Incapacitated Indigent and Alone Guardianship New York

Incapacitated, Indigent, and Alone: Meeting
Guardianship and Decision Support Needs

in New York
Pamela B. Teaster, Erica F. Wood, John N. Holt, Kimberly S. George

Report to the New York Community Trust
NOVEMBER 30, 2018

Pamela B. Teaster, PhD
Professor and Director, Center for Gerontology, Virginia Tech
Erica F. Wood, JD
Assistant Director, American Bar Association Commission on Law and Aging
John N. Holt, JD
Director of Legal Services and Policy
The Guardianship Project at the Vera Institute of Justice
Kimberly S. George, MIA

Executive Director
The Guardianship Project at the Vera Institute of Justice
Contents
Executive Summary 5
Section 1. Introduction 13
Section 2. Methods 19
Section 3. Who Needs Services? 22
Section 4. Who Serves as Guardian? 33
Section 5. New York Court Processes: Barriers to

Effective Service and Oversight 48
Section 6. The National Landscape: Public

Guardianship and Decision Making Services 60
Section 7. The TGP Model—Staff and Stakeholders’

Assessment of Effectiveness and Replicability 71
Section 8. Summary of Recommendations 95
References 100
Appendices 101
Acknowledgements
We acknowledge the assistance of Fatemeh Zarghami primarily on three streams of coordinated research:
and Yuxin Zhao, graduate research assistants, at Virginia Family Gerontology, Health and Aging, and Elder Rights.
Tech. Although the center is part of the College of Liberal Arts
and Human Sciences, it has a university-wide purview,
We also thank Jacqueline Baillargeon, former executive
with more than 80 faculty affiliates representing seven
director of The Guardianship Project.
colleges and 28 departments or units across campus.
The Center for Gerontology serves as the organiza-
The mission of the American Bar Association Commission
tional unit and focal point for aging-related activities at
on Law and Aging is to serve as a collaborative, interdis-
Virginia Polytechnic Institute (Virginia Tech). The center’s
ciplinary leader of the association’s work to strengthen
primary mission is to foster and facilitate multidisci-
and secure the legal rights, dignity, autonomy, quality
plinary research that enhances the quality of life of older
of life, and quality of care of aging persons.
adults. In support of this mission, the center focuses
Disclaimer
The views expressed herein have not been approved by the House
of Delegates or the Board of Governors of American Bar Association
and, accordingly, should not be construed as representing the policy
of the American Bar Association.
5
Executive Summary
In 2005, the Vera Institute of Justice (Vera) and New a likelihood that family members will be spread out
York State’s Office of Court Administration launched geographically, there is a continued and escalating
The Guardianship Project (TGP) to serve as court-ap- need for guardians as well as other decisional options.
pointed agency guardian to a vulnerable, largely indi-
This study aimed to analyze ways to increase and
gent population—elders and persons with disabilities
improve guardianship and decision support services
lacking family or other support—enabling them to live
for this challenging and often overlooked population—
as independently as possible. In launching TGP, Vera
people, formerly called “unbefriended” individuals, who
sought to cast a spotlight on a desperately missing
are alone, with no one to help, and few or no resources.
element of the social safety net and to provide an
The study objectives were to: (1) document the need
approach that humanely addressed critical needs for
for guardianship and decision support services for
individuals in a way that allowed key institutions to
the population, (2) assess the current local and state
operate in concert and more effectively.
ability to meet that need, (3) understand the best prac-
TGP offers a comprehensive guardianship model tices of states providing comparable guardianship and
available in New York City and employs attorneys, decision support services, (4) assess the TGP model of
social workers, and financial and property managers guardianship to ascertain if it is an appropriate model
and partners with investment advisors, volunteers for expansion to meet the increased need in New York
and, when necessary, pro bono counsel, to provide City and in other parts of the state, and (5) highlight
guardianship services for those under its care. TGP’s barriers in court guardianship processes in New York
clients are referred to the program due to a wide variety City and state and improvements that might be made.
of issues, including dementia, serious medical prob-
lems, pending evictions, elder abuse, and placement
in institutional settings against their will. As of 2018,
TGP serves 180 clients year-round.
The question is: what happens to other individuals

in New York City and New York State who are indi-
gent, whom the court determines are “incapacitated,”
and who have no one to serve—individuals who are
among the neediest in society, who may be taxing
to serve, and whose voice is not heard. With a rising
population of older persons, increasing dementia,
increasing longevity for individuals with disability, and
Incapacitated, Indigent, and Alone: Meeting Guardianship and Decision Support Needs in New York
6
Who needs In response to these findings, our study makes the

following recommendations:
guardianship and • Data. New York should continue and intensify
decision support its collection of basic guardianship data to better

inform estimates of unmet need and strategies
services? for meeting the need.
While data is lacking, our study’s surveys and interviews • Supportive services. New York should provide
uncovered a compelling and undeniable unmet need adequate funding for home and community-based
for guardianship and related services for individuals care and affordable housing for indigent individuals
in New York who are indigent, have been named by a at risk of, or subject to, guardianship—especially
court as “incapacitated,” and who have no one to serve. 1
congregate housing for older adults where people
can age in the community and easily access support
The cases are often urgent and concern the needi-
services.
est in our society, with an alarming mix of Medicaid,
housing, mental health, long-term care, and social • Social work skills. New York should find ways to
services issues—frequently with no one to help. The increase the number of professionals with social
need is especially intense for nursing home residents work and nursing skills to act as guardians for
and for individuals at risk of eviction from housing. individuals with no family or friends to serve.
Guardianship databases would help to confirm, clarify, • Less-restrictive options. New York should provide
and focus the unmet needs and suggest solutions. judicial and legal training on screening for less-re-
Clearly, there is great and equal demand for more strictive options—including a range of decision
available and skilled guardians and for more atten- supports and supported decision making, the
tion to less-restrictive options—as well as a greater use of forms that emphasize screening for such
emphasis on the social work skills required to sort options, and tracking the use of these options in
out the pressing human needs. avoiding unnecessary appointments.
• Restoration of rights. New York court procedures

should ensure access for petitions for modifica-
The cases are often urgent tion or termination of guardianship orders and
restoration of rights when guardianship is not
and concern the neediest in needed.
• Increased number of clerks. New York should

our society—frequently with provide funding for an increased number of
clerks to assist judges with the high volume and
no one to help. complexity of guardianship cases.
1 Unless New York City is specified, “New York” refers to the state throughout this report.
7
• Increased number of guardians. New York should a nursing home or similar residential facility, leaving
pursue multiple approaches toward increasing a serious and sometimes life-threatening void where
the number of available and skilled guardians to there is no one to make health and personal decisions
serve indigent individuals in need as a last resort and oversee facility care. Moreover, the programs are
after less-restrictive options, including supported overwhelmed with cases.
decision making, have been examined.
New York Judicial Rules, Part 36, provides for appoint-
ments by the court, including appointments of guard-
Who serves as ians. The Part 36 list is predominantly composed of
guardian for the target lawyers, whereas it is often social work skills that are
needed. Additionally, the number of professionals on
population? the list willing to serve as guardians (as opposed to

court evaluators, court examiners, or other roles) has
New York has four “guardian of last resort” schemes dwindled. Many cannot afford to take no-fee/low-fee
for individuals who are indigent, have been judicially cases because of the enormous complexity and time
deemed “incapacitated”, and who have no family or intensity required. Even though the cap on compen-
friends to serve. Each contributes to meeting the need sation recently was raised, judges cannot rely on the
for these persons in important ways. Each is stretched. list to fully meet the growing number of cases.
Taken together, they fall markedly short of meeting
New York has scattered not-for-profit agencies that
the compelling need.
take guardianship cases, generally using meager funds
New York law and regulations provide for local from the estates or small Medicaid-exempt stipends. Such
commissioners of social services to act as the guardian agencies are vastly underfunded to serve as guardian
of last resort. In some but not all areas of the state, the and do not exist throughout the state. Individuals we
commissioner names adult protective services (APS) to interviewed agreed that funding for additional nonprofits,
fulfill guardianship responsibilities. APS guardianship especially those with a multidisciplinary team model,
practices vary throughout the state. However, APS would help to staunch the unmet need.
as guardian is clearly a conflicting role because APS
There was widespread recognition by those we
is responsible for petitioning for guardianship. APS
surveyed and interviewed that there is a marked
also is responsible for investigating reports of abuse,
need for increased funding to provide for guardians
neglect, and financial exploitation—although in practice,
in low-fee/no-fee cases where there is no one else
APS generally does not investigate suspected abuse
to serve. Many, but not all, supported a statewide
by guardians, thus barring an essential safeguard.
public guardianship system with flexibility to meet
Additionally, APS staff often are overburdened, and
local needs. Two pilot programs are underway, and
the system is underresourced.
evaluation of their experiences will offer critical input
New York law also provides for community guardian toward addressing the unmet need in other areas of
programs funded by local social services offices. New the state.
York City has three such programs. Community guardian
programs must relinquish cases when a person enters
8
by the national public guardianship study by Teaster

There is a marked need for et al. (2010)).
• Guardianship for nursing home residents. While

increased funding to provide recognizing that not all nursing home residents
need guardians, at the same time, New York should
for guardians in low-fee/ address the current gap that occurs when commu-
nity guardian programs must relinquish cases in
no-fee cases where there is no which an individual requires nursing home care.
Guardians can be needed advocates for quali-
one else to serve. ty of care. Extending the role of the community
guardian programs to selected nursing home cases
would prevent unnecessary burden on the court
In response to these findings, our study makes the
in finding another guardian and ensure continuity
in the guardian’s care and decision making—thus
• Funding for diversity of services. New York allowing the guardian to best identify and support
should provide additional funding for a diverse individual wishes and needs.
pool of guardianship and decision support services.
• Incentives for serving in low-fee/no-fee cases.
Funding for such services should prioritize living in
New York should provide incentives such as free
the community as a primary goal. Funding should
continuing education courses for professionals
come from a variety of sources, including fees
on the Part 36 list, provide incentives for social
excluded from the calculation of Medicaid “net
workers and nurses to agree to serve as guard-
available monthly income” payment in nursing
ians in low-fee/no-fee cases, and encourage their
home cases.
appointment by judges in appropriate cases where
• APS role in guardianship. New York should iden- there is no less-restrictive option.
tify other approaches for guardianship services
• Evaluation and expansion of pilot projects. New
instead of relying on APS through departments of
York should continue the two 2018–2019 pilot
social services to serve as guardian of last resort.
programs to allow for additional time to measure
This would avoid an inherent conflict of services.
effectiveness. Based on experience of the initial
Additionally, it could free up APS resources for
pilot demonstration projects, New York should
its other important protective roles, including a
fund additional projects, building in a formative
critical role in investigating suspected guardian-
evaluation process and moving toward addressing
ship abuse.
the unmet need for guardianship and less-restrictive
• Community guardian programs. New York City decisional options, including supported decision
and/or state should provide additional funding to making, throughout the state.
community guardianship programs to meet the
pressing needs, ensure quality services, and seek
less-restrictive options, with consideration to a
reasonable staff-to-client ratio (as recommended
9
Do New York court evaluations. Other delays may be addressed through

solutions such as a uniform, plain-language petition,
processes act as as well as additional court clerks to move the process
ahead.
barriers to effective
service and oversight?
While it is important to
Complicating attempts to address unmet needs are
barriers in court guardianship processes that may
comply with time deadlines
needlessly hamper efforts to get people the help they
need. In the development of Article 81, maximizing
set out in the law, it is also
self-determination and expediting guardianship cases
were both prominent features. While it is important
important to focus on the
to comply with time deadlines set out in the law, it is
also important to focus on the individual and support
individual and support his or
his or her rights. The balance may be challenging. Our
study examined issues of timing in court processes and
her rights.
in the monitoring to identify solutions that streamline
procedures yet preserve rights.
A study in 14 counties by the Brookdale Center for Article 81 specifies that the judge should issue an
Healthy Aging at Hunter College found that, on average, order within seven days after the hearing, unless for
it takes 211 days—significantly longer than the Article good cause shown, yet the Brookdale study showed
81-mandated 50 days—from the filing of a petition it took an average of 82 days. Sometimes judges need
for guardianship to the commissioning of a guard- extra time to find the best and least restrictive answer
ian. Guardianship cases are complicated and require in difficult cases. Mediation may be helpful, especially
sufficient time and attention to individual needs and with family disputes. However, several of our survey
rights—and this is especially so for no- or low-fee cases respondents cited “bottlenecks” concerning the proposed
with scant resources at hand and no one to serve. Yet order and offered practical solutions.
some delays may stem from systemic inefficiencies
Article 81 specifies 15 days from the date of the
that result in wasted efforts and higher costs. Our
order to the guardian’s commission, yet the Brookdale
surveys and interviews sought reasons for the delays
study found it took an average of 66 days. This may
and possible solutions.
be due to court backlogs and attorney delays, but
While Article 81 provides 28 days from the filing of also lay guardians frequently don’t realize that their
the petition to the first hearing, the Brookdale study authority depends on getting not just an order but also
found it takes an average of 63 days. Some delays are a commission. Survey respondents proposed ways
inherent in the very nature and complexity of the cases— to help guardians and to simplify and streamline the
time for needed accommodations, investigation, and commission process. Our survey also found bonding
10
practices uneven and that bonding guidelines might • Employ additional clerks. New York should
be useful. provide funding for the addition of administrative
staff trained to move the guardianship process
Article 81 requires the guardian to file an initial report
forward in a timely way.
after 90 days and an annual report thereafter. The
Brookdale study found the average time to the filing • Consider complaint resolution approaches.
of a first report is 237 days. Our study confirmed that New York should explore complaint procedures
a substantial number of reports and accountings are from other states so that problems can readily be
not submitted on time. Often lay guardians lack expe- brought to the attention of courts and consider
rience and training in filing a timely and complete dispute resolution options such as mediation and
report and accounting; survey respondents urged ombudsman functions.
ways of making filing easier. Other delays may be
due to the lack of banks understanding of a guardian’s
authority. Survey respondents emphasized the need
How do other states
for a uniform statewide template for initial and annual provide comparable
reports. An additional issue pointed out by interviewees
was the need for a guardianship complaint procedure services?
or ombudsman function.
As part of our study, we invited programs from other
In response to these findings, our study makes the states that had participated in the national public guard-
following recommendations: ianship study by Teaster et al. (2010) to complete a brief
update in order to inform efforts in New York. We were
• Develop uniform documents. New York courts
able to gather information from five sites in five states:
should create uniform documents for the petition,
the Pima County Public Fiduciary (Arizona); the Office
order to show cause, initial report, and annual
of the Public Guardian (Los Angeles County, California);
report.
the Office of the Public Guardian (Delaware); the Office
• Facilitate filing of reports to enhance monitoring. of Public and Professional Guardians (Florida); and the
New York courts should generate reminders of Cook County Office of the Public Guardian (Illinois).
filing deadlines, provide reporting instructions and Highlights of our findings and recommendations for
samples, and offer electronic filing options. There New York included the following:
is also a need to educate banks about guardian
• Array of funding. New York programs must have
authority to avoid unneeded delays.
adequate funding from a stable set of funding
• Expedite guardian commission process. New sources. Most of the public guardian programs
York courts should educate lay guardians about in the other states we looked at have funding
the need to get a commission and consider ways derived from an array of sources, including state
to combine or streamline the order/commission funds, county funds, grants/foundations, client
process. fees, and estate recovery. Only Delaware had
one funding source.
11
• Scope of authority. New York programs should

have authority to make decisions about financial
Is the TGP model
and personal affairs if the court order has such a considered to
scope of authority. All the programs make decisions
about people’s personal and financial affairs. be effective and
• Advocate, arrange, monitor. New York programs replicable by staff and
should advocate for, arrange, and monitor service
delivery to the people served by the program. Public
stakeholders?
guardian programs advocated for, arranged, and
The TGP model is supported both internally by the
monitored services. The Cook County Office of the
staff members and externally by stakeholders we
Public Guardian (Illinois) also had responsibility
surveyed and interviewed. TGP’s team approach is a
for directly providing some services.
holistic “one-stop shopping” approach to the provision
• Representative payee and supported decision of guardianship and related services, and the low ratio
making. New York programs should serve as of staff to individual affords high quality, person-cen-
representative payees and provide supported tered services.
decisions. Programs serve as representative payees,
Program strengths included dedicated staff members,
personal representatives of decedents’ estates,
financial management programs, licensure of guard-
private guardians, and providers of supported
ians, an asset recovery program, and attention to the
decision making.
needs and wishes of the people under guardianship.
• Live at home. New York programs should work
Program challenges included difficulties obtaining
to keep people in their own homes as much as
public benefits, lack of mental health services, staff
possible. Primary residences of people under
reductions in the face of a rising population of persons
guardianship varied across the programs.
needing guardianship, confusion concerning the role
• 1:20 staff-to-person ratio. New York programs of a public guardian, insufficient resources, and high
should comport to a 1:20 staff-to-person ratio. staff turnover due to inadequate compensation of
Staff-to-protected-person ratios ranged from 1:30 staff members.
to 1:80. In the most recent national study of public
TGP is considered especially outstanding in its efforts
guardianship, Teaster et al. (2010) recommended
to either keep people living in community settings or to
a staff-to-person ratio of 1:20.
return people to community settings as appropriate.
TGP’s quality of service is not without costs. The program
struggled for many years to find a sustainable funding
model until, most recently, it obtained a sizable, multi-
year contract from the Office of Court Administration.
Also, unlike other Vera-initiated programs, it has not
yet “spun off” independently, partly due to funding
and partly due to several changes in leadership since
12
its inception. TGP’s struggle to sustain itself is not due Throughout the year, the program examines case
to its programmatic model, however, but rather, due records; however, staff could go deeper via more
to its mix of high-fee, low-fee, and no-fee cases that routinized and sustained efforts by the whole staff.
the court orders TGP to take. Often, it is the most
• Optimize mix of cases and caseloads. Case
resource-intensive cases that are very low or no fee.
managers’ caseloads should be reviewed regarding
Hence the need for programs (and alternative funding
staff-to-client ratios as well as mix of cases given
sources) specifically to serve indigent persons.
to each case manager.
• Improve funding model. The original funding

model of cases with estates and no-fee cases
Often, it is the most resource- should be maximized so that TGP can have greater
sustainability.
intensive cases that are very
• Increase funding. TGP should have more funding
low or no fee. Hence the need in order to take on more cases.
• Continue outreach efforts. TGP should contin-

for programs (and alternative ue efforts at outreach and involvement in policy
discussions.
funding sources) specifically
• Replicate the TGP model. The TGP model should
to serve indigent persons. be replicated and evaluated. The evaluation should
be a formative, process and summative evaluation.
Although the model is a promising one, it is a costly

one, and stakeholders raised this important point.
While TGP is successful in a city with a high-density
population such as New York City, it would likely need
to be modified if it were to be replicated in more rural
areas. Its replication and adaptation should be piloted
to determine feasibility, including requirements for
technology, training, oversight, and partnerships to
access services.
In response to these findings, our study makes the

