Wisconsin Act 115: Patient Representative Rules for Nursing Home Admission

Your parent is in a Wisconsin hospital, unable to make decisions, and has no power of attorney on file. Until recently, the only path to authorize a nursing home placement was a full court guardianship — weeks of delay, thousands in legal fees, all while your parent sits in a hospital bed waiting.

Wisconsin Act 115 changed that. Effective June 1, 2026, this law created a streamlined next-of-kin authorization pathway that fills one of the most painful gaps in elder care transitions.

What Act 115 Does

Act 115 allows a designated "patient's representative" to consent to the admission of an incapacitated patient to a nursing home or community-based residential facility (CBRF) directly from an inpatient hospital unit — without a power of attorney or a guardianship order.

The representative can also:

• Make health care decisions on the patient's behalf
• Enroll the patient in Medicaid
• Authorize health-care-related expenditures to the same extent as a court-appointed guardian

This is not a full substitute for a power of attorney or guardianship. It's a targeted emergency authority designed for the specific scenario of a hospital-to-facility transition.

The Priority List

Act 115 determines who qualifies as the patient's representative using a strict hierarchical priority list. The first available, willing, and competent person in this order holds the authority:

1. Spouse or registered domestic partner
2. Adult child
3. Parent
4. Adult sibling
5. Grandparent
6. Adult grandchild
7. Close friend

If multiple people share the same priority level — for example, three adult children — they must reach agreement. The law does not automatically defer to the eldest or the one who happens to be present. Disagreements at the same priority level may still require court intervention.

Key Limitations

Act 115's authority is narrower than a full guardianship or health care POA. Understanding the boundaries prevents missteps:

Facility-only scope. The representative can consent to admission to a nursing home or CBRF from a hospital. This authority does not extend to other community-based care settings, adult family homes, or discharge directly to the patient's home with services.

Automatic termination. The representative's authority ends when any of these occur:

• A guardian is appointed by the court
• The patient is discharged to a non-facility setting
• A valid, activated Power of Attorney for Health Care is located
• The patient protests the representative's authority
• The patient regains decision-making capacity

Sunset provision. All admissions authorized under Act 115 are scheduled to sunset on June 1, 2029. After that date, the law expires unless the legislature extends it.

No financial management. The representative can authorize health-care-related expenditures, but Act 115 does not grant general financial power of attorney. Managing bank accounts, selling property, or handling non-medical finances still requires a financial POA or guardianship of the estate.

The Hospital's Role

Hospitals and admitting facilities must verify that the patient's representative meets the priority requirements. The representative must complete Form F-03436, the Patient's Representative Declaration. The declaration is signed under penalty of false swearing, requires no notary, is filed with the county Register in Probate, and copies go to Adult Protective Services (APS), the discharging hospital, and the admitting facility.

Initial incapacity requires two physicians, or one physician and one advanced practice clinician, to certify that the patient lacks decision-making capacity. The certification is made on Form F-03435, Medical Certification of Capacity for determining a patient's representative authority to act.

When You Still Need Guardianship

Act 115 doesn't eliminate the need for guardianship in every situation. You'll still need to petition the circuit court under Chapter 54 if:

• The patient needs long-term placement in a licensed residential care facility with more than 16 beds (Chapter 55 protective-placement requirements still apply)
• There's a dispute among family members at the same priority level
• The patient needs financial management beyond health-care-related expenses
• The Act 115 sunset approaches and the patient's incapacity is permanent

For families managing an immediate hospital crisis, though, Act 115 removes the most urgent barrier: getting authorization to move a parent from a hospital bed to the care setting they need, without waiting weeks for a court date.

Using Act 115 in a Hospital Discharge

The Wisconsin Hospital Discharge Guide covers the full Act 115 process, including the priority verification steps, the F-03436 form, and how this pathway interacts with Medicaid enrollment and facility admission contracts. It also explains when Act 115 authority is sufficient versus when you should pursue a formal guardianship in parallel.

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