ELDER ABUSE

The Extent of Abuse 

by Guardians Is 

Unknown, but Some 

Measures Exist to 

Help Protect Older 

Adults

Report to Congressional Requesters

November 2016

GAO-17-33

United States Government Accountability Office
United States Government Accountability Office

Highlights of GAO-17-33, a report to 

congressional requesters

November 2016

ELDER ABUSE

The Extent of Abuse by Guardians Is Unknown, but 

Some Measures Exist to Help Protect Older Adults

What GAO Found

The extent of elder abuse by guardians nationally is unknown due to limited data 

on key factors related to elder abuse by a guardian, such as the numbers of 

guardians serving older adults, older adults in guardianships, and cases of elder 

abuse by a guardian. Court officials from six selected states GAO spoke to noted 

various data limitations that prevent them from being able to provide reliable 

figures about elder abuse by guardians, including incomplete information about 

the ages of individuals with guardians. Officials from selected courts and 

representatives from organizations GAO spoke to described their observations 

about elder abuse by a guardian, including that one of the most common types 

appeared to be financial exploitation. Some efforts are under way to try to collect 

better data on elder abuse and guardianship at the federal, state, and local levels

to support decision making and help prevent and address elder abuse by 

guardians. For example, the Department of Health and Human Services (HHS) 

plans to launch the National Adult Maltreatment Reporting System—a national 

reporting system based on data from state Adult Protective Services (APS) 

agency information systems by early 2017. According to HHS and its contractor, 

this system has the capability to collect information that could specifically help 

identify cases of elder abuse where a guardian was involved. GAO also identified 

state and local initiatives to capture key data points and complaint data as well 

as identify “red flags” such as unusually high guardian fees or excessive vehicle 

or dining expenses.

The federal government does not regulate or directly support guardianship, but 

federal agencies may provide indirect support to state guardianship programs by 

providing funding for efforts to share best practices and facilitate improved 

coordination, as well as by sharing information that state and local entities can 

use related to guardianship. State and local courts have primary responsibility 

over the guardianship process and, as such, have a role in protecting older 

adults with guardians from abuse, neglect, and exploitation. Measures taken by 

selected states to help protect older adults with guardians vary but generally 

include screening, education, monitoring, and enforcement. 

Measures Used to Help Protect Older Adults with Guardians from Abuse

View GAO-17-33. For more information, 

contact Kathryn A. Larin at (202) 512-6722 or 

larink@gao.gov.

Why GAO Did This Study

The number of older adults, those over 

age 65, is expected to nearly double in 

the United States by 2050. When an 

older adult becomes incapable of 

making informed decisions, a 

guardianship may be necessary. 

Generally, guardianships are legal 

relationships created when a state 

court grants one person or entity the 

authority and responsibility to make 

decisions in the best interest of an 

incapacitated individual—which can 

include an older adult—concerning his 

or her person or property. While many 

guardians act in the best interest of 

persons under guardianship, some 

have been reported to engage in the 

abuse of older adults.

GAO was asked to review whether 

abusive practices by guardians are 

widespread. This report describes (1) 

what is known about the extent of elder 

abuse by guardians; and (2) what

measures federal agencies and 

selected state and local guardianship 

programs have taken to help protect 

older adults with guardians.

GAO reviewed relevant research, 

reports, studies, and other publications 

issued by organizations with expertise 

on elder abuse and guardianship 

issues. GAO also conducted interviews 

with various guardianship stakeholders 

including federal agencies such as 

HHS, six selected state courts, and 

nongovernmental organizations with 

expertise in guardianship-related

issues. In addition, GAO identified 

eight closed cases of abuse by 

guardians in which there was a 

criminal conviction or finding of civil or 

administrative liability to use as 

nongeneralizable illustrative examples.

GAO makes no recommendations in 

this report.
Page i GAO-17-33 Elder Abuse

Letter 1

Background 4

The Extent of Elder Abuse by Guardians Is Unknown, and 

Available Information Varies by State and Locality, but Some 

Efforts Are Under Way to Gather More Data 6

Federal Agencies Provide Funding to Support Coordination and 

Sharing Information, While State and Local Entities Oversee the 

Guardianship Process to Help Protect Older Adults with 

Guardians from Abuse 15

Agency Comments 25

Appendix I Coordination between Federal Representative Payee Programs and State 

Guardianship Programs 26

Appendix II GAO Contact and Staff Acknowledgments 30

Related GAO Products 31

Tables

Table 1: Types of Elder Abuse 5

Table 2: Selected Closed Cases of Elder Abuse by a Guardian 10

Table 3: Counts of Older Adults Receiving Federal Benefits, and 

Related Number of Representative Payees and 

Guardians 26

Figure

Figure 1: Measures Used to Help Protect Older Adults with 

Guardians from Abuse 19

Contents
Page ii GAO-17-33 Elder Abuse

Abbreviations

ACUS Administrative Conference of the United 

States

APS Adult Protective Services

CFPB Bureau of Consumer Financial Protection

HHS Department of Health and Human Services

NAMRS National Adult Maltreatment Reporting 

System

NCSC National Center for State Courts

SSA Social Security Administration

WINGS Working Interdisciplinary Networks of 

Guardianship Stakeholders

This is a work of the U.S. government and is not subject to copyright protection in the 

United States. The published product may be reproduced and distributed in its entirety 

without further permission from GAO. However, because this work may contain 

copyrighted images or other material, permission from the copyright holder may be 

necessary if you wish to reproduce this material separately.
Page 1 GAO-17-33 Elder Abuse

441 G St. N.W.

Washington, DC 20548

November 16, 2016

The Honorable Susan M. Collins

Chairman

The Honorable Claire McCaskill

Ranking Member

Special Committee on Aging

United States Senate

The Honorable Orrin G. Hatch

Chairman

Committee on Finance

United States Senate

In 2014, the U.S. Census Bureau estimated that there were over 46 

million older adults—individuals aged 65 and over—in the United States. 

The Census Bureau predicts this number will nearly double to 88 million 

by 2050. When an older adult becomes incapable of making informed 

decisions, a guardianship may be necessary. Generally, guardianships 

are legal relationships created when a state court grants one person or 

entity the authority and responsibility to make decisions in the best 

interest of an incapacitated individual—which can include an older adult—

concerning his or her person or property.1 State and local courts are 

generally responsible for overseeing guardianship appointments. The 

federal government does not regulate or directly support guardianship, 

but federal agencies may provide indirect support to state guardianship 

programs by providing funding for efforts to share best practices and 

facilitate improved coordination. In addition, some agencies have 

established programs that appoint representative payees to manage 

 1

The focus of this report is older adults with guardians. While some states differentiate 

between various types of guardianships and conservatorships, for the purposes of this 

report we define guardianship broadly as a relationship created by state law in which a 

court gives one person or entity the duty and power to make personal or property 

decisions, or both, for another person—often called a ward or person under guardianship. 

While terminology and responsibilities vary from state to state, in this report we use the 

term “guardian” broadly to refer to various types of state guardians and conservators.

Letter
Page 2 GAO-17-33 Elder Abuse

federal benefits for individuals who are unable to do so for themselves.2

While many guardians act in the best interest of persons under 

guardianship, some have been reported to engage in the abuse of older 

adults.3

Because of your concern about the financial exploitation and other 

abuses of older adults, you asked us to review whether abusive practices 

by guardians are widespread. This report describes (1) what is known 

about the extent of elder abuse by guardians; and (2) what measures 

federal agencies and selected state and local guardianship programs 

have taken to help protect older adults with guardians from abuse. In 

addition, appendix I contains information related to coordination between 

federal representative payee programs and state guardianship programs.

To determine what is known about the extent of elder abuse by 

guardians, we reviewed relevant research, reports, studies, and other 

publications issued by organizations with expertise on elder abuse and 

guardianship issues. We also conducted interviews with various 

guardianship stakeholders including the following:

• Federal agencies including the Department of Health and Human 

Services (HHS), Bureau of Consumer Financial Protection (CFPB), 

and Department of Justice to discuss efforts to support to state 

guardianship programs. We also interviewed officials from the Social 

Security Administration (SSA), the Department of Veterans Affairs, 

and Office of Personnel Management to discuss their representative 

payee programs.