• Increase ease of information access. TGP’s

reports should be combined and retrievable in
one place; this is possible because the accounting
system is structured to have data all in one place.
13
Section 1: Introduction
In 2005, the Vera Institute of Justice and New York State’s Office of Court
Administration initiated The Guardianship Project (TGP) to serve as court-ap-
pointed agency guardian to a vulnerable, largely indigent population—elders
and persons with disabilities lacking family or other supports—thus enabling
them to live as independently as possible. In launching TGP, Vera sought
to cast a spotlight on a desperately missing element of the social safety net
and to provide an approach that humanely addressed critical needs for
individuals in a way that allowed key institutions to operate in concert and
more effectively. Guardianship is one among an array of mechanisms (e.g.,
supported decision making, agent under power of attorney for healthcare,
power of attorney for finances, healthcare proxy, advance directive, living
will) to help people with decision making when they are unable to do so in
part or completely—temporarily or permanently.
TGP offers a comprehensive guardianship model available in New York City

and employs attorneys, social workers, and financial and property managers
and partners with investment advisors, volunteers and, when necessary, pro
bono counsel, to provide guardianship services for those under its care. TGP’s
clients are referred to the program due to a wide variety of issues, including
dementia, serious medical problems, pending evictions, elder abuse, and
placement in institutional settings against their will.
Under New York law, there are two kinds of guardians for adults. Under
Article 81 of the New York Mental Hygiene Law, a Supreme Court, Civil
Branch or a county court, may appoint a guardian for an adult to manage the
adult’s personal and/or financial affairs when the court finds the individual
is not able to do so. Under Article 17A, a Surrogate’s Court may appoint a
guardian for an adult with an intellectual or developmental disability. This
report concerns appointments under Article 81. According to the statute,
such Article 81 appointments are only warranted when there has been a
showing to a judge that a person has functional limitations, is unable to
recognize the extent of those limitations, is likely to come to harm as a result,
and there are no less-restrictive options.
14
Nationally, while data is scant, the number of persons who need help with
decision making through guardianship or a less-restrictive option appears to
be growing. This growth is attributable to an aging population (the graying
of the Baby Boomers), increased longevity, increased awareness of mental
illnesses and developmental disabilities, military service-related disabilities,
advances in medical treatment, the aging of caregivers, the rising awareness
of elder abuse, and the occurrence of blended families and their increasing
mobility. Although there are few statistics on adult guardianship filings
and caseloads, it is clear that the demand for adult guardianship services is
increasing across the country (Teaster et al., 2010). For example, in New York,
from 2007–2011, the average number of initial New York State guardianship
filings under Mental Health Law Article 81, as reported by the Office of Court
Administration, was almost 2,400 cases per year. Because accurate data
collection is lacking, as yet there is no way to determine exactly how many
cases, and thus, types of guardians, are currently still active in the system
from previous years.
Types of guardians
When classifying guardians who are appointed to assist people who are in
need of this type of surrogate decision maker, it is necessary to distinguish
between private guardians and public guardians. Most guardians are private
guardians and typically family members or friends, although attorneys,
corporate trustees, agencies, or even volunteers also serve in this role.
Attorneys, corporate trustees, agencies, and volunteers generally have the
discretion to choose cases for which they wish to serve. While there are a
number of factors that affect their determination, the intensity of services
needed and availability of payment are two strong incentivizing factors.
Unlike persons with family and friend connections, it can be difficult to
find guardians for at-risk people and/or people with low incomes and high
needs. Attempts to locate a suitable surrogate decision maker can lead to
delays in selecting a guardian and/or the appointment of a guardian who
is ill equipped to meet the needs of the person needing the services of a
guardian. As a result, those with low incomes may fail to receive need-
ed services; fall prey to third-party interests; become victims of abuse,
neglect, and exploitation; have inappropriate or insufficient health care;
15
and receive inappropriate placement in facilities. To fill this gap, for people
who are aging alone and without resources, as a last resort, there are public
guardians.
Public guardians
Public guardians, such as TGP, represent a small but highly important subset
of guardians. Public guardianship, sometimes called guardianship of last
resort, refers to the appointment of a public official or publicly funded entity
as guardian in the absence of willing, able, and responsible family members
and friends to serve, or without resources to employ a private guardian
(Schmidt et al., 1981; Teaster et al., 2010). All states have either implicit or
explicit public guardianship—that is, in an explicit scheme, the state estab-
lishes a public guardianship program; whereas in an implicit scheme, a state
designates a state agency to serve (public guardian programs are funded
through state appropriations, Medicaid funds, county monies, legislated
fees from the individual under guardian, or some combination). Among
the populations that public guardian programs often serve are people with
mental illness, traumatic brain injury, intellectual disability, or developmen-
tal disabilities; the homeless; substance abusers; and persons with chronic
diseases, such as dementia.
The purpose of this project was to analyze ways to increase and improve
guardianship and decision support services for individuals in New York City
and statewide whom the court has deemed “incapacitated” and who are
alone with no one to help. Its objectives were to: (1) document the need for
guardianship and decision support services for the population; (2) assess
the current local and state ability to meet that need; (3) understand the best
practices of states providing comparable guardianship and decision support
services; (4) assess the TGP model of guardianship to ascertain if it is an
appropriate model for expansion to meet the increased need in New York
City and in other parts of the state; and (5) highlight barriers in court guard-
ianship processes in New York City and state and improvements that might
be made.
16
The Guardianship Project

In 2004, in the wake of studies and news reports documenting abuses
committed by overwhelmed, ill-trained, and/or nefarious guardians in New
York State (including a guardian who stole approximately $2.1 million from
17 clients [Worth, 2003]), the Vera Institute recognized the lack of available,
appropriate guardians as an access to justice issue that warranted interven-
tion to help ensure that all New Yorkers, regardless of their resources, could
have high-quality, trustworthy guardians to meet their needs. Working
in collaboration with the New York Office of Court Administration, Vera
designed and launched TGP to test an innovative, cost-effective model of
guardianship. The TGP model consists of a multidisciplinary team of social
workers, lawyers, and financial professionals who are capable of providing
wraparound support for client needs in the least restrictive setting possible.
In launching TGP, Vera sought to cast a spotlight on a desperately missing
element of the social safety net and to provide an approach that humanely
addressed critical needs for individuals in a way that allowed key institu-
tions to operate in concert and more effectively. Like all Vera demonstration
projects, the goal was not to run TGP in perpetuity but rather to fully develop
the model, thoroughly assess its effectiveness, and once the operational
framework had been refined, if appropriate, to spin it off into an indepen-
dent nonprofit.
TGP offers a comprehensive guardianship program available in New York

City to ensure quality representation, employing attorneys, social workers,
and financial and property managers. TGP partners with investment advi-
sors, volunteers and, when necessary, pro bono counsel, to provide guard-
ianship services for those under its care. TGP’s clients are referred to the
program due to a wide variety of issues, including dementia, serious medical
problems, pending evictions, elder abuse, and placement in institutional
settings against their will. TGP currently accepts guardianship appointments
in New York City only; its clients live throughout the boroughs of Brooklyn,
Manhattan, Queens, and the Bronx. TGP accepts cases regardless of the
client’s ability to pay and tries to take complex cases where its multidisci-
plinary team model can be most effective in serving clients with difficult
and complicated needs. Courts have found it increasingly difficult to find
17
professional guardians willing to serve in cases where there are little to no

assets that can generate fees, particularly where those cases are presenting
with complicated issues that will require a great deal of effort and expertise
to successfully address and resolve. Consequently, courts in the jurisdictions
where they practice will often seek TGP to be appointed on cases for this
population.
TGP cases usually involve the coordination of complex legal, health care,
case management, and property issues that would be difficult for an individ-
ual guardian to effectively manage due to the resource intensive nature of
these cases and the breadth of knowledge needed to adequately address the
diversity of issues faced by the client. Individual cases are handled by a team
of TGP staff. TGP lawyers manage all legal matters, including litigating on
collateral issues. Case managers offer intensive social services and discharge
planning. A benefits specialist coordinates any and all public benefits for
which clients are eligible, including Medicaid, food stamps, Supplemental
Security Income, rental supplement, etc. The financial team offers assistance
supervising assets, including marshaling bank accounts and overseeing
investments, budgeting, and bill payment. TGP’s property manager works
with landlords, tenants of clients who own property, and the clients them-
selves, in order to keep homes safe and secure for residents.
TGP staff members navigate issues that their at-risk clients face, includ-
ing but not limited to entitlements, budgeting, health care, housing, as well
as those in the legal, financial, and medical systems. From July 1, 2014, to
November 30, 2018, TGP served as court-appointed guardian for 257 living
clients and performed work in furtherance of discharge of TGP as guardian
for an additional 111 clients who passed away before or during that time
period. As of November 1, 2018, TGP was actively commissioned on 160 living
clients. In addition to these clients, TGP is working on 55 cases where an appli-
cation for discharge has been made, mostly in response to a client’s death.
TGP’s clients are demographically diverse. Based on who was served in

calendar year 2017, they are approximately 52 percent white/Caucasian, 27
percent black/African American, 15 percent Latino or Hispanic, 3 percent
Asian or Middle Eastern, and 2 percent of multiple races or ethnicities.
Seventy percent of its clients are women. Of the clients whose finances are
managed by TGP, 83 percent are living on less than the median annual per
18
capita income in New York City ($66,800) (U.S. census 2017). Nearly half (42
percent) are living at or below the poverty threshold for 2018 ($12,060 for
a single-family household) (Health and Human Services, 2018). Over three-
fourths (81 percent) of all clients are Medicaid recipients. Over this period,
TGP has been able to maintain approximately 57 percent of its clients in
community settings. Although most of TGP’s clients are older adults and poor,
all its clients have one thing in common—they have no one else to reliably
take care of them at a time in their lives when they are deeply, and in many
cases, dangerously vulnerable.
Once appointed, TGP strives to help its clients return to or remain in their
homes and avoid unnecessary and costly nursing home admissions, hospital
stays, and other types of institutionalization. In fiscal year (FY) 2018, TGP
returned or maintained approximately 57 percent of its clients in deinstitu-
tionalized settings. Although TGP attempts to keep as many of its clients as
possible in the community, its goal is to provide every client, regardless of
his or her habilitation status, as much self-determination and agency as each
situation allows.
19
Section 2: Methods
This project examined ways to increase and improve New York’s guardianship
system and other ancillary decision support services for a growing population
of indigent individuals adjudicated by the court as “incapacitated,” and who
have no family or friends able or willing to serve. The project also assessed
the TGP model to determine whether it is considered effective, efficient,
and sustainable by a variety of stakeholders and staff. Evaluation of the TGP
model helps inform the scalability of the project in other areas as well as
serves as an impetus for a system of guardianship in the state of New York.
The project first analyzed previous national research as well as research

conducted by the New York City-based Brookdale Center on Aging that
attempted to quantify the current and future need for guardianship services
in New York. Second, the project, a joint effort with TGP and the evaluation
team of Teaster and Wood, also included a statewide “unmet need” survey
to ascertain, categorize, and quantify current efforts in New York for indi-
gent, unbefriended, incapacitated individuals under guardianship.2 Third,
we surveyed national contacts to learn about the most up-to-date, cutting-
edge guardianship practices in order to guide efforts in New York. Fourth,
we examined current New York City and statewide judicial guardianship
processes to determine potential efficiencies that can make representation
of this population easier to achieve. Fifth, we conducted a formal assessment
to ascertain stakeholders’ views on the effectiveness of TGP in serving adults
who may need decision making help, as well as on sustainability of the TGP
model. We attempted to understand persons and populations in need of
services, who was serving them, and improvements that might be made in
court processes.
2 Originally, the project team also included Winsor C. Schmidt, JD, LLM, Metrolina Medical Foundation
Distinguished Professor of Public Policy on Health, University of North Carolina at Charlotte. Professor
Schmidt, a longtime colleague of Wood and Teaster, died on May 18, 2018. Professor Schmidt had a
special interest in guardianship in New York, as he was a native of New York.
20
Specifically, our research included both online surveys and telephone

interviews. Online surveys were developed in conjunction with staff at TGP.
Protocols for research were approved by the Institutional Review Board of
Virginia Tech. Table 1 summarizes the numbers of individual respondents in
each category; findings from the surveys are reflected in sections 3, 4, and 5
of this report. We attempted to survey guardianship agencies, departments of
social services, court clerks, and bar associations, but the response numbers
were either none or too low to report.
TABLE 1. the new york guardianship study survey summary
Online surveys total responses
Guardians 33
Judges 23
Court evaluators 66
Court examiners 18
We also surveyed public guardians nationally using an online survey plat-

form. We used respondents for the national survey by Teaster et al. (2010),
surveys that yielded five responses (i.e., Pima County Public Fiduciary
(Arizona), Office of the Public Guardian, Los Angeles County (California),
Office of the Public Guardian (Delaware), Office of Public and Professional
Guardians (Florida), and Cook County Office of the Public Guardian (Illinois).
Additionally, the project investigators Teaster and Wood conducted telephone
interviews with both stakeholders in the guardianship process in the state
of New York as well as staff of TGP. The number of interviews and categories
of individuals whom we interviewed is shown in Table 2 and is explained in
greater detail in Section 7.
TABLE 2. the new york guardianship study interview summary
telephone interview total responses
Judges: 5
Court examiners: 1
Guardianship stakeholders
Mental hygiene legal services: 4
Misc.:4
TGP staff 8
21
Note: TGP staff included the interim executive director, director of legal services and former director
of legal services, former director of finance, director of case management, the legal department, the
finance department, and the case management department.
The methods above allowed us to use mixed methods in determining the

need for guardianship and the replicability of the TGP model. Section 3 (Who
Needs Services?), Section 4 (Who Serves as Guardian?), Section 5 (New York
Court Processes), Section 6 (The National Landscape), and Section 7 (The TGP
Model), which follow, provide answers to the issues of need and program
replication for the state of New York .
22
Section 3: Who Needs

Services?
In this section, we describe our findings on the need for guardians and
the extent of the need. In Section 4, we examine who serves as guard-
ian for this high-risk population. Read together, the two sections paint an ur
gent picture of the New York guardianship landscape with some gaping gaps
in services that greatly endanger the safety and well-being of these incapaci-
tated persons.
Who needs services?

The demographics. New York State currently has 3.7 million individuals
aged 60 and older and ranks fourth in the country in the number of older
adults. The state population is projected to be over 24 percent older people
in 2025. Between 2010 and 2020, the minority population aged 60 plus will
increase by 51 percent. The poverty rate for older New Yorkers is slightly over
11 percent with “pockets of poverty … for example, among older women living
alone” (New York State Office for the Aging, 2015). New York has 380,000
people with an Alzheimer’s diagnosis, with an expected increase of 21.1
percent by 2025 (Alzheimers.net).
Converging with the aging of the population is an increase in the number

of “oldest old” people over 85, a rising lifespan of individuals with disabilities,
and increased mobility of family members—adding up to a greater need for
decisional support, including a need for guardianship. A court examiner we
surveyed stressed: “With the increase in the number of people over 65, the
trend that family members move away from parental homesteads, and the
increase in life expectancy along with the potential for dementia … I believe
there will be an increase in the number of guardians assigned.” One judge
we interviewed pointed out that a lot of people have no one and have outlived
their children and relatives. Another judge observed that older people have
worked hard in their community and should be respected and have a roof
over their head.
23
Converging with the aging of the population
is an increase in the number of “oldest old”
people over 85, a rising lifespan of individuals
with disabilities, and increased mobility of
family members.
The cases. The cases show a tangled and acute mix of mental health prob-
lems, dementia, abuse, exploitation, and problematic family dynamics. There
is often no money, no available housing or long-term supports and services,
and no one to serve when a surrogate decision maker is needed. In our inter-
views, we learned the fact patterns of many challenging cases, for example:
• A sister was caring for her brother with developmental disabilities,

who was in a nursing home. As time went on, the sister stopped
cooperating, the brother needed additional assistance, and there were
decisions to be made, but there was no one to serve.
• An older woman was being abused by her grandson, who was using all
her money and had taken over her house, forcing her to sleep in the
living room, without medical treatment. The landlord complained that
the rent was not being paid.
• A nursing home resident fell, and her daughter petitioned for guard-
ianship. The daughter planned to shelter the settlement money illegal-
ly and was not aware of Medicaid regulations.
• A nursing home resident with developmental disabilities refused to

eat, and the facility said he was not a candidate for a feeding tube. The
not-for-profit guardianship agency had a high caseload and had no
time to examine the situation and suggest solutions. When the judge
inquired about feeding the resident by hand, the facility responded,
and the resident began eating.
24
The unmet need. Like most states, New York has no statewide database
showing the number and characteristics of open guardianship cases. Thus,
it is difficult to quantify increases in the caseload and even more difficult to
estimate the extent of unmet need. The Office of Court Administration (OCA)
has recognized the need for guardianship data and has begun in mid-2018
to collect case-level information. OCA has asked that judges, after issuing
an Article 81 Order appointing a guardian, complete a data sheet recording
information about the petitioner, guardian, individual subject to guardian-
ship, and the order. The request includes two specific questions on the unmet
need for guardians: whether the individual’s lack of assets limits the choice
of available guardian; and whether the assets and/or income is sufficient to
adequately compensate a guardian (New York Office of Court Administration,
2018).
Given the lack of data, our survey asked judges to estimate unmet need

for guardianship services for individuals deemed incapacitated but with no
available family members or others to step in. Some 55 percent of responding
judges said this population makes up 21 to 40 percent of their guardianship
caseload. When asked about cases where there are limited financial resources,
one third said “low-fee or no-fee” cases involving this population make 21 to
40 percent. One New York City judge we interviewed estimated that these
cases make up over 60 percent of his caseload.
Over half the responding judges said that there are not enough resources to
handle their current, active caseload involving these no-fee or low-fee cases
and named an increased number of guardians and increased number of
clerks as resources that would help. Over 80 percent indicated it can be
difficult to find an appropriate guardian to serve for the no-fee or low-fee
cases—and over 55 percent said this occurs “most of the time.” When asked
whether there are a sufficient number of guardians with skills to take the
no-fee/low-fee cases, 60 percent said no, but 40 percent said yes. Comments
attributed the difficulty of finding qualified guardians to the fact that the
work required exceeds available payment.
The judges described a somewhat different situation for fee-generating

cases involving those with no available family or friends. Over 76 percent
said that such cases comprise 0–20 percent of their active guardianship
25
caseload, and over 70 percent reported they had enough resources to handle
the cases, although many said that an increased number of available guard-
ians and an increased number of clerks would enable them to better handle
the cases. Just over half of responding judges said that it is sometimes even
difficult to find an appropriate guardian for fee-generating cases, noting
that attorneys are reluctant to take on the responsibility and that they seek
a higher rate than is approved—and that it is hard to match the needs of the
individual with the skills of a potential guardian.
Over half the responding judges said that
there are not enough resources to handle their
current, active caseload involving these no-fee
or low-fee cases.
Other survey and interview responses confirmed this perception of unmet

need. We interviewed attorneys from Mental Hygiene Legal Services, a New
York State agency responsible for representing, advocating and litigating on
behalf of individuals receiving services for a mental disability. They said the
vast majority of their clients are those with low incomes, and it is difficult
to find guardians for them (especially if social services does not petition, as
explained in Section 4). A referee observed that it is getting more difficult to
find effective and skilled guardians. We also surveyed and interviewed “court
examiners”—who are statutorily required to examine guardian reports before
they are filed—and many agreed. One examiner remarked that there are diffi-
culties dealing with people who may have limitations and impairments, and it
is hard to find those who can do it.
Within the overarching unmet need, there are two specific situations in
which the gap is especially harsh:
• Community guardian clients who are institutionalized. As

explained in Section 4, Adult Protective Services (APS) and
26
Community Guardian Programs are focused on serving as guardians

for individuals in the community and must relinquish a case if the
person subject to guardianship goes into a nursing home or similar
residential setting. This situation leaves the person unserved and puts
the judge in a bind to find someone. As one judge explained, this is “a
big problem because there is no money, as the person’s assets likely
were spent down for Medicaid—no family, no decisional ability. They
need someone to make medical decisions and to be a strong advocate
to ensure good care and often there is no one.”
• Cases in which APS was not the petitioner. As noted in Section 4,

while Adult Protective Services is the state’s guardian of last resort,
APS generally service only in cases in which it petitioned—leaving a
huge need for instances in which a nursing home, hospital, or other
interested party brought the case. When there is no agency contrac-
tually obligated to take a case, there is no guarantee any private or
nonprofit guardians will be willing to take a case.
What services are needed?

