Jefferson County v. J. L. L.

COURT OF APPEALS
DECISION NOTICE
DATED AND FILED This opinion is subject to further editing. If
published, the official version will appear in
the bound volume of the Official Reports.
November 26, 2025
A party may file with the Supreme Court a
Samuel A. Christensen petition to review an adverse decision by the
Clerk of Court of Appeals Court of Appeals. See WIS. STAT. § 808.10
and RULE 809.62.

Appeal No. 2024AP1949 Cir. Ct. No. 2024GN000015

STATE OF WISCONSIN IN COURT OF APPEALS
DISTRICT IV

IN THE MATTER OF THE GUARDIANSHIP AND
PROTECTIVE PLACEMENT OF J.L.L.:

JEFFERSON COUNTY,

PETITIONER-RESPONDENT,

V.

J.L.L.,

RESPONDENT-APPELLANT.

APPEAL from orders of the circuit court for Jefferson County:
ROBERT F. DEHRING, JR., Judge. Affirmed.

Before Graham, P.J., Blanchard, and Nashold, JJ.

Per curiam opinions may not be cited in any court of this state as precedent

or authority, except for the limited purposes specified in WIS. STAT. RULE 809.23(3).
No. 2024AP1949

¶1 PER CURIAM. J.L.L. appeals orders granting petitions for a
guardianship of her person and estate and for a protective placement. She argues
that the evidence was insufficient to support the orders. We reject J.L.L.’s
arguments and affirm.

BACKGROUND

¶2 In 2024, Jefferson County petitioned for temporary and permanent
guardianship of J.L.L.’s person and estate and for protective placement, including
emergency protective placement. The petitions alleged the following. J.L.L. had
recently been hospitalized as a result of several significant medical conditions that
she was not managing and was placing herself in “imminent danger.” Specifically,
J.L.L. had a respiratory condition that required treatment with oxygen and she was
found in her motel room hypoxic1 with an “altered mental status.” She also had a
significant pressure ulcer on her ischium,2 and an open wound on her left foot,
which was exposed to the fat layer. J.L.L. had been living out of a motel room,
with limited or no services to assist her with her needs. Her house was unlivable
due to mold issues that J.L.L.’s insurance company had been trying to remedy
since 2018, but J.L.L. refused to grant access to her house.

¶3 The circuit court ordered a temporary guardianship and an
emergency protective placement and appointed Dr. James Freiburger, a licensed

1
“Hypoxia” is “a deficiency of oxygen reaching the tissues of the body.” Hypoxia,
MERRIAM-WEBSTER DICTIONARY, https://www.merriam-webster.com/dictionary/hypoxia (last
visited Nov. 24, 2025).
2
“Ischium” is “the lower and posterior of the three principal bones composing either half
of the pelvis.” Ischium, MERRIAM-WEBSTER DICTIONARY, https://www.merriam-
webster.com/dictionary/ischium (last visited Nov. 24, 2025).

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No. 2024AP1949

psychologist, to examine J.L.L. and submit a report to the court. Freiburger and
two other witnesses were called to testify by the County at a hearing, and
Freiburger’s report was entered into evidence. In both his testimony and report,
Freiburger concluded that J.L.L. has an impairment in the form of a degenerative
brain disorder—specifically, a neurocognitive disorder—that is permanent or
likely to be permanent; that she is in need of guardianship of her person and estate;
and that she requires protective placement.

¶4 The County also called Sarah Fitch, an occupational therapist who
works with J.L.L. in the skilled nursing facility in which J.L.L. resides, and Shelly
Theder, the lead adult protective service worker for the County. J.L.L. testified on
her own behalf, opposing guardianship and protective placement. J.L.L.’s
guardian ad litem informed the circuit court that, consistent with his report, he
believed that it was in J.L.L.’s best interest for the court to grant the petition for
guardianship of J.L.L. and her estate and to order protective placement.

¶5 The circuit court granted the County’s petitions for guardianship and
protective placement. J.L.L. appeals.

DISCUSSION

¶6 J.L.L. argues that the County failed to present sufficient evidence to
support the order granting a guardianship of her person and estate or the order for
protective placement. Whether the evidence supports a guardianship or a
protective placement is a question of law that we review de novo. See Walworth
County v. Therese B., 2003 WI App 223, ¶21, 267 Wis. 2d 310, 671 N.W.2d 377.
We will not overturn the circuit court’s findings of fact unless they are clearly
erroneous. See id. For the reasons that follow, we conclude that sufficient
evidence supports the circuit court orders.