• State court officials that oversee or are otherwise knowledgeable on 

guardianship-related issues from California, Florida, Minnesota, Ohio, 

Texas, and Washington. These states were selected because they 

had the largest populations of older adults as well as at least two of 

the following criteria: guardian certification requirements, a Working 

 2

The Social Security Administration (SSA), the Department of Veterans Affairs, and the 

Office of Personnel Management have programs that appoint representative payees to 

manage federal benefits received by individuals who are unable to do so for themselves. 

We use the term “representative payee” to refer to Department of Veterans Affairs 

fiduciaries and SSA or Office of Personnel Management representative payees. A 

representative payee may also be a guardian, and some beneficiaries with a 

representative payee also have a guardian.

3

For the purposes of this report, we define elder abuse as any knowing, intentional, or 

negligent act by anyone that causes harm or a serious risk of harm to an older adult, 

including physical, sexual, or emotional abuse, neglect, and financial exploitation. 
Page 3 GAO-17-33 Elder Abuse

Interdisciplinary Networks of Guardianship Stakeholders (WINGS) 

program, an independent guardianship support program, or citation 

during our preliminary interviews as having promising practices or 

known problems.4 In addition, we spoke with an official from the 

Conservator Account Auditing Program, a statewide program housed 

in the Minnesota court system that audits the periodic accounting 

information certain guardians are required to provide to the court. We 

also interviewed prosecutors, judges, and county clerk officers from 

some of the six states referred to us during our interviews with other 

court officials and nongovernmental organizations. The observations 

gleaned from interviews with officials from these states are not 

generalizable to other states.

• Nongovernmental organizations with expertise in guardianship-related 

issues. Specifically, we interviewed officials from the American 

Bankers Association, American Bar Association, Center for Elders 

and the Courts, National Adult Protective Services Association, 

National Center for State Courts (NCSC), National Committee for the 

Prevention of Elder Abuse, National Association to Stop Guardian 

Abuse, National Guardianship Association, Center for Guardianship 

Certification, Uniform Law Commission, and Virginia Tech Center for 

Gerontology. We selected nongovernmental organizations to interview 

by reviewing published materials related to elder abuse by guardians, 

conducting a web search using terms related to elder abuse by 

guardians, and referrals from our preliminary interviews.

We also identified eight closed cases of elder abuse by guardians in 

which there was a criminal conviction or finding of civil or administrative 

liability in the last 5 years, to illustrate the types of abuse that guardians 

have been found to inflict on older adults under guardianship. Seven of 

these cases were identified using public-record searches, while an eighth 

was referred to us during one of our interviews.5 To corroborate key 

information about each case, we examined court records, police reports, 

or other relevant documents. The illustrative examples we identified are 

nongeneralizable and cannot be used to make inferences about the 

overall population of guardians.

 4

WINGS programs are court–community partnerships designed to affect the ways courts 

and guardians practice and to improve the lives of people who need help in decision 

making.

5

Public-record searches included web searches for terms related to elder abuse by a 

guardian such as “elder abuse,” “guardianship abuse,” “convicted,” and “sentenced.” We 

also reviewed public websites that list disciplinary actions taken against certified 

guardians. 
Page 4 GAO-17-33 Elder Abuse

To identify measures federal agencies and selected state and local 

guardianship programs have taken to help protect older adults with 

guardians from abuse, we reviewed relevant research, publications, and 

other materials on elder abuse and guardianship. We also conducted 

interviews with the various guardianship stakeholders described above.

We conducted this performance audit from November 2015 to November 

2016 in accordance with generally accepted government auditing 

standards. Those standards require that we plan and perform the audit to 

obtain sufficient, appropriate evidence to provide a reasonable basis for 

our findings and conclusions based on our audit objectives. We believe 

that the evidence obtained provides a reasonable basis for our findings 

and conclusions based on our audit objectives.

In general, state courts appoint a guardian for individuals when a judge or 

other court official determines that an individual lacks the capacity to 

make important decisions regarding his or her own life or property. 

Depending on the older adult’s needs and relevant state laws, a court 

may appoint a “guardian of the person” who is responsible for making all 

decisions for the older adult, or a “guardian of the estate”—or 

conservator—who only makes decisions regarding the older adult’s 

property.

When state courts appoint guardians, older adults often forfeit some or all 

of their decision-making powers. Depending on the terms of the court’s 

guardianship appointment, older adults may no longer have the right to 

sign contracts, vote, marry or divorce, buy or sell real estate, decide 

where to live, or make decisions about their own health care.

Courts can generally appoint different types of guardians including the 

following:

• Family guardians. According to the Center for Elders and the Courts, 

courts favor the appointment of a family member or friend, often called 

Background

Guardianship
Page 5 GAO-17-33 Elder Abuse

a family guardian.6 However, it may not always be possible to find 

family or friends to take on this responsibility.

• Professional guardians. A professional guardian may be hired for a 

fee to be paid by the older adult, and may serve more than one older 

adult at a time. Some states require that a professional guardian be 

certified. This requirement is described in additional detail later in this 

report.

• Public guardians. If an older adult is unable to find a capable family 

or friend and is unable to afford the fees and associated expenses of 

hiring a professional guardian, a public guardian—whose cost is 

funded by the state or local government—may be appointed.

Elder abuse is a complex phenomenon.7 Table 1 describes the types of 

elder abuse, according to the National Center on Elder Abuse.8 Each of 

these can affect older adults with guardians, as well as those without. The 

categories include physical, sexual, and emotional abuse, as well as 

financial exploitation, neglect, and abandonment, but it is not uncommon 

for an older adult who has been abused to experience more than one 

type of abuse simultaneously.

Table 1: Types of Elder Abuse

Typea Description

Physical abuse The use of physical force that may result in bodily injury, physical pain, or impairment.

Sexual abuse Nonconsensual sexual contact of any kind with an older adult.

Psychological abuse Also referred to as verbal or emotional abuse, psychological abuse is the infliction of 

anguish, pain, or distress through verbal or nonverbal acts.

Financial exploitation The illegal or improper use of an older adult’s funds, property, or assets.

Neglect The refusal or failure to fulfill any part of a person’s obligations or duties to an older adult.

 6

The Center for Elders and the Courts, a project of the NCSC, attempts to increase 

judicial awareness of issues related to aging, and provides training tools and resources to 

improve court responses to elder abuse and guardianships.

7

For recent GAO reports related to elder abuse, see GAO, Elder Justice: National 

Strategy Needed to Effectively Combat Elder Financial Exploitation, GAO-13-110

(Washington, D.C.: Nov. 15, 2012); and Elder Justice: Stronger Federal Leadership Could 

Enhance National Response to Elder Abuse, GAO-11-208 (Washington, D.C.: Mar. 2, 

2011).

8

The National Center on Elder Abuse is a national resource center dedicated to the 

prevention of elder abuse. Funded by the Administration on Aging in HHS, it is made up of 

a consortium of grantees. 

Elder Abuse
Page 6 GAO-17-33 Elder Abuse

Abandonment The desertion of an older adult by an individual who has assumed responsibility for 

providing care for an older adult, or by a person with physical custody of an older adult.

Source: National Center on Elder Abuse. | GAO-17-33

a

Federal and state law may define these terms differently.

The extent of elder abuse by guardians nationally is unknown due to 

limited data on the numbers of guardians serving older adults, older 

adults in guardianships, and cases of elder abuse by a guardian. While 

courts are responsible for guardianship appointment and monitoring 

activities, among other things, court officials from the six selected states 

that we spoke to were not able to provide exact numbers of guardians for 

older adults or of older adults with guardians in their states. Also, on the 

basis of our interviews with court officials, none of the six selected states 

appear to consistently track the number of cases related to elder abuse 

by guardians.

Court officials from the six states we spoke with described the varied, 

albeit limited, information they have related to elder abuse by guardians 

and noted the various data limitations that prevented them from providing 

reliable figures on the extent of elder abuse by a guardian.

