Guardianships: Collaboration Needed to Protect Incapacitated Elderly People
Published: 2004-07-13T00:00:00

Fast Facts:

Highlights:
section_title: Why GAO Did This Study
paragraphs: As people age, some become incapable of managing their personal and financial affairs. To protect these people, state laws provide for court appointment of guardians to act on their behalf. In many cases federal programs provide these incapacitated people financial benefits. GAO was asked to examine: (1) what state courts do to ensure that guardians fulfill their responsibilities, (2) what guardianship programs recognized as exemplary do to ensure that guardians fulfill their responsibilities, and (3) how state courts and federal agencies work together to protect incapacitated elderly people.
section_title: What GAO Found
paragraphs: All states have laws requiring courts to oversee guardianships, but court implementation varies. Most require guardians to submit periodic reports, but do not specify court review of these reports. Interstate jurisdictional issues sometimes arise when states do not recognize guardianships originating in other states. Most courts responding to our survey did not track the number of active guardianships, and few indicated the number of incapacitated elderly people under guardianship. Four courts recognized by members of the National Guardianship Network as having exemplary guardianship programs devote staff to strong programs for guardianship training and oversight. Three of these courts offer training to guardians even though state law does not require it. Three also have programs in which volunteers or social work student interns visit people under guardianship and report on their condition. Although state courts and federal agencies are responsible for protecting many of the same incapacitated elderly people, they generally work together only on a case-by-case basis. Some courts send notices of guardianship to the Department of Veterans Affairs and the Social Security Administration, but generally coordination among federal agencies and courts is not systematic. Federal agencies and courts do not systematically notify other agencies or courts when they identify someone as incapacitated, or when they discover that a guardian or a representative payee is abusing the incapacitated person. This lack of coordination may leave incapacitated people without the protection of responsible guardians and representative payees.

section_title: Letter
paragraphs: As people age, some of them become incapable of caring for themselves  and must rely on a guardian—a person or entity appointed to make  decisions for them. In the United States, the number of people requiring a  guardian is expected to increase considerably in the years ahead. The  number of elderly people (those aged 65 and older) is expected to increase  substantially over the next several decades, and the number of people  aged 85 and older is expected to triple by 2040 to 15 million. The Census  Bureau estimates that about one-quarter of the people in this older age  group has Alzheimer’s disease, which may lead to dementia that is severe  enough that people become incapable of caring for themselves. Generally,  adults are identified as incapacitated when they become physically or  mentally incapable of making or communicating important decisions, such  as those required in handling finances or securing possessions. In many  cases, incapacitated adults are elderly, but in many other cases they are  not, and generally the same laws and procedures apply to all incapacitated  adults. Often, family members can provide assistance, but sometimes a  state or local court needs to appoint a guardian to act on behalf of the  incapacitated person. The guardian becomes responsible for making  decisions to protect the incapacitated person from financial and physical  abuse or neglect, and the incapacitated person loses decision-making  rights.
Although guardianship is a state responsibility, there are many  incapacitated elderly people who receive federal benefits, and this group  of people may need federal agencies to identify a representative payee—a  person or organization designated to handle those benefits on their behalf.  State and local courts are responsible for oversight of guardianship  appointments, and federal agencies are responsible for oversight of  representative payees. Courts and federal agencies have identified  instances in which guardians or representative payees have taken  advantage of incapacitated elderly people by, for example, stealing from  them or billing for services not provided. Such cases of abuse and neglect  of elders by guardians and representative payees have prompted questions  about the oversight of these programs.
As part of your committee’s focus on aging issues, you asked us to study  guardianships for the elderly and the representative payee programs of  federal agencies such as the Social Security Administration (SSA), the  Department of Veterans Affairs (VA), and the Office of Personnel  Management (OPM), which manages retirement programs for federal  employees. In response to your request, we examined: (1) what state  courts do to ensure that guardians fulfill their responsibilities, (2) what  exemplary guardianship programs do to ensure that guardians fulfill their  responsibilities, and (3) how state courts and federal agencies work  together to protect incapacitated elderly people. To study these topics, we  reviewed state statutes and conducted surveys of courts responsible for  guardianships in the three states with the largest elderly populations— California, Florida, and New York. Forty-two of 58 courts in California,   55 of 67 courts in Florida, and 9 of 12 judicial districts in New York  responded to our surveys. We also visited courts in eight states and  interviewed officials responsible for representative payee programs at  SSA, VA, and OPM and officials at the Department of Health and Human  Service’s Administration on Aging. In addition, we visited 4 courts  identified by members of the National Guardianship Network (a joint  council representing eight national organizations involved in guardianship  issues) as having exemplary guardianship programs. We conducted our  work between March 2003 and May 2004 in accordance with generally  accepted government auditing standards. (For details concerning our  scope and methodology, see app. I.)
subsections: section_title: Background
paragraphs: The number of people age 65 and older will nearly double by the year   2030 to 71 million. An estimated 6 percent of people aged 65 or older have  Alzheimer’s disease, a degenerative condition that may lead to dementia.