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No. 2024AP1949

I. Guardianship of J.L.L.’s Person and Estate

¶7 The criteria for a guardianship of a person and the person’s estate are
set forth in WIS. STAT. § 54.10(3)(a) (2023-24).3 A court may find a person
“incompetent” and appoint a guardian of the person and the person’s estate if the
court finds all of the following by clear and convincing evidence:

1. The individual is aged at least 17 years and 9
months.

2. For purposes of appointment of a guardian of the
person, because of an impairment, the individual is unable
effectively to receive and evaluate information or to make
or communicate decisions to such an extent that the
individual is unable to meet the essential requirements for
his or her physical health and safety.

3. For purposes of appointment of a guardian of the
estate, because of an impairment, the individual is unable
effectively to receive and evaluate information or to make
or communicate decisions related to management of his or
her property or financial affairs, to the extent that any of the
following applies:

a. The individual has property that will be
dissipated in whole or in part.

b. The individual is unable to provide for his
or her support.

c. The individual is unable to prevent
financial exploitation.

4. The individual’s need for assistance in decision
making or communication is unable to be met effectively
and less restrictively through appropriate and reasonably
available training, education, support services, health care,
assistive devices, a supported decision-making agreement
under [WIS. STAT.] ch. 52, or other means that the
individual will accept.

3
All references to the Wisconsin Statutes are to the 2023-24 version.

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No. 2024AP1949

“Impairment,” as used in § 54.10(3)(a)2., 3., means “a developmental disability,
serious and persistent mental illness, degenerative brain disorder, or other like
incapacities.” WIS. STAT. § 54.01(14).

A. Guardianship of J.L.L.’s Person

¶8 J.L.L. does not dispute that she suffers from an “impairment” in the
form of a degenerative brain disorder under WIS. STAT. §§ 54.10(3)(a)2. and
54.01(14). In challenging the guardianship of her person, J.L.L. argues that the
County did not present clear and convincing evidence that, due to her impairment,
she is “unable effectively to receive and evaluate information or to make or
communicate decisions to such an extent [that she is] unable to meet the essential
requirements for … her physical health and safety” under § 54.10(3)(a)2. The
phrase “meet the essential requirements for physical health or safety” means
“perform those actions necessary to provide the health care, food, shelter, clothes,
personal hygiene, and other care without which serious physical injury or illness
will likely occur.” § 54.01(19). We conclude that, contrary to J.L.L.’s argument,
the County established these statutory criteria by clear and convincing evidence,
which we summarize below.

¶9 At the time of the hearing, J.L.L. was a 76-year-old resident of a
skilled nursing facility. Freiburger conducted an in-person examination of J.L.L.
two weeks before the hearing and his report was received into evidence and
considered by the circuit court in making its determination. In his report,
Freiburger noted that J.L.L. has a degenerative brain disorder—specifically, a
neurocognitive disorder—that interferes with her ability to receive and evaluate
information, use information in a decision process, communicate decisions, and
meet essential requirements of her health and safety. Freiburger’s report further

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No. 2024AP1949

stated that J.L.L. could “not demonstrate adequate verbal understanding,
judgment, and insight, evidencing substantial impairments in insight and ability to
receive and evaluate information, recall what she has seen, heard, and read, and
make informed decisions.” The report also stated that, because J.L.L.’s “judgment
is significantly distorted[,] she is seen as a safety risk at present if left to her own
devices” and that her “[i]mpairments in judgment and insight are demonstrated
through testing scores and experiences leading to hospitalization and placement.”

