IN THE COURT OF APPEALS OF IOWA
No. 19

- 1761 Filed August 5, 2020

IN THE MATTER OF THE GUARDIANSHIP AND CONSERVATORSHIP OF B .Z , B .Z. , Respondent

- Appellant.

________________________________________________________________ Appeal from the Iowa District Court for Dubuque County, Monica Zrinyi Wittig , Judge.

A respondent appeals an order appointing her adult daughter as her
perm anent guardian and conservator

. AFFIRMED.

Bridget L. Goldbeck of Hughes & Trannel, P.C., Dubuque, for appellant. James E. Goodman, Jr. and Alyssa M. Carlson of O’Connor & Thomas, P.C., Dubuque, for appellee.

Considered by Tabor, P.J. , and May and Greer, JJ.2

TABOR , Presiding Judge

. The district court found B

. Z

. in need of a guardian and conservator based on her long

- standing psychological issues and her accompanying disregard for her
health and financial well

- being

. Because B .Z. has a history of not appreciating her mental

- health condition and because she often places herself in dangerous situations, the court de cided she needed more permanent assistance. So the court appointed B .Z.’ s daughter, Ashley, as guardian and conservator. On appeal, B .Z. argues the district court erred in finding she cannot attend
to her safety and basic ne eds

. S he also claims the court erred in finding her unable to carry out important decisions about her finances. F inally, B .Z. argues the court should have consider ed whether third

- party assistance w ould meet her needs. Because substantial evidence confirms B.Z.’s diminished ability to care for herself and her financial affairs, we affirm the district court ’s resolution

. W e also reject B.Z.’s third

- party

- assistance argument

. I. Facts and Prior Proceedings
As the district court remarked , i t is not easy for children to watch their
pa rents decline. Parents are to love and care for their children as they grow up. But as parents get older, sometimes it is necessary for the grown c hildren to care for their parents in return. Here, the court approved that role for Ashley , daughter of respondent B.Z. 1

1 Effective January 1, 2020, Iowa Code section 633.3(37) refers to the person who is alleged to need a guardianship or conservatorship as “respondent ” rather than “ward” or “proposed ward.” 2019 Iowa Acts ch. 57, § 6. While this legislation was not in effect at the time of the district court’s ruling, we find this designati on more appropriate and will use it in this opinion.3

I n 2014 , B .Z. lost her job and was evicted from the house she had been

r enting for eight years in Lawton, near Sioux City

. After that, B .Z. found an apartment in Sloan where she lived for two months but left because she “did not like apartment living.” B .Z. then began living out of her car. Also during this time , B .Z. repeatedly committed criminal trespass and spent time in jail

. Out of concern for their mother, B .Z. ’s sons sought a civil commitment in late April 2014 at Mercy Medical Center in Sioux City. From her first evaluation,
B .Z. denied she had mental

- health issues , denied she was homeless, and expressed confusion as to why she was brought to the hospital. In addition, B .Z. was uncooperative with treatment and refused oral medications . S o her doctor s started her on anti

- psychotic injections. According to Mercy Medical Center ’ s records , B .Z. was diagnosed with psychosi s and mood disor der. U pon her discharge from Mer cy Medical Center , B .Z. moved in with her brother in the farmhouse where they grew up in Nebraska. 2 Ashley testified the conditions at the farmhouse were “deplorable” and, at one point, it did not have
heat or electricity. Yet B .Z. lived there for a year and a half before her brother
demanded that she leave because of differences in their lifestyles. 3 She c herished her family’s farm, but

— to her dismay

— her brothers sold the land in 2018. 4

2 B .Z. was discharged from Mercy Medical Center in mid

- May 2014. She traveled to the farmhouse but was without food, water, or transportation. Upon her request, B .Z. ’s brother returned her to Mercy Medical Center , where she was admitted again six days later. Her doctors expressed significant concern s about her psychological condition , her refusal to believe she had a mental illness, her in ability to make financial decisions, and her noncompliance w it h taking oral medications. 3 B .Z. testified she paid her brother $200 per month to live there. 4 Before the property sold, she earned between $2500 and $3000 in rent every six months.4
Finding h erself without hearth and home for the second time, B .Z