• California. A court official in California stated that while the Judicial 

Council of California collects information about requests for restraining

orders to prevent elder abuse, it does not separately identify those 

cases alleging elder abuse by a guardian. The council also collects 

the number of new guardianships filed each year statewide. The 

official stated the number of new adult guardianships is partially 

The Extent of Elder 

Abuse by Guardians 

Is Unknown, and 

Available Information 

Varies by State and 

Locality, but Some 

Efforts Are Under 

Way to Gather More 

Data

Courts Lack 

Comprehensive Data on 

Older Adults in 

Guardianships and Elder 

Abuse by Guardians, but 

Some Courts Have 

Limited Information
Page 7 GAO-17-33 Elder Abuse

estimated because about half of the courts in the state report a 

combined number of guardianships for minors and adults.

• Florida. A court official in Florida acknowledged that the court does 

not collect guardianship and elder abuse information such as the 

number of guardians for older adults, the types of guardians currently 

serving in guardianship roles for older adults, and the number of elder 

abuse hearings conducted. This official cited lack of funding as a 

barrier for collecting this type of information. Detailed information on 

financial exploitation specifically may be available at the county level. 

For example, officials from one county in Florida told us that it collects 

data on the number of guardianships and the assets guardians 

control, and also identified the amount of fraud over a 4-year period.

• Minnesota. A court official in Minnesota told us that the state 

differentiates between guardianship of the person and 

conservatorship of the estate. The state collects figures on the (1) 

number of guardianship cases, (2) number of conservatorship-only 

cases, and (3) number of combined guardianship and conservatorship 

cases; and can break these figures out by minors and adults. The 

state also has a statewide program housed in the court system—the 

Conservator Account Auditing Program—that audits the financial 

reports that guardians of the estate (or conservators) are required to 

submit electronically through a system called MyMNConservator. This 

system can calculate the total assets under court jurisdiction in 

Minnesota, which are presented in an annual report. According to the 

annual report, the program audits accounts with assets over a certain 

threshold at regular intervals and upon referral by the court. However, 

one of these officials told us that this system does not track the age of 

the individuals with guardians of the estate, so the number of older 

adults in this arrangement is not identifiable.

• Ohio. An official from the Supreme Court of Ohio told us probate 

courts in the state report to the Supreme Court quarterly aggregate 

caseload data including the number of pending guardian applications 

for adults, the number of new applications for the appointment of 

guardians, and the number of guardianships closed, but the data are

not classified by the age of the person under guardianship. 

Additionally, although local courts may do so, the Supreme Court of 

Ohio does not capture the number of complaints related to 

guardianships. Court officials directed us to state Adult Protective 

Services (APS) elder abuse complaint data.

• Texas. Court officials in Texas told us that every county is required to 

submit monthly information to the Office of Court Administration 

pertaining to active guardianships. However, officials told us that 
Page 8 GAO-17-33 Elder Abuse

some counties do not report any active guardianships (considered to 

be underreporting), and some counties overreport on active 

guardianships that should have actually been closed, such as when 

the person under guardianship is deceased.

• Washington. A court official in Washington stated that while she 

could provide the number of adult guardianships statewide, she could 

not provide this information specifically for older adults. Further, the 

state’s Certified Professional Guardian Board publishes the number of 

grievances against professional guardians each year its annual 

Grievance Report, but does not identify which were for older adults.9

This official stated that while the court has case information on abuse 

by professional guardians, it does not track information on abuse by 

family guardians.

Representatives from nongovernmental organizations we spoke with also 

told us that the way cases are classified in the court system makes 

collecting data on elder abuse by guardians difficult. For example, 

representatives from the Center for Elders and the Courts told us that few 

cases appear to be clearly labeled with phrases such as “elder abuse” in 

the court system, making it difficult to identify the universe of these cases. 

These representatives explained that cases of elder abuse may appear 

as other charges, such as assault, battery, or theft. Identifying all cases 

involving elder abuse, and more specifically that by a guardian, would 

require a difficult manual review of a large volume of court cases. Further, 

stakeholders we spoke to noted that instances of elder abuse by 

guardians can be difficult to prosecute, reducing the number of known 

cases in the legal system and presenting an additional challenge to 

identifying the extent of elder abuse by guardians.

Collecting reliable information about court practices related to 

guardianship can also be challenging. At the request of SSA, the 

Administrative Conference of the United States (ACUS) administered and 

analyzed the results of a survey of judges, court staff, and guardians to 

 9

Washington’s Certified Professional Guardianship Board defines a grievance as a written 

document filed by any person with the board or directly by the board itself, for the purpose 

of commencing a review of the professional guardian’s conduct under the rules and 

disciplinary regulations applicable to professional guardians.
Page 9 GAO-17-33 Elder Abuse

review guardianship practices in state courts in 2014.10 The survey 

collected information regarding appointment, monitoring, and discipline of 

guardians; caseloads and electronic case-management capabilities; and 

court interaction with federal agencies and other organizations.11

However, in administering this survey, ACUS was unable to identify a 

sample of courts that were representative of the guardianship practices in 

all states as no comprehensive list identifying courts or judges that have 

oversight of adult guardianship cases exists, which makes it impossible to 

generalize the findings to a known universe.

In the absence of reliable data, information on individual cases can 

provide some insight into the types of abuse guardians have been found 

to inflict on older adults under guardianship. In a 2010 report, we 

identified hundreds of allegations of abuse, neglect, and exploitation by 

guardians in 45 states and the District of Columbia between 1990 and 

2010. At that time, we reviewed 20 of these cases and found that 

guardians had stolen or otherwise improperly obtained $5.4 million from 

158 incapacitated victims, many of whom were older adults.12 Table 2 

provides a summary of eight new cases in which guardians were found to 

have financially exploited or neglected older adults under guardianship in 

the last 5 years. Seven of these cases were identified using public-record 

searches, while the eighth was referred to us during one of our interviews. 

We examined court records, police reports, or other relevant documents 

to corroborate key information about each case. The illustrative examples 

of selected closed cases of elder abuse by a guardian we identified are 

nongeneralizable and cannot be used to make inferences about the 

overall population of guardians.

 10ACUS is an independent federal agency that attempts to improve the administrative 

process through research and provides advice and recommendations for improved federal 

agency procedures. This study was done in response to recommendations by GAO and 

Congress to improve SSA’s collaboration with state courts to help protect incapacitated 

persons and better prevent the misuse of federal funds.

11Administrative Conference of the United States, SSA Representative Payee: Survey of 

State Guardianship Laws and Court Practices (Dec. 24, 2014).

12See GAO, Guardianships: Cases of Financial Exploitation, Abuse, and Neglect of 

Seniors, GAO-10-1046 (Washington, D.C.: Sept. 30, 2010).
Page 10 GAO-17-33 Elder Abuse

Table 2: Selected Closed Cases of Elder Abuse by a Guardian

Case 

number

Type of elder 

abuse

Case details

1 Financial 

exploitation

• According to a complaint filed by an official in the Office of the State Attorney in Florida, over 

the course of 21 months a family guardian spent money of the person under guardianship—an 

elderly disabled adult—on items unrelated to the care and welfare of that individual including 

personal bills, services, restaurant purchases, and cash withdrawals.

• In 2013, the guardian pleaded guilty to the exploitation of an elderly or disabled adult, and was 

sentenced to 120 days in jail and ordered to pay over $33,000 in restitution.

2 Financial 

exploitation

• According to Supreme Court of Ohio documents, a professional guardian misappropriated 

funds from persons under guardianship—at least one of whom was elderly—to support his 

drug addiction. The court found that the guardian’s misconduct caused harm by 

misappropriating more than $200,000 over a 6-year period.

• In 2014, the guardian was convicted of three felony counts of theft from the elderly, and was 

sentenced to a 4-1/2-year prison term, and ordered to pay restitution. In 2016, he was 

indefinitely suspended from the practice of law in Ohio.

3 Financial 

exploitation

• According to a criminal complaint in Virginia, a family guardian spent money of the person 

under guardianship—her 83-year-old aunt—on personal expenses including an $11,645 

pickup truck for a friend and $360 at a sunglasses retailer in Tennessee, and told law 

enforcement officials that she believes she is entitled to be taken care of using her aunt’s 

funds.

• In 2012, the guardian pleaded guilty to intent to defraud, and agreed that total losses were no 

less than $29,000. The guardian was sentenced to 12 months in prison and ordered to pay 

restitution of over $32,000.