¶10 Freiburger supported these conclusions with testimony and
statements in the report that included the following. J.L.L. initially told Freiburger
that the only condition or problem area she experiences is pain, which, according
to Freiburger, was “significant,” because she suffers from “conditions and
deteriorations,” in addition to pain, that “have placed her in substantial danger.”
Specifically, J.L.L. had a significant pressure ulcer, a wound on her left foot that
was exposed to the fat layer, and respiratory concerns requiring oxygen; and she
was hospitalized after “being found hypoxic with altered mental status.” J.L.L.’s
risk of falling was elevated because her ambulation was limited and she
demonstrated an unsteady gait. J.L.L. had been living out of a motel room,
“refusing help and assist[ance].” Her house was not livable due to black mold
issues and, although her insurance company had been attempting to access the
house to address the issue since 2018, J.L.L. would not allow insurance company
personnel or cleaning services into her house unless she was present and she was
“unwilling to make accommodations to be there.” Her stated reason for not
allowing people into her house was that a relative told her that “people had come
into his house and had stolen items and money from him.” In addition, J.L.L. had
“no service[s] … coming into the motel” to help her, because “they withdrew due
to safety concerns.” According to Freiburger, J.L.L. was unable to “understand

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No. 2024AP1949

and problem-solve for her healthcare and finances” and her belief that she could
do so was based on her “historical functioning,” that is, her ability to do so in the
past.

¶11 Freiburger testified that, as a result of J.L.L.’s neurocognitive
disorder, she “is unable to make informed decisions regarding her healthcare and
finances, and she is unable to adequately provide for her own care and custody and
safety.” Although J.L.L. “is able to take in information, she’s not adequately able
to process and apply that information [in order] to make an informed decision.”
For example, according to J.L.L.’s medical team, J.L.L. has acute and chronic
respiratory failure with hypoxia; however, J.L.L. denied having the underlying
condition and did not believe that she needed to be treated with oxygen, resulting
in her discontinuing her oxygen against medical advice. In addition, Freiburger
believed that one of J.L.L.’s wounds was not healing well, which required “staff
assists.” Nevertheless, J.L.L. indicated that pain was her only condition “and
believed that she could return back to her hotel and live there on her own without
help and supports” and that she “didn’t believe” the information that physicians
and medical staff were attempting to convey to her. J.L.L.’s statements were
significant to Freiburger as a psychologist because “an individual’s inability to
even acknowledge their … impairments or conditions, leads to” uninformed
decision-making, “because they’re not using rational, reality-based information to
adequately plan for themselves.”

¶12 Freiburger also performed a series of tests to evaluate J.L.L.’s
mental status and reasoning abilities. As to J.L.L.’s reasoning, Freiburger checked
“moderate” on the form, which according to Freiburger, is “clinically significant.”
Freiburger also assessed J.L.L.’s executive functioning, which includes the ability
to be able to execute financial and physical needs, and to process and complete

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No. 2024AP1949

independent activities of daily living. According to Freiburger, J.L.L.’s executive
functioning was “significantly impaired.” He based this determination on various
factors, including J.L.L.’s inability to care for her wound or address the black
mold in her house and her indication to Freiburger that she had been “doing fine”
in the motel room with in-home services, even though: the in-home provider
refused to continue services due to the “significant incontinence of both bowel and
bladder and due to the smell and disrepair of the room”; the in-home provider
stated that continuing to provide in-home care presented a safety risk and that
adequate help could no longer be provided; and the motel would not allow J.L.L.
back due to the condition of the room. Further, although J.L.L. could not return to
her house due to the mold issues, she would not allow insurance company
personnel or others to enter her home to fix the problem.

¶13 In addition to Freiburger’s testimony, the circuit court heard
testimony from Fitch, an occupational therapist who had been treating J.L.L. at the
skilled nursing facility. Fitch’s testimony included the following. J.L.L. posed a
moderate fall risk and was able to walk no more than 150 feet using a front-
wheeled walker with standby assist. J.L.L. required both a walker and standby
assist for her safety and balance, and to manage her oxygen tank tubing. In the
context of walking, “standby assistance” means that the person providing
assistance is standing by to help if needed, which in J.L.L.’s case was
approximately 10 percent of the time, primarily to help with the oxygen
equipment. J.L.L. also required standby assist for all toileting transfers, bathing,
and hygiene, and J.L.L. was not able to perform those tasks independently. J.L.L.
also experienced incontinence, during which she required physical assistance with
cleanup because without such assistance, incontinence may be “detrimental to skin
integrity” and create the risk of infection. In fact, at the time of the hearing, J.L.L.

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No. 2024AP1949

had a wound on “her backside.” J.L.L.’s incontinence was a “consistent
occurrence” and with every episode of incontinence, J.L.L. required physical
assistance for cleanup.

