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If the person hasn't designated POA to someone. If the person hasn't signed an Advanced Healthcare Directive. Or if the person has designated someone to just one of these positions but not the other.
Guardianship might also be appropriate if the person has dementia and can't make decisions on their own.
If the person has dementia and refuses to go into a nursing home. If the person is very ill and refuses to go into a nursing home.
If there is no POA and the person is being taken advantage of by a friend or family member.
There are many circumstances in which a person might need a guardian.