. resorted to hitchhiking the highways without a reliable vehicle or access to money. In 2018, Ashley began getting calls from social workers and law enforcement about her mother. They were concerned about B.Z.’s safety and tried to assist her with food and housing, but B .Z. refused. Also around this time , B .Z. voluntarily went to a hospital about one hour outside Norfolk, Nebraska , for physical

- health issues. A doctor there called Ashley and asked about her mother’s mental health. After Ashley explained B .Z. ’s first commitment in Sioux City, the doctors transferred B .Z. to a hospital in Norfolk. T he doctors noted B .Z. lacked insight about her condition, appeared unkempt, and had trouble communicating

. The hospital released B .Z. with instructions to maintain contact with her doctor for treatment and to keep taking her medications

. Again, B .Z. refused to follow the medical advice

. B .Z. was now homeless in Norfolk. Ashley testified that she and her
br others would receive phone calls about their mother trying to find housing and food. B .Z. roamed the streets during the day and sle pt on porches at night

— without permission. This practice led to encounters with the police. By this point,
B .Z. realized s he was not in a safe physical or financial situation , so she drove to Boone, Iowa, where her son , Aaron , lived

. 5 Ashley testified her mother ran out of
gas several times on her way to Boone and ask ed strangers for help

. After a brief visit with Aaron, B.Z. drove to Ankeny to see if her other son, Austin, would give her money. B .Z. testified tha t he did not welcome her inside so she slept in the SUV on his driveway.

5 B.Z. manage d to acquire an SUV , t hough it was not registered nor was it insured.5 Striking out with her sons, B .Z. turned to her daughter Ashley, despite being out of c ontact with her for a few years. She dro ve to Ashley’s home in Dubuque, but Ashley was away

. B .Z. elected to wait in her car for a few hours in the extreme,
late July heat until Ashley returned

. When Ashley arrived, her mother appeared confused and stru ggled to communicate why she was in her daughter’s driveway. Ashley took B .Z. to the emergency room. The staff recommended B .Z. s tay at a crisis housing shelter. The next day, Ashley discovered her mother left the shelter during the night and was now on her porch. After this chain of events, Ashley, Aaron, and Austin decided their mother needed assistance again. Ashley sought an involuntarily commit ment for her
mother at Mercy Hospital in Dubuque. During B .Z. ’s commitment , social worke rs and doctors recommended that Ashley become her mother’s guardian and
conservator to better assist her. Ashley tried instead to see if B .Z. c ould function
with extensive family support. Mercy Hospital ’s doctors diagnosed B.Z. with schizophrenia and pre scribed anti

- psychotic medication. While p laced at a care facility , h er condition improved on the medication. B .Z. was then transferred to a residential living facility where she had more independence and responsibilities such as paying rent

. By this time, the doct or s changed her diagnosis to a mood disorder and took her off the anti

- psychotic medication because she was reportedly experiencing side effects like mu scle stiffness. Through the rest of 2018 until early 2019, B.Z. stabilized , acc ording to Ashley

. Unfortunately, B .Z.’s progress soon unraveled , and she slipped back into problematic behaviors and thought processes. B .Z. could not recognize the severity of her mental

- health concerns, and she displayed poor decision making.6

On ce , sh e left the residential living facility without telling anyone and eventually returned confused. Her doctor recommended she get back on medication, but B .Z. refused. An other time , she withdrew $10,000 and carried it as she walked ar ound Dubuque. After a while, B .Z. called Ashley confused and could not explain what happened.
B .Z.’s condition deteriorated , and her health care providers instructed her to resume her anti

- psychotic medication. Again, she refused

. Worried about her mother, Ashley launched a third involuntary commitment proceeding. The court found B.Z. was seriously mentally impaired and lacked the insight to maintain
treatment. B .Z. was hospitalized again at Mercy Hospital in Dubuque. The doctor there recommended Ashley seek guardianship and conservatorship for her
mother. Eventually, B .Z. moved to a residential care facility where she resumed her medications and, according to Ashley, became more communicative and
clearer