4 Financial 

exploitation

• According to a criminal complaint in Virginia, the legal assistant of a professional guardian in 

Virginia used her unauthorized access to the bank accounts of an elderly person under 

guardianship to obtain more than $100,000 to support a drug habit by issuing and cashing 

fraudulent checks.

• The guardian initially discovered the thefts but, because of a personal relationship with his 

assistant, he failed to remove the access to the accounts, thereby allowing the thefts to 

continue, and attempted to conceal the scope and extent of the thefts from law enforcement 

officials and others.

• In 2014, the guardian pleaded guilty to misprision of a felony, agreed to repay the stolen 

funds, and in 2015 consented to the revocation of his law license.

5 Financial 

exploitation and 

neglect

• According to documents from the Certified Professional Guardian Board in the state of 

Washington, a professional guardian violated the Certified Professional Guardian Standards of 

Practice by (1) failing to properly manage the financial affairs of an elderly person under 

guardianship including the untimely filing of tax returns and payment of medication bills, (2) not 

providing basic clothing, (3) not visiting regularly or making arrangements for qualified visits, 

and (4) improperly taking guardian fees without consultation of the person under guardianship 

when the guardian was already being paid by the Office of Public Guardianship.

• The mismanagement of the funds of the person under guardianship represented a potential 

loss of up to $25,000 and accounted for up to 25 percent of the person’s assets.

• In 2015, the state Certified Professional Guardian Board revoked the guardian’s certification,

and the guardian was required to pay administrative costs of approximately $20,000.
Page 11 GAO-17-33 Elder Abuse

Case 

number

Type of elder 

abuse

Case details

6 Financial 

exploitation and 

neglect

• According to documents from the Texas Judicial Branch Certification Commission, a 

professional guardian was responsible for more than 50 persons under guardianship 

statewide, including at least 6 older adults in two facilities 400 miles from the guardian’s home 

and place of business.

• For the persons under guardianship in these two facilities, the guardian went months without 

contacting these individuals, did not provide them with shoes and clothing, was late in paying 

facilities, withheld moneys from their monthly stipends, and was nonresponsive to 

communications from their facilities.

• This conduct resulted in 16 violations of provisions of Texas’s Minimum Standards for 

Guardianship Services. On the basis of these and other unrelated violations, the guardian was 

required to pay an administrative penalty of over $25,000 and is not permitted to renew her 

guardian certification.

7 Financial 

exploitation

• According to court documents, a professional guardian in Nevada withdrew money from the 

bank accounts of persons under guardianship including over $78,000 in cash from an elderly 

person, falsified payments to her own company, and inappropriately used the funds of person 

under guardianship for other personal purchases such as jewelry items and payment to a cellphone company.

• In 2013, the guardian pleaded guilty to the exploitation of an elderly or vulnerable person, 

which is a felony in Nevada, and was sentenced to 8 years in prison and ordered to pay over 

$160,000 in restitution.

8 Financial 

exploitation

• According to court documents, a professional guardian in Oregon mistreated or stole money 

from 26 persons under guardianship including at least five older adults.

• The guardian, among other things, (1) intercepted checks made out to persons under 

guardianship, third-party care providers, and ambulance companies to deposit them in her 

own personal bank account and (2) when persons under guardianship died, the guardian 

diverted funds to her own personal bank account.

• In total, the guardian was convicted of five counts of Criminal Mistreatment in the First Degree, 

four counts of Aggravated Theft in the First Degree, one count of Theft in the First Degree, 

one count of money laundering, and one count of tax evasion. The guardian was sentenced to 

48 months in prison and was ordered to pay more than $117,000 in restitution to the victims. 

The guardian’s certification was also revoked.

Source: GAO analysis of court, police, state certifying board, and other state agency data. | GAO-17-33

Stakeholders we spoke to described their observations about elder abuse 

by a guardian. According to stakeholders, financial exploitation is among 

the more common types of elder abuse. Similarly, all eight of the closed 

cases of elder abuse by a guardian we found, presented above in table 2, 

were examples of financial exploitation. A prosecutor in one of the states 

we spoke to shared her observation that the majority of financial 

exploitation by professional guardians is done through overcharging for 

services that were either not necessary or were never performed. One 

representative commented that greed was a driving factor for guardians 

to financially exploit persons under guardianship. Some stakeholders we 

spoke to also expressed concerns that guardians may become 

overwhelmed by their guardianship responsibilities, or may not have the 
Page 12 GAO-17-33 Elder Abuse

proper training and education to understand and perform their 

guardianship duties.

Federal, state, and local entities have some efforts under way to try to 

collect better data on elder abuse and guardianship to support decision 

making and help prevent and address elder abuse by guardians. While 

state courts are responsible for overseeing the guardianship process—

appointment and screening, education, monitoring, and enforcement—

HHS has also taken steps to collect better data on guardianship and elder 

abuse. In 2011, we found that existing studies likely underestimated the 

full extent of elder abuse and could not be used to track trends.13 At that 

time, we recommended that HHS coordinate with the Attorney General to 

conduct a pilot study to collect, compile, and disseminate data on the 

feasibility and cost of collecting uniform, reliable APS administrative data 

on elder abuse cases from each state, and compile and disseminate 

those data nationwide. HHS agreed with our recommendation.

In 2013, HHS’s Administration on Aging began developing the National 

Adult Maltreatment Reporting System (NAMRS)—a national reporting 

system based on standardized data submitted by state APS agency 

information systems.14 The goal of the system is to provide consistent, 

accurate national data on the exploitation and abuse of older adults and 

adults with disabilities as reported to state APS agencies. According to 

HHS officials and the contractor developing NAMRS, this system will 

have the capability to collect information that could help identify cases of 

elder abuse where a guardian was involved.15 For example, NAMRS can 

collect information about substitute decision makers, including guardians, 

associated with the complaint such as whether there was a substitute 

decision maker at the start and end of the investigation, whether the 

perpetrator was the older adult’s substitute decision maker, and what 

recommendations or actions the state APS agency initiated against the 

perpetrator. An official from the Administration on Aging stated that the 

 13See GAO, Elder Justice: Stronger Federal Leadership Could Enhance National 

Response to Elder Abuse, GAO-11-208 (Washington, D.C.: Mar. 2, 2011).

14HHS’s Administration on Aging aims to promote the well-being of older adults by 

providing services and programs designed to help them live independently in their homes 

and communities.

15State APS agencies receive some complaints about incidents of elder abuse, so their 

systems represent a potential source of information for compiling national data on elder 

abuse. 

Federal, State, and Local 

Entities Have Some Efforts 

Under Way to Collect 

More Information on Elder 

Abuse by Guardians
Page 13 GAO-17-33 Elder Abuse

pilot phase of the system is complete and the agency hopes to roll it out 

for data submissions from all states by early 2017.

16

Representatives from the National Adult Protective Services Association 

stated that NAMRS would provide important information that could inform 

the guardianship process once fully implemented.17 For example, a court 

official from Florida suggested that having more information on elder 

abuse by a guardian may help guardianship programs decide whether to 

place more focus on screening, education, and monitoring of guardians, 

and enforcement of policies and laws governing guardians, as described 

later in this report.

In addition to this federal effort, some state and local efforts are also 

under way to collect better data on elder abuse and guardianship. 

However, some of the stakeholders we spoke to acknowledged that these 

efforts face funding challenges and require ongoing support.

• Compiling data points. Officials in one county in Florida described 

an ongoing project they have to extract key data points from 

guardianship cases, such as the reason for alleged incapacity, asset 

values, and time spent with a guardian, to share with other state 

guardianship programs. These officials expect that the data points will 

be used to assess the guardianship system in this county, and 

suggested that courts could use critical data points on guardianship 

such as the average time in guardianship, average burn rate of 

assets, or typical fees charged in order to make appropriate datadriven decisions on how to better address cases of potential elder 

abuse by a guardian. A court official in Florida told us that in the fall of 

2016, the Chief Justice of Florida will appoint a workgroup under the 

state’s Judicial Management Council to examine judicial procedures 

and best practices related to guardianship to help ensure that courts 

are protecting these individuals. Similarly, in Texas, the Office of 

 16While the system was designed to be flexible enough to be able to eventually gather 

data from different sources besides state APS agencies, there are currently no plans to 

enter information from other sources into NAMRS.

