult cannot manage important affairs or communicate/understand decisions well enough to protect their health, safety, or property.
  • A suitable guardian and the right “type” of guardianship: The clerk must decide who should serve and whether the appointment should cover personal/medical decisions, financial decisions, or both.

What the Statutes Say

Analysis

Apply the Rule to the Facts: The facts describe an adult hospitalized in North Carolina with severe medical issues and significant memory/cognitive decline, where the care team reports the person cannot make decisions, cannot live independently, and may be unsafe if discharged home. Those facts typically line up with the core issue in an incompetency case: whether the adult can understand, make, or communicate informed decisions about health and finances. Because the person refuses to sign a power of attorney, the family generally cannot rely on voluntary planning documents and instead must ask the Clerk of Superior Court to adjudicate incompetence and appoint a guardian with authority matched to the person’s needs (medical, financial, or both).

Process & Timing

  1. Who files: A family member or other interested person. Where: The Clerk of Superior Court in the appropriate North Carolina county (venue can depend on where the person resides and where the case is handled). What: A verified petition to adjudicate incompetence, and an application to appoint a guardian (guardian of the person, guardian of the estate, or general guardian). When: As soon as decision-making authority is needed and the adult cannot or will not sign a power of attorney.
  2. Notice, representation, and evaluation: The court process includes formal notice and protections for the adult (the “respondent”). The clerk will consider medical information and other evidence about functioning and safety, and the adult has rights in the proceeding. The clerk may also appoint a guardian ad litem in certain guardianship-related proceedings if the clerk finds the adult’s interests are not adequately represented.
  3. Hearing and appointment: The clerk holds a hearing on incompetency. If the clerk adjudicates the adult incompetent, the clerk can then appoint the appropriate guardian(s) and issue letters of guardianship that third parties (like hospitals and financial institutions) often require before accepting a guardian’s authority.

Exceptions & Pitfalls

  • Guardianship is not automatic just because a diagnosis exists: The clerk focuses on functional decision-making—what the adult can and cannot do—not just labels like dementia or cognitive decline.
  • Choosing the wrong “type” of guardian: Medical decision authority and financial authority are not always the same appointment. Seeking a guardian of the person, guardian of the estate, or a general guardian should match the actual needs.
  • Incomplete information in the filings: North Carolina requires specific information in the guardianship application, including next of kin and a general picture of assets/liabilities to the extent known. Missing information can slow the case.
  • Family conflict and suitability concerns: If multiple relatives disagree, the clerk may scrutinize who should serve and may limit powers or appoint someone else if that better protects the adult.
  • Confusing guardianship with a guardian ad litem: A guardian ad litem is typically a court-appointed representative in a case; it is not the same as a long-term guardian who can manage ongoing medical and financial decisions outside litigation.

For more on refusal to cooperate in these cases, see what happens if an adult refuses to cooperate with guardianship and how guardianship differs from powers of attorney and advance directives.

Conclusion

In North Carolina, when an adult is mentally unable to make medical and financial decisions and refuses to sign a power of attorney, the usual solution is to file an incompetency petition with the Clerk of Superior Court and request appointment of a guardian (of the person, the estate, or both). The clerk must find the adult incompetent before a guardian can be appointed. The practical next step is to file the verified incompetency petition and guardianship application with the Clerk of Superior Court as soon as discharge or safety decisions require legal authority.

Talk to a Guardianship Attorney

If a family is dealing with a hospitalized adult who cannot make safe medical or financial decisions and refuses to sign a power of attorney, a guardianship case may be the fastest way to get clear legal authority. Our firm has experienced attorneys who can help explain options, prepare the filings, and track the court’s required steps and 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.