If in fact there is an unmet need as established above, precisely what services
are needed? Although our study focused on the need for guardianship
services—both personal needs and property guardians—the question of how
to provide those services presented complicated questions of ways to best
match the varied, intersecting needs of those subject to guardianship with
the skills and resources of those available to serve.
Complex legal–social services. Attorneys make up a substantial portion of

guardians appointed by the court for low-income individuals with no one else
to serve and no less-restrictive options available (see Section 4). Yet a repeated
theme in our surveys and interviews was that, while guardianship is a legal
appointment, the needs that guardians meet are not strictly legal in nature.
Indeed, the needs represent an intricate mix of legal, financial, and social
services. Respondents said the following:
• “More time needs to be spent on the social work aspects of these cases.”
27
• “We’re dealing here with people who don’t fit the typical lawyer–client
relationship, and they need help from those who are well versed in not
only Medicaid, but supportive housing and community services, and
mental health services.”
• “Often it is not lawyer’s work—we need nurses and social workers.”
Services that keep people in community settings. We heard that a

frequent pattern in guardianship is for the guardian to spend down the
person’s assets, prepare a Medicaid application, and get the person into a
nursing home, where it is thought that there is less need for regular super-
vision and for financial management. Maintaining or returning a person to
the community is often an incredibly time-consuming and difficult propo-
sition that involves qualifying individuals for and securing varied benefits
(including home care), the coordination of community-based health care,
close monitoring and active control of finances, accessing appropriate social
services and improving quality of life, managing real property, and protect-
ing against exploitation and abuse, often all while operating under extreme
financial constraints for a population largely dependent on fixed incomes.
A repeated theme in our surveys and
interviews was that, while guardianship is a
legal appointment, the needs that guardians
meet are not strictly legal in nature.
Most people want to stay in their home and community. Ideally, guardians
would facilitate this strong desire if possible. One judge interviewee lamented
this predominant “pipeline to nursing home pattern,” noting that the way
the system is set up around asset spend-downs for nursing home placement,
there is a disincentive for guardians to do the right thing by trying to keep
people in the community. Another said that it is critical to put money toward
28
“good guardianship,” not just guardianship to fill a gap, and noted that poor
guardianship can be extremely costly.
Less-restrictive decisional options. Under Article 81 and as a moral imper-

ative to preserve individual rights and self-determination, guardianship
should be a last resort. Less-restrictive decisional options might include
financial powers of attorney, health care powers of attorney and advance
directives, trusts, use of representative payees, surrogate health care deci-
sions made under the Family Health Care Decisions Act, and supported deci-
sion making. In supported decision making, people with a disability make and
communicate their own choices about their lives with support from others
(National Resource Center; Supported decision making New York; Blanck &
Martinis, 2015; Diller 2016).
Little information exists on the extent to which guardianship petitions are

screened for less-restrictive options. We surveyed “court evaluators,” who are
professionals appointed by the judge during the initial guardianship hearing.
Court evaluators are to interview individuals alleged to need a guardian, the
nominated guardian, and any other party who may have relevant knowledge
regarding the need for a guardianship. The court evaluator is to use the
gathered information to make a report to the court recommending whether
the appointment of a guardian is necessary and if there are less-restrictive
interventions.
Under Article 81 and as a moral imperative
to preserve individual rights and self-
determination, guardianship should be a last
resort.
In our survey, the responding court evaluators said that they recommend
such options in only 0 to 20 percent of their cases, and most recommend
it “seldom.” They recommended limited guardianship orders in only 0 to 20
29
percent of their cases as well. It was not clear if the reported low usage was
because by the time the cases reach the evaluator, the needs are too great and
there are simply no workable options.
Some interviewees commented on the importance of earlier intervention

with critical services to meet daily needs—the front-end need for supportive
services in avoiding guardianship. A judge said, “A number of people in New
York City could avoid guardianship if services were available beforehand.
There should be more attention to preventing guardianship. More aggressive
case management and supported decision making.” Others remarked that
a large number of petitions stem from family disagreements and do not
necessarily involve functional limitations that would make guardianship an
appropriate intervention. One judge commented that “Many petitions—in
fact almost all of them—should never have been brought as they are not
motivated by concern for the [individual].3 Frequently, they are products of
fights between family members for assets. Some filtering mechanism would
be helpful—one which investigated whether the person had need of the
court’s protection.”
However, we also heard about successful use of less-restrictive options

instead of guardianship. In our judge’s survey, we asked respondents about
reasons a petition might not result in appointment of a guardian. Finding
of an appropriate alternative to guardianship was rated as a mean of 2.40
on a 1–6 scale in which number 1 was the most common reason—showing a
reasonably strong use of screening for options other than guardianship.
Respondents described specific cases in which less-restrictive options

sufficed. One judge described a case in which an older woman had early onset
dementia, and while a petition for guardianship was pending, she appoint-
ed her son as agent under a power of attorney. He put a support network in
place, and so the petition was withdrawn. A court evaluator described a case
concerning a petition for a woman with limited English skills and a difficult
personality. The woman was able to secure for herself social services and
3 This observation was made in the most recent study of public guardianship by Teaster et al. (2010).
30
rental subsidies, showing an ability to navigate the system, and once these
were in place, she did not need a guardian.
The goal of limiting guardianship does not end with the appointment of a
guardian, but also must take into account the changes in functional status
and available supports that occur post-adjudication, something that seems
to rarely occur in the current system in New York. Our survey asked judges
about the percentage of cases in which they had terminated a guardianship
and restored rights to the individual. Close to 47 percent of judges report-
ed they terminated a guardianship order and restored rights in less than 1
percent of their cases, 20 percent said they took such actions in 1 to 2 percent
of cases, and the remainder did so in either 3 to 5 percent or 6 to 10 percent
of their cases. This confirms the findings in a 2017 national report about
restoration of rights, finding it very rare—and not even tracked by most court
systems. A recent news story profiled the poignant case of a New York resi-
dent seeking termination of a guardianship and restoration of rights (Leland,
2018).
Housing and mental health services. Another recurring theme we heard

is that housing plays a huge role in guardianship cases, and that eviction is
a gateway to guardianship. “What worries me most,” one judge interviewee
explained, “is the effort needed to prevent seniors from being evicted. If the
person had these services earlier, they would not need guardianship.”
“What worries me most,” one judge
interviewee explained, “is the effort needed to
prevent seniors from being evicted.
To protect against eviction, the court will appoint a guardian ad litem, and
that appointment may lead to a guardianship petition. However, according
to a court evaluator, often the person “is just poor and no judge wants to put
them out on the street. You wind up with a lot of cases where the person is
adjudicated as incapacitated, but actually has a personality disorder, and the
31
landlord does not want to continue renting to them. These cases are difficult
for the court examiner because the person does not want or need a guardian—
needs help but it might not be a guardian.”
Several judges confirmed that common gateways into the guardianship

system in New York City are evictions and foreclosures. One judge explained
a domino effect in which an eviction can lead to a guardianship petition and
then a defaulting of a landlord’s mortgage, adding to the housing crisis. A
judge in a more rural area of the state sees housing problems as well, but
they are more likely to concern people who own their homes but are living
in squalor, people who can no longer afford to stay in their own homes, or
family squatter situations. Hence, housing may be the real service needed,
not guardianship.
Section summary
With a rising population of older persons, increasing dementia, increas-
ing longevity for individuals with disability, and a likelihood that family
members will be spread out geographically, there will be a continued and
escalating need for guardians as well as other decisional options. While data
is lacking, our study uncovered a compelling and undeniable unmet need for
guardianship and related services for individuals who are indigent, have been
named by a court as “incapacitated,” and who have no one to serve.
The cases are often urgent and concern the neediest in our society, with an
alarming mix of Medicaid, housing, mental health, long-term care, and social
services issues—and often, with no one to help. The need is especially intense
for nursing home residents and for individuals at risk of eviction from
housing.
Guardianship databases would help clarify and focus the unmet needs
and suggest solutions. Clearly, there is great demand for more available and
skilled guardians as well as more attention to less-restrictive options and a
greater emphasis on the social work skills required to sort out the pressing
human needs.
32
Recommendations
• Data. New York should continue and intensify its collection of basic
guardianship data to better inform estimates of unmet need and
strategies for meeting the need.
• Supportive services. New York should provide adequate funding for

home and community-based care and affordable housing for indigent
individuals at risk of, or subject to, guardianship—especially congre-
gate housing for older adults where people can age in the community
and easily access support services.
• Social work skills. New York should find ways to increase the number
of professionals with social work and nursing skills to act as guardians
for individuals with no family or friends to serve.
• Less-restrictive options. New York should provide judicial and legal

training on screening for less-restrictive options—including a range
of decision supports and supported decision making, the use of forms
that emphasize screening for such options, and tracking the use of
these options in avoiding unnecessary appointments.
• Restoration of rights. New York court procedures should ensure

access for petitions for modification or termination of guardianship
orders and restoration of rights when guardianship is not needed.
• Increased number of clerks. New York should provide funding for an

increased number of clerks to assist judges with the high volume and
complexity of guardianship cases.
• Increased number of guardians. New York should pursue multiple

approaches toward increasing the number of available and skilled
guardians to serve indigent individuals in need as a last resort after
less-restrictive options, including supported decision making, have
been examined.
33
Section 4: Who Serves As

Guardian?
New York has four “guardian of last resort” schemes for individuals who are
indigent, have been judicially deemed “incapacitated,” and have no family or
friends to serve. Each of these schemes contributes to meeting the surrogate
decision making needs of this high-risk population in important ways. Each is
stretched thin. Taken together, they appear to fall markedly short of address-
ing the compelling need for surrogate decision makers for adults when there
is no one willing or appropriate to help. They make up a patchwork approach
that includes: (1) adult protective services, (2) community guardian programs,
(3) attorneys and others on the judicial appointment list, and (4) nonprofit
organizations. This section illuminates the portions of our surveys and inter-
views that reflect the roles, perceptions—and identified strengths, weakness-
es and gaps—for each provider.
Adult Protective Services

Adult Protective Services (APS) is “a social services program provided by
state and local governments nationwide serving older adults and adults
with disabilities. APS is charged with receiving and responding to reports of
maltreatment and working closely with clients and a wide variety of allied
professionals to maximize clients’ safety and independence” (Administration
for Community Living, 2016). In New York, oversight of Adult Protective
Services is through the Office of Children and Family Services, Bureau of
Adult Services. APS is a mandated service provided by the state’s local social
services districts. It “involves intake, investigation and assessment of refer-
rals of abuse, neglect, and financial exploitation” of adults age 18 and older
who “due to physical or mental impairment are unable to protect themselves
…or have no one available who is willing and able to assist responsibly” (Office
of Children and Family Services).
APS has a triple role in the state’s guardianship system. First, if APS identi-

fies abuse, neglect, or exploitation, the commissioner of the local department
of social services may petition for guardianship to protect an individual from
34
harm. Thus, APS is a major gateway into guardianship. Second, theoretically,

APS may investigate instances in which there is a report of abuse or exploita-
tion by guardians and ask the court to remove a guardian who breaches
fiduciary duties. However, we did not hear about such investigations in our
study. Third, in some areas of the state outside of New York City, APS also
serves as guardian if no one else is available. This role is authorized by New
York statute and regulations:
• Mental Hygiene Law Article 81 includes “a local department of social

services” in the definition of “guardian” [Article 81.03(a)].
• Article 81 specifies that eligibility to serve as guardian includes “a

social services official, or public agency authorized to act in such
capacity which has a concern for the incapacitated person” [Article
81.19(a)(2)].
• New York Social Services Law on Adult Protective Services states that
APS services include: “Arranging, when necessary, for commitment,
guardianship, or other protective placement for [eligible] individuals
either directly or through referral to another appropriate agency...”
[Article 9B, Title 1, 473(c)].
• APS regulations state that APS services include “functioning as a

guardian…where it is determined such services are needed and there
is no one else available or capable of acting in this capacity [18 New
York Code of Rules and Regulations, Sec. 457(d)].
Thus, in New York, APS is the designated “guardian of last resort.” The
national public guardianship study (Teaster et al., 2010) called such an agen-
cy designation an “intrinsic” form of public guardianship—that is, there is
no established program devoted to the function, but if there is no one else
to serve, an executive agency is named by the court, and the head of the
agency then selects staff to manage cases. The 2017 APS Guardianship Map
(Appendix B, Bureau of Adult Services, Office of Children and Family Services)
shows the number of cases in which the local commissioner of social services
was appointed by the court to serve as guardian, designating APS staff or a
contracting agency (see below, section on “community guardian programs”)
to fulfill responsibilities. The map shows that in 2017, there were 3,023 cases
(as compared with 2,886 in 2016). A striking pattern shown in the map is that
35
in most upstate counties, there are very few active adult guardianship APS/
department of social services cases, but the number increases in the midstate
area and spikes dramatically downstate, particularly in New York City (where
contracting community guardian programs serve).
Our interviews of New York guardianship stakeholders revealed that while

the Bureau of Adult Services provides uniform statewide training on guard-
ianship to APS staff, practices vary significantly throughout the state in a
number of aspects:
• Petitioning vs. serving. In some areas, such as New York City, APS
petitions but does not serve as guardian (due to the presence of the
community guardian programs). In many mostly upstate areas, APS
both petitions and serves.
• APS as petitioner. In some areas, APS serves as guardian only if APS

has already petitioned, but in other areas, APS may serve regardless of
who petitioned (for example, a nursing home or hospital).
• Finding other options. In some areas, APS appears to be more

attuned than in other areas to identifying less-restrictive options and
other means of supporting individuals, thus avoiding guardianship.
• Designated staff. In some areas, APS has designated experienced

staff to fulfill the responsibilities of serving as guardian, while
in others, staff with a range of duties and skills in this arena may
manage the cases.
As noted above, a responsibility of APS is to investigate and monitor services

provided to individuals with guardians, as well as reports of possible abuse,
neglect, or exploitation by guardians. APS therefore is an essential safeguard
in the guardianship system for monitoring the conduct of the guardian.
Thus, an issue is whether there is a conflict of interest to have APS serve as
guardian—securing social services, making end-of-life and other health care
decisions, and making financial and Medicaid decisions. Indeed, the nation-
al public guardianship study found that there is an inherent clash in such
competing roles, and therefore, “states should avoid a social services agen-
cy model” of public guardianship, as it can hamper effective advocacy for
clients (Teaster et al., 2010). New York Mental Hygiene Law at Article 81.19(e)
36
addresses conflict of interest, barring creditors and direct service providers

from appointment, but it does not refer to APS. Moreover, as stated above,
APS eligibility for appointments is recognized in other statutory provisions.
Interviewees generally supported the role of APS serving as guardian but only
as a true last resort, observing that the need is critical, but the conflict is only
potential—and that in some cases, APS may be named temporarily while a
search for someone else is underway.
Our surveys and interviews revealed that most courts and stakeholders in
the system are grateful that APS may be appointed if there is no one else and
that caseworkers generally have the expertise and services needed. APS has
contacts and knowledge to manage care and finances. However, appointing
APS as guardian is perceived by some as not ideal, due to the conflict, and it in
no way fully meets the glaring need for guardians as last resort. Additionally,
it pulls APS away from performing its other important functions of adult
protection. Our respondents said, in sum:
• Serving as guardian is not the primary role of APS. APS staff have a
heavy load of tasks to detect and address adult abuse across a broad
range of settings and must engage with clients, often under trying
circumstances. Serving as guardian “diverts resources from their
other mandated services.”
• APS is intended by law to be the guardian of last resort but often

becomes a rote default.
• In smaller counties, APS often struggles to fulfill obligations of a

guardian, especially for property.
• APS is underresourced and overburdened, requiring additional funds

to meet guardianship and related needs. There are simply more cases
than they can handle. While they don’t always accept cases, in other
instances, they may feel they cannot turn down cases even though
they lack needed support to do the job. And these are only APS-eligible
cases—what about the others?
We also learned that generally if APS, in responding to a report of suspected

abuse, finds that a guardian has been appointed, APS generally closes the
37
case. This closes off an essential outside eye on guardianship and prevents
investigations that would be useful to the court in monitoring.
Community guardian programs

In some areas of the state, instead of designating APS to fulfill the statutory
duty as guardian of last resort, the commissioners of local social services may
contract with statutory “community guardian programs” authorized under
Social Services Law. The law specifies that “a social services official may bring
a petition to appoint a community guardian program…for an individual who
is eligible for adult protective services, without a capable friend or relative
willing and able to serve, and living outside a hospital or residential facility”
(Article 9-B, Sec. 473-D).
New York City has three community guardian programs—New York

Foundation for Senior Citizens, Self-Help Community Services, and the
Jewish Association Serving the Aging. On the APS Map (Appendix B), the 2,117
open cases, including the 257 new appointments in 2017, are all community
guardian cases.
As the name implies, community guardian programs are to serve indi-

viduals in the community and, according to the law, must relinquish the
case when a person enters a nursing home. This leaves a disturbing and, in
some cases, potentially life- or health-threatening gap, as there could be a
significant delay in appointing a successor guardian. It also creates a judicial
resource problem because a successor guardian must be located. Nursing
homes are likely to provide better care if a guardian is there to advocate for
a resident, who otherwise would have no voice. Some judges recognize the
problem, and despite the statutory limitation, name a community guardian
program to serve—or fail to discharge such a program upon nursing home
admission—as there may be no other viable solution.
38
Nursing homes are likely to provide better
care if a guardian is there to advocate for a
resident, who otherwise would have no voice.
At the same time, some interviewees stated that the community guardian
programs, while knowledgeable, are overwhelmed, have significant staff
turnover, sometimes turn in incomplete reports, and cannot handle the
pressing need in a timely way. Simply put, they are beyond their capacity.
Part 36 judicial appointment list

New York Judicial Rules, Part 36 (New York Courts) provides for appointments
by the court, including appointments of guardians. If there is no one willing
and appropriate to serve, the courts can identify an attorney or other profes-
sionals on the list to serve as guardian of the person, guardian of the property,
or guardian of both, taking compensation from the individual’s estate if there
is one. The rule provides for a cap on compensation to spread out fee-generat-
ing cases fairly:
• “(1) No person shall be eligible to receive more than one appointment

within a calendar year for which the compensation anticipated to be
awarded to the appointee in any calendar year exceeds the sum of
$15,000.
• (2) If a person has been awarded more than an aggregate of $100,000

in compensation by all courts during any calendar year, the person
shall not be eligible for compensated appointments by any court
during the next calendar year” (Part 36.2(d)).
The cap was recently raised to the $100,000 level to expand the number of
professionals on the list who will take cases.
The court makes some appointments as pro bono guardians in no-fee or

low-fee cases. Interviewees noted it is an unfair option for professionals on
the list. One judge explained it might be asking an attorney to spend 20 hours
39
a week on a complex housing case, with no expectation of payment. There is

no data on the frequency of such pro bono or low-fee appointments. Judicial
survey respondents said “Many attorneys will only take fee-generating cases,”
but one noted that some attorneys “will handle pro bono over the year.”
Themes concerning Part 36

appointments
Our surveys and interviews highlighted several themes concerning Part 36
appointments.
Multiple appointment roles. The list includes appointments of guardians

ad litem, court evaluators, court examiners, attorneys for an alleged incapac-
itated person and others. Those willing to take on the tough and time-con-
suming tasks involved in serving as guardian are a minority, and some
respondents said a dwindling minority, especially among attorneys. “Many
attorneys have taken themselves off the Part 36 list. Those who continue to
serve as guardians are overwhelmed.”
Complexity of cases. The cases are challenging and frustrating. They

require knowledge of public benefits, subsidized housing, discharge planning,
health and long-term care, property management, Medicaid, and mental
illness. Survey respondents characterized the cases as “high maintenance”
and “time-intensive” appointments that cause “burnout.” One interviewee
likened taking such as case to taking on another family member. Legal practi-
tioners said:
• “I am not comfortable making health care decisions.”
• “I am often the person who has to make unpopular decisions, and the
person I am helping rarely understands the help I provide.”
• “I do not believe judges understand the amount of time, energy, and

expenses that go into managing someone’s affairs when entering a
situation already in disarray.”
• “Property management is extremely difficult, especially if reality is

involved.”
40
• “The current system leaves judges scrambling to find guardians when

the individual has few assets or various issues and problems that are
time critical.”
Limitations on payment. Our surveys found that the cap, even with the
recent raise, can “eliminate good guardians” and that the scant compen-
sation “generally overcomes the time-consuming responsibilities.” Several
survey and interview respondents said there is an informal quid pro quo for
better paying cases, but this is not written anywhere, can’t be relied on by
attorneys, and is problematic for judges. One judge we interviewed said, “I
would like to know that when I am presiding in a case where the [individual]
will need a guardian who won’t get fees that I don’t need to make deals with
those on the Part 36 list for them to be appointed.” A legal practitioner stated,
“More people including myself would be more apt to take a low paying case if
there was some guarantee” of better payment or a fee-generating case.
Many practitioners simply said they could not keep up their solo practice
with high-input, low-fee, or pro bono cases. However, a few noted they felt
“an obligation to accept no-fee/low-fee cases” and that it was “gratifying” to
help the people involved. One judge emphasized the “compassion” of some on
the list, particularly knowledgeable elder law attorneys who are dedicated to
their service.
Legal vs. social work needs. A related issue is whether the payment for
attorneys is or should be at their rate for legal work, or at a lower rate
for guardianship services, many of which are not law-related. One judge
commented, “the issue of fees is the elephant in the room as there is no rule
on fees for lawyers who serve as guardian.”
Several respondents remarked that what is really needed in many of the