17The National Adult Protective Services Association is a nonprofit organization whose 

goal is to provide APS programs a forum for sharing information, solving problems, and 

improving the quality of services for victims of elder and vulnerable adult mistreatment. Its 

mission is to strengthen the capacity of APS at the national, state, and local levels, to 

effectively and efficiently recognize, report, and respond to the needs of elders and adults 

with disabilities who are the victims of abuse, neglect, or exploitation, and to prevent such 

abuse whenever possible.
Page 14 GAO-17-33 Elder Abuse

Court Administration started the Guardianship Compliance Pilot 

Project, which provides additional resources to courts handling 

guardianships by supplementing local staff to review compliance with 

statutory requirements and by developing an electronic database to 

monitor guardianship filings of initial inventory and annual 

accountings. Information collected includes the number of courts 

involved in the project, the number of guardianships reviewed, the 

number of guardianships out of compliance with required reporting, 

the number of guardians reported to the court for person under 

guardianship well-being or financial exploitation concerns, and the 

status of technology developed to monitor guardianship filings.

• Collecting complaint data. In Washington, the state’s Certified 

Professional Guardianship Board collects complaint and grievance 

information about professional guardians. In its annual report, the 

state publishes the number of cases opened, closed, investigated, 

and in need of investigation. The state also discloses the number of 

sanctions, which can include decertification, suspension, reprimand, 

prohibition from taking new cases, and admonishment, imposed on 

professional guardians. Ohio’s Disciplinary Counsel also reported the 

number of grievances filed regarding guardianships in 2015 and 

through September 2016. A court official from the Judicial Council of 

California told us his state tracks the number of requests for 

restraining orders under California’s Elder Abuse and Dependent 

Adult Civil Protection Act, which can include those against guardians.

• Identifying red flags. Representatives from the National Center for 

State Courts (NCSC) are using data collected from Minnesota’s 

Conservator Account Auditing Program to identify “red flags,”—or risk 

indicators—such as unusually high guardian fees or excessive vehicle 

or dining expenses that would help courts detect cases that need 

additional review or monitoring.18 Representatives from the NCSC told 

us they are hopeful that these efforts will help courts move forward in 

preventing and responding to abuses.

 18The NCSC is an independent, nonprofit court-improvement organization that serves as a 

clearinghouse for research information and comparative data to support improvement in 

judicial administration in state courts.
Page 15 GAO-17-33 Elder Abuse

While the federal government does not regulate or directly support 

guardianship, federal agencies, such as HHS, may provide indirect 

support to state guardianship programs by providing funding for efforts to 

share best practices and facilitate improved coordination. The federal 

government also shares information that state and local entities can use 

related to guardianship.

HHS has assumed a national role for funding grants to support 

coordination and information sharing that could help educate guardians 

and other parties.

• HHS has funded grants through the National Legal Resource Center 

to share best practices related to guardianship with states, attorneys, 

and other interested parties. The grant activities cover a wide range of 

guardianship issues related to court oversight and monitoring and 

illustrate the ongoing commitment to developing nationwide “Best 

Practice” resources on this issue. For example, grant activities have 

included providing technical assistance and policy guidance to states 

on guardianship issues, oversight and monitoring improvements, 

developing standards of practices for guardians, training attorneys 

practicing in the area of guardianship law, and developing solutions 

for interstate jurisdictional issues involving guardianship cases.

Federal Agencies 

Provide Funding to 

Support Coordination 

and Sharing 

Information, While 

State and Local 

Entities Oversee the 

Guardianship 

Process to Help 

Protect Older Adults 

with Guardians from 

Abuse

Federal Agencies’

Measures to Help Protect 

Older Adults with 

Guardians Include 

Providing Funding to 

Support Coordination and 

Sharing Information

Providing Funding to Support 

Coordination
Page 16 GAO-17-33 Elder Abuse

• HHS launched the Elder Justice Innovation Grants program in fiscal 

year 2016. The purpose of the program is to support foundational 

work to create credible benchmarks for elder abuse, neglect, and 

exploitation prevention and control, and for program development and 

evaluation. HHS expects projects funded by these grants will 

contribute to the improvement of the field of elder abuse prevention 

and intervention by developing and advancing approaches to address 

new and emerging issues related to elder justice, or by establishing 

and contributing to the evidence-base of knowledge. In 2016, HHS 

identified abuse in guardianship as one of the targeted priority areas 

for this program, and according to agency officials awarded three

grants in this target area—each grant is funded at approximately 

$1,000,000 over 2 years, September 2016 through September 2018. 

At the completion of these grants, HHS expects grantees will have 

developed materials and information for further replication and testing.

• HHS also funds the National Center on Elder Abuse, which collects 

information regarding research, training, best practices, news, and 

resources on elder abuse, and provides this information to 

policymakers, professionals in the elder justice field, and the public.

In addition, the State Justice Institute has provided grants to various 

entities to improve coordination and develop and share best practices.19

• With help from funding provided by the State Justice Institute and 

others, states have developed Working Interdisciplinary Networks of 

Guardianship Stakeholders (WINGS) programs to facilitate enhanced 

coordination. WINGS programs bring together judges and court staff, 

the aging and disability networks, the public and private bar, mentalhealth agencies, advocacy groups, medical and mental-health 

professionals, service providers, family members and individuals 

affected by guardianship, and others to drive changes affecting the 

ways courts and guardians practice and to improve the lives of older 

adults (and others) with guardians. National Guardianship Association 

representatives told us that WINGS groups look at the broader picture 

of what is happening to address guardianship-related issues across 

the country and are not just focused on abuse and neglect.20 WINGS 

 19Congress established the State Justice Institute as a private, nonprofit corporation that 

awards grants to improve the quality of justice in state courts, and create solutions to 

common issues faced by all courts. 42 U.S.C. §§ 10701 – 10713.

20The National Guardianship Association is a nonprofit corporation whose mission is to 

advance the nationally recognized standard of excellence in guardianship. 
Page 17 GAO-17-33 Elder Abuse

programs can make recommendations to state supreme courts and 

state legislatures based on their observations. American Bar 

Association representatives told us one of the keys to the success of 

a WINGS program is ongoing communication.21 The programs are not 

designed to be onetime conversations or a task force, but instead 

represent an ongoing communication mechanism to ensure optimal 

coordination. During our interviews, feedback for WINGS programs 

was consistently positive, and the WINGS group we spoke with 

emphatically encouraged other states to develop their own WINGSlike programs and expressed interest in continued funding support for 

its program.22 In addition, one of the goals of grants awarded through 

the Elder Justice Innovation Grants program is to establish, expand, 

and enhance state WINGS programs to improve the ability of state 

and local guardianship systems to develop protections less restrictive 

than guardianship and advance guardianship reforms. As of 

September 2016, at least 14 states and the District of Columbia have 

adopted either WINGS programs or something that resembles these 

programs.

CFPB has developed materials that can be used by guardians, banks, 

and others to help better protect older adults with guardians from abuse.

• CFPB has published numerous educational materials to help protect 

older adults from financial abuse and exploitation. These include 

guides for fiduciaries that lay out the rules and responsibilities for 

appropriately handling the finances of another person.23 CFPB has 

also developed guidance for financial institutions. For example, in 

2013, CFPB and seven other federal agencies issued guidance on 

privacy laws and reporting information on financial exploitation.24 This 

guidance is intended to make it clear that reporting suspected 

financial abuse of older adults to appropriate local, state, or federal 

agencies does not, in general, violate the privacy provisions of the 

 21The American Bar Association is a voluntary professional organization for attorneys that, 

among other things, has developed extensive research on guardianship and related 

matters.

22The American Bar Association and National Guardianship Network developed a 10-step 

guide for replicating WINGS programs. 

23According to CFPB officials, these guides can be adapted to incorporate state-specific 

rules and terminology. 

24Board of Governors of the Federal Reserve System, Interagency Guidance on Privacy 

Laws and Reporting Financial Abuse of Older Adults (Washington, D.C.: 2013).