- minded. In June 2019, Ashley petitioned the court for guardianshi p and conservatorship for her mother. She attached a letter from B .Z.’s doctor that stated: [ B.Z. ] has chronic schizophrenia and a long

- standing history of treatment non

- compliance and poor insight. She does not have insight into the severity of her cond ition or the need for her to have longitudinal treatment and medications. I believe that it would be in her best interests in the long

- term to have a guardian for her medical care to make safe decisions on her behalf that will maximize her likelihood of r emai ning well over time. A month later, the court appointed Ashley as B.Z.’s tem porary guardian and
conservator. In September 2019 , the court heard testimony from Ashley and B .Z.7

Soon after, the court appointed Ashley as her mother’s guardian and conservator. B.Z. appeals.
II. Scope and Standard of Review “Actions for the appointment of a guardian or conservator are triable at law.” In re Conservatorship of Leonard , 563 N.W.2d 193, 194 (Iowa 1997) (citations omitted). Thus, we review for the correction of legal error

. Id. at 195; see Iowa R. App. P. 6.907. “Because our review is for errors at law, we affirm only if there is substantial evidence to support the district court’s findings.” Leonard , 563 N.W.2d
at 195 ; Iowa R. Ap p. P. 6.904(3)(a)

. “Evidence is substantial if a reasonable person ‘would accept it as adequate to reach the same findings.’” In re Guardianship of Feistner , No. 17

- 2108, 2018 WL 4913669, at *1 (Iowa Ct. App. Oct. 10, 2018) (quoting In re Conservatorship of Deremiah , 477 N.W.2d 691, 693 (Iowa Ct. App. 1991) )

. III. Analysis
A petitioner must prov e the guardianship and conservatorship are necessary and m ust do so by clear and convincing evidence. Id. (citing Iowa Code
section 633.551(1), (2)). That standard means there is no serious or substantial doubt about the correctness of a particular conclusion the court draw s from the evidence. Id.
A. Guardianship We first address whether Ashley proved the grounds necessary to establish
an involunt ary guardianship. We begin with the presumption the proposed respondent is competent. In re Guardianship of R.H. , No. 19

- 0007, 2019 WL 4297878, at *1 (Iowa Ct. App. Sept. 11, 2019) (citing Neidermyer v. Neidermyer ,8

22 N.W.2d 346, 350 (Iowa 1946)). Ashle y then must prove by clear and convincing
evidence that B.Z.’s decision

- making capacity was so impaired that she was unable to care for her personal safety, or to provide for necessities such as food, shelter, clothing, or medical care without which physic al injury or illness may occur. See I owa Code § 633.552( 2 )(a) (2019)

. The record shows B .Z. has chronic schizophrenia , which requires a continuous regimen of anti

- psychotic medication. But B .Z.

— from her first involuntary commitment until her testimony at trial

— denied she ha d a mental illness. 6 Relatedly, B.Z. has a long history of refusing medication both because she d id not believe she need ed it and because of its side effects such as muscle stiffness. As her doctors and her child ren have recognized, B .Z. is u nable to appreciate the magnitude of her diagnosis. That B .Z. cannot appreciate the existence and serious ness of her mental illness

— after several fam ily interventions,
commitments , and treatments

— shows her capacity for decision making is severely impaired

. Beyond the medication issues, her history of homelessness reveals an inability to effectively care for herself and to provide for basic necessities like food and shelter. Sinc e losing her job in 201 4 , B.Z. has found herself homeless at least
three times across two states. Each time, she wandered the streets and slept in her car or on nearby porches

— asking for food and money anywhere she could.

6 During trial, B .Z. was asked if she knew why the court in June 2019 fo und she had schizophrenia. B .Z. responded, “I wasn’t paranoid; I wasn’t hearing voices; I was upset. I get a little eccentric . . . when I’m upset, I do. That’s [B.Z.]