Part 36 cases is less legal work than social work. Another judge stated that
what is often required is “social, not legal support. Lawyers do not make the
best guardians for those individuals, but they make up a large majority of the
Pat 36 list.” While there are some nurses and social workers on the list, it is
not clear how many are taking guardianship cases as opposed to serving as
court evaluator.
41
Many practitioners simply said they could not
keep up their solo practice with high-input,
low-fee, or pro bono cases.
Varying levels of expertise. While several respondents lauded the expertise

and dedication of those on the list willing to serve as guardians, others said
the quality was not uniform. One judge explained that there is no way of
knowing how those listed have managed the affairs of their clients. Another
said, “You see 200 lawyers’ names. None of them want to do this anymore
because it’s not cost effective for them.”
Nonprofit agencies serving as

guardian
In addition to community guardian programs, which are paid by the local
departments of social services, there are a few additional agencies scat-
tered throughout the state that take guardianship cases but are not under
a contract with social services and have no steady income stream. There is
little income from estates, as most individuals in need are indigent. Some of
the agencies are able to secure small monthly fee payments (typically $450 to
$500) for clients on Medicaid in nursing facilities, which are excluded from
the calculation of the net available monthly income (NAMI) that Medicaid
recipients are typically required to pay towards the cost of care. These fees
are not always available, for example, when the sole source of income is Social
Security and are solely at the discretion of the Department of Social Services’
approval during the Medicaid budgeting process.
We discovered that no complete list of such agencies existed, and our study
sought to compile a list through queries to interviewees (see Appendix C).
Though it may not be fully complete, it offers the best compilation to date and
invites additions.
42
Overwhelmingly, our survey and interview respondents all highlighted

the dire need for funding for such for-profit and nonprofit agencies. They
recognized that TGP offers the Cadillac model (see Section 7), but it has not
been self-sustaining—i.e., court fees and NAMI payments alone are not
enough to support the services and significant additional funds are needed.
Respondents said:
• “We have insufficient nonprofits handling these cases.”
• “Create more Vera projects!”
• “We have one service provider, but when they have a conflict or reach
their limit of cases they can take, it is difficult to find an alternative.”
• “Many of these cases are assigned to nonprofit guardianship organiza-

tions which have a limit to how many pro bono cases they will take.”
• “We do have an available not for profit which will act as guardian, but
they require a minimum monthly stipend which many incapacitated
individuals cannot afford.”
• “We need more nonprofit organizations.”
• “We need more and better trained nonprofit guardianship organiza-

tions which have more personnel to handle dysfunctional families and
psychologically impaired persons as opposed to a solo practitioner.”
• “We need more funds for agencies to serve as guardians or funds for
those appointed to draw from to compensate them.”
• “There are only two nonprofits in the county, and one has stopped
taking cases.”
Is public guardianship the solution?

Testing in two pilots
With the substantial gaps outlined above for indigent individuals named by
the court as “incapacitated” but with no one to serve, the need for a statewide
public guardianship program has been a focus of discussion in New York for
many years. As early as 1996, an article in an elder law publication set out
43
“public guardianship issues for New York” (Schmidt, 1996). In 2001, the New
York Courts’ Commission on Fiduciary Appointments recommended that
“public funds should be available to compensate Article 81 guardians in cases
involving minimal or no assets” and noted that “one option is the creation of
a public guardian office…“(Commission, 2001). In 2004, the Second Judicial
Department Guardianship Task Force maintained that “the only real solu-
tion…is to establish an Office of Public Guardianship” (Supreme Court, Second
Judicial Department, 2004). In 2016, the Brookdale Center for Healthy Aging
study supported “development of publicly funded guardianship programs
that can provide comprehensive case management to eligible clients in need
of services.”
Our study found high support for increased funding, with many referenc-
ing the potential of a public guardianship program. Close to 90 percent of
responding judges and all of our interviewees said there is a significant need
for increased funding in New York State to provide guardians in these no-fee
and low-fee cases. Comments included the following responses:
• “Provide an incentive for persons to spend time with issues of

strangers.”
• “This should be a Medicaid cost.”
• “We need a public guardianship program, and even more than that, we
need the computer tools to enforce compliance.”
• “Public guardianship is not a panacea, but would greatly diminish the

problem cases, especially where family members are induced to take
cases where they lack the ability to handle and which they undertake
only reluctantly with predictable results.”
In 2018, the New York legislature took a first step toward recognizing the
unmet need for guardianship service. The legislature provided a $500,000
appropriation for two pilot projects—one in Suffolk County and one in
Nassau County. New York State Senate appropriations language specified
that the funding was “to facilitate the use of non-attorneys to serve as guard-
ians appointed by a court under Article 81” (New York State Senate, 2018).
44
• Suffolk County pilot. The Hon. Arthur Diamond of Suffolk County

is coordinating a one-year pilot project that will use geriatric social
workers as guardians compensated at a rate of $125 per hour.
• Nassau County pilot. The Hon. Richard Horowitz of Nassau County is

coordinating a one-year pilot project that will establish a not-for-prof-
it organization to serve as guardian, using Retired Senior Volunteer
Program members, nursing students, social work students, and law
students to be assigned to manage cases with supervision, work as a
team, and enter information into a database.
The judges, as well as several interviewees, explained that the different

models could be evaluated and adapted to meet needs in other areas of the
state. One viable strategy, used successfully in Virginia, is to expand coverage
using similar pilots, moving incrementally toward a statewide public guard-
ianship system. Indeed, the 1996 article on New York public guardianship
cited above noted that in view of the state’s size and diversity, “demonstra-
tion projects could test [various] models’ effectiveness” (Schmidt, 1996).
Section summary
New York has four “guardian of last resort” schemes for individuals who are
indigent, have been judicially deemed “incapacitated,” and have no family or
friends to serve. Each contributes to meeting the need for these persons in
important ways. Each is stretched. Taken together, they fall markedly short of
meeting a compelling need.
New York law and regulations provide for local commissioners of social
services to act as guardian of last resort. In some but not all areas of the state,
the commissioner names Adult Protective Services (APS) to fulfill guardian-
ship responsibilities. APS guardianship practices vary throughout the state.
However, APS as guardian is a clearly conflicting role, staff is often overbur-
dened, and the system is underresourced.
45
New York has four “guardian of last resort”
schemes for individuals who are indigent, have
been judicially deemed “incapacitated,” and
have no family or friends to serve.
New York law also provides for community guardian programs funded
by local social services offices. New York City has three such programs.
Community guardian programs must relinquish cases when a person enters a
nursing home or similar residential facility, leaving a serious and sometimes
life-threatening void where there is no one to make health and personal
decisions and oversee care by the facility. Moreover, the programs are over-
whelmed with cases.
New York Judicial Rules, Part 36, provides for appointments by the court,
including appointments of guardians. The Part 36 list is predominantly
lawyers, though the skills required of the guardians usually extend well
beyond the legal arena and are so diverse as to make it difficult to find a
single individual appointee well equipped to meet all needs. Additionally, the
number of professionals on the list willing to serve as guardians (as opposed
to court evaluators, court examiners, or other roles) has dwindled and may of
the best are capped out, even with the recent increase in the cap, and cannot
take additional cases. Many cannot afford to take no-fee/low-fee cases of the
enormous complexity and time-intensity required.
New York has scattered not-for-profit social service agencies that, among
other services, take guardianship cases using meager funds from the estates
or small Medicaid stipends where there is any income to be managed. Such
agencies are vastly underfunded to serve as guardian and do not exist
throughout the state. There was agreement by those we interviewed that
funding for additional nonprofits, especially those similar to the TGP model,
would help to staunch the unmet need.
46
There was widespread recognition by those we surveyed and interviewed

that there is a marked need for increased funding to provide for a diverse
pool of guardians in low-fee/no-fee cases where there is no one else to serve.
Many, but not all, supported a statewide public guardianship system with
flexibility to meet local needs. Two pilot programs are underway which may
provide a model to address some of the unmet needs across the state.
Recommendations
• Funding for diversity of services. New York should provide addition-
al funding for a diverse pool of guardianship and decision support
services. Funding for such services should prioritize living in the
community as a primary goal, similar to TGP (see Section 7). Funding
should include Medicaid payment in nursing home cases.
• APS role in guardianship. New York should identify other approaches

for guardianship services instead of relying on APS through depart-
ments of social services to serve as guardian of last resort. This would
avoid an inherent conflict of services. Additionally, it could free up
APS resources for its other important protective roles, including a
critical role in investigating suspected guardianship abuse.
• Community guardian programs. New York should provide additional

funding to the community guardianship programs to meet the press-
ing need and ensure quality services, with consideration to a reason-
able staff-to-client ratio (as recommended by the national public
guardianship study, see Section 6).
• Guardianship for nursing home residents. While recognizing that

not all nursing home residents need guardians, at the same time, New
York should address the current gap that occurs when community
guardian programs must relinquish cases in which an individual
requires nursing home care. Guardians can be needed advocates
for quality of care. Extending the role of the community guardian
programs to selected nursing home cases would prevent an unnec-
essary burden on the court in finding another guardian and ensure
continuity in the guardian’s care and decision making—thus allowing
the guardian to best support individual wishes and needs.
47
• Incentives for serving in low-fee/no-fee cases. New York should

provide incentives such as free continuing education courses for
professionals on the Part 36 list, provide incentives for social workers
and nurses to agree to serve as guardians in low-fee/no-fee cases, and
encourage their appointment by judges in appropriate cases where
there is no less-restrictive option.
• Evaluation and expansion of pilot projects. New York should contin-

ue the two 2018–2019 pilot programs to allow for additional time to
measure effectiveness. Based on experience of the initial pilot demon-
stration projects, New York should fund additional projects, building
in a formative evaluation process and moving toward addressing the
unmet need for guardianship and less-restrictive decisional options
throughout the state.
48
Section 5: New York Court

Processes—Barriers to
Effective Service and
Oversight
New York State Mental Hygiene Law Article 81 was enacted in 1992 with a
stated purpose of “establishing a guardianship system which is appropriate
to satisfy either personal or property management needs of an incapaci-
tated person in a manner tailored to the individual needs of that person,
which takes in account the personal wishes, preferences and desires of the
person, and which affords the person the greatest amount of independence
and self-determination and participation in all the decisions affecting such
person’s life” (NYS Mental Hygiene Law Article 81.01, 1992).
Since the enactment of Article 81, reviews have sought to determine how
well practice is carrying out the law’s intent—including a 2001 New York
Courts report on fiduciary appointments (Commission, 2001), a 2004 Second
Judicial Department Guardianship Task Force Report (Supreme Court, 2004)
and others. The Brookdale Center for Healthy Aging at Hunter College
completed an in-depth file review in 14 New York counties, examining a total
of 2,414 Article 81 guardianship case files (Callahan et al., 2016). Along with
TGP, the Office of Court Administration assisted the project in accessing the
files. The Brookdale project examined basic demographic data on individuals
served, petitioners, and guardians; reasons for guardianship; length of the
process; monitoring; and outcomes in terms of social services and public
benefits secured.
There are many aspects of Article 81 implementation that affect individu-

als alleged to need a guardian—including those in our target population of
indigent individuals with no one to serve. While some aspects of implementa-
tion were outside the scope of our study, we sought to build on the Brookdale
findings concerning both timeliness of court processes and court monitoring.
49
Shortly after the enactment of Article 81, a law review article noted that:
“Expeditious timing is a feature of the new legislation designed to cure a

system ‘plagued with unconscionable delays.’ The legislation states that ‘[a]
proceeding under this article is entitled to preference over all other causes in
the court,’ and sets forth a timetable…These provisions respond to the urgen-
cy of the matters involved where the previous statutes left the fate of schedul-
ing the hearing or trial to the court system.” (Von Stange, 1993)
Article 81 provides for 50 days to complete a full guardianship proceeding.

However, the Brookdale study found an average time of 211 days from the
petition until the guardian’s commission. The Brookdale report named many
potential reasons for delays in court processes, often inherent in the very
nature and complexity of the cases. Other delays, however, may stem from
systemic inefficiencies that result in wasted efforts and higher costs—and
that could be streamlined to better meet the needs of individuals and families.
Our surveys and interviews asked stakeholders what “bottlenecks” they saw
and what remedies might work.
Not all of our survey and interview respondents perceived any bottlenecks
in the system—including 40 percent of judges surveyed, almost 37 percent
of court evaluators, 53 percent of court examiners, and 29 percent of practi-
tioners. Others saw delays but reported that while the processes are lengthy,
they appropriately allow for attention to needs and rights, observing that the
50-day statutory timeframe is simply unrealistic and even unfair: “Frankly,
50 days is a ridiculous number. No one’s rights should be infringed upon with
such a rushed judicial process.” Many, however, described various unneces-
sary roadblocks in three phases of the process, as summarized below.
Delays from the petition to the first

hearing
Article 81 provides 28 days from the date the petition is filed until the first
hearing; yet the Brookdale study found it takes an average of 63 days. Most of
the respondents in our study did not perceive bottlenecks at this stage of the
process—only 20 percent of judges, less than 8 percent of court evaluators,
50
6 percent of court examiners, and 13 percent of practitioners said there are

bottlenecks.
Some respondents perceived delays that were mostly predictable with

guardianship cases, especially contested cases. For instance, many parties
need to be notified; arrangements may need to be made for proceedings
outside of court if the individual cannot come to the courthouse, or other
accommodations may be required; and the evaluation may take longer than
anticipated, especially if the individual refuses to participate (Callahan, 2016).
Court evaluators and court examiners pointed out that it simply takes time
to investigate and secure relevant financial and medical records—and that
sometimes conflicting schedules make it hard to find a hearing date that
works for everyone. They explained:
• “Indigent alleged incapacitated individuals can be difficult to serve,

requiring adjournments or continuations. It can be difficult to
complete an investigation and produce a thorough report in time. It
can be very difficult to get in touch with doctors and caseworkers. The
alleged incapacitated person will often cancel meetings. Some cannot
be reached by phone. Tracking down family members takes time.
Obtaining financial information from third parties can take weeks.”
• “There can be significant delays in the petitioner’s obtaining personal

jurisdiction over uncooperative alleged incapacitated persons. People
rarely move quickly enough.”
• “Attorneys for the parties often need to investigate issues like mental
illness, which require time and effort and contacting third parties.
Additionally, it seems like the pro bono cases sometimes take a back
seat in many attorneys’ caseload” see Section 6.
There can be significant delays in obtaining
personal jurisdiction over uncooperative
alleged incapacitated persons.

51
Other delays, though, may be fixable:
• Petition forms. The petition is the entry into the system. It can set
the case off on the right track or hold things up unnecessarily right
away. One judge commented, “our clerks reject many petitions due
to errors in form and substance.” Family members and other nonpro-
fessionals often find it challenging to fill out a petition form. Another
judge remarked that often petitioners fail to tell the court—and
it may not be elicited in the form—that the person does not speak
English, or cannot read English, and that a translator is needed. A
uniform, plain-language, accessible petition form could reduce
time-consuming errors in the petition and make sure that all needed
information is included. Clear instructions and samples can be help-
ful as well. Uniformity could also help clerks to review the form more
expeditiously.
• Court staffing. Judges and court examiners repeatedly noted that

courts are understaffed and stretched thin: “Courts are overburdened
and cannot always get the first hearing scheduled within the statutory
time.” A recurrent statement throughout the judicial survey was the
need for more clerks to perform the range of administrative chores
necessary to move the process ahead in a timely way.
Finally, court evaluators suggested other practical solutions as well, such as

the following:
• Court evaluators should be provided with signed subpoenas for medi-

cal and financial information when they accept appointment.
• The court should contact the parties before sending out the order to
show cause to see if they are available on the date shown.
Delays from the first hearing to the

order and judgment
Article 81 specifies that the judge should issue an order within seven days
after the hearing, unless for good cause shown. The Brookdale study showed
this phase of the process took an average of 82 days. In our survey, while the
52
majority of respondents did not perceive bottlenecks from the first hearing
to the order and judgment, some did—almost 27 percent of judges, almost 37
percent of court evaluators, and close to 12 percent of court examiners.
Some survey respondents reported delays due to scheduling issues, the

sheer number of administrative steps involved—and often multiple hearings.
One court evaluator highlighted “transcript delays, backlogs in the clerk’s
office, Part 36 appointees submitting affirmations of service, getting signed
orders to the guardian.” Another lamented that “there are too many contin-
uances and also hearings that proceed with the intent of another hearing
because not all parties can attend—a big waste of time, energy and effort.”
Some stated that appointment of a temporary guardian can be useful while
the process is unfolding—and may turn out to suffice, avoiding the need for a
permanent appointment.
Finding solutions short of permanent guardianship. Sometimes, however,

a judge may take extra time to find the right—and least restrictive—solution
in challenging cases. A court examiner remarked that “Many judges prefer to
settle than try the case, or spread the hearing out over a longer period of time,
particularly in difficult cases.” A judge noted that “we have had some success
in slowing down certain cases where a permanent guardian is not necessar-
ily needed. Over time, families may resolve their conflicts, individuals may
execute powers of attorney or make use of other less-restrictive options.”
Another stated that “sometimes a short-term appointment to complete a
Medicaid application, facilitate a discharge or deal with other immediate
needs is sufficient.” Thus, taking some extra time can be beneficial and
can result in finding solutions short of permanent guardianship. One tool
increasingly used throughout the country is guardianship mediation—which
can help to sort out particularly tangled cases, especially involving family
disputes (Radford, 2002).
Proposed order. Several court examiners mentioned time consumed with

the proposed order itself: “It may take weeks for the petitioner’s attorney to
prepare an order and weeks for the court to review and sign, leaving everyone
in limbo during that period.” They suggested solutions:
• “It would expedite the process if the court staff could print an order
and judgment right at the hearing rather than wait for one of the
53
parties to submit it to court—such delays allow for the possibility of

omissions and mistakes. “
• “A short form order gets the guardian in place immediately so he or

she can begin to get the job done.”
Of course, flexibility to tailor the order to the individual needs of the person,
as required by Article 81, is important. But a uniform order template with
selected options could be both efficient and individualized (Frolik, 2002). A
uniform order and judgment form was recommended by the Second Judicial
Department Guardianship Task Force Report as early as 2004 (Second Judicial
Department, 2004).
Delays from the order and judgment

to the commission
Guardian commission. Article 81 provides that the court should issue a
commission to the guardian within 15 days from the decision. The Brookdale
study found it took an average of 66 days. Several respondents in our study
named this as an unnecessary bottleneck—over 53 percent of judges, 19
percent of court evaluators, 29 percent of court examiners, and 25 percent of
practitioners. Repeated comments pointed out that there are court backlogs
and attorney delays, but also that lay guardians frequently don’t realize that
their authority depends on getting not just an order but a commission, and
they end up in a bind when they need to take action and cannot:
• “The procedure is antiquated and relies entirely on the speed of the

clerk.”
• “Many guardians are not fully educated and need help to get their
commissions.”
• “In many counties, it takes an eternity for the clerk to record the notic-
es of entry. I have waited weeks…before I or my clients could obtain
commissions.”
• “The petitioner’s attorney fails to adequately assist the designated

guardian.”
54
Our survey respondents offered practical solutions:
• “Use a simple commission that is attached to a copy of the order, incor-

porating it.”
• “A certified copy of the final order should serve as temporary

commission.”
• “Make the order the commission.”
• “At the hearing, give all lay guardians a handout explaining the
commission process.”
• “Hire additional clerks.”
Bonding. Another critical and sometimes problematic issue is bonding.