Sharing Information
Page 18 GAO-17-33 Elder Abuse

Gramm-Leach-Bliley Act or its implementing regulations.25 CFPB 

officials stated that they hoped the 2013 Interagency Guidance will 

help financial institutions better understand their ability to report 

suspected financial exploitation to relevant federal, state, and local 

agencies. Additionally, in 2016, CFPB released an advisory and

related recommendations for financial institutions on preventing and 

responding to elder financial exploitation.

State and local courts have primary responsibility over the guardianship 

process and, hence, have a role in protecting older adults with guardians 

from abuse. In 2014, the National Association for Court Management 

published an adult guardianship guide with detailed information about 

how to plan, develop, and sustain a court guardianship program.26 This 

report laid out detailed suggestions for practices to effectively establish 

guardianships, monitor guardians, and train relevant stakeholders. 

Guardianship laws can also vary by state, but organizations such as the 

Uniform Law Commission—an organization that drafts legislation for 

states intended to bring clarity and stability to state statutory law—have 

developed model legislation to promote the uniformity of procedures for 

appointing guardians and conservators and strengthening due process 

protections for individuals in guardianship proceedings and jurisdictional 

conflicts. On the basis of our review of published materials and interviews 

with various state courts and nongovernmental stakeholders, we 

observed that measures states can take to help protect older adults with 

guardians vary but generally include screening, education, monitoring, 

and enforcement as shown in figure 1.

 25Gramm-Leach-Bliley Act, Pub. L. No. 106-102, Title V, §§ 501 – 510, 113 Stat. 1338, 

1436 – 1445 (Nov. 12, 1999) and 12 C.F.R. §§ 1016.1 – 1016.17.

26National Association for Court Management, Adult Guardianship Guide: A guide to plan, 

develop, and sustain a comprehensive court guardianship and conservatorship program, 

2013-2014 Guide (Williamsburg, Virginia: 2014).

State and Local Measures 

Can Include Screening, 

Education, Monitoring, and 

Enforcement
Page 19 GAO-17-33 Elder Abuse

Figure 1: Measures Used to Help Protect Older Adults with Guardians from Abuse

According to multiple stakeholders we spoke with, an important step of 

the guardianship process is for a court to ensure that only those in need 

are appointed a guardian. Once the need for a guardian has been 

identified, state courts generally are responsible for screening proposed 

guardians to help ensure suitable individuals are appointed. On the basis 

of our review of published materials and interviews with various state 

courts and nongovernmental stakeholders, we observed the following 

promising practices and challenges related to screening.

• Least-restrictive option. Due to the loss of rights experienced when 

an older adult is placed into a guardianship, courts determine whether 

a guardian is appropriate. One representative from a state WINGS 

program that we spoke with expressed concern that guardianship may 

not be appropriate for some persons under guardianship, especially 

when the appointment is made for the convenience of others. To 

address this concern, this representative told us that courts in her 

state have modified court guardianship forms to encourage the use of 

less-restrictive alternatives to guardianship, such as a caregiver.27

• Periodically reexamine guardianship. Some courts periodically 

reexamine the appropriateness of the guardianship to ensure that it is 

working for the person under guardianship and remains appropriate, 

since it can be difficult for an older adult with a guardian to 

demonstrate that his or her capacity has been restored.

• Criminal history and credit checks. These types of checks provide 

an easy and relatively inexpensive way to ensure that potential 

guardians do not have a criminal history or financial concerns. 

 27A caregiver is an individual who provides compensated or uncompensated care to an 

older adult who needs supportive services in any setting. 

Screening
Page 20 GAO-17-33 Elder Abuse

However, one of the stakeholders we spoke with described some 

limitations regarding background checks. For example, criminalbackground check systems may not present a complete picture for 

various reasons, including that many elder abuse cases are not 

prosecuted. Even when prospective guardians have been prosecuted, 

a number of factors determine whether the criminal history appears in 

the background check. For example, a background check may not 

always identify a criminal history in another state.

Stakeholders we spoke with agreed that education plays an important 

role in helping ensure that guardians understand their roles and 

responsibilities and appropriately perform their duties. On the basis of our 

review of published materials and interviews with various state courts and 

nongovernmental stakeholders, we observed the following promising 

practices and challenges related to education.

• Educational requirements. Education allows guardians to better 

understand their roles and responsibilities. For example, a court rule 

requires professional guardians in Washington to complete a training 

program developed by the state’s Certified Professional Guardian 

Board, while a statute generally requires family guardians to complete 

video or web-based training. According to state officials, the 

professional guardian training consists of a 90-hour course offered by 

the University of Washington, while family guardians usually complete 

a 2-hour training module. Florida statutes also generally require family 

guardians to undergo course work on guardian responsibilities, while 

applying more rigorous requirements for professional guardians. 

These types of training requirements may help to address 

unintentional and nonmalicious mistreatment such as comingling 

assets of the guardian and the person under guardianship. Officials at 

the National Guardianship Association told us that education about 

how to be an effective guardian is very important because guardians 

may make bad decisions due to lack of training or education about 

their role, and not intentional abuse. However, educational 

requirements for guardians are not in place in many states.

• Standards of practice and certification. The National Guardianship 

Association has developed standards of practice that define a 

guardian’s duty to comply with laws and regulations; the guardian’s 

relationship with the courts, protected persons, and others; and other 

duties to the person under guardianship. Also, the Center for 

Guardianship Certification has developed a certification program that 

tests a prospective certified guardian’s ability to apply these standards 

Education
Page 21 GAO-17-33 Elder Abuse

of practice.28 Under this certification program, certified guardians must 

meet continuing educational requirements to maintain their status as 

professional guardians. According to the Center for Guardianship 

Certification, 12 states require professional guardians to be certified, 

including 8 states that require certification via the use of Center for 

Guardianship Certification examinations, as of September 2016.

• Educational materials. Courts in all six of the selected states we 

spoke to post written guidance for guardians online. These guides 

explain the responsibilities and duties associated with becoming a 

guardian while providing other potentially useful information. For 

example, a guide from California discusses the importance of 

separating funds of guardian and of persons under guardianship by 

warning guardians that mixing their money with that of the persons 

under guardianship could get the guardian in serious trouble. 

Minnesota has also made online videos that explain the guardianship 

process as well as guardian roles and responsibilities. In conjunction 

with the NCSC, North Dakota developed a web-based information 

seminar that guardians can use to better understand their 

responsibilities. The training is scenario-based and helps the trainee 

understand his or her options, and was designed to be easily modified 

for replication in other states. One challenge that one official noted is 

that it can be difficult to reach family guardians to provide them with 

educational materials. Also, even when family guardians can be 

reached, one stakeholder suggested that a 30-minute training video is 

unlikely to radically enhance guardian performance when a guardian 

is faced with some of the more complicated scenarios.

• Support for guardians. One of the stakeholders we spoke with 

suggested that guardians and persons under guardianship would 

benefit from other initiatives, such as states providing guardians with a 

mechanism to ask questions and allowing guardians to receive 

positive feedback when something went well instead of just warnings 

when something went wrong. Another stakeholder told us it would be

beneficial for guardians to interact with one another to finds ways to 

achieve better outcomes.

According to some of the stakeholders we spoke with, most states require 

guardians to be monitored, but the level of oversight and specific 

 28The Center for Guardianship Certification was created in 1994 as an allied organization 

of the National Guardianship Association to enhance the quality of guardianship services 

through national certification. Voluntary certification through CGC is open to all guardians, 

not just professional guardians. 

Monitoring
Page 22 GAO-17-33 Elder Abuse

requirements vary by state. On the basis of our review of published 

materials and interviews with various state courts and nongovernmental 

stakeholders, we observed the following promising practices and 

challenges related to monitoring.29

• In person visits and well-being checks. To monitor the person 

under guardianship’s personal well-being, one stakeholder told us 

courts in every state should periodically send a court investigator to 

conduct an unannounced site visit to check on that individual.