¶14 J.L.L. also testified. J.L.L. denied refusing oxygen since going into
the hospital, and testified that she has not refused care from the nursing staff
regarding the wound on her foot or the ulcer on her ischium. When J.L.L. was
asked by her attorney whether she acknowledged the need for some in-home
health assistance, J.L.L. was equivocal in her response, responding, “Well, it’s an
adjustment period when people go through something like that, and I think I was
looking for a second or third opinion….” When asked if she would seek home
healthcare in the community if she were discharged from her current facility, she
responded “absolutely,” but she then testified that there was “one home care
agency that for some reason refused to treat me, which I think was a liability.”
She testified that she had taken care of her health and her financial situation for the
20 years since her husband’s death and “way before that” and that she found the
suggestion that she could not do so “insulting.” As to her health situation, J.L.L.
testified that she had osteoporosis and high blood pressure and “a lot of different
health conditions that [she is] very well aware of,” but that she doesn’t “walk
around crying about [her] health conditions,” and instead maintains a strong faith
and positive attitude.

¶15 In the course of reviewing the evidence and granting guardianship of
J.L.L.’s person, the court credited the testimony of the County’s witnesses over
J.L.L.’s testimony, saying:

The [County’s] witnesses are professionals in the
community, with no direct stake in the outcome, other than
trying to do their jobs well. Their testimony is intelligent
and reasoned.

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No. 2024AP1949

[J.L.L.’s] testimony, and she also comes across as a
well-spoken, intelligent lady; however, she does have a
stake in the outcome and her testimony in some areas
directly contradicts that of the professionals.

We defer to these credibility determinations. See Therese B., 267 Wis. 2d 310,
¶26 (circuit court in guardianship and protective placement cases may weigh the
testimony and determine the credibility of witnesses, and this court “must defer to
this assessment of the credibility of the experts and the weight of the testimony.”).
The court then summarized and adopted key points in the County’s evidence and
rejected J.L.L.’s suggestion that, because she had been able to meet her own needs
in the past, she could do so now and going forward.

¶16 The evidence set forth above supports the circuit court’s order for
guardianship of J.L.L.’s person. Specifically, and contrary to J.L.L.’s contention,
the County presented clear and convincing evidence that, at the time of the
hearing, due to J.L.L.’s impairment, she was “unable effectively to receive and
evaluate information or to make … decisions to such an extent [that she was]
unable to meet the essential requirements for … her physical health and safety”
and, specifically, that she was unable to “perform those actions necessary to
provide the health care, … shelter, … personal hygiene, and other care without
which serious physical injury or illness will likely occur.” WIS. STAT.
§§ 54.10(3)(a)2., 54.01(19). J.L.L.’s arguments to the contrary are not persuasive.

¶17 In challenging the circuit court’s determination, J.L.L. emphasizes
the statutory language requiring the County to prove that “serious physical injury
or illness will likely occur,” WIS. STAT. § 54.01(19), and suggests that the County
failed to satisfy this standard. She further notes that, pursuant to WIS. STAT.
§ 54.10(3)(b), a guardianship “may not be based on mere old age, eccentricity,
poor judgment, [or] physical disability” (subject to an exception not applicable

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No. 2024AP1949

here), and suggests that the guardianship order was based solely on these
considerations. J.L.L. asserts that “at best, the [C]ounty proved that [J.L.L.] was
76 years old, that she had exercised some poor judgment about her healthcare, and
that she is physically disabled.”

¶18 As support for her position, J.L.L. relies on Fitch’s testimony that:
although J.L.L. poses “a moderate fall risk,” Fitch was not aware of any incidents
during J.L.L.’s time at the current facility that J.L.L. has fallen while walking;
J.L.L. is able to use her arms and hands to address problems with oxygen tubing
that arise when she is walking; and the incidents of incontinence at the facility
were not “emergency situations” at the time they occurred. J.L.L. also relies on
her own testimony acknowledging that she has health conditions and that she has
not refused oxygen since being at the current facility, as well as evidence
indicating that she is willing to take medications, accept medical interventions,
and engage in occupational therapy.