While not a factor in indigent cases, bonding practices may affect some low
to moderate income or higher asset cases. Failure of a proposed guardian
of property to get a bond might or might not cause delay (over 73 percent of
judges said it did not). One court examiner suggested that there should be
bonding services in the court to help family or other lay guardians.
Our survey asked judges to name criteria they use in determining wheth-
er a bond should be set. They named asset amounts, results of background
checks, monthly income, and whether the guardian is a professional. In the
survey, 40 percent of judges said they set bonds in less than half of cases, and
one-third said they set bonds between 50 percent and 65 percent of cases.
Guidelines on bonding may be helpful to judges and clerks, to create more
uniformity of practice.
Court monitoring of guardian

reports
Filing of reports. Article 81 requires the guardian to file an initial report 90
days after the commission and an annual report thereafter. Annual reports
are due May 31 for the preceding year. The Brookdale study found that the
average time between the filing of the commission and the first report
(whether initial or annual) was 237 days—with longer averages in New York
County and Kings County, and shorter averages in the other counties studied.
55
Our survey confirmed that a substantial portion of guardian reports and

accountings are not submitted on time. Just over 31 percent of the respond-
ing court examiners said the accountings are submitted on time in 61 to 80
percent of cases, and almost 44 percent said the accountings are on time
41 to 60 percent of the time. None of the responding court examiners said
annual accountings are submitted on time in 81 to 100 percent of cases. (The
remaining 25 percent specified on time filings 0 to 40 percent of the time.) Of
the responding judges surveyed, over 28 percent named “failure of guardian
to file reports in a timely manner” as a barrier that prevents the court from
identifying problems in a low- or no-fee case, and over 46 percent in fee-gen-
erating cases.
Without a timely report the court has no way
of assessing the well-being of the individual or
the extent to which the guardian is carrying
out fiduciary duties.
Reports and accountings are the primary way in which the court learns of
problems in the guardianship. Without a timely report (or with a failure to
report at all), the court has no way of assessing the well-being of the individ-
ual or the extent to which the guardian is carrying out fiduciary duties. One
judge commented that “It is hard to know if the guardian is actually doing
visits they should be doing and whether they are doing the best for the person
with the resources at hand.”
Court examiners attributed the delays in submission of reports and

accountings to lack of lay guardian experience and training. Moreover, many
family guardians are full-time caregivers. Legal practitioners said guardians
need time at the beginning of a case to address pressing concerns “as opposed
to paperwork.” Ways to make filing easier, including options for electronic
filing, would help. The National Association for Court Management states that
56
“Ideally, [reporting] forms should be available online and filed electronically…

to reduce paper logistics, offload costly data entry, and reduce errors and
redundancy” (National Association, 2014). Our study respondents suggested
several solutions to promote more timely reporting:
• Develop uniform initial and annual report forms.
• Email reminders to the guardian about the report deadline.
• Provide specific plain-language instructions about how to complete

the report, with samples.
• Make electronic filing options available.
Also, one legal practitioner observed that banks do not always recognize the
authority of a guardian, accounting for additional effort and delay. The prac-
titioner suggested that the court offer education for banks on guardianship
and develop a form letter stating that the commission grants the guardian
the power to access financial information.
Review of report. Article 81 requires all reports to be reviewed by a court

examiner within 30 days of filing, yet the Brookdale study found an average
of 210 days before a report is examined. The Brookdale study also found that
“some counties only require the review of reports every other year in low
asset cases, although the statute does not permit anything less than annual
reports.”
Of the judges responding to our survey, over 30 percent named “lack

of court resources to review reports” as a barrier in the annual reporting
process. All 100 percent of the judges agreed that “uniform statewide
templates for guardianship annual and final reports would make the process
more efficient for all involved. One judge explained, “I think uniformity
would make the job of reporting simpler for lay guardians. I also believe it
would simplify the work of the court examiners and the court staff reviewing
the reports.” Another judge noted that the third department already has such
standardized templates, and they are on the court’s website.
Other critical aspects of report review and court monitoring—such as

court examiner practices and court investigative and sanctioning actions—
were outside the scope of our survey, but some came up on our interviews.
57
Notably, one judge urged the creation of an ombudsman for the guard-
ianship process—a recommendation that was made as early as 2001 by
the Commission on Fiduciary Appointments. The commission found that
“laypersons believe they have nowhere to go with questions and complaints”
and urged that the court system “designate an ombudsman to provide
information and field complains about the fiduciary process” (Report of the
Commission, 2001).
Section summary
In the development of Article 81, maximizing self-determination and expedit-
ing guardianship cases were both prominent features. While it is important
to comply with time deadlines set out in the law, it is also important to focus
on the individual and support his or her rights. The balance may be challeng-
ing. Our study examined issues of timing in court processes and monitoring
to identify solutions that streamline procedures yet preserve rights.
A 2016 file review in 14 counties by the Brookdale Center for Healthy Aging
at Hunter College found that on average, it takes 211 days—significantly
longer than the Article 81 mandated 50 days—from the filing of a petition
for guardianship to the commissioning of a guardian. Guardianship cases
are complicated and require sufficient time and attention to individual
needs and rights—and this is especially so for no- or low-fee cases with
scant resources at hand and no one to serve. Yet some delays may stem from
systemic inefficiencies that result in wasted efforts and higher costs. Our
surveys and interviews sought reasons for the delays and possible solutions.
While Article 81 provides 28 days from the filing of the petition to the first
hearing, the Brookdale study found it takes an average of 63 days. Some
delays are inherent in the very nature and complexity of the cases—time for
needed accommodations, investigation, and evaluations. Other delays may be
addressed through solutions such as a uniform, plain-language petition, as
well as additional court clerks to move the process ahead.
Article 81 specifies that the judge should issue an order within seven days
after the hearing, unless for good cause shown, yet the Brookdale study
showed it took an average of 82 days. Sometimes judges need extra time to
find the best and least restrictive answer in difficult cases. Mediation may
58
be helpful, especially with family disputes. However, several of our survey

respondents cited bottlenecks concerning the proposed order, and offered
practical solutions.
Article 81 specifies 15 days from the date of the order to the guardian’s
commission, yet the Brookdale study found it took an average of 66 days. This
may be due to court backlogs and attorney delays, but also lay guardians
frequently don’t realize that their authority depends on getting not just an
order but a commission. Survey respondents proposed ways to help guard-
ians and to simplify and streamline the commission process. Our survey
also found bonding practices uneven, and that bonding guidelines might be
useful.
Article 81 requires the guardian to file an initial report after 90 days and
an annual report thereafter. The Brookdale study found the average time to
the filing of a first report is 237 days. Our study confirmed that a substantial
number of reports and accountings are not submitted on time. Often lay
guardians lack experience and training in filing a timely and complete report
and accounting; and survey respondents urged ways of making filing easi-
er. Other delays may be due to lack of bank understanding of a guardian’s
authority. Survey respondents emphasized the need for a uniform statewide
template for initial and annual reports. An additional issue that came up in
the interviews was need for a guardianship ombudsman mechanism.
Recommendations
• Develop uniform documents. New York courts should create uniform
forms for the petition, order to show cause, initial report, and annual
report.
• Facilitate filing of reports to enhance monitoring. New York courts

should generate reminders of filing deadlines, provide reporting
instructions and samples, and offering electronic filing options.
Educate banks about guardian authority, to avoid unneeded delays.
• Expedite guardian commission process. New York courts should

educate lay guardians about the need to get a commission and consid-
er ways to streamline the process.
59
• Employ additional clerks. New York courts should provide funding

for the addition of court administrative staff trained to move the
guardianship process forward in a timely way.
• Consider complaint resolution approaches. New York courts should

explore complaint procedures from other states so that problems can
readily be brought to the attention of courts and consider dispute
resolution options such as mediation and ombudsman functions.
60
Section 6: The National

Landscape—Public
Guardianship and
Decision Making Services
The first national study of public guardian programs was conducted by
Schmidt, Miller, Bell, and New in 1981. Nearly 30 years later, the second
national study was published by Teaster, Schmidt, Wood, Lawrence, and
Mendiondo (2010). Because over 10 years had elapsed since we gathered data
from the programs, we conducted a truncated survey of the programs we
studied earlier to discern important aspects of program functioning, specif-
ically those that might guide the development of a statewide system in New
York. From July–September 2018, as part of the study, we invited guardian
programs that had participated in the national study of public guardians by
Teaster et al. (2010) to complete a brief update of their programs in the United
States.
After multiple attempts to solicit responses, we were able to gather infor-

mation from five sites in five states:4
• Pima County Public Fiduciary (Arizona)
• Office of the Public Guardian, Los Angeles County (California)
• Office of the Public Guardian (Delaware)
• Office of Public and Professional Guardians (Florida)
4 The following ten participants from the previous study were all invited to participate: Pima County
Public Fiduciary (Arizona), Maricopa County Public Fiduciary (Arizona), Office of the Public Guardian,
Los Angeles County (California), San Bernardino County Public Guardian (California), Office of the Public
Guardian (Delaware), Office of Public and Professional Guardians (Florida), Office of the State Guardian
(Illinois), Cook County Office of the Public Guardian (Illinois), Public Guardianship Services, Senior Legal
Assistance, and Elder Abuse Prevention, Maryland Department on Aging, and Adult Public Guardianship
and Office of Adult Services, Maryland Department of Human Services (Maryland).
61
• Cook County Office of the Public Guardian (Illinois)
The following definitions guided the answers to the questions asked:
• Guardian: A person lawfully invested with the power, and charged

with the duty, of taking care of the person and managing the property
and rights of another person considered incapable of administering
his or her own affairs.
• Public guardianship: The appointment and responsibility of a public

official or publicly funded organization to serve as legal guardian in
the absence of willing and responsible family members or friends to
serve as, or in the absence of resources to employ, a private guardian.
• Public guardianship program: The entity responsible for exercising

public guardianship duties.
Information gathered from the five

participating programs
Budgets for fiscal year 2017 were influenced by the overall need for guardians
as well as population size.
TABLE 3. Budgets by program for fiscal year 2017
pima county los angeles delaware (state florida (state cook

(az) county (ca) program) program) county (IL)
$2,420,000 $21,560,000 $680,000 $7,000,000 $7,000,000
Funding sources were derived from an array of sources, including state

funds, county funds, grants/foundations, client fees, and estate recovery.
Only Delaware had one funding source.
62
TABLE 4. funding sources for the programs
FUNDING pima county los angeles delaware (state florida (state cook
SOURCES (az) county (ca) program) program) county (IL)
Federal
State X X X
County X X X X
Medicaid
Grants/foundation X
Private donations
Client fees X
Estate recovery X X
Other
All the programs were empowered to make decisions about people’s personal
and financial affairs. All the programs had the following roles: monitoring the
delivery of services, arranging for the delivery of services, and advocating for
services. The Cook County Office of the Public Guardian (Illinois) also had respon-
sibility for directly providing some services. In their role as surrogate decision
maker, programs also serve as representative payees, personal representatives of
decedents’ estates, private guardian, and providers of supported decision making.
TABLE 5. other surrogate decision and decision support functions
program pima county los angeles delaware (state florida (state cook
roles (az) county (ca) program) program) county (IL)
Representative
X X X
payee
Personal
representative
X
of decedents’
estates
Private
guardianship X
services
Supported
X X
decision making
63
Petitioning function. The Pima County Public Fiduciary, Arizona; Office

of the Public Guardian, Los Angeles County, California; and Cook County,
Office of the Public Guardian, Illinois Office of the Public Guardian programs
petition for adjudication of legal incapacity. These programs also petition for
appointment of themselves as guardian.
For fiscal year 2017, Table 6 shows the cumulative total of public guardian
clients served by each program.
TABLE 6. total number of people served in fiscal year 2017

370 3,300 270 3,200 700
We asked the programs to provide for us, for fiscal year 2017, the approxi-
mate number of people served in the following age groups.
TABLE 7. total number of people served in fiscal year 2017 by age group
age groups pima county los angeles delaware (state florida (state cook
People 65+ 50% (185) Don’t know 45% (122) 50% (1600) 66% (462)
People 18-64 50% (185) 39% (107) 50% (1600) 33% (231)
People under 23 conservatorships

age 18 only
We also asked the programs to provide staff-to-client ratios, which ranged

from 1:30 to 1:80 (Table 8). Teaster et al. (2010) recommended a staff-to-client
ratio of 1:20.
TABLE 8. staff to client ratios

Staff to protected
1:30 1:80 1:60 1:40 1:40
person ratio
64
For fiscal year 2017, we asked programs to describe the primary residence
clients (Table 9). Residences varied widely across the programs.
TABLE 9. primary residence of the people under guardianship
primary pima county los angeles delaware (state florida (state cook
residence (az) county (ca) program) program) county (IL)
Own home or
X X X
apartment
Assisted living X X X
Nursing home X X X
Mental health
X X
facility
Group home X X X
Acute hospital X X X
Jail X X X
Missing or
whereabouts X
unknown
Other X
Restoration of rights. For fiscal year 2017, one person subject to guardian-
ship was restored to partial legal capacity in Delaware, and 10 people were
restored to full legal capacity in Cook County, Illinois, which has a significant
population of younger clients.
We asked the guardian programs to provide examples of cases that were

successful and cases that were challenging. We also asked about strengths
and challenges faced by the programs. Their responses are below.
Examples of successful cases

Pima County Public Fiduciary (Arizona). “Remarkably, even the worst cases
have successful components. I attribute this to our thorough intake process,
65
which includes a weekly triage of new referrals, current investigations, and

ongoing challenges.”
Office of the Public Guardian Los Angeles County (California). “Client

within the one year of a mental health conservatorship was able to move from
acute inpatient to a long-term locked special-treatment center and then to
a board-and-care setting. Client has an important and healthy relationship,
which led to a proposal for marriage. The fiancé was named as conservator to
ensure ongoing treatment compliance.”
Office of the Public Guardian (Delaware). “Contacted by hospital to act as

guardian for an elderly lady with advanced dementia whose son was attempt-
ing to retitle her home in his name and transfer all her funds to himself.
Office of the Public Guardian (OPG) prevented the retitling of the home and
prevented the wayward son from taking possession after a review of whether
or not she was able to return home with community and family supports.
After determining there was not a safe way for client to remain in home, the
home was sold and client was placed safely in a facility. OPG prevented finan-
cial exploitation and found a safe placement for client. Her wayward son was
keeping her in the home in order to collect her income and was not providing
appropriate care, resulting in multiple hospitalizations and near death.”
Cook County Office of the Public Guardian (Illinois). “Many successes.

Some examples include: 1. We had someone with a once-thriving, then-dilap-
idated bar and restaurant in the Wrigley Field neighborhood. We rehabbed
the bar and restaurant, had the food and liquor licenses reinstated, obtained
an excellent tenant, and then sold the bar/restaurant for a tidy sum for the
person under our guardianship. 2. Every restoration is a successful case.
3. Every individual we are able to assist in exercising the right to vote is a
success. 4. We believe our financial recovery program to be the largest of
its kind in the country. We have recovered more than $50 million over the
last 10 years for the people we serve. 5. Last year we took a person under our
guardianship, a life-long Cubs fan, to the World Series! Seeing the Cubs in
the World Series was something she dreamed of doing her entire life. Tickets
were very expensive, and she needed a companion, but she had adequate
resources so we were able to achieve this.”
66
Examples of challenging cases

Pima County Public Fiduciary (Arizona). “Appointed as a successor guard-
ian for an adult male whose primary issue is noncompliance with services
and dialysis treatments. He was moved to our county from another jurisdic-
tion secondary to lack of services available in that area. He continues to be
noncompliant and frequently ends up in the hospital. He has only recently
been found eligible for long-term care benefits, but placement continues to be
an issue secondary to his behaviors.”
Office of the Public Guardian (PG), Los Angeles County (California).

“Older adult living in a condominium owned jointly with brother (but brother
not living in the condo) and condo is in a senior complex. Conservatee has
longstanding relationships with “kids” in the neighborhood, but unfortu-
nately, these individuals are all in gangs. They terrorize the neighbors of
the senior complex and take advantage of the older adult. They have “moved
into” the condo and use it for prostitution and drug use. Law enforcement
unable to stop the criminal activity because conservatee keeps bringing the
gang members and others back into his home. Moved conservatee, but gangs
managed to find him, and they broke into the condo that PG had re-keyed and
secured. Court has not authorized a secure placement, so every placement
PG arranges, he continues to leave, or the gang finds him to bring him back
home.”
Office of the Public Guardian (OPG) (Delaware). “A client with mental

health issues and dementia was unable to remain in her home with supports.
OPG placed her, as she wished, in an assisted living while trying to private pay
for the required amount of time and transition to Medicaid. Client is really
only happy at her home in the community, but she was having delusions and
repeatedly calling the police and other emergency responders. She became
depressed in the assisted living facility and began acting out. The assisted
living facility became unhappy with her being there and attempted to force
her eviction by insisting on 1:1 supervision, exhausting her funds, sending
her to an acute mental health care placement, and then refusing to accept her
back.
67
OPG attempted to find a better placement by working with departments of

aging and mental health. Unfortunately, state agencies serving these popu-
lations do not combine care for physical and mental health issues, forcing a
determination of the primary issue for placement at the expense of the other.
Treatment for paranoid schizophrenia at the expense of treatment of phys-
ical disabilities. Client is currently at a long-term acute mental health care
facility because the state refused to admit her to a long-term care facility,
and she had no private options for that service. OPG thinks it might be in her
best interest to accept primary placement based on treatment of her mental
health. Mental health issues are the largest obstacle to community placement,
which is preferred.”
Cook County Office of the Public Guardian (Illinois). “1. The bar/restau-
rant in Wrigleyville discussed earlier. 2. We have many challenging hoarding
cases including cases with severe environmental hazards, such as mold and
chemical contaminants. 3. Some of our financial exploitation recovery cases
are very complex, challenging, and resource intensive, especially those with
financial institutions as defendants. 4. We have people going through difficult
divorces, which are resource intensive cases.”
Strengths of the programs

Pima County Public Fiduciary (Arizona). “Smaller city where most of our
wards and protected persons reside in the metropolitan area rather than
in rural areas. All Guardian/Estate Administrators are currently licensed.
Arizona requires licensure for nonfamilial appointments.”
Cook County Office of the Public Guardian (Illinois). “1. Our outstanding,
caring, compassionate, smart, hardworking, passionate, tenacious interdis-
ciplinary staff. 2. Our financial recovery program. 3. Our home care program.
4. Our sophisticated asset management and collection practice. 5. We imple-
mented one of the first digital asset-collection programs. 6. Our access to top
consults in virtually all professions due to our location in Chicago.”
Office of the Public Guardian (Delaware). “OPG has excellent case manag-
ers and focuses on providing consents that reflect what the client wants for
themselves and will advocate strongly for the clients’ desires, despite being
guardian.”
68
Office of the Public Guardian, Los Angeles County (California).