• Examinations of guardian expenditures. A state court official we 

spoke with cautioned that, without effective monitoring, guardians 

basically have free access to the person under guardianship’s money 

and other officials we interviewed outlined some specific related 

measures. For example, an official from one organization suggested 

that steps should be taken to help ensure that fees are appropriate for 

the services rendered (e.g., attorneys should not charge attorney 

rates for grocery shopping), while another representative of a different 

organization suggested that fees should be capped to help protect 

persons under guardianship. Other related suggestions from various 

stakeholders included independent reviews of mandatory annual 

financial reports, an initial inventory of the person under 

guardianship’s assets, and utilizing effective accounting controls to 

help protect that individual’s assets. Technology can be used to 

support the oversight process. For example, as previously described, 

Minnesota monitors the state’s conservators using an online program 

that allows auditors to flag suspicious spending patterns and other 

warning signs for potential abuse.

Despite the known importance of monitoring efforts, stakeholders 

described how challenges in monitoring guardians often arise from 

resource limitations. According to one of the stakeholders we interviewed, 

courts often do not have the resources to employ court visitors, 

investigators, auditors, or robust case-management systems for tracking 

key filings and case events. Another stakeholder told us that guardians 

are supposed to submit annual reports about persons under 

guardianship, and in many states and counties these reports are filed, but 

no one checks to see if the reports have been filed on time or to verify if 

what is reported is accurate.

 29In 2007 the AARP Public Policy Institute and American Bar Association issued a study 

on promising practices for court monitoring. See AARP Public Policy Institute, Guarding 

the Guardians: Promising practices for court monitoring (Washington, D.C.: 2007), for 

additional details about these practices.
Page 23 GAO-17-33 Elder Abuse

In addition, other monitoring efforts can be limited. For example, a court 

official in Washington told us some reviews are paper audits where no 

one conducts a site visit to the person under guardianship to verify his or 

her well-being. Representatives from the National Guardianship 

Association told us that while guardianships have some oversight, there is 

significant variation in the level of oversight performed by different states. 

The investment in monitoring the activity of guardians is up to local 

counties and constrained by resources. One of the recurring themes 

these representatives find when they examine guardianship issues is that 

states would like to apply more robust oversight, but the states say that 

there are not enough resources available to investigate and oversee 

these cases.

To help overcome resource limitations, the American Bar Association and 

AARP have developed programs courts can use to recruit and train 

volunteers to help monitor guardian activities. While there are some costs 

associated with these programs, according to stakeholders, they can 

reduce the burden on courts for monitoring guardian activities.

Enforcement activities punish the guardian for his or her abusive actions 

against a person under guardianship, deter future abuse by sending the 

message that the abuse of older adults by guardians will not be tolerated, 

and at times may allow for restitution to the victim. On the basis of our 

review of published materials and interviews with various state courts and 

nongovernmental stakeholders, we observed the following promising 

practices and challenges related to enforcement.

• Complaint systems. In addition to providing educational benefits to 

guardians, certification systems can provide states with a mechanism 

for receiving complaints and addressing noncriminal guardian 

performance issues (e.g., not submitting required accountings), while 

offering other potential certification-related benefits such as screening 

opportunities and continuing education requirements. In states that 

certify guardians, complaints may also be directed to the guardianship 

certification board. State-operated hotlines can also help identify 

cases of abuse. For example, the Palm Beach County Clerk’s 

Inspector General set up a hotline that allows the public to report 

concerns about guardians via telephone, e-mail, or the Internet, or inperson. From fiscal year 2011 through February 2016, the Palm 

Beach County Clerk’s Inspector General reported 516 contacts, 250 

of which were actionable. However, multiple stakeholders also 

identified some challenges related to complaints. For example, some 

of the representatives we spoke with stated that it may be difficult or 

Enforcement
Page 24 GAO-17-33 Elder Abuse

impossible for people with diminished capacity to file a complaint 

about a guardian, so complaints typically originate from family 

members. Also, one of the stakeholders we interviewed told us it is 

not always clear where complaints about guardians should be sent, 

but that anyone with an elder-abuse related concern could contact law 

enforcement agencies or the state APS agency. In addition, this 

stakeholder told us that courts may have complaint processes, but it 

can be difficult to navigate these processes without effective counsel.

• Dedicated investigative resources. Palm Beach County, Florida, 

dedicated resources to independently audit guardian spending reports 

and also dedicated resources to the investigation and monitoring of 

guardianship-related activities, which has had a positive effect, 

according to officials there. A prosecutor that we spoke with in San 

Diego discussed similar efforts in his jurisdiction, but noted that lawenforcement entities in most cities do not have departments dedicated 

to investigating elder abuse.

• Appropriate disciplinary measures. Guardianship enforcement 

activities can range from removing guardians for poor performance to 

prosecution for overt criminal actions. States that apply such 

measures appropriately can punish bad actors, obtain restitution for 

victims, and deter future abuse.30 However, there can be investigative 

and prosecutorial challenges associated with cases of elder abuse by 

a guardian. Stakeholders we spoke to highlighted obstacles that can 

obstruct efforts to punish abusive guardians. For example, a 

prosecutor in Washington noted that when abuse by guardians takes 

the form of overcharging an older adult for the guardian’s services, 

because the courts have approved the payments in question it is 

virtually impossible for the prosecutor’s office to file charges. This 

prosecutor explained that a guardian charged with financial 

exploitation in such a case would be able to argue that the fees he or 

she obtained were appropriate because they were sanctioned by the 

courts; this would almost certainly prevent such a guardian from being 

found guilty at trial. Also, a prosecutor in California opined that lawenforcement officials generally feel that when someone is in a position 

of trust, law enforcement officials cannot and should not get involved. 

Specifically, they feel it is a civil matter that should be handled in the 

civil jurisdiction. Other representatives we spoke with raised concerns 

about the cost of investigating cases of potential abuse. For example, 

 30In some states, guardians are generally required to post a bond in an amount set by the 

court to allow victims to recover losses resulting from a guardian’s failure to properly 

perform his or her duties.
Page 25 GAO-17-33 Elder Abuse

representatives from the National Guardianship Association noted the 

forensic analysis to identify evidence in these cases can cost $20,000 

or more for just one case. Other challenges relate to the penalties 

associated with these crimes. For example, an official in Washington 

has noted the sentences tend to be insignificant and jail time can 

often be avoided. This official also noted that prosecutors will rarely 

proceed with cases that do not exceed certain dollar thresholds.

We are not making recommendations in this report. We provided a draft 

of this report to HHS, CFPB, the Department of Justice, SSA, the 

Department of Veterans Affairs, and the Office of Personnel Management

for review and comment. CFPB and SSA provided technical comments, 

which we incorporated as appropriate. HHS, the Department of Justice, 

the Department of Veterans Affairs, and the Office of Personnel 

Management had no comments on this report.

As agreed with your offices, unless you publicly announce its contents 

earlier, we plan no further distribution of this report until 30 days from its 

issue date. At that time, we will send copies of this report to relevant 

congressional committees; the Commissioner of the Social Security

Administration; the Secretary of Veterans Affairs; the Secretary of Health 

and Human Services; and other interested parties. In addition, the report 

will be available at no charge on the GAO website at http://www.gao.gov.

If you or your staff have any questions concerning this report, please 

contact me at (202) 512-6722 or larink@gao.gov. Contact points for our 

Offices of Congressional Relations and Public Affairs may be found on 

the last page of this report. GAO staff who made key contributions to this 

report are listed in appendix II.

Kathryn A. Larin

Acting Director

Forensic Audits and Investigative Service

Agency Comments
Appendix I: Coordination between Federal 

Representative Payee Programs and State 

Guardianship Programs

Page 26 GAO-17-33 Elder Abuse

The Social Security Administration (SSA), the Department of Veterans 

Affairs, and the Office of Personnel Management have programs that 

appoint representative payees to manage federal benefits received by 

individuals who are unable to do so for themselves.1 Federal agencies 

are responsible for oversight of representative payees assigned under 

these programs, while state and local courts are responsible for oversight 

of guardianship appointments. A representative payee may also be a 

guardian, and some beneficiaries with a representative payee may also 

have a guardian. According to a white paper prepared for the Elder 

Justice Coordinating Council, the representative payee and the guardian 

might or might not be the same person or organization.2 Table 3 shows 

the number of beneficiaries who are older adults and have representative 

payees, as well as the number of representative payees and courtappointed guardians or conservators that the respective federal agency is 

aware of.