¶19 J.L.L.’s arguments—which focus on her conduct and condition
while under guardianship and protective placement in a skilled nursing facility—
ignore the evidence of the circumstances that brought her to that point. These
arguments also ignore the overwhelming evidence showing that, at the time of the
hearing, J.L.L. was unable to “perform those actions necessary to provide the
health care, … shelter, … personal hygiene, and other care without which serious
physical injury or illness will likely occur.” WIS. STAT. § 54.01(19); see WIS.
STAT. § 54.10(3)(a)2. This evidence includes the unrefuted testimony that J.L.L.
informed Freiburger that she believed she was “fine,” despite the undisputed
evidence showing that while living at the motel she was hypoxic with an altered
mental status requiring hospitalization and had a significant ulcer on her ischium,
a foot wound exposing the fat layer, and incontinence, none of which she was

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No. 2024AP1949

adequately addressing; that J.L.L. could not return to her house due to a years-long
mold issue which she had not remedied and could not return to the motel because
the motel would not allow her return and because in-home help refused further
services; and that J.L.L. lacked the ability to independently perform basic hygiene
functions like bathing and toileting. The evidence also includes Freiburger’s
opinions—which were not contradicted by any contrary expert or professional
opinion—that J.L.L. was unable to currently understand and address her
healthcare and that her belief that she could do so rested too heavily on her ability
to do so in the past.

¶20 In sum, based on the record before us, we conclude that clear and
convincing evidence supports the circuit court’s order granting the County’s
petition for guardianship of J.L.L.’s person.

B. Guardianship of J.L.L.’s Estate

¶21 J.L.L. also challenges the sufficiency of the evidence with respect to
the guardianship of her estate. As previously noted and as pertinent here, to obtain
guardianship of a person’s estate, the petitioner must prove by clear and
convincing evidence that

because of an impairment, the individual is unable
effectively to receive and evaluate information or to make
or communicate decisions related to management of his or
her property or financial affairs, to the extent that any of the
following applies:

a. The individual has property that will be
dissipated in whole or in part.

b. The individual is unable to provide for his or her
support.

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No. 2024AP1949

WIS. STAT. § 54.10(3)(a)3.a., b. We conclude that the evidence which we now
summarize supports the circuit court’s order for guardianship of J.L.L.’s estate.

¶22 First, Freiburger’s testimony and report establish that, due to her
impairment, J.L.L. was “unable effectively to receive and evaluate information or
to make … decisions related to management of ... her property” to the extent that
the property would “be dissipated in whole or in part” WIS. STAT.
§ 54.10(3)(a)3.a. J.L.L. allowed black mold to persist in her house for
approximately six years by refusing to allow her insurance company to fix the
issue. According to Freiburger’s report, when he asked J.L.L. why it had taken so
long for the mold situation to be fixed, J.L.L. said that the insurance company had
not given her any estimates yet and had made no efforts to help with the mold,
while also telling Freiburger that she “won’t let people into [her] house” because
“people went into [her brother’s] home and stole $30,000 worth of coin.” Also, as
mentioned, Freiburger’s report stated that J.L.L.’s “house is not livable” due to the
mold issue and that although “the insurance company has been attempting to
access the house to address [the mold] since 2018,” J.L.L. “would not let them
enter unless she is present and has been unwilling to make accommodations to be
there,” nor would she allow cleaning services to enter her house without her
present. Moreover, in his report, Freiburger noted that J.L.L.’s incapacity
interferes with her ability to “address the risk of property being dissipated in
whole or in part.” The record provides clear and convincing evidence to support
the guardianship of J.L.L.’s estate under § 54.10(3)(a)3.a.

¶23 The evidence also shows that guardianship of J.L.L.’s estate was
warranted under WIS. STAT. § 54.10(3)(a)3.b.—i.e., because J.L.L. was “unable
effectively to receive and evaluate information or to make … decisions related to
management of … her financial affairs” to the extent that she was “unable to

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No. 2024AP1949

provide for … her support.” Specifically, Freiburger’s report stated that J.L.L.’s
incapacity interferes with her ability to “manage … her property and financial
affairs” and “provide for … her own support.” The report also stated that, based
on Independent Living Scales Testing, which evaluates “the degree to which an
individual is capable of caring for themselves … and their property,” J.L.L. “could
not identify her bills” and “require[d] help with health care appointments,
finances, orchestrating and managing bills and health insurance, home and health
maintenance, daily routine orchestration and management, and problem solving.”
The report further noted that J.L.L.’s “response to functional and adaptive
questions were incomplete when asked what she could do regarding problems with
power, water, gas, and lights.” Thus, under either subdivision paragraph 3.a. or
3.b., or both, there was clear and convincing evidence to support guardianship of
J.LL.’s estate. We are not persuaded by J.L.L.’s arguments to the contrary.