. I’ve been [B.Z.] for as long as I can remember. I might do some silly things . . . I might look a little eccentric, but I’m [B.Z.]

. ”9

These decisions led to trespass charges and concerned the communities where she found herself. Sometimes she would drive away from the situation but ran out of gas and money

— stranded and at the mercy of strangers. This pattern of risky
choices supports the court’s appointment of a guar dian. True, B .Z. is physically capable of many everyday tasks. See Feistner , 2018 WL 4913669, at *2 (noting ability to perform daily living activities as a factor).
But she also has a diminish ed capacity for sound decision making. This is a dangero us combination because B.Z. can walk into an unsafe situation without realizing its risk or how she got there. While B .Z. has never reported suicidal thoughts, it is inescapable that

— as the district court stated

— “[s]he has experienced many different epis odes that place her in danger.” See id. (noting absence of thoughts of “suicidal ideation or self

- harm ” as a factor). These episodes result from a severely diminished capacity for decision making. The

re cord includes substantial evidence that B .Z. canno t provide for her own care and safety. Thus, we agree with the district court that B .Z. needs a guardian.
B. Conservatorship Next, we address whether Ashley proved the grounds necessary to establish an involuntary conservatorship. Ashley must prove by c lear and convincing evidence that B.Z.’s decision

- making capacity was so impaired that she

was unable to make, communicate, or carry out important decisions about her financial affairs. See Iowa Code § 633.5 66 ( 2 )(a). Without dispute, B .Z. has overseen her finances in the past. For instance , B .Z. paid her rent for eight years before facing eviction. She also paid rent to her brother at the farmhouse in Nebraska and to the residential living facility in10

Dubuque. She has a n awareness
— albei t limited

— of her debts and has considered the need to manage them. As for her homelessness and panhandling , B .Z. insists irresponsibl e money management is not enough to show the need for a conservatorship. See In re Guardianship & Conservatorship of Teet er , 537 N.W.2d 808, 810 (Iowa Ct. App. 1995) (“The fact Shirley may spend money foolishly or give money to a child is not in itself sufficient to find she is not competent.”). B.Z. also plays down her decision to withdraw $10,000 and carry i t unsecured ar ound the city

. Contrary to B.Z.’s contention s , her fiscal welfare is not the equivalent of

“ irresponsible spending

. ” Rather, the record reveals her impaired capacity to make important decisions about her financial affairs. Case in point, i n May 2014, d uring her second stay at Mercy Medical Center in Sioux City , B .Z.’s doctors recommended her “daughter or family petition for protective payee as [B .Z. ] is unable to manage money appropriately.” They explained B .Z. was unable to make monetary decisions “ ap propriate for her safety.” Finally, her doctors “strongly recommend[ed] that she apply for disability as her mental illness renders her incapable of working and providing for herself.” Without that protection, B .Z. accumulated significant debt in medical bills,
around $36,000 , by the time of trial. She was accepted for social security disabil ity, which could have offset tho se expenses, but she denied the benefit or f ailed to fill

o ut the paperwork. Eventually, th e Social S ecu rity Administration office called Ashley to take care of her mother’s financial affairs.
While B .Z. knows of her debts and has made finan cial decisions in the past, those facts do not erase the need for a conservatorship. The record provides11

substantial evidence that she can not carry out important decisions about her financial affairs. C. Third - party assistance Lastly, in proceedings to establish a guardianship or conservatorship, “ the court shall consider credible evidence from any source to the effect of third

- party assistance in meeting the needs of the” respondent

. Iowa Code § 633.551(4); see In re Guardianship of Hedin , 528 N.W.2d 567, 579 (Iowa 1995) (“[T]he court must consider the availability of third

- party assistanc e to meet a [respondent’s] need . . . if credible evidence of such assistance is adduced from any source.” ). But neither party has the burden to produce such evidence. Id.
No credible evidence on the availability of third

- party assistance could have be en adduced from this record, nor did either party produce such evidence. The district court did not have to consider what was not there.
AFFIRMED.