Nationally, Mother Jones reports, over one million adults are currently under guardianship. This is an invisible civil rights crisis—hidden in plain sight.
Having a guardian affects a person’s fundamental right to live in a community, make decisions about their life, and remain free from unnecessary confinement. While the “Free Britney” movement briefly made “guardianship” and “conservatorship” household words, most people who are affected have far fewer resources to recover their rights than Britney Spears.
For far too long, our society has tolerated a guardianship system that systematically strips civil rights from those who are most vulnerable—the poor, people with disabilities, the unhoused, and those without adequate legal representation.
The time has come, however, for comprehensive reform recognizing guardianship not as a routine administrative process but as a valued and necessary intervention to be used only as a last resort. Fortunately, more effective alternatives exist that prioritize individual autonomy and community integration.
How Guardianship Fails the Most Vulnerable
The current guardianship system is flawed and carries profound human consequences, as well as straining an already overtaxed healthcare system. A new report by the Massachusetts Guardianship Policy Institute indicates that an estimated 3,000 to 4,000 “unbefriended” or “unrepresented, at-risk” individuals in my home state “face significant risks to their health, safety, and well-being due to decisional incapacity and a lack of financial or social resources.”
For far too long, our society has tolerated a guardianship system that systematically strips civil rights from those who are most vulnerable.
In Massachusetts alone, as the new policy institute report details, thousands of medically stable individuals remain trapped in hospitals, nursing homes, and psychiatric institutions not because they require ongoing medical care but because they lack a legal guardian authorized to make decisions about their discharge and future care.
The Bay State’s experience is just one example of the devastating human and financial costs of systemic failure. While guardianship laws are often presented as tools for compassionate interventions, as implemented they frequently result in forced confinement in institutional settings in which patients may lack access to adequate care, housing options, or genuine recovery-oriented services.
Institutional Bias and Its Consequences
However, the root of this crisis lies in the legal system’s overreliance on guardianship to manage complex human needs. Rather than investing in robust community-based supports and social service workers, many jurisdictions default to institutionalization in long-stay residential facilities under the guise of protection and safety.
This approach creates a devastating cycle. Courts often appoint guardians who become risk-averse, are overwhelmed by caseloads, and/or are institutionally aligned with facility-based care providers. Guardians face no legal requirement to prioritize the least-restrictive alternative or to explore supported decision-making models that could preserve individual autonomy. Furthermore, minimal legal accountability or systemic pressure exists to expedite discharges or facilitate meaningful community integration.
The root of this crisis lies in the legal system’s overreliance on guardianship to manage complex human needs.
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These issues arise from four factors: First, deep-seated assumptions equate disability or aging with incompetence. Second, people are often placed under guardianship without adequate legal representation, a full understanding of the proceedings, or a meaningful opportunity to contest the decision. Third, once guardianship is established, ongoing supervision is typically minimal. Finally, perhaps most troubling, is how difficult it becomes to restore rights once guardianship has been imposed. Even when a person’s circumstances change significantly—through improved health, new coping strategies, or enhanced support networks—the legal and practical hurdles to regaining autonomy are high.
Forging a Path Forward That Centers Dignity
Meaningful guardianship reform must begin with a fundamental shift in societal attitudes away from assumptions that equate disability or aging with incompetence. The Massachusetts Guardianship Policy Institute emphasizes the need for “person-centered” guardianship, characterized by understanding the individual, involving them in decisions, utilizing planning tools, spending meaningful time, adhering to court oversight, and seeking continuous quality-of-life improvement. This shift requires recognizing that autonomy and safety are not mutually exclusive. Rather than defaulting to protective custody, policy should seek to preserve individual agency and dignity.
The extraordinary authority granted to guardians over a person demands equally extraordinary accountability, transparency, and responsiveness, including:
- Regular review of guardianship arrangements with a presumption toward rights restoration
- Clear standards requiring guardians to pursue the least-restrictive alternatives
- Mechanisms for individuals under guardianship to easily challenge or modify their arrangements
- Training for judges, attorneys, and guardians on disability rights and supported decision-making
The establishment of oversight bodies like the Massachusetts Office of Adult Guardianship and Conservatorship Oversight represents progress, but more comprehensive accountability measures are needed.
Investment in Community-Based Alternatives
A crucial component of reform involves significantly expanding investment in community-based supports, especially social service workers, and alternatives to guardianship, such as supported decision-making (SDM), which has been used internationally for decades and is starting to be used more widely in the United States. SDM allows people to retain their legal rights while receiving assistance from trusted individuals they choose. This approach recognizes that many people need help understanding information or considering options, but that they can still make their own decisions when provided with appropriate support.
Legal reforms must ensure that guardianship truly becomes a last resort. Achieving this goal includes beginning with less-restrictive alternatives before guardianship can be imposed, ensuring qualified legal representation for all individuals facing guardianship proceedings, providing regular and accessible pathways for individuals to challenge or terminate guardianship arrangements, and offering clear timelines for guardianship reviews and rights restoration procedures.
Finally, the Guardianship Policy Institute’s research shows that increased state funding to eliminate waitlists and ensure timely access to services for all eligible individuals is not just morally imperative but fiscally responsible. Economic analyses by the University of Massachusetts Donahue Institute and the American Bar Association in New York support potential annual savings of tens of thousands of dollars per person through effective guardianship programs.
A Nonprofit Role
Nonprofit organizations can also help transform the guardianship system. The success of initiatives like Public Guardian Services in Massachusetts—which operates a privately funded pilot program that offers social-work support for unrepresented individuals—shows the potential for nonprofit innovation in this space.
Nonprofits operating with the disability community could develop and expand guardianship services rooted in person-centered values that demonstrate how transparent and ethical oversight can be provided with a clear commitment to community integration. They are also uniquely positioned to educate service providers, families, legal professionals, and judges about SDM alternatives and help build the infrastructure needed to support the widespread adoption of these approaches.
Nonprofits can also engage in sustained legislative advocacy to reform the foundational assumptions embedded in guardianship law. Perhaps most importantly, they can work to ensure that the people most affected by guardianship are at the center of policy advocacy.
A crucial component of reform involves significantly expanding investment in community-based supports.
Too often, individuals under guardianship—or who are at risk of it—are excluded from discussions about the policies and practices that shape their lives. Nonprofits can create meaningful opportunities for self-advocates to speak, lead, and codesign solutions. These actions ensure that policy is grounded in lived experience and real-world wisdom rather than abstract discussions.
Toward a Rights-Respecting Future
Guardianship reform is not merely a technical legal issue—it is a fundamental question of how we treat those who are most vulnerable among us.
The current social service and legal system is biased toward institutionalization, which often amounts to the systematic removal of basic civil rights and a profound violation of human dignity. The path forward requires courage to challenge entrenched systems and assumptions. It demands investment in community-based alternatives that many jurisdictions have been reluctant to find. It requires a fundamental commitment to the principle that all people—regardless of disability, age, or circumstance—have the right to live with dignity and independently in their communities.
The policy ideas highlighted here are not merely aspirational but essential steps toward creating a society that truly values autonomy, inclusion, and human rights.
Every day that society fails to adjust guardianship policy, more individuals lose their liberty unnecessarily, more families are separated, and more communities are deprived of their members’ contributions. The Guardianship Policy Institute’s findings show that the current system’s poor outcomes are “unaffordable, both financially and in terms of human well-being,” underscoring the urgency of action.
The time for half-measures and incremental change has passed. Building a model that emphasizes professional, person-centered guardianship; sustainable funding; and comprehensive oversight offers a potential roadmap for transformation.