Over time, some elderly adults may become physically or mentally  incapable of making or communicating important decisions, such as those  required to handle finances or secure their possessions. In addition, while  some incapacitated adults may have family members who can assume  responsibility for their decision-making, many elderly incapacitated people  do not. The Census Bureau predicts that in the future the elderly  population will be more likely to live alone and less likely to have family  caregivers. In situations such as these, additional measures may be  necessary to ensure that incapacitated people are protected from abuse  and neglect.
Several arrangements can be made to protect the elderly or others who  may become incapacitated. A person may prepare a living will, write  advance health care directives, and appoint someone to assume durable  power of attorney, or establish a trust. However, such arrangements may  not provide sufficient protection. Some federal agencies do not recognize  durable powers of attorney for managing federal benefits. SSA, for  example, will assign a representative payee for an incapacitated person if  it concludes that the interest of the incapacitated beneficiary would be  served, whether or not the person has granted someone else power of  attorney. In addition, many states have surrogacy healthcare decision- making laws, but these alternatives do not cover all cases. Additional  measures may be needed to designate legal authority for someone to make  decisions on the incapacitated person’s behalf.
To provide further protection for both elderly and non-elderly  incapacitated adults, state and local courts appoint guardians to oversee  their personal welfare, their financial well being, or both. The  appointment of a guardian typically means that the person loses basic  rights, such as the right to vote, sign contracts, buy or sell real estate,  marry or divorce, or make decisions about medical procedures. If an  incapacitated person becomes capable again, by recovering from a stroke,  for example, he or she cannot dismiss the guardian but, rather, must go  back to court and petition to have the guardianship terminated.
The federal government does not regulate or provide any direct support  for guardianships, but courts may decide that the appointment of a  guardian is not necessary if a representative payee has already been  assigned to an incapacitated person by a federal agency. Representative  payees are entirely independent of court supervision unless they also  serve their beneficiary as a court-appointed guardian. Guardians are  supervised by state and local courts and may be removed for failing to  fulfill their responsibilities. Representative payees are supervised by  federal agencies, although each federal agency with representative payees  has different forms and procedures for monitoring them.
Each state provides a process for initiating and evaluating petitions for  guardianship appointment. Generally, state laws require that a petition be  filed with the court and notice be provided to the alleged incapacitated  person and other people with a connection to the person. In nearly all  states, the alleged incapacitated person is granted the right to be present  at the hearing, and the right to counsel. Most states require clear and  convincing evidence of a person’s incapacity before a guardian can be  appointed. The court may appoint a family member, friend, attorney, a  paid private professional, a nonprofit social service agency, or a local  public agency to serve as the guardian.
In many cases, both courts and federal agencies have responsibilities for  protecting incapacitated elderly people, as shown in figure 1. For federal  agencies, a state court determination that someone is incapacitated or  reports from physicians often provide evidence of a beneficiary’s  incapacity, but agency procedures also allow statements from lay people  to serve as a sufficient basis for determining that a beneficiary needs  someone to handle benefit payments on their behalf—a representative  payee. SSA, OPM, and VA ask whether the alleged incapacitated person  has been appointed a guardian and often appoint that person or  organization as the representative payee. In some cases, however, the  agencies choose to select someone other than the court-appointed  guardian. Social Security officials sometimes designate the nursing home  where the incapacitated person resides as the representative payee  because it provides for direct payment to the nursing home, ensuring  continuity of care for the incapacitated person.
In many cases, guardians are appointed with a full range of responsibilities  for making decisions about the incapacitated person’s health and well- being as well as their finances, but several states’ laws require the court to  limit the powers granted to the guardian, if possible. The court may  appoint a “guardian of the estate” to make decisions regarding the  incapacitated person’s finances or a “guardian of the person” to make  nonfinancial decisions. An incapacitated person with little income other  than benefits from SSA for example, might not need a “guardian of the  estate” if he or she already has a representative payee designated by SSA  to act on their behalf in managing benefit payments. Sometimes the  guardian is paid for their services from the assets or income of the  incapacitated person, or from public sources if the incapacitated person is  unable to pay. In some cases, the representative payee is paid from the  incapacitated person’s benefit payments.
