Special report: How can Michigan fix a guardianship system that fails some kids and older adults?

Special report graphic
This article is part of State of Health, a series about how Michigan communities are rising to address health challenges. It is made possible with funding from the Michigan Health Endowment Fund.

Courts often appoint a guardian to take over legal responsibility and make all legal, social, financial, and health care decisions for a child or an incapacitated adult, known as a ward. The purpose of guardianship is to make sure that wards are protected from harm, homelessness, neglect, or financial fraud. And while few court-appointed guardians take intentional advantage of their wards, the guardianship system as it works today in Michigan puts wards at risk for both unnecessary forfeiture of all civil rights and diminished quality of life.

In some cases, family members have been passed over in favor of professional guardians; wards have been moved from their long-time homes into nursing homes, with their treasured personal items ending up in the garbage; guardians have prevented visits with loved ones; and guardians have spent wards' money in questionable ways.

"We've prosecuted a number of professional guardians in the last two years because they siphoned off resources of the people that they were appointed to protect," says Scott Teter, Michigan assistant attorney general and leader of the Michigan Attorney General’s Office Elder Abuse Task Force.

Guardianship is a hot topic for many agencies, policy advocates, and elected officials in Michigan, who are pursuing a variety of solutions to ensure that guardianship is judiciously applied to the benefit of Michigan's wards and that alternatives to full guardianship are made more available.

"A problem in the present system is there's not good education on the alternatives to guardianship. So part of our legislative agenda this past year was to increase the alternatives," Teter says. "We don't have guardian certification in the state of Michigan. There are no mandatory minimum educational requirements, background checks, criminal history checks, bonding requirements, nothing, and no continuing education. All that you need to be appointed to take over another human being’s life in the state of Michigan is that the judge appointed you."

One solution to Michigan's guardianship issues, endorsed by the Elder Abuse Task Force, is a set of bills currently making their way through the state legislature. Michigan House Bills 4909-4912 and 5047 would require guardians to visit their wards monthly instead of quarterly; set a caseload cap on guardians appointed to serve indigent individuals; and ensure that guardians ad litem — the court-appointed professionals who assist courts in determining if guardianship is warranted — report uniform, high-quality information to probate courts.

"Judges who are assigned to appoint these guardians and make those determinations on whether or not somebody needs one don't get the best information," Teter says. "Part of our legislative package is to make sure the lawyer who's appointed to represent the ward would have an adequate time to review the report and then cross-examine on it like we deal with any other piece of evidence submitted in court. In addition, we have increased the requirements in medical assessment."

This means the guardian ad litem would be required to communicate with wards at their locations, away from other interested persons, and in a language they can understand. The guardian ad litem would be required to explain the person’s legal rights, ask who they want or do not want as a guardian, and take steps to ensure they are able to attend their guardianship hearing. If they can’t, efforts could be made to move the hearing or provide other reasonable accommodations.

"The irony is that you cannot buy a Christmas tree in the state of Michigan without having to go through a licensed grower and a licensed seller. We have more regulations and supervision over the people who grow potatoes in the state of Michigan than we do the people who control other people's lives as a guardian or conservator. That makes no sense at all," Teter says. "Part of our legislative package is to require guardian certification. If you're going to have that kind of power and that kind of responsibility over another human being’s life, we believe you ought to be properly trained to execute those responsibilities."

Guardianship and health care delivery

Sarah Milanowski, enrollment and marketing manager for LifeCircles PACE in Ottawa County, sees firsthand how guardians sometimes drop the ball. In her work with older adults participating in a PACE (Program of All-inclusive Care for the Elderly), she has seen guardians who do not fully understand the rights, responsibilities, and expectations that go along with their role. She's also seen PACE participants who have guardians appointed in a different county "fall off the radar."

"If we don’t know who is the person making a medical decision in a crisis situation, we're in a pickle as a health care provider," Milanowski says. "Another common challenge we see is professional guardians. Most of them have to take on a lot of cases to make the business run financially. While those agencies are often very well intentioned, they are usually the ones handling the most intense cases with the most significant crises. Sometimes clients in crises aren't able to access the services they need because the agency is putting out fires for other people."

Sarah Milanowski with a PACE participant.
Milanowski notes that while more Michiganders are living longer, they are not living better. Complicated living situations, complex health issues, and financial constraints make it difficult to make decisions.

"Do we need a permanent guardian for every single decision?" she says. "Or do we need alternatives so the person can make decisions based on what matters most to them with the support of a trusted person?"

Milanowski says that while the intent of the new state legislation is good, she would prefer to see available alternatives to guardianship utilized more often. For example, adults can proactively appoint a family member or loved one as a power of attorney over their financial and health affairs, to be activated only if they are incapacitated. Limited guardianship can preserve more of an individual’s civil rights. She would also like to see a state office or program to help people navigate guardianship decisions and provide education on other alternatives.