“Flexibility and resilience. Staff willingness to do whatever it takes to meet
the needs of the conservatee.”
Challenges that programs face

Pima County Public Fiduciary (Arizona). “Public benefits are increasingly
hard to obtain. Mental health issues and services continue to be an issue.
Increasing pressure from county, state, mental health, and hospital provid-
ers to petition on cases that do not meet criteria and fail to have realistic
outcomes. In the past seven years, staff reduction of 25 percent.
We are continually challenged by the misunderstanding of what our

program can do and what is simply impossible due to the lack of community
funding to safeguard vulnerable adults and provide for post-acute care, as
well as on-going custodial supervision and care.”
Cook County Office of the Public Guardian (Illinois). “By far, our biggest
challenge is resources. Our resources have been going down every year while
our caseloads, and the complexity of the cases, continue to increase. Last year,
Cook County had a $200 million deficit to fill, and next year, it is expected to
be another $80 million.”
Office of the Public Guardian (Delaware). “Funding. Our resources are

inadequate to meet the needs of guardianship across the state. Second,
our Judicial Branch considers us an outside program and does not actively
engage, without us, to make needed improvements to guardianship process-
es, such as statutorily requiring less-restrictive alternatives being exhausted
or only imposing limited guardianship. To be fair, the court has edged toward
these things but not embraced any reform efforts, which are desperately
needed to meet the needs of citizens and health care providers.
I think we are making progress in Delaware, but I think there is work

remaining, and I am hopeful we can find way (more ways) to bring people to
the table and to educate the public. It is difficult without resources.”
Office of the Public Guardian, Los Angeles County (California). “Program

is considered an entry-level position and is not appropriately classified
and compensated, so we are unable to retain employees. There have been
69
significant vacancies and turnovers which impacts service delivery and abili-
ty to meet legal and fiduciary mandates.”
Section summary
While the mix of information from county and state programs around the
country are not representative of all programs, information from each paints
a picture of public guardianship that is illuminating in its own right and
instructive for New York as it contemplates the replication of TGP and the
expansion of public guardianship programs across the state.
Recommendations
• Array of funding. New York programs must have adequate funding
from a stable set of funding sources. Funding derived from an array
of sources, including state funds, county funds, grants/foundations,
client fees, and estate recovery. Only Delaware had one funding
source.
• Scope of authority. New York programs should have authority to

make decisions about financial and personal affairs if the court order
has such a scope of authority. All the programs make decisions about
people’s personal and financial affairs.
• Advocate, arrange, monitor. New York programs should advocate

for, arrange, and monitor service delivery to the people served by the
program. Public guardian programs advocated for, arranged, and
monitored services. The Cook County Office of the Public Guardian
(Illinois) also had responsibility for directly providing some services.
• Representative payee and supported decision making. New York

programs should serve as representative payees and providers of
supported decisions. Programs serve as representative payees,
personal representatives of decedents’ estates, private guardians, and
providers of supported decision making.
70
• Live at home. New York programs should work to keep people in their
own homes as much as possible. Primary residences of people under
• 1:20 staff-to-person ratio. New York programs should comport to

a 1:20 staff-to-person ratio. Staff-to-protected-person ratios ranged
from 1:30 to 1:80. In the most recent national study of public guard-
ianship, Teaster et al. (2010) recommended a staff-to-person ratio of
1:20.
Program strengths included dedicated staff members, financial manage-

ment programs, licensure of guardians, an asset recovery program, and
attention to the needs and wishes of the people under guardianship.
Program challenges included difficulties obtaining public benefits, lack

of mental health services, staff reductions in the face of a rising population
of persons needing guardianship, confusion concerning the role of a public
guardian, insufficient resources, and high staff turnover due to inadequate
compensation of staff members.
71
Section 7: The TGP

Model—Staff and
Stakeholders’ Assessment
of Effectiveness and
Replicability
An important component of this project was the external assessment of TGP.
For this component of our report, we used a two-pronged evaluation approach
using interviews conducted by telephone. The project investigators Teaster
and Wood interviewed staff members at TGP either one-on-one or as a depart-
ment. We referenced the organizational chart (Appendix A) and interviewed
the following staff members/departments (see Table 2 above). In addition
to interviewing TGP staff members, we interviewed stakeholders identified
as working with the program as suggested by TGP as well as stakeholders
from the Working Interdisciplinary Network of Guardianship Stakeholders
(WINGS) group in New York (see Table 2 above).
Interviews were pre-arranged and approximately one hour in duration.

Questions were tailored to the expertise of the person/department. Questions
included position and time in position, experience with public guardianship,
funding and funding sources, administrative structure (e.g., costs and cost
savings, challenges), functions of the department or program (e.g., protocols,
staffing, community education); characteristics of the clients served (e.g.,
client visits, decision making and supported decision making, clients in facil-
ities, diversity, search for other appropriate guardians, search for less-restric-
tive options, restoration); and monitoring, experience, and assessment of TGP.
After presenting an overview of TGP, we discuss findings relating to its

administrative structure, least restrictive alternative principle, program
functioning, outreach, staff reflections on TGP’s reputation, staff perspectives
on challenges and opportunities, project replicability, TGP’s strengths, TGP’s
weaknesses, threats to TGP, section summary, and recommendations.
72
Description of The Guardianship

Project
TGP is a demonstration project of the Vera Institute of Justice (Vera)
begun in April 2005 with support from the New York State Office of Court
Administration (OCA) and The Fan Fox and Leslie R. Samuels Foundation
(Samuels). TGP serves as court-appointed agency guardian to a vulnerable,
largely indigent population of persons with disabilities and older people who
may lack family or other supports that enable them to live independently as
possible. In launching TGP, Vera, OCA, and Samuels sought to cast a spotlight
on a missing element of the social safety net, to provide an approach that
humanely addressed critical needs for these people, and allowed key institu-
tions to operate and collaborate more effectively on their behalf. In addition
to providing high quality direct services, TGP actively works to further guard-
ianship policy in New York State by crafting model policies and procedures,
exploring expansion or replication of its model statewide, assessing the
model’s cost effectiveness, and participating in reform discussions with other
stakeholders in New York and nationwide. The Vera Guardianship Project is
the last Vera demonstration project and, at its inception, was anticipated to
become self-sustaining within five to eight years.
TGP sought to cast a spotlight on a missing
element of the social safety net, to provide an
approach that humanely addressed critical
needs for people, and allowed key institutions
to operate and collaborate more effectively.
Vera, OCA, and Samuels originally planned to have TGP clients at all levels
of income and assets, and to fund the program appreciably with fees from the
73
one-third of clients who were expected to have significant income and assets.
However, TGP ended up with appointments of mostly indigent clients and a
relatively low percentage of clients with the ability to pay fees. This, therefore,
necessitated an important shift in TGP’s business model and greater reliance
on government contracts and foundation support. (See Budget section below
for more detail on TGP’s funding sources.)
TGP currently provides services in Brooklyn, Manhattan, Queens, and the

Bronx and accepts cases regardless of the client’s economic status. TGP’s
services are largely for very complex cases; the program offers a holistic
guardianship services model. TGP’s model involves the coordination of
services through a multidisciplinary workforce of staff attorneys, social work-
ers, finance and property managers, and outside experts working together
to address the complex legal, health, case management, and property issues
its clients face. When appropriate, TGP partners with investment advisors,
skilled volunteers, and pro bono counsel to address specific issues required to
maintain clients in the least restrictive environment possible.
TGP receives its referrals directly from the appointing courts and is typi-
cally called upon to serve in cases where there are limited resources and the
complexities of the case put the incapacitated person at risk of being unnec-
essarily institutionalized in an overly restrictive setting. Some of the common
presenting issues include difficulty securing adequate home care, need for
effective real property management, instability caused by severe mental
illness, elder abuse and exploitation, and adversarial landlord tenant issues
arising from client behaviors such as extreme hoarding.
Client census
In calendar year 2017, TGP served a total of 190 clients. TGP clients were 70
percent female, of whom 17 percent were 60 years or younger, 41 percent
were 61 to 80 years, 27 percent were 81 to 90 years, and 15 percent were 91
or older.5 TGP serves an ethnically diverse population: 52 percent white/
Caucasian, 27 percent black/African American; 15 percent Hispanic; 3 percent
Asian; and 3 percent other/unknown. Clients’ living arrangements are such
that 60 percent resided in their homes or communities, 37 percent resided
in a nursing home, and 3 percent were hospitalized. Over three-fourths (83
74
percent) lived below the New York City median annual income ($66,800),
42 percent lived at or below the poverty threshold ($12,060), and 87 percent
had active Medicaid.6 In addition to serving as guardian, TGP serves as Social
Security Administration representative payee for 98 percent of its clients.
Administrative structure
TGP staff visit clients at least once a month, even though the law mandates
only four visits per year, in order to prevent or proactively address challenging
issues that its clients face (e.g., dementia, serious medical problems, evic-
tion, elder abuse, and placement in institutional settings against their will).
An essential component of the work of TGP is accepting cases where a client
is languishing needlessly in a hospital or nursing home because no one will
take on the challenges of transitioning him or her back to their homes or to
a less-restrictive setting with proper oversight. TGP recognizes that keeping
as many individuals as possible in the community can save Medicaid dollars.
For example, a 2015 cost-benefit analysis shows that TGP was able to save
over $3.1 million in Medicaid dollars (the majority of which was from nursing
home avoidance for clients), which improved the quality of life for clients and
recognizes and respects each person’s autonomy and dignity (TGP, January
2018). Incorporated into TGP case standards is language mirroring that of the
National Guardianship Association, including that the program is client-cen-
tered and maximizes autonomy.
A unique aspect of the program is that TGP is able to access funding streams
beyond fees that allow the agency to maintain a low client-to-staff ratio allow-
ing the staff to spend more time on individual cases, identify and take actions
on what is best for client, and not have to factor in the number of other clients
waiting. In addition, but difficult to quantify, is the TGP ethos, which is a
unique culture dedicated to this particular type of work. TGP receives a subset
of cases from the court that are very difficult cases, cases that need special
5 Demographic information is for the 151 clients for whom TGP was actively serving as guardian on
June 30, 2017.
6 New York City and federal income statistics and thresholds are for 2017.
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people brought in to handle complex and sensitive issues. It is critical to select

people who are a good fit for the program, because their acumen leads to good
outcomes for clients, which is something that sets TGP apart.
An essential component of the work of TGP is
accepting cases where a client is languishing
needlessly in a hospital or nursing home
because no one will take on the challenges of
transitioning him or her back to their homes
or to a less-restrictive setting.
Budget. The annual TGP budget is growing: it was over $1.8 million in
fiscal year (FY) 2016, almost $2.3 million in FY 2017, and projected to be $2.6
million in FY 2018. Seventy-five percent of the $2.6 million is from the Office
of Court Administration contract mentioned earlier. In addition, 5 percent of
the budget is from a second state contract, 10 percent from a city contract, 5
percent from foundation grants, and it is estimated that 5 percent will come
from court fees and Medicaid exempt payments. The court fees are gener-
ally calculated as a percentage of each financial transaction and requested
at the time of filing of the annual or final account, are paid for with client
assets upon approval by the court, and are awarded and paid often years
after the services are rendered. The FY 2018 budget amount is therefore
mainly income received in FY 2018 for services rendered in prior years, the
main exception being the monthly Medicaid exempt payments. The Medicaid
exempt payments (i.e., NAMI), as mentioned earlier, are $450–$500 per month
and subtracted from what the client owes Medicaid to be paid to the guardian
contemporaneously with the rendering of services. Currently, TGP collects
about $55,000 a year in NAMI fees from approximately 10 clients on Medicaid
living in nursing homes.
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Staffing model. TGP has an executive director to whom all of TGP’s senior
management staff directly report. There are four departments (legal, case
management, finance, and development/communications) and two special-
ties (property management and benefits coordination). The Legal Department
consists of a director, a deputy director and two staff attorneys. The Case
Management department consists of a director, eight case managers, and a
benefits coordinator. The Finance Department consists of a director and six
finance associates. A real property manager also directly reports to the exec-
utive director. The Development/Communication Department consists solely
of a director of development/communication. TGP also has an administrative
coordinator who oversees two part-time employees who provide clerical and
receptionist support, both of whom are paid by the New York City Department
for the Aging.
Also assisting TGP in its work are various interns, volunteers, fellows, and
temporary staff members who work with the program at any given time.
Human resources and information technology functions are performed
by the central office at the Vera Institute and the New York Unified Court
System, respectively.
Staffing ratios. TGP attempts to keep case management to client ratios at

about 1:25; for attorneys, the ratio is 1:50; for finance associates, it is 1:29;
for benefits coordination, it’s 1:200; and for property management, it is
about 1:20. The total staff providing direct services to client ratio is 1:9. As
described, there are several different ratios, depending on the department
as well as the longevity of the client; TGP values consistency and attempts to
have the same staff members or teams working with the clients over time.
Training. Every new staff member takes Article 81 training provided by

the Guardianship Assistance Network. Legal training is also provided (Part
36, Fiduciary Training). TGP is working to set up more cross-training, such as
with APS on elder abuse.
Volunteers. As early as 2005, the program began using volunteers. The

volunteers are a supplement to case management and provide clients with
increased socialization. The coordinator matches people who are peers with
each other. Examples of volunteers are a retired police detective who was
77
connected with a retired corrections officer. The program has matched about
15 volunteers with clients.
Attrition. TGP is limited as to the salaries it can pay. If staff members move
on, then TGP replaces them by recruiting qualified candidates. TGP conducts
rigorous background checks on its prospective employees. Turnover seems
to come in waves. Case managers are the cornerstone of services, which are
stable when people have remained for two or more years. Turnover, according
to one former executive director, is no higher than other legal services or
social work positions. The work is difficult, and so people leave due to burnout
and licensing requirements. John Holt is the longest standing member of TGP,
having been with the organization as a full time-staff member since 2010 and
having worked as a legal intern since 2009. There has been significant turn-
over of executive directors, with four permanent and three interim directors
from 2005 to 2018.
TGP’s least restrictive alternative

principle
TGP uses a least restrictive alternative model that is a driving force of every-
thing the organization does. First, although guardianship powers are crafted
by the courts, TGP chooses how to interpret and use its powers as narrowly
as possible while also keeping the client safe. Second, TGP works to employ
robust and inventive strategies for maintaining its clients in the community,
from pulling together a myriad of community supports to create a sustain-
able and safe care plan to accessing the equity in real property to provide for a
client’s cost of living. When a person is unable to be safely maintained in the
community due to a lack of financial resources, appropriate place of abode, or
because their care needs are too high, TGP continues to work to ensure clients
are in the least restrictive setting, for example finding a facility in a familiar
neighborhood, with staff who speak a client’s primary language and access to
religious services and culturally familiar foods.
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TGP uses a least restrictive alternative model
that is a driving force of everything the
organization does.
TGP fosters supported decision making in a variety of ways. Where clients

are able to execute advance directives, TGP assists them in preparing these
documents and making sure their wishes are understood and articulated
accurately. Even when the ability to sign formal documents may be lacking,
TGP strives to understand and incorporate the wishes of a client into its
day-to-day decision making. These efforts help empower the client and scale
back unnecessary power over them so that clients are given autonomy to the
extent possible. Even with this approach, the complete restoration of rights
and termination of guardianship remains relatively rare because of the types
of clients for whom TGP is a guardian (e.g., persons with progressive diseases,
traumatic brain injury, or development disabilities) (Leland, 2018).
Program functioning
Collaboration amongst TGP’s teams is at the heart of program functioning
because of the organizational structure and model. Once TGP is appointed
the guardian, the program determines the extent to which the client can
participate in decision making. Case managers do an initial assessment and
get a sense of the clients’ needs and wants; finance investigates what income,
expenses, and assets they have; the property manager assess their home,
if applicable; and then staff meet as a team (i.e., representatives from the
departments of case management, legal, and finance department) to develop
a plan with which they are constantly balancing autonomy versus safety.
During the team meetings, they determine if there are family or friends that
are or can be supports for the client, though unfortunately, that is not possi-
ble for about half of TGP clients, as they are persons aging alone. In addition
to the client-centered approach that strives to maximize client autonomy in
decision making, TGP must operate within in the boundaries prescribed by
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the appointing court in the order and judgment and the statutory framework
of Article 81. Within the authority granted by the courts, daily decisions
usually flow from the case managers because they have the most contact with
the clients and often need to make decisions quickly. When complicated situ-
ations arise—such as ones that involve financial decisions, moving a client,
repairing or selling a property, protecting a client from abuse, addressing
uncleanliness and hoarding, preventing eviction and/or homelessness, etc.—
the client’s entire team is engaged. If further input is needed regarding a
specific client, the team is enlarged to include the executive director so that a
strategy can be put in place. Some specific cases, such as end-of-life decisions,
or using the Family Healthcare Decisions Act, are those for which the director
of TGP makes the final call. Some decisions, for example permanent place-
ment in a nursing facility or sale of real property, require court oversight and
judicial approval.
Quality assurance. TGP accomplishes quality assurance in a number of

ways. There is general oversight by each department, including a number of
cross checks. Formally, there are two documents—a best-practices manual,
which is expression of what the team should strive to do, and an operating
manual, which details procedures for each department—legal, finance, and
case management. For example, when TGP gets a new client, the program
has developed a procedure for marshaling a client’s assets so that they can
discover the clients’ estate to the greatest extent possible. There is also direct
oversight from the appointed court examiners, generally through the review
of submitted reports, and the appointing court. Also, the program refers to
guidelines promulgated by the National Guardianship Association.
For each client, TGP keeps case notes, including notes by case managers and
notes by the legal team. For the most part, the finance department does not
use the case notes function of the database, but finance keeps a book balance
in the same database. The goal is for the tracking system to be structured so
that all data is in one place. Currently, there is a central database, but it does
not have fields for everything that needs to be tracked. Each department
therefore also maintains its own Excel spreadsheets. TGP is currently in the
process of hiring an expert to upgrade its database, consolidating all track-
ing into the central system and creating canned reports for easier analysis
of data. Also, the current system includes a shared calendar documenting
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reminders and activities so that the location of coworkers is retrievable at

any given moment. TGP must also prepare reports to its funders, though a
staff remarked that some information is not shared as much as it should be.
Relatedly, one staff member acknowledged that throughout the year, the
program examines case records, but recommended that staff go deeper via
more routinized and sustained effort of by the whole staff.
Preparation of annual reports. Staff members spend focused time prepar-

ing a rigorous annual report as required by Article 81, an important check on
the work TGP does for its clients. Each finance staff member is assigned 25 to
30 clients. The staff member completes the inventory, initial report, annual
reports, and final report. On May 31 of each year, all annual reports are due
for activities of the prior year. The reports account for all of the financial
activities undertaken on behalf of the client and must be reviewed by a court
examiner prior to approval by the court. Finance staff works the entire year
preparing for the submission of annual reports by keeping timely records
of financial activities, aggregating backup documentation, and preparing a
schedule of accountings to keep on track for the 160-plus accountings that
will have to be prepared, reviewed, and filed this year. The finance team has
worked over the past several years to increase the automation of the reports
from the existing data in its accounting system and will continue to stream-
line that process to improve efficiency and accuracy of reporting.
The activities recorded and tracked by the finance team are also used in
real time throughout the year by all teams to inform decision making for the
clients. Every transaction is recorded, back up documentation is scanned, and
bank statements are monitored and reconciled to the system. The finance
team is also responsible for submitting reports to outside entities, such as the
Social Security Administration, for clients for whom the program serves as
representative payee, which is about 98 percent of TGP clients.
Supported decision making. TGP makes a concerted attempt to support

the decisions for clients who are able to make them (e.g., clothes, furniture,
various items that they might need, advance directives, end-of-life decisions).
Respecting and attending to clients’ wishes is a TGP priority. In many instanc-
es where the court grants TGP broad powers, the organization has chosen to
narrowly exercise them to afford clients greater agency.
81
TGP also works to establish and maintain relationships with clients in care
facilities and visits them on a monthly basis just as the organization does
for those in living in the community. TGP works with clients to make sure to
meet client needs and respect client wishes. To do this, TGP staff members
work closely with facility staff, including nurses. TGP faithfully attends care-
plan meetings to ensure that all aspects of clients’ lives are monitored and
addressed.
Cultural diversity and sensitivity. TGP has diverse staff members, includ-
ing Spanish-speaking staff to help clients with language needs and to reach
out to families. Staff are mostly women and one-quarter white. Staff also
include people who are LGBTQ. Staff try to account for religious identities of
clients and try to keep cultural diversity and sensitivity in the front of their
minds, including their dietary needs. Staff acknowledged that sensitivity and
communication needs filters into health care and end-of-life needs and pref-
erences. Said one staff member, respect for each individual “creates a better
situation for everyone when they respect their wishes, and it makes things
less antagonistic.”
We were not made aware of any cultural diversity training. One staff
member observed that TGP has had non-English speaking Asian clients and
has experienced challenges in serving them due to language barriers, despite
attempts to seek outside translation services.
End-of-life decision making. For end-of-life decisions, TGP is guided by the