Guardians and representative payees may have conflicts of interest that  pose risks to incapacitated people. While many people appointed as  guardians or representative payees serve compassionately, often without  any compensation, some will act in their own interest rather than in the  interest of the incapacitated person.  Oversight of both guardians and  representative payees is intended to prevent abuse by the people  designated to protect the incapacitated people.
While the incidence of elder abuse involving persons assigned a guardian  or representative payee is unknown, certain cases have received  widespread attention. The following are examples of abuse by guardians  and representative payees provided by courts and federal agencies:    A guardian and an employee of the guardian’s law firm brought a  nursing home resident in New York a cake and flowers on her birthday  and billed her $850 for the visit using hourly rates for legal services.
Rather than using electronic direct deposit, a guardian in New York  City appointed to protect an incapacitated person regularly traveled to  their branch bank in another borough to deposit her monthly $50 Social  Security check, charging her $300 per deposit.
A company in Michigan acting as guardian for more than 600  incapacitated people committed felonies against them, including selling  one individual’s home to a relative of a company employee for $500.
A woman in the position of Public Fiduciary at the Gila County Public  Fiduciary’s Office in Arizona served as guardian of incapacitated  people and in that capacity embezzled and misused a total of at least  $1.2 million of public funds. The county’s investigation concluded that  “the Court’s lack of oversight contributed to the enormous loss of  public monies.”
A woman in Washington State established a nonprofit service  organization that SSA designated as the representative payee for about  200 beneficiaries. One of her clients was a homeless man entitled to  retroactive payment of benefits totaling about $15,000. She received the  payment on his behalf, but used the money as her own, along with SSA  benefits for others. She embezzled a total of approximately $107,000 of  SSA benefits.
A guardian and representative payee for veterans pled guilty to four  counts of misappropriation after a joint VA and SSA Office of Inspector  General investigation substantiated allegations that he had embezzled  over $400,000 from the veterans’ estates.
The head of a foundation in West Virginia serving as a representative  payee for 140 people (including veterans and elderly people) embezzled  over $300,000 from them over a 4-year period, consisting mostly of  Social Security benefits.
section_title: State Laws Provide for Court Oversight of Guardianships, but Court Procedures Vary
paragraphs: All 50 states and the District of Columbia have statutes providing for state  or local court oversight of guardianship appointments, but court  procedures for implementing these laws vary considerably. Generally,  guardians submit periodic reports to the court, but courts’ procedures for  reviewing reports vary, as do procedures for monitoring guardianships and  the penalties courts impose when guardians do not perform their duties.  Jurisdictional issues, such as courts in 2 states being asked to appoint a  guardian for the same incapacitated person, sometimes complicate  guardianship appointments. In addition, most state courts surveyed do not  maintain information needed for effective monitoring and oversight of  guardianships.
subsections: section_title: State Laws Require Courts to Oversee Guardianships, but Jurisdictional Issues Complicate Oversight
paragraphs: State laws provide for court appointment and oversight of guardianships.  Nearly all states require two kinds of reports: one regarding the personal  status and well being of the incapacitated person and another regarding  the accounting of the person’s finances. The personal status reports  usually include information regarding the condition of the incapacitated  person, although many states require more specific information regarding  various aspects of the incapacitated person’s status. In many states, the  laws require the report to include documentation of the need for  continued guardianship. Many statutory requirements are very detailed  and require a physician’s statement, a determination of the mental status  of the incapacitated person, or in some instances, reports of any change in  the condition of the incapacitated person. Other basic report elements  may include living conditions, place of residence, and the number of  guardian visits. Some states may allow courts to waive certain reporting  requirements.
Most states require that guardians submit a financial accounting and  record of expenditures for the care of the incapacitated person on an  annual basis. This document may list the assets and income of the  incapacitated person, including bank balances, real property holdings, and  detailed expenses associated with the care and housing of the  incapacitated person. State statutes usually require court approval for the  sale of real estate by a guardian.
How often guardians are required to submit reports varies. Most states  require guardians to submit personal status reports at least annually. Only  the District of Columbia’s law requires submission at least semiannually.  Statutory requirements for filing financial accountings range from annually  to at least once every 3 years. (See fig. 2.) In states where accounting  frequency requirements are left to the discretion of the courts, the  minimum requirement is that an accounting be made upon resignation or  removal of the guardian. In many states, there is an explicit requirement  that court personnel take action when reports are not filed on time. In  Texas, if a guardian of the person fails to file a report or a guardian of the  estate fails to file an annual accounting, the guardianship appointment  expires.
Some state statutes require an independent party or court personnel to  determine the accuracy and validity of personal status and accounting  reports. However, fewer than half of the states require courts to review the  reports guardians have submitted to them. Other states leave it to the  court to determine who reviews the reports. For example, Texas specifies  