"Professional guardians are needed. I don't want to see us create so much legislation that we leave them out, because that creates a whole other problem," Milanowski says. "The solution has to be multifaceted. Support what already exists, but also educate people. The public guardians that exist in our area now are doing the best they can with really challenging circumstances. If we don't have a great comprehensive plan, we might put people at more risk."

A new alternative: Michigan Guardianship Diversion Project

With funding from the Michigan Health Endowment Fund, the Michigan Elder Justice Initiative (MEJI) is collaborating with probate courts and local organizations in Genesee, Bay, Grand Traverse, and Muskegon counties on a two-year pilot called the Michigan Guardianship Diversion Project (MGDP). Launched in March 2024, the project seeks to reduce unnecessary guardianship of older adults and adults with disabilities by connecting them to community services, public benefits, and legal alternatives to guardianship.

MGDP staff are working with probate court staff, guardians ad litem, lawyers, health care providers, and other community partners to troubleshoot cases where an alternative to guardianship may exist. Organizers say the pilot is already showing positive results.

"We hope that we can produce something that's scalable, sustainable, can draw attention, find solutions, develop protocols, and develop trainings and materials that can benefit lots of people all around Michigan and beyond," says Laura Kubit, MEJI staff attorney and MGDP co-coordinator.

Kubit brings nearly 30 years of experience with Adult Protective Services and 10 years as a civil legal aid attorney to the project.

Laura Kubit.
"We can try to craft solutions that hopefully work for everyone and really make a difference," she says. "When you know the inner workings of that system, you can advocate in a way that will be most effective."

The alternatives that MGDP staff facilitate for folks can include appointing powers of attorney for health care or finances, and representative payees for Social Security or veterans' benefits. Those appointees can be trusted family members or friends who can also help the person in supported decision-making. The program also connects people to home- and community-based services like Meals on Wheels or transition services for people in long-term care facilities who want to reenter the community.

Rachel Richards."The options are out there already. You don't need to create them," says MGDP co-coordinator Rachel Richards. "I've worked with the adult elderly and disabled populations since 1995. I think Michigan has seen some great strides that are long overdue. This project is one of them."

Kubit says current guardianship law has the potential to work well, but practical barriers prevent all evidence from being considered in a guardianship appointment, while potential wards are not guaranteed the right to communicate what’s important to them. Current law requires that guardians communicate to the greatest extent possible with wards about important decisions in their lives, exercise authority in the least restrictive way, and promote autonomy.

"A lot of professional guardians, whether they're public, private, family members, or lay guardians, don't necessarily have the knowledge, support, resources, or time to provide all of the needs in the best possible way that the law contemplates," Kubit says. "I do think that most people are doing the best that they can."

Kubit also wants wards to be able to get out of guardianships more easily. She recalls a past client who was discharged from the hospital to a nursing home. His Medicare coverage ran out and he was trying to apply for Medicaid. While temporarily physically incapacitated, he was fully able to handle his own finances. His bank refused to release needed bank statements unless he came to get them in person. With great difficulty, Kubit was able to jump through all the hoops necessary to enroll him in Medicaid. Without her help, the nursing home would have had two options for addressing his growing bill: evict the man against his will or petition for guardianship. 

In other cases, guardianships are overly restrictive. Richards explains that instead of granting limited guardianships, courts usually grant full guardianships that take away a ward’s autonomy over decisions that they're still capable of making for themselves. When a guardian is not a family member or friend, they may not know the individual or their expressed wishes. Because professional and public guardians have multiple wards, the amount of time they can spend with the person is limited, and it is difficult for them to determine the person's wishes and desires.

"Where do they want to live? Who do they want to have relationships with? What do they like to eat? What are their daily habits? Those are some of the ways that this falls short," Richards says. "There are times when bad actors abuse authority. For our project, that's a concern. But individuals are coming to us before the guardianship occurs to try to look at alternative methods to alleviate the need for guardianship."

Better enforcement, education, and certification

Former Elder Abuse Task Force member Steven Burnham worked for 17 years as the Kalamazoo County probate register. During his tenure, he was often asked why Kalamazoo County had fewer guardians appointed than any other county in the state. His answer was "My diversion programs." At Burnham’s recommendation, the county hired an investigator to look into guardianships before, or sometimes after, they were put in place. He also worked with a Western Michigan University Medical School program, Active Citizenship, to send students to interview guardians and wards.

By better getting to know what was going on in prospective wards’ lives, the court was able to come up with individual alternatives that suited some people better than guardianship. For some, a guardian was the best solution. Because not all Michiganders have a friend, family member, or other trusted individual who can take on that role, public and professional guardians will always be needed.

"Sometimes we’ve got to step in and get a substitute decision-maker to help make decisions as to their wellbeing, their health care, who they hang out with," says Burnham, who also serves on the board of the Michigan Guardianship Association (MGA). "A large and growing segment of those that need a public guardian are much younger, [in their] 30s, 40s, 50s. It could be a traumatic brain injury or substance abuse."