¶24 J.L.L. asserts that “none of the [C]ounty’s witnesses provided any
proof that [J.L.L.]’s purported incapacity rendered her unable to manage her
property or financial affairs.” As shown above, the circuit court had a reasonable
basis to find to the contrary. J.L.L. also asserts that “[a]t best the evidence shows
that [J.L.L.] made decisions about her home that others deemed unwise.” She
points to her testimony that she owned her home and cared for her finances for 20
years following her husband’s death and “way before that”; that she paid off the
mortgage on her house, paid medical bills, and cashed out an annuity; and that she
“never has a problem” with finances. J.L.L. further suggests that she was justified
in not allowing people into her house without her being present in order to protect

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No. 2024AP1949

herself from theft.4 However, as previously noted, Freiburger observed that J.L.L.
was “unwilling to make accommodations to be [at her house]” to resolve the mold
issue for approximately six years. He further opined that J.L.L.’s belief that she
could currently manage her health care and home rested too heavily on her ability
to do so in the past. And, as also noted, the circuit court credited Freiburger’s
testimony over J.L.L.’s and J.L.L. does not provide a basis for us conclude that
this was clearly erroneous.

¶25 In sum, we conclude that the County presented clear and convincing
evidence to support the circuit court order granting guardianship of J.L.L.’s estate.

II. Protective Placement

¶26 A protective placement is “‘a massive curtailment of liberty.’” State
ex rel. Watts v. Combined Cmty. Servs. Bd. of Milwaukee Cnty., 122 Wis. 2d 65,
80, 362 N.W.2d 104 (1985) (quoting Vitek v. Jones, 445 U.S. 480, 491-92 (1980);
see also id. at 76-77 (“Protective placements … are the only involuntary
commitments under Wisconsin law that are indefinite in duration and thereby are
tantamount to a life sentence to a nursing home or other custodial setting.”).

4
To clarify, the circuit court found that J.L.L. would not let people into her house to fix
the mold problem, and that this was “due to people having stolen money from her in the past,” a
finding that J.L.L. relies on in support of her argument that the evidence was insufficient to
support guardianship of her estate. However, there was no evidence presented at the hearing that
J.L.L. believed that anyone had stolen money from her, only that a relative had reported a theft.
Thus, this particular finding is clearly erroneous, although it has no bearing on our decision.

Separately, we disregard two sources of evidence on which J.L.L. relies because neither
was introduced into evidence at the final hearing on guardianship and protective placement and
there is no indication that the circuit court relied on either in reaching its determinations: a report
submitted by Dr. Sandhya Shah that the County relied on in support of its petition for temporary
guardianship and emergency protective placement and an inventory of J.L.L.’s property that
J.L.L.’s guardian submitted to the court several months after the hearing and the court’s decision.

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No. 2024AP1949

¶27 In order for an individual to be protectively placed, a petitioner must
prove, by clear and convincing evidence, that, as pertinent here: (1) “[t]he
individual has a primary need for residential care and custody”; (2) “the individual
… is an adult who has been determined to be incompetent by a circuit court”;
(3) “[a]s a result of … degenerative brain disorder …, the individual is so totally
incapable of providing for his or her own care or custody as to create a substantial
risk of serious harm to himself or herself or others”; and (4) the “disability … is
permanent or likely to be permanent.” WIS. STAT. § 55.08(1).

¶28 J.L.L. argues that the County did not prove by clear and convincing
evidence that, as a result of a permanent degenerative brain disorder, J.L.L. is “so
totally incapable of providing for … her own care or custody as to create a
substantial risk of serious harm to herself or others.” WIS. STAT. § 55.08(1)(c).
“Care” as used in § 55.08(1)(c) means “that the person’s incapacity to provide for
his or her daily needs creates a substantial risk of serious harm to the person or
others.” Jackson County v. Susan H., 2010 WI App 82, ¶17, 326 Wis. 2d 246,
785 N.W.2d 677. “Custody” as used in this provision means “that the person
cannot provide for himself or herself the protection from abuse, financial
exploitation, neglect, and self-neglect that the control and supervision by others
can provide.” Id. J.L.L. asserts, “At most, the evidence proved that [she] had
physical health conditions that required temporary hospitalization or
rehabilitation.”