Table 3: Counts of Older Adults Receiving Federal Benefits, and Related Number of Representative Payees and Guardians

Agency Number of 

program 

beneficiaries 

over age 65

Number of beneficiaries 

over age 65 with 

representative payees

Number of 

representative payeesa Beneficiaries with a courtappointed guardian or 

conservatorb

Social Security 

Administration 

(SSA)c

44,888,000 652,688 550,493 91,744

Department of

Veterans Affairsd 2,413,353 121,946 108,987 2,793

Office of Personnel 

Managemente 2,051,946 6,619 6,339 4,641

Source: SSA, Department of Veterans Affairs, and Office of Personnel Management. | GAO-17-33

a

A single representative payee may assist multiple federal beneficiaries.

b

Federal agencies are responsible for oversight of representative payees assigned under these 

programs, while state and local courts are responsible for oversight of guardianship appointments.

c

SSA directed GAO to its July 2016 Monthly Statistical Snapshot to determine the number of program 

beneficiaries over age 65 and to its 2015 Annual Statistical Supplement to provide the number of 

beneficiaries over age 65 with representative payees. SSA directly provided the remaining figures as 

of July 2016.

1

We use the term “representative payee” to refer to both Department of Veterans Affairs 

fiduciaries and SSA or Office of Personnel Management representative payees.

2

Erica Wood, Statement on Federal Approaches Toward Elder Financial Exploitation by 

Fiduciaries—Representative Payees & Guardians, paper prepared for the Elder Justice 

Coordinating Council (Oct. 31, 2012). 

Appendix I: Coordination between Federal 

Representative Payee Programs and State 

Guardianship Programs
Appendix I: Coordination between Federal 

Representative Payee Programs and State 

Guardianship Programs

Page 27 GAO-17-33 Elder Abuse

d

The Department of Veterans Affairs uses the term fiduciary to describe the person who supports 

individuals who are unable to manage their financial affairs. The number of beneficiaries over the age 

of 65 with a court-appointed guardian or conservator only includes those court appointments 

recognized by the Department of Veterans Affairs. The Department of Veterans Affairs provided the 

number of program beneficiaries over 65 as of September 2015, and provided the number of 

beneficiaries with representative payees, number of representative payees, and number of 

beneficiaries with a court-appointed guardian or conservator as of August 2016.

e

The Office of Personnel Management provided figures for all columns as of August 2016.

We have previously found that, among other things, poor communication 

between the courts and federal agencies has enabled guardians to 

chronically abuse persons under guardianship and others.3 In 2011, we 

found that information sharing among federal fiduciary programs and 

state courts could improve the protection of older adults with guardians.4

More specifically, we found that information about SSA’s incapable 

beneficiaries and their representative payees could help state courts (1) 

avoid appointing individuals who, while serving as SSA representative 

payees, have misused beneficiaries’ SSA payments in the past, and (2) 

provide courts with potential candidates for guardians when there are no 

others available.5 At that time, we recommended that SSA should 

determine how it can, under current law, disclose certain information 

about beneficiaries and fiduciaries to state courts upon request, 

potentially proposing legislative changes to allow such disclosure. Upon 

review of our recommendation, SSA determined it could not disclose 

information about SSA beneficiaries and representative payees to state 

courts for the purposes of determining guardianship without written 

consent because legal limitations prevent the sharing of this information.

While we continue to believe that it is in the best interest of incapable 

SSA beneficiaries for the agency to disclose certain information about 

beneficiaries and fiduciaries to state courts, SSA officials with whom we 

 3

See GAO, Elder Justice: National Strategy Needed to Effectively Combat Elder Financial 

Exploitation, GAO-13-110 (Washington, D.C.: Nov. 15, 2012).

4

See GAO, Incapacitated Adults: Oversight of Federal Fiduciaries and Court-Appointed 

Guardians Needs Improvement, GAO-11-678 (Washington, D.C.: July 22, 2011).

5

Pursuant to 42 U.S.C. § 405(j)(2)(B)(ii), SSA maintains a centralized file of individuals 

whose certification as a representative payee has been revoked, who have been 

convicted of certain types of fraud under the Social Security Act, or who have otherwise

misused certain SSA benefits. Generally, these individuals may not serve as 

representative payees for SSA benefits. SSA officials told us that the agency has 

determined that a routine use for sharing this information with state courts is not legally 

permissible under the Privacy Act (5 U.S.C. § 552a) because such a use is not compatible 

with the purposes for which SSA collected the information.
Appendix I: Coordination between Federal 

Representative Payee Programs and State 

Guardianship Programs

Page 28 GAO-17-33 Elder Abuse

spoke in 2016 maintain that the agency cannot disclose information 

regarding SSA beneficiaries and representative payees to courts for the 

purposes of determining guardianship issues without written consent, 

unless a Privacy Act exception applies. SSA officials also told us they 

were not aware of any routine exchanges of information between state 

courts and their agency; however SSA does share limited information 

about representative payees with other federal agencies when legally 

authorized to do so.

Officials from state courts we spoke to also reiterated the need for 

increased coordination and communication with federal representative 

payee programs. For example, a court official in Washington explained 

that it is important for courts to know when there is an issue with a 

representative payee who is trying to become a guardian, and it is also 

important for SSA to know when there is a problem guardian.6 Also, court 

officials in Ohio described another challenge related to their monitoring 

efforts that occurs when they are unaware of significant increases in the 

assets of the person under guardianship, caused by the receipt of sizable 

back payments paid by SSA.

As described in this report, the Administrative Conference of the United 

States administered and analyzed the results of a survey of judges, court 

staff, and guardians to review, among other things, court interaction with 

federal agencies.7 In August 2016, SSA officials told us the agency was 

using the study to make improvements that will leverage the work of state 

courts in SSA’s process for determining whether a representative payee 

is necessary. For example, SSA is exploring whether the agency could 

automatically appoint guardians—or individuals who are currently serving 

in a similar capacity—as representative payees. Additionally, SSA 

officials told us they are using the results to identify better ways to 

communicate with state and local courts and the guardians appointed by 

these entities. These efforts include providing clarification to agency 

 6

SSA officials reviewed this comment made by the Washington court official and noted 

that SSA’s standards for representative payees differ from state guardianship standards; 

thus, while some problems may be helpful for SSA to know about, others may not. SSA 

officials also noted that under the Privacy Act, SSA must maintain in its records only such 

information about an individual as is relevant and necessary to accomplish the purpose of 

administering its programs. 5 U.S.C. § 552a(e)(1).

7

Administrative Conference of the United States, SSA Representative Payee: Survey of 

State Guardianship Laws and Court Practices (Dec. 24, 2014).
Appendix I: Coordination between Federal 

Representative Payee Programs and State 

Guardianship Programs

Page 29 GAO-17-33 Elder Abuse

technicians on permitted disclosures to state and local courts and legal 

guardians.
Appendix II: GAO Contact and Staff 

Acknowledgments

Page 30 GAO-17-33 Elder Abuse

Kathryn A. Larin, (202) 512-6722 or larink@gao.gov

In addition to the contact named above, Gabrielle Fagan (Assistant 

Director), John Ahern, Nada Raoof, and April Van Cleef made key 

contributions to this report. Also contributing to the report were Lorraine 

Ettaro, Colin Fallon, Maria McMullen, and James Murphy.

Appendix II: GAO Contact and Staff 

Acknowledgments

GAO Contact

Staff 

Acknowledgments
Related GAO Products

Page 31 GAO-17-33 Elder Abuse

Elder Justice: More Federal Coordination and Public Awareness Needed. 

GAO-13-498. Washington D.C.: July 10, 2013.

Elder Justice: National Strategy Needed to Effectively Combat Elder 

Financial Exploitation. GAO-13-110. Washington D.C.: November 15, 

2012.

Incapacitated Adults: Oversight of Federal Fiduciaries and CourtAppointed Guardians Needs Improvement. GAO-11-678. Washington 

D.C.: July 22, 2011.

Elder Justice: Stronger Federal Leadership Could Enhance National 

Response to Elder Abuse. GAO-11-208. Washington D.C.: March 2, 

2011.

Guardianships: Cases of Financial Exploitation, Neglect, and Abuse of 

Seniors. GAO-10-1046. Washington D.C.: September 30, 2010.

Related GAO Products

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