Burnham does not support the proposed guardianship legislation. He says that the current situation in Michigan reflects poor enforcement of existing laws and wonders if new laws will be enforced any better. Like Milanowski, he worries that requiring guardians to spend more time with wards without additional compensation may shrink a workforce already squeezed by shortages. Guardians with a ward living solely on Social Security are paid $83 a month.

However, like the Elder Abuse Task Force, Burnham and the MGA strongly endorse more education for guardians and a state-mandated certification process.

"To become a nail technician or dog groomer takes hundreds of hours of training in what to do [and] what not to do," Burnham says. "And here’s the scary thing: if I put your name on a line in a petition and a judge decides you’re incapacitated and no family member is trying to be appointed, you’d have a big shock. With respect to guardianship, we’re more concerned about pets and French nails than adults."

Estelle Slootmaker is a working writer focusing on journalism, book editing, communications, poetry, and children's books. You can contact her at Estelle.Slootmaker@gmail.com or www.constellations.biz.

Lead graphic by Jay Hero. All other images courtesy of the sources.
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Q&A: Self-neglect and guardianship
Q&A: Self-neglect and guardianship

Former U.S. Assistant Secretary for Aging Kathy Greenlee now works with ADvancing States, a national association representing state departments on aging. Greenlee is particularly concerned about recent adult protective services (APS) data that reports 50% of all APS cases nationwide are related to self-neglect.

"I'm just interested in ways we support people to age independently," Greenlee says. "Self-neglect can become some of the most complex cases and people to serve."

Greenlee has worked with the Michigan Health Endowment Fund, Michigan’s Adult Protective Services, the Michigan Department of Health and Human Services, and some of the state’s Area Agencies on Aging to bring awareness to issues surrounding self-neglect.

We chatted with Greenlee about self-neglect and how it relates to current efforts to improve policies and outcomes around legal guardianship in Michigan. 

This interview has been condensed for length and clarity.

Q: What does elder self-neglect entail? What kind of problems does it cause for people?

A: Self-neglect happens when a person is unable to take care of themselves, their physical health, their physical environment, or their mental health. It’s terribly unhealthy for individuals — and it's prevalent. 50% of APS cases nationwide are self-neglect. In some states, it's like 60% to 70% of the cases.

Adult protective services, by design, are for emergency problems with a short-term intervention. People who are experiencing self-neglect have chronic or longer-term problems, so a high number of people are returned to APS over and over again. People become reluctant to accept help for various reasons, and there's certainly a large interlay of mental health problems and capacity issues.

One of the reasons why there's some challenge does relate to guardianship. People are very independent, and as we age, we want to be in charge of ourselves. There's not an exception to that. So the state government through adult protective services, who are showing up trying to help, can be seen as a threat to individuals, and that's not misplaced. There are people who end up getting referred to guardianship and lose their independence because they've been reported to APS when that's not necessarily the best outcome for them, and certainly not what they want.

From a big-picture societal perspective, guardianship has too often been the default option. We need alternatives. You can't splice away the guardianship piece from self-neglect because, often, it's what ends up happening to people when they were just trying to live on their own and they needed support.

Q: What kind of supports could help people experiencing self-neglect to remain independent?

A: I think it's about adequately assessing individuals and figuring out how to make modest improvements to mitigate the risks that they're living under. Focus on how to connect them to resources. Maybe bring in home-delivered meals or provide transportation assistance if they need to go see a doctor. It is not dissimilar from other people living independently who need support from their Area Agency on Aging. It’s that these are particularly acute situations and behavioral health is a huge problem. There are things we can do. These are some of the most difficult people to serve. We can't just assume APS can solve things for people when they have such complex needs, and we really need to pay attention.

Q. Why isn’t guardianship always the best solution?

A: Guardianship rips people away from the lives that they prefer, which is living independently at home. There are people who need guardianships, who are tremendously unsafe, who are at risk financially or physically, who have no trusted person in their life who can make decisions for them. I just think our application of guardianship as an intervention in this country has been overly broad. It is a paternalistic intervention. And it's a very blunt instrument, to remove someone's civil rights and autonomy as a way to address the underlying problems. The power of a plenary guardian is breathtaking.

Q: What are other alternatives to guardianship?

A: I want to cheer for the [Michigan Guardianship Diversion Project, described in main article]. It's new … and it's proving early success. They're being alerted by county clerks when someone comes in to file a guardianship. They can intervene at that point in time to assess what's driving the move towards guardianship. What does the person need? The clerks who are there processing it and even the judges are not the experts on how you provide long-term services and supports.

From a judicial perspective, there's not been a social worker at the ready to do that kind of case management social work piece right before you take that step of filing for guardianship. If we got in right there and provided assessments and supports, could we completely eliminate or postpone the need for guardianship? It raises questions about the capacity of a high-volume judicial system to provide that kind of support for individuals. How do we do social work at the courthouse? That's really going to be the question. I think this project will prove that it is worth it.