Bringing together law, medicine, aging, and health policy to study guardianship as it is implemented and experienced in practice across America.
1.5-2 Million
Adult guardianships in the US
200,000
New cases annually
$100+ Billion
Assets under guardianship
50
States in our research scope
“Guardianship should be used only when clearly necessary and in the least intrusive form appropriate to the circumstances.”
Adult guardianship is a court-sanctioned mechanism, governed by state law, intended to protect individuals who lack decision-making capacity. It is often used for older adults who are alleged to be facing mental decline and inability to handle their own affairs.
In practice, guardianship typically results in loss of fundamental civil rights, including control over finances, residence, medical care, and social relationships. While many guardianships function appropriately, documented cases in many states reveal patterns of financial exploitation, coercive control, unnecessary institutionalization, social isolation, and abusive care.
Despite the magnitude of lives and money affected, these systems operate with limited transparency and minimal oversight. Existing knowledge is derived largely from investigative reporting, legal cases, and small-scale studies.
AGRRI treats guardianship as a dynamic, multi-institutional process rather than a uniform legal intervention, studying how it is implemented and experienced in practice.
Statute named “Guardianship” outside the National Archives, Washington, D.C.
Guardianship systems often operate with minimal transparency. Harmful guardianships frequently involve repeat actors whose decisions routinely fail to prevent, and sometimes facilitate, abuse.
Guardianship strips fundamental civil rights: control over finances, residence, medical care, and personal relationships. Reform must carefully balance protection with personal liberty.
#1
Guardianship should be used only when clearly necessary and in the least intrusive form appropriate to the circumstances.
#2
Legal mechanisms are needed to ensure that Principle #1 is followed consistently in practice, across all institutional settings.
#3
Protection of adults with diminished decisional capacity must be balanced with respect for personal liberty and their prior expressed wishes.
#4
The preferences of wards and family members should be respected, absent clear, documented contrary evidence of abuse or bad faith.
#5
Oversight and transparency are essential for accountability across judicial, clinical, and professional settings.
#6
Policy debates should be informed by data – and not unrepresentative examples or automatic presumptions of good or bad faith.
AGRRI pursues four complementary, evidence-driven goals to transform how guardianship is understood, regulated, and reformed across the United States.
Emperical research to document the scope, structure, and outcomes of adult guardianship systems across all 50 states. Initial focus: assessing, accessability, and completeness of guardianship data by state.
Policy-oriented research identifying legal structures that better balance protection of vulnerable adults, autonomy, and guardian accountability. Examining due process protections, oversight mechanisms, and pathways to restore rights.
Promoting alternatives to a guardianship through earlier family planning: trusts, powers of attorney, advance healthcare directives. Exploring strategies to educate adults and families about all available options.
Supporting impact litigation in selected states and supporting litigation initiated by others, including expert witness testimony and amicus briefs. Building on precedent-setting cases including the 2025 Colorado consent decree.
Faculty Associate, Buehler Center for Health Policy and Economics, Feinberg School of Medicine.
Leading expert in law and policy with deep expertise in guardianship, elder law, and regulatory reform.