¶29 We conclude that clear and convincing evidence supports the circuit
court’s order for protective placement. This evidence includes the following. In
his report, Freiburger stated that J.L.L. has an incapacity in the form of a
degenerative brain disorder that is likely to be permanent and that renders her so
incapable of providing for her own care and custody as to create a substantial risk

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No. 2024AP1949

of serious harm to herself.5 The report further stated that J.L.L. has a primary
need for residential care and custody in a secured setting with 24-hour supervision.

¶30 In support of these conclusions, Freiburger’s report stated that “24-
hour supervision and oversight is important” for J.L.L. because of her “inability to
comprehend and plan for her needs” and her “history of refusing help and
support.” This includes J.L.L.’s belief that she was “just fine” in the motel room
leading up to the hospitalization and placement. It also includes her
“noncompliance with treatments and medications critical for her health and
safety,” including her refusal to use the oxygen prescribed to her despite her
“history of acute chronic respiratory failure with hypoxia,” the “deep and infected”
wound on her foot, and her significant pressure ulcer—all conditions that placed
her in “severe danger.” Freiburger also noted the information he had received
from J.L.L.’s social worker that J.L.L. “continues to have issues with incontinence
as she remains incontinent more than 50 [percent] of the days,” and Fitch testified
at the hearing that J.L.L. needed assistance with cleanup for each incident of
incontinence to avoid infection.

¶31 In addition, Freiburger testified that, based on his in-person
evaluation of J.L.L. that occurred two weeks before the final hearing, his opinion
was that J.L.L. had a primary need for residential care and custody in a licensed,
certified, or registered setting, because “there is a real resistance, reluctance,
suspiciousness for her to allow for adequate help and supports” and that this was
“in part, due to [J.L.L.’s] belief … that she does not have the conditions that she

5
“Incapacity” means “the inability of an individual effectively to receive and evaluate
information or to make or communicate a decision with respect to the exercise of a right or
power.” WIS. STAT. § 54.01(15).

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No. 2024AP1949

has, does not have the impairment and then, therefore, does not need the help and
assistance that she needs.” Freiburger testified that J.L.L. needed 24-hour
supervision to attend to her medication needs, to monitor her for falls, and to
attend to wound care. Freiburger also testified that, if J.L.L. were discharged from
the skilled nursing facility, there was no identifiable place where she would be
able to stay. He testified that J.L.L.’s insurance company has determined that they
will no longer pay for stays outside of her house, and that J.L.L. could not return
to her house given its condition.

¶32 J.L.L.’s need for protective placement was also supported by the
testimony of the County’s other two witnesses, which the circuit court credited.
Fitch, J.L.L.’s occupational therapist, testified that it was her recommendation that
J.L.L. remain at a skilled nursing facility. Fitch’s opinion was based on the fact
that J.L.L. was in need of standby assist for all toileting transfers, bathing, and
hygiene because J.L.L. was not able to perform those tasks independently, and due
to J.L.L.’s recurring incontinence. Theder, the lead adult protective service
worker for the County, testified that she took J.L.L. into custody under WIS. STAT.
ch. 55 after Theder was contacted by a hospital where J.L.L. was then a patient
and was told by hospital staff that they deemed J.L.L. “incapacitated” and that
J.L.L. was saying she was going to leave the hospital. Theder attempted to find
out from J.L.L. and other sources whether J.L.L. had “family, friends or other
supports,” but was unable to locate any such support.

¶33 We conclude that, based on the totality of the record, the County
proved by clear and convincing evidence that all of the standards for protective
placement were met.

18
No. 2024AP1949

CONCLUSION

¶34 For the reasons stated, sufficient evidence supported the circuit
court’s orders for guardianship of J.L.L.’s person and estate, and for protective
placement. Accordingly, we affirm the court’s orders.

By the Court.—Orders affirmed.

This opinion will not be published. See WIS. STAT.
RULE 809.23(1)(b)5.

19