New York State’s Family Health Care Decisions Act, which, among its other
provisions, allows guardians with health care decision making authority
granted by the court to make end-of-life decisions and provides a patient-cen-
tered framework for those decisions, particularly if a client is in a hospital
setting. The staff tries early on to build a rapport with its clients because, as
one staff member stated, it facilities an understanding of a client’s wishes,
which can be critically important when the time comes to make a decision as
important as those made under the Family Health Care Decisions Act. Absent
the known wishes of a client, and in order to make the best decisions possible
in end-of-life situations, TGP staff reaches out to family and friends to find
out what clients have verbalized or to speak with persons who might be able
to provide information that could help TGP understand a person’s personal
82
beliefs, including reaching out to clients’ religious leaders if and when

possible.
For end-of-life decisions,
TGP is guided by the New York State’s
Family Health Care Decisions Act.
Responsive to its duties under Article 81, TGP also prioritizes the establish-
ment of a pre-need funeral contract as early in the guardianship as possible,
to help ensure there are adequate resources to fund it and to maximize the
likelihood that clients are able to participate in the planning. Upon the death
of a client, TGP case managers make funeral arrangements and, as required
by Article 81, inform relevant people, such as family members. Staff make
sure that the client is buried with dignity, informed by work done before
death, including a pre-need funeral contract and, when possible, discussion
about wishes.
TGP has protocols concerning securing property and other assets after
death. TGP is usually granted authority to pay for outstanding expenses (e.g.,
charge accounts or electric bills) post-death if said authority existed and the
bills accrued before death. TGP is responsible for filing final accounting to the
court and distributing funds to the estate. TGP involves the public administra-
tor as quickly as possible, as the majority of its clients do not have a last will
and testament or family members available to seek letters of administration.
Outreach
TGP maintains relationships with legal services, APS, or other entities as
needed, reaching out for additional expertise as needed in order to best
serve its clients. In the beginning of the program, TGP assembled an advisory
committee from New York as well as around the country to guide its program-
matic structure, data collection, and outreach. In addition to helping shape
83
TGP’s model and services, the advisory committee introduced TGP to key
players and helped TGP become known nationally.
Acknowledging that a general lack of understanding about guardianship

exists, TGP is actively involved in community engagement and works with
the courts, helps lead education efforts to educate families, and attends city
council meetings (TGP attends council meetings for the purposes of lobbying).
TGP also reaches out to AARP and APS. TGP initiated the Guardian Assistance
Network (GAN), which was later moved to the Office of Court Administration,
which continues to provide training to lay guardians. John Holt, a staff
member from TGP, is one of the presenters at GAN’s quarterly in-person
training, where there are typically 20–30 people in attendance. Mr. Holt
also developed an online version that may be accessed by guardians across
the state. During the year, there are also various panels and informational
sessions that TGP staff attend, as well as posting materials available on the
TGP website www.vera.org/guardianship and in the TGP newsletter. TGP was
featured in the New York Times (2008) and on NPR Marketplace focusing on
cost savings (2006–2007).
Staff reflections on TGP’s reputation

Staff members believe that TGP is well regarded in New York City and has
a good reputation with judges who are sending them cases that are more
difficult than most guardianship cases. Sending them these cases reflects
the judges’ belief that they can handle complex cases as well as abide by their
maximum caseloads. Said one case manager, “We have a good reputation,
in my opinion.” TGP is also a point of contact related to issues of public poli-
cy; TGP staff are involved in WINGS and the New York State Office of Court
Administration Guardianship Advisory Committee.
Staff perspectives on challenges and

opportunities
The TGP model has both challenges and opportunities. The Vera Institute
identifies gaps in the justice system and works with community partners to
design a programmatic response. TGP was formed in response to the number
84
of people in need of high quality guardianship services. Since inception,

the plan has been that, if successful and sustainable, TGP will eventually
spin off as a nonprofit or part of government. Though delayed, the goal
remains for the TGP model to become sustainable and independent from
the Vera Institute. Still a demonstration model, the Vera Institute launched
TGP because it saw that New York had a lack of guardians with full skill sets
to handle highly complex cases. Being part of Vera unlocks doors, such as
resources and access to data analysis. A challenge is that being a part of Vera
creates another layer of bureaucracy to navigate. Also, opportunities for
branding, strategic planning, and raising public awareness of guardianship
may also be missed due to Vera’s many other focus areas and priorities.
Opportunities for the program would be to increase funding and staff so

that the program can take on more cases and expand the model. Another
opportunity would be to examine case mix for the staff, reducing some for
case managers. Still another opportunity would be to conduct a deep and
annual review of clients’ cases.
There are often significant challenges in managing client finances. For

example, TGP staff pointed out that banks and financial firms often do not
understand the role and powers of a guardian, even after presentation of the
court order, and not infrequently, the front line staff at the financial institu-
tion are completely unfamiliar with the concept of guardianship as distinct
from other fiduciary appointments such as power of attorney. As a result,
the team does not get responses right away and is sometimes prevented from
exercising their duly granted authority. The finance team recommended that
the banks should adopt a model that works. Some banks have a guardianship
department and can respond promptly.
Examples of TGP cases

Teaster and Wood asked TGP for examples of cases that highlight some of the
complex situations that TGP is asked to remedy in order to make its clients
safe (physically, emotionally, and financially) and as independent as possible.
The examples below illustrate how TGP’s structure and guiding principles,
described above, combine to create successful case outcomes.
85
When asked about activities related to individual cases, one TGP staff
member observed, “TGP spends an enormous amount of time on these [client]
functions. There is no such thing as an average client.”
Case example 1. TGP was appointed as a guardian for a 79-year-old

bedbound client who was living with congestive heart failure in a basement
apartment in the brownstone that she owned. Her reverse mortgage was
in default and pending foreclosure because a previous guardian, her niece,
had taken the proceeds intended to make home repairs and pay the carrying
costs of the property and instead fled with the money. The client was left with
a reverse mortgage in default due to her inability to pay taxes, insurance
premiums, and utility arrears totaling thousands of dollars, and was unable
to repair a home with manifestly unsafe conditions—electric outlets dangling
from walls, unstable staircases, and water damage. The client wanted noth-
ing more than to remain in her home of 40 years, and TGP worked to settle
the foreclosure action with the mortgage company, set up payment plans
to “keep the lights on”, and began making repairs to keep her and the other
tenants safe. TGP also reported the niece’s fraud to the Kings County district
attorney and brought an action in guardianship court to retrieve the misap-
propriated funds. TGP staff worked on this case for dozens of hours, but
before justice could be done, the client unexpectedly died in her sleep. While
this was heartbreaking to everyone who had worked so hard for her, one very
important solace remained—the client was able to remain in her home until
the day she died.
86
Her reverse mortgage was in default and
pending foreclosure because a previous
guardian, her niece, had taken the proceeds
intended to make home repairs and pay the
carrying costs of the property and instead fled
with the money.
Case example 2. TGP became the guardian of a 94-year-old Holocaust survi-

vor living in a nursing home. The gentleman desperately wanted to return
home, but he was not able to make the needed care plan. TGP developed a
safe discharge plan with home care in place so that he could return home.
The client’s Holocaust reparation payments had lapsed, and TGP successfully
restored them and put in place a sustainable financial plan to ensure that
the man could remain home for as long as possible. When the client’s phys-
ical condition declined and increased home care services were denied, TGP
successfully appealed and secured the needed home care hours. TGP also
advocated with the man’s landlord to install a ramp outside his building so
that his caregivers and he could more easily access his community. TGP made
sure that the man had access to kosher meals, had special dinners delivered
for the holidays, and matched him with a friendly visitor who could spend
time with him in his home.
Case example 3. TGP became the guardian for an undocumented gentle-

man. A construction worker, he was hit by a car and taken to a local hospital
where he remained in a comatose state. The hospital wanted to discharge
him, as he had no source of insurance beyond the small portion of his care
paid by emergency Medicaid, but no long-term care facility would accept him.
The client’s family had attempted to obtain visas to visit him in the United
States but were denied. TGP met with consulate staff from the client’s home
country and discovered that it had a program designed to help repatriate
87
injured citizens and train their families to provide care. After weighing the
options, TGP felt that a return to the home country would be in the client’s
best interest, as it would allow him to be with his family. TGP negotiated with
the hospital to pay for the cost of having the client take a Medivac plane to his
home country and sought the requisite authority from the court to effectuate
the discharge. TGP was later notified that the client died, surrounded by his
mom and sister.
Case example 4. TGP became guardian for a woman with severe, untreated
paranoid schizophrenia. At the time of appointment, she was involved in an
eviction proceeding, was behaving erratically by calling hundreds of times
to complain about the condition of her apartment, and was barred from
interacting with members of her family by an order of protection issued
in a recently resolved criminal matter. TGP was able to resolve the eviction
proceeding, even negotiating a reduction of the rent owed due to issues with
the condition of the apartment. Unfortunately, the client’s mental illness
remained untreated, and in a delusional state, she violated the order of
protection, was arrested, and sent to Rikers Island. TGP advocated for her to
be placed in its psychiatric unit, where she would be better monitored and
protected, and she was able to secure funds to make her bail. When she was
released, she acted increasingly erratically until, fearing for her safety, TGP
successfully petitioned for her to be involuntarily admitted to a psychiatric
hospital. While she was hospitalized, TGP made arrangements for her dogs to
be boarded, worked with the hospital to put a sustainable care plan in place,
and worked with counsel to defend the new criminal charges that she was
facing. Upon her release from the hospital, TGP helped the client remain as
compliant as possible with her medication, therapies, and court mandated
probation. Working together with her criminal defense counsel, TGP reached
a plea agreement that avoided a felony conviction and the possibility of jail
time. Though much progress was made, the client continues to require active
intervention to prevent her from lapsing into behaviors that put her at risk of
institutionalization.
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TGP became the guardian for an
undocumented gentleman. A construction
worker, he was hit by a car and taken to a local
hospital where he remained in a comatose
state.
Case example 5. A person living in supportive housing with a diagnosis of

schizophrenia was able to live independently until the system broke down
for him, and he landed in a hospital. He had bed bugs, suffered a mental
breakdown, and was moved to a nursing home where he hurt his knee and
could not return to supportive housing. A TGP case manager helped him have
simple things he enjoyed, such as a honey bun. Still, the client’s health was
failing, and he went into renal failure. The doctors suggested that the client
would need to have a feeding tube inserted. Before that happened, the TGP
case manager brought him a honey bun, which he ate. Eventually, he was able
to eat oatmeal, and later, solid food. Although he is no longer living inde-
pendently, he is happier in the nursing home than when he was originally
admitted, knowing it is the best place for him to get the care he needs. The
case manager who intervened in this case remarked, “A little bit of attention
sometimes goes a long way.”
Case example 6. A client suffered a traumatic brain injury because of an

abusive husband. Though the woman presents well and is highly intelligent,
she has cognitive limitations because of the brain injury, five kinds of arthri-
tis, and pain management problems. She lives in the same apartment she had
shared with her husband before he was removed and an order of protection
put in place. She had been sleeping on the same mattress for 30 years. TGP
made it possible to purchase a new mattress that reduced her emotional and
physical pain.
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Case example 7. A client with developmental disabilities who was unhappy

residing in a group home was given an opportunity to assert his indepen-
dence in a private residence run by the New York State Office for People with
Developmental Disabilities (OPWDD). Unfortunately, the client did not do
well without the structure of a group home, and he allowed strangers to use
his new apartment for a variety of inappropriate purposes and engaged in
behavior that resulted in his arrest and incarceration. TGP worked with the
client and his counsel to ensure that he was kept in as safe an environment as
possible while he was in jail and brought about the best possible disposition
of his case. While he was incarcerated, the service provider who contracted
with OPWDD for his apartment and support services cancelled its services
and TGP attempted to work with OPWDD to arrange an appropriate residence
that he could enter upon release from jail. When the client’s criminal case
was resolved, an alternative residence had not been located. TGP staff worked
closely with jail staff to plan the man’s discharge to an appropriate shelter
to avoid street homelessness. Initially, the Department of Homeless Services
(DHS) attempted to deny him services, stating that because of his mental
health and developmental disabilities, he was inappropriate for the shelter
system and could not go through intake. TGP worked with a homeless advoca-
cy organization to reach staff higher in DHS’s organizational structure and,
eventually, helped him receive a bed in a shelter, thus preventing him from
being street homeless.
Stakeholders’ comments
Use of Medicaid funds. Mentioned above, the project investigators Teaster
and Wood interviewed 14 stakeholders, including judges, representatives
from New York State Mental Hygiene Legal Services, court examiners, and
other individuals who were presently or had recently worked with members
of TGP. Interviews of most stakeholder lasted about an hour. Participants
were asked if TGP used Medicaid funds appropriately and effectively.
Respondents all agreed that TGP did so. Said one respondent, “Absolutely.
[They are using funds appropriately] In keeping people out of nursing homes,
which is what Vera is doing. Money is very effectively spent. They are saving
the state money if they keep people in the community.”
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Performance. Stakeholders were asked for their impressions of TGP’s

performance, and most had a very favorable impression of the program. TGP
was regarded as responsive to questions, and their response rates to tele-
phone calls were regarded as better than other providers with the same client
case mix.
One stakeholder remarked, “Of all the community guardians in my inven-

tory, they are on top of things more than others and are much, much more
detailed in reporting and responses.” However, a stakeholder also remarked,
“Their initial reports are so incredibly detailed, almost overly detailed. They
even specified that the client preferred ‘Peter Pan’ peanut butter.” Another
stakeholder remarked that TGP did not mind serving as a temporary guardian
and saw this openness as a positive attribute.
Project replicability. Participants were asked if they would support a New

York public guardianship program based on the TGP model. Most were in
support of such a program. One person stressed to have the model located in a
place with the greatest need and recommended demonstrating what kind of
model proved to be the most cost effective. TGP was regarded as an outstand-
ing model program because of its focus on keeping people in the community.
Most stakeholders would support replication of the model if it were funded
properly. They acknowledged that TGP remains a model program. One respon-
dent observed, “The people who would save money using this model are the
feds, not the state.”
One respondent emphasized, “It was always a focus for TGP—maintaining

people in the community was a gold standard. The Vera Institute thought it
would be expensive and knew it was a high-end model. Staff at TGP thought
the judges would give them some high-fee cases, but there were two prob-
lems. One, it is hard to buck the system. For the private bar, guardianship was
a source of revenue, with the money being in petitioning. Secondly, if a judge
came to probate from the criminal court, he or she did not have ties to TGP.”
There was general agreement that the model of having a mix of cases that
include both poor people and people with assets would have worked if there
was a way to control the mix of cases, reliably predict fee amounts, and
collect payments in a timely fashion. Theoretically, TGP would have been
able to offset the cases that brought in nothing with fee-generating cases.
91
Unfortunately, the income generated from the cases with assets has not
been nearly enough to offset that no asset cases combined with the complex,
resource-intensive cases that TGP receives.
TGP discovered that its work produces not only greater autonomy related to
living in the home but also a cost savings from moving people out of nursing
homes and keeping them in the community with a level of care more suited
to their particular functional abilities. For example, a client who was indepen-
dent with most activities of daily living, but was prevented from returning
from a nursing home to an apartment due to the condition of the apartment,
was able to safely live in the community with a minimal amount of homecare
after the apartment conditions were improved. Home improvement services
are much more cost effective than incurring the expense of a nursing home
bed and would likely result in significant savings to Medicaid.
Other people interviewed thought the model would be replicable with the
caveat that the program should make sure that all alternatives to guardian-
ship were fully explored. As a stakeholder remarked, a number of people in
New York City could avoid guardianship if services were available before the
filing of a petition.
Finally, one stakeholder had this to say about the TGP model: “If you can
make it here, you can make it anywhere,” while another stakeholder said,
“Please create as many Veras [TGPs] as possible.”
Support for public guardianship in New York. People we interviewed were

also asked if they would support a geographically limited pilot public guard-
ianship program (any model) with public funds to be evaluated for replica-
tion. Most were supportive of public guardianship when used as a last resort
intervention. The New York WINGS group is especially hopeful regarding this
outcome.
92
TGP discovered that its work produces not
only greater autonomy related to living in the
home but also a cost savings from moving
people out of nursing homes and keeping
them in the community.
Strengths, weaknesses, challenges, and opportunities of the TGP model.

