A family’s alarm

The call never came for Gary Brown. As his father, Gary Ellis, lay dying in August 2023, staff phoned a newly appointed state guardian instead of family. Brown told the Chicago Tribune he learned only afterward that Northwestern Memorial Hospital had moved—without his knowledge—to have the state take charge of all decisions for the 69-year-old retired CTA bus driver. He dashed off a handwritten plea to the judge, asking to be appointed guardian. Two weeks later, his father died under guardianship, with no loved ones by his side, the Tribune reported.

Brown’s story is not an outlier. In an 18-month span ending June 2024, Chicago-area hospitals initiated 369 adult guardianship petitions in Cook, DuPage, Kane, Lake, McHenry and Will counties, according to the Chicago Tribune. The University of Chicago Medical Center accounted for 68 filings and Northwestern Memorial 35, far more than many peers; Rush had six, Stroger five and Loyola University Medical Center none, the Tribune found.

How hospitals use guardianship

Guardianship can quickly clear a path to discharge, sometimes over family objections, the Tribune’s investigation found. Roughly one-third of patients placed under hospital-initiated guardianships were discharged to nursing homes with one-star federal ratings or to facilities flagged for patient abuse, according to the Chicago Tribune. In cases where patients had few assets, hospitals often sought the publicly funded Office of State Guardian, at the hospital’s expense; when assets were present, hospital lawyers “almost always” recommended a particular private care management firm as guardian—opening a pipeline to the patient’s savings through care and legal fees, the Tribune reported.

Hospitals say the petitions are a last resort. In statements to the Tribune, Northwestern described guardianship as a “compassionate solution” and “vital safeguard” when patients lack decision-makers, while the University of Chicago Medical Center said the process “plays a critical role in protecting vulnerable patients” and that the number of petitions reflects the complexity of its cases, as reported by the Chicago Tribune.

The human toll can be stark. Kenya Lawrence told the Tribune her family discovered paperwork for a temporary guardianship petition in 2023 in the hospital room of her grandmother, 90-year-old Earsline Rose, at the University of Chicago Medical Center. Family members wanted to bring Rose home to the Milwaukee area. Instead, she was discharged to a poorly rated South Shore nursing home and died there days after Lawrence petitioned to be guardian, according to the Chicago Tribune. “She had no business in the system; she has relatives,” Lawrence said.

What the law requires

Illinois law builds in procedural safeguards. A petition must be filed by an “interested person,” and known relatives are supposed to be identified and notified. A physician’s report must contain observations and conclusions regarding the person’s decision-making capacity; age or frailty alone does not qualify someone for guardianship, according to the Illinois Office of State Guardian. Judges in Cook County apply a “clear and convincing” evidence standard before removing rights, a high bar, Probate Division Presiding Judge Daniel Malone told the Chicago Tribune.

Yet the court’s view is often shaped by hospital-generated medical evaluations, sometimes completed early in a hospitalization, and by discharge pressures. Some families succeeded in pushing back. Derrell Collier, who held his mother’s health care power of attorney, told the Tribune a long-term acute care hospital moved for a public guardian when insurance coverage was ending and he opposed discharge; the petition was withdrawn after he secured another placement. In another case, Northwestern sought guardianship over 36-year-old Brian Sivley after he resisted a nursing home discharge; with legal help, Sivley executed a health care power of attorney and the longer-term guardianship bid was dropped, the Chicago Tribune reported.

Race and risk

The Tribune identified a racial imbalance in filings. At least 39% of patients in the hospital-initiated cases were identified as Black in records, in a county that is about 22% Black, according to the Chicago Tribune. The disparity lands in a city where health outcomes already split sharply along racial lines; recent reporting shows Chicago’s overall life expectancy recovered to about 78.7 years in 2023, but Black residents continue to have the lowest life expectancy citywide, according to Axios.

Systemic oversight concerns extend beyond Chicago. “In theory and in practice, an older adult unable to make decisions for herself should be better off with a guardian or an attorney in fact, than without one. But, too frequently, the fate of people under guardianship is poorly monitored in sufficient, meaningful, and diligent ways,” said Dr. Pamela Teaster in testimony before the Senate Special Committee on Aging. Congress.gov

Alternatives and reforms

Guardianship should be the option of last resort, courts and advocates say, and less-restrictive tools exist. The U.S. Department of Justice highlights supported decision-making, advance directives, health care proxies, financial powers of attorney, and narrowly tailored court orders as ways to preserve autonomy and address specific needs without stripping broad civil rights.

Illinois has moved to strengthen the system. Since January 1, 2023, guardians appointed over adults with disabilities must complete state-mandated training under Public Act 102-770, an effort to improve preparedness and accountability, according to O’Flaherty Law. A pending statutory update, SB 2645, would require guardian training to include Alzheimer’s and dementia content—communication best practices and strategies to support the rights of those with cognitive impairment—beginning July 1, 2024, as noted by the Illinois General Assembly.

Despite the law’s preference for tailoring, the Tribune found courts seldom used limited guardianship when hospitals initiated cases: only about 2% of hospital-driven filings in the 18-month review left individuals with some decision-making authority, according to the Chicago Tribune.

What families can do

If a hospital raises guardianship, families can act quickly to protect a loved one’s voice:

  • Execute health care and financial powers of attorney and share them with providers, as encouraged by the U.S. Department of Justice.
  • Ask the court to consider supported decision-making or a limited order for specific decisions instead of full guardianship, per the U.S. Department of Justice.
  • Provide the hospital and court with complete, up-to-date contact information for relatives and close friends to ensure notice and participation, consistent with the Illinois Office of State Guardian.
  • Request that any physician report reflect the person’s current functioning and context, as Illinois procedure expects detailed observations, according to the Illinois Office of State Guardian.

The discharge dilemma

Hospitals argue they must ensure safe discharges for patients who cannot manage on their own. But the Tribune’s reporting shows how the tool can sideline families, speed transfers to substandard facilities, and lock in a legal status that can take months—and money—to unwind. Families like William Donaldson’s secured control only after hiring counsel and litigating; others, like Brown and Lawrence, watched loved ones die under someone else’s control, according to the Chicago Tribune.

Whether Illinois’ new training requirements and proposed dementia-focused curricula will curb overreach remains to be seen. The alternatives are well known; the rules are on the books. The question is how quickly hospitals, courts and guardians can align practice with principle so that, when a crisis comes, protection doesn’t eclipse autonomy—and no son arrives to find the last call went to a stranger.

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