Stakeholders regarded that a major strength of TGP was that the staff were
experts in their area of guardianship. While many guardians have far-rang-
ing issues with which to deal, TGP tries through many approaches to keep
clients in their homes. Said one stakeholder, “TGP places an emphasis on
keeping people in the community. The holistic services they provide are great
for helping people and is critical. [Their approach] Makes a big difference
for their clients—one that other programs do not have for their clients.”
Similarly, another stakeholder had this to say, “Their team approach is what
distinguishes it. They can provide a full range of services for the individu-
als under guardianships. Their attorneys, social workers bring expertise on
behalf of the individual.” Many stakeholders regarded that TGP is in a catego-
ry of their own.
Stakeholders also pointed out a number of limitations of the program. One

was that TGP is limited in how many cases they can take. One judge requested
to “see if you can get us more [TGPs].” One stakeholder suspected that TGP is
overburdened and underfunded, though not due to any fault of its own. The
stakeholder observed that funding issues have probably stretched them due
to funding structure.
One stakeholder was unhappy with the way TGP marshaled assets. Most
guardians go to the bank, marshal assets, and open a guardianship account.
TGP used to keep all money in one account and track a running balance for all
clients. Thus, TGP could not show a bank statement with the exact amount of
93
money by client. This stakeholder thought that there should be one account
that is individual to a single person, thus limiting problems. Instead, TGP
marshaled funds together in all one big account. (Note, this scenario was true
three years ago but was changed. TGP now opens individual guardianship
accounts for each client and manages over 400 separate bank accounts.)
Stakeholders regarded that the major threat to TGP was inadequate funding
and large caseloads. One stakeholder remarked that, “there was a time when
they were behind on their reporting.” You want to be a model in all respects.
One stakeholder asked, “Would a scaled down version be less costly?”
Stakeholders, at the same time, believed that the TGP model “has gained
traction and that in New York City there is a growing acceptance of what
standards should be in terms of keeping people at home.” Opined one stake-
holder, “I am not sure that that this administration recognizes this, but you
can save dollars by supporting people in the community.”
Another stakeholder suggested that TGP should expand and be able to take
on more cases. To do so, TGP should continue to engage in policy discussions.
Finally, one stakeholder suggested developing a mediation project of some
kind: “Some new cases, such as self-petitions, or pro se petitions, which
are difficult and time consuming, could use mediation. If we could get TGP
involved and work out family guardians, that would be good.”
Section summary
The TGP model is supported both internally by the staff members and exter-
nally by stakeholders. TGP’s team approach is a holistic “one-stop shopping”
approach to the provision of guardianship services, and the low ratio of
guardian-to-protected person affords persons in need of services high-quality
guardianship. TGP is especially outstanding in its efforts to either keep people
living in community settings or to return people to community settings as
appropriate. TGP’s quality of guardianship service is not without costs, and
so the program was previously unable to attain a level of sustainability that
would enable it to spin off from the Vera Institute. TGP’s inability to spin off
from Vera is not due to its programmatic model, however, but rather due to
the need to find additional funding streams because the mix of high-fee and
94
low-fee/no-fee cases that TGP is appointed does not balance out to cover the
cost of providing the services.
Although the model is a promising one, it is a costly one, and stakeholders

raised this important point. While TGP is successful in a city with a concen-
tration of people, such as New York City, and is likely possible in other cities
across the country with sufficient population density, it would likely need to
be modified if it were replicated in more rural areas and should be piloted to
determine its feasibility, including requirements for technology, training,
oversight, and provision and partnership in order to access services.
Recommendations
• Increase ease of information access. TGP’s reports should be
combined and retrievable in one place; this is possible because
the accounting system is structured to have data all in one place.
Throughout the year, the program examines case records; however,
staff could go deeper via more routinized and sustained efforts by the
whole staff.
• Optimize mix of cases and caseloads. Case managers’ caseloads

should be reviewed regarding staff-to-client ratios as well as the mix
of cases given to each case manager.
• Improve funding model. The original funding model of cases with

estates and no-fee cases should be maximized so that TGP can have
greater sustainability.
• Increase funding. TGP should have more funding in order to take on

more cases.
• Continue outreach efforts. TGP should continue efforts at outreach

and involvement in policy discussions.
• Replicate the TGP model. The TGP model should be replicated and
evaluated. The evaluation should be a formative, process, and summa-
tive evaluation.
95
Section 8: Summary of
Recommendations
Who needs services
• Data. New York should continue and intensify its collection of basic
guardianship data to better inform estimates of unmet need and
strategies for meeting the need.
• Supportive services. New York should provide adequate funding for

home and community-based care and affordable housing for indigent
individuals at risk of, or subject to, guardianship—especially congre-
gate housing for older adults where people can age in the community
and easily access support services.
• Social work skills. New York should find ways to increase the number
of professionals with social work and nursing skills to act as guardians
for individuals with no family or friends to serve.
• Less-restrictive options. New York should provide judicial and legal

training on screening for less-restrictive options—including a range
of decision supports and supported decision making, the use of forms
that emphasize screening for such options, and tracking the use of
these options in avoiding unnecessary appointments.
• Restoration of rights. New York court procedures should ensure

access for petitions for modification or termination of guardianship
orders and restoration of rights when guardianship is not needed.
• Increased number of clerks. New York should provide funding for an

increased number of clerks to assist judges with the high volume and
complexity of guardianship cases.
• Increased number of guardians. New York should pursue multiple

approaches toward increasing the number of available and skilled
guardians to serve indigent individuals in need as a last resort after
96
less-restrictive options, including supported decision making, have

been examined.
Who serves as guardian for the

target population
• Funding for diversity of services. New York should provide addition-
al funding for a diverse pool of guardianship and decision support
services. Funding for such services should prioritize living in the
community as a primary goal. Funding should come from a variety of
sources, including fees excluded from the calculation of Medicaid “net
available monthly income” payment in nursing home cases.
• APS role in guardianship. New York should identify other approaches

for guardianship services instead of relying on APS through depart-
ments of social services to serve as guardian of last resort. This would
avoid an inherent conflict of services. Additionally, it could free up
APS resources for its other important protective roles, including a
critical role in investigating suspected guardianship abuse.
• Community guardian programs. New York City and/or state should

provide additional funding to community guardianship programs to
meet the pressing needs, ensure quality services, and seek less-restric-
tive options, with consideration to a reasonable staff-to-client ratio (as
recommended by the national public guardianship study by Teaster et
al., 2010).
• Guardianship for nursing home residents. While recognizing that

not all nursing home residents need guardians, at the same time, New
York should address the current gap that occurs when community
guardian programs must relinquish cases in which an individual
requires nursing home care. Guardians can be needed advocates
for quality of care. Extending the role of the community guardian
programs to selected nursing home cases would prevent unnecessary
burden on the court in finding another guardian and ensure conti-
nuity in the guardian’s care and decision making—thus allowing the
guardian to best identify and support individual wishes and needs.
97
• Incentives for serving in low-fee/no-fee cases. New York should

provide incentives such as free continuing education courses for
professionals on the Part 36 list, provide incentives for social workers
and nurses to agree to serve as guardians in low-fee/no-fee cases, and
encourage their appointment by judges in appropriate cases where
there is no less-restrictive option.
• Evaluation and expansion of pilot projects. New York should contin-

ue the two 2018–2019 pilot programs to allow for additional time to
measure effectiveness. Based on experience of the initial pilot demon-
stration projects, New York should fund additional projects, building
in a formative evaluation process and moving toward addressing the
unmet need for guardianship and less-restrictive decisional options,
including supported decision making, throughout the state.
New York court processes—barriers

to effective service
• Develop uniform documents. New York courts should create uniform
documents for the petition, order to show cause, initial report, and
annual report.
• Facilitate filing of reports to enhance monitoring. New York courts

should generate reminders of filing deadlines, provide reporting
instructions and samples, and offer electronic filing options. There
is also a need to educate banks about guardian authority to avoid
unneeded delays.
• Expedite guardian commission process. New York courts should

educate lay guardians about the need to get a commission and consid-
er ways to combine or streamline the order/commission process.
• Employ additional clerks. New York should provide funding for the
addition of administrative staff trained to move the guardianship
process forward in a timely way.
• Consider complaint resolution approaches. Explore complaint

procedures from other states so that problems can readily be brought
98
to the attention of courts, and consider dispute resolution options

such as mediation and ombudsman functions.
National public guardianship

programs
• Array of funding. New York programs must have adequate funding
from a stable set of funding sources. Funding derived from an array
of sources, including state funds, county funds, grants/foundations,
client fees, and estate recovery. Only Delaware had one funding
source.
• Scope of authority. New York programs should have authority to

make decisions about financial and personal affairs if the court order
has such a scope of authority. All the programs make decisions about
people’s personal and financial affairs.
• Advocate, arrange, monitor. New York programs should advocate

for, arrange, and monitor service delivery to the people served by the
program. Public guardian programs advocated for, arranged, and
monitored services. The Cook County Office of the Public Guardian
(Illinois) also had responsibility for directly providing some services.
• Representative payee and supported decision making. New York

programs should serve as representative payees and provide support-
ed decisions. Programs serve as representative payees, personal repre-
sentatives of decedents’ estates, private guardians, and providers of
supported decision making.
• Live at home. New York programs should work to keep people in their
own homes as much as possible. Primary residences of people under
• 1:20 staff-to-person ratio. New York programs should comport to

a 1:20 staff-to-person ratio. Staff-to-protected-person ratios ranged
from 1:30 to 1:80. In the most recent national study of public guard-
ianship, Teaster et al. (2010) recommended a staff-to-person ratio of
1:20.
99
The TGP model—assessment of

effectiveness and replicability
• Increase ease of information access. TGP’s reports should be
combined and retrievable in one place; this is possible because
the accounting system is structured to have data all in one place.
Throughout the year, the program examines case records; however,
staff could go deeper via more routinized and sustained efforts by the
whole staff.
• Optimize mix of cases and caseloads. Case managers’ caseloads

should be reviewed regarding staff-to-client ratios as well as mix of
cases given to each case manager.
• Improve funding model. The original funding model of cases with

estates and no-fee cases should be maximized so that TGP can have
greater sustainability.
• Increase funding. TGP should have more funding in order to take on

more cases.
• Continue outreach efforts. TGP should continue efforts at outreach

and involvement in policy discussions.
• Replicate the TGP model. The TGP model should be replicated and
evaluated. The evaluation should be a formative, process, and summa-
tive evaluation.
100
References Schmidt, Winson, “Public Guardianship Issues for New York:

Insights from Research,” Elder Law Attorney 6, no. 3 (1996).
Blanck, Peter, and Jonathan G. Martinis, “The Right to Make
Supported Decision Making New York, https://perma.cc/Y35L-
Choices: The National Resource Center for Supported Decision
3SLB.
Making,” Inclusion 3, no. 1 (2015), 24–33.
Supreme Court of the State of New York, Appellate Division:
Callahan, Jean, Raquel Malina Romanek, and Angela Ghesqui-
Second Judicial Department, Report and Recommendations of the
ere, “Guardianship Proceedings in New York State: Findings and
Guardianship Task Force (2004), https://perma.cc/L3SJ-D2SJ.
Recommendations,” Bifocal 37, no. 4 (2016), 83–89.
Teaster, Pamela Booth, Winson Schmidt Jr, Erica F. Wood, Susan
Commission on Fiduciary Appointments, Report of the Commis-
A. Lawrence, and Marta S. Mendiondo, Public Guardianship: In the
sion on Fiduciary Appointments (New York: New York Courts, 2005).
Best Interest of Incapacitated People? (Santa Barbara, CA: Praeger,
Diller, Rebekah, “Legal Capacity for All: Including Older Persons 2010).
in the Shift from Adult Guardianship to Supported Decision
U.S. Census Bureau, “Quick Facts, New York City, New York, 2017,”
Making,” Fordham Urban Law Journal 43, no. 3 (2016), 495.
https://www.census.gov/quickfacts/fact/table/newyorkcityn-
Frolik, Lawrence, “Promoting Judicial Acceptance and Use of Lim- ewyo-rk/PST040217.
ited Guardianship,” Stetson Law Review 31, no. 3 (2002), 735-756.
U.S. Department of Health and Human Services (HHS), Adminis-
Karp, Naomi, and Erica Wood, Incapacitated and Alone: Health tration for Community Living, First National Voluntary Consensus
Care Decision Making for the Unbefriended Elderly (Washington, DC: Guidelines for State Adult Protective Services Systems (Washington,
American Bar Association Commission on Law and Aging, 2003), DC: HHS, 2016).
vii and 1.
HealthCare.gov, “Federal Poverty Level,”
Leland, John, “I’m Petitioning…for the Return of My Life,” New York https://perma.cc/G7QA-LCJ5.
Times, December 7, 2018, https://www.nytimes.com/2018/12/07/
Vera Institute of Justice, “The Guardianship Project,” https://per-
nyregion/court-appointed-guardianship-like-prison.html.
ma.cc/H4AG-7FL6.
National Association for Court Management (NACM), Adult
Von Stange, Nora, and Gary von Stange, “Guardianship Reform in
Guardianship Guide (Williamsburg, VA: NACM, 2014), 18.
New York: The Evolution of Article 81,” Hofstra Law Review 21, no.
National Resource Center for Supported Decision Making, http:// 3, article 5 (1993), 773.
www.supporteddecisionmaking.org.
Wood, Erica, Pamela Teaster, and Jenica Cassidy, Restoration of
New York Consolidated Laws, Social Services Law, Article 9–B, Rights in Adult Guardianship; Research & Recommendations (Wash-
https://perma.cc/75WH-NDLN. ington, DC: American Bar Association Commission on Law and
Aging with the Virginia Tech Center for Gerontology, 2017).
“New York Dementia Care Resources and Facilities,” Alzheimers.
net, 2018, https://perma.cc/BK5L-UV36. Worth, Robert W., “Prison Term for Guardian Who Stole From
Clients,” New York Times, October 9, 2003, https://www.nytimes.
New York State Office for the Aging, “New York State Plan on com/2003/10/09/nyregion/prison-term-for-guardian-who-
Aging: 2015–2019,” https://perma.cc/8AYX-QJ2X. stole-from-clients.html.
New York State Office of Children and Family Services (accessed

November 3, 2018), https://perma.cc/T2KG-K5T5.
New York State Office of Court Administration, Article 81 Data

Sheet, 2018.
Radford, Mary F., “Is the Use of Mediation Appropriate in

Adult Guardianship Cases?” Stetson Law Review 31, no. 3 (2002),
611–686.
101
APPENDIX A.
TGP Organizational Chart
EXECUTIVE
DIRECTOR
DIRECTOR OF LEGAL DIRECTOR OF CASE DIRECTOR OF DEVELOPMENT ADMINISTRATIVE INTERIM DIRECTOR PROPERTY
SERVICES AND POLICY MANAGEMENT AND COMMUNICATIONS COORDINATIOR OF FINANCE MANAGER
DEPUTY DIRECTOR BENEFITS CASE RECEPTIONIST SENOIR FINANCE

OF LEGAL SERVICES MANAGER MANAGER (PART-TIME) ASSOCIATE
STAFF CASE CASE RECEPTIONIST FINANCE

ATTORNEY MANAGER MANAGER (PART-TIME) ASSOCIATE
STAFF CASE CASE FINANCE

ATTORNEY MANAGER MANAGER ASSOCIATE
DATA AND POLICY CASE CASE

FINANCE
MANAGER MANAGER MANAGER
ASSOCIATE
CASE CASE MANAGEMENT FINANCE

MANAGER SUPPORT (PART-TIME) ASSOCIATE
FINANCE
ASSOCIATE
FINANCE VOLUNTEER
(PART-TIME)
102
APPENDIX B. APS MAP
2017 GUARDIANSHIP FOR ADULTS—COMMISIONER OR DESIGNEE (CONTRACT AGENCY)

New appointments in 2017/ Total cases in 2017
(self-reported data)
Statewide total: 3023 cases in 2017 compare with 2886 in 2016.
0/0
New York City: 2117 ST. REGIS
Rest of the state: 906 5/13

0/0 CLINTON
FRANKLIN
0/2
ST. LAWRENCE
0/2
1/4 ESSEX
JEFFERSON
1/2
LEWIS
0/0
HAMILTON 1/5
WARREN
2/13
OSWEGO
0/18 0/7 0/6

ORLEANS ONEIDA
NIAGARA 26/109 0/0 2/9 1/1
MONROE WAYNE 1/9
1/9 1/5 FULTON SARATOGA WASHINGTON
4/33 HERKIMER
GENESEE ONONDAGA
1/2 0/0 4/7
ONTARIO 0/0 MONTGOMERY
MADISON 4/24
11/51 0/0 SENECA 2/7 SCHENECTADY
ERIE WYOMING 3/9 CAYUGA 1/8 7/36
LIVINGSTON 1/6 OTSEGO 2/12 23/86 RENSSELAER
CORTLAND SCHOHARIE ALBANY
1/8
0/2 CHENANGO
0/2 TOMPKINS
SCHUYLER 4/21
4/22 GREENE 8/28
1/9 0/15 0/3 0/10 2/6 11/34 COLUMBIA
CHAUTAUQUA CATTARAUGUS ALLEGANY STEUBEN 1/11 DELAWARE
CHEMUNG TIOGA BROOME
6/39
6/34 ULSTER
SULLIVAN 6/29
DUTCHESS
23/49 0/7
PUTNAM
ORANGE
5/10
WESTCHESTER
2/16
ROCKLAND
2/12
SUFFOLK
257/2117
NEW YORK CITY
7/55
NASSAU
Please note: this map only shows cases in which Adult Protective Services is guardian or contracts with a community guardian. It
does not include family, private, or other nonprofit guardianship cases.
103
APPENDIX C. EXPLORATORY LIST OF NEW YORK NONPROFIT AGENCIES SERVING AS GUARDIAN7
AGENCY COUNTIES SERVED
Bronx Community Guardianship Network, Inc. Bronx
Catholic Family Center Monroe
Center for Elder Law & Justice Erie
Empower Assist Care Network Montgomery, Nassau, Steuben, Suffolk
Family Service Society of Yonkers Bronx, Ontario, Rensselaer, Washington
Integral Guardianship Services Bronx, Jefferson, New York, Putnam, Queens
Jewish Association Serving the Aging8 Bronx, Kings, Nassau, New York, Queens
LCG Community Services—United Guardianship Services Bronx, Kings, Nassau, New York, Queens, Suffolk
Lifespan of Greater Rochester Monroe
New York Foundation for Senior Citizens 9

New York
New York Guardianship Services, Inc. New York
Self-Help Community Services, Inc. 10

Bronx, Kings, Nassau, New York, Queens, Wayne
Vera Institute of Justice—The Guardianship Project Bronx, Kings, New York, Queens
7 Note: Vera/TGP staff compiled the initial list for the New York Community Trust study, with additional input from the Office of Children
& Family Services, as well as study interviewees. It does not represent a complete, final, or official list. Rather, it is an exploratory list as
a basis for further confirmations and additions.
8 New York City Community Guardian Program

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Incapacitated, Indigent, and Alone: Meeting

Guardianship and Decision Support Needs

Pamela B. Teaster, Erica F. Wood, John N. Holt, Kimberly S. George

NOVEMBER 30, 2018

Kimberly S. George, MIA

Section 3. Who Needs Services? 22

Section 4. Who Serves as Guardian? 33

Section 5. New York Court Processes: Barriers to

Section 6. The National Landscape: Public

Section 7. The TGP Model—Staff and Stakeholders’

Section 8. Summary of Recommendations 95

The question is: what happens to other individuals

Who needs In response to these findings, our study makes the

decision support its collection of basic guardianship data to better

• Restoration of rights. New York court procedures

• Increased number of clerks. New York should

population? the list willing to serve as guardians (as opposed to

by the national public guardianship study by Teaster

• Guardianship for nursing home residents. While

Do New York court evaluations. Other delays may be addressed through

• Scope of authority. New York programs should

• Improve funding model. The original funding

• Continue outreach efforts. TGP should contin-

Although the model is a promising one, it is a costly

In response to these findings, our study makes the

• Increase ease of information access. TGP’s

TGP offers a comprehensive guardianship model available in New York City

The Guardianship Project

TGP offers a comprehensive guardianship program available in New York

professional guardians willing to serve in cases where there are little to no

TGP’s clients are demographically diverse. Based on who was served in

The project first analyzed previous national research as well as research

Specifically, our research included both online surveys and telephone

TABLE 1. the new york guardianship study survey summary

Online surveys total responses

We also surveyed public guardians nationally using an online survey plat-

TABLE 2. the new york guardianship study interview summary

telephone interview total responses

The methods above allowed us to use mixed methods in determining the

Section 3: Who Needs

Who needs services?

Converging with the aging of the population is an increase in the number

Converging with the aging of the population

is an increase in the number of “oldest old”

people over 85, a rising lifespan of individuals

with disabilities, and increased mobility of

• A sister was caring for her brother with developmental disabilities,

• A nursing home resident with developmental disabilities refused to

Given the lack of data, our survey asked judges to estimate unmet need

The judges described a somewhat different situation for fee-generating

Over half the responding judges said that

there are not enough resources to handle their

current, active caseload involving these no-fee

Other survey and interview responses confirmed this perception of unmet

• Community guardian clients who are institutionalized. As

Community Guardian Programs are focused on serving as guardians

• Cases in which APS was not the petitioner. As noted in Section 4,

What services are needed?

Complex legal–social services. Attorneys make up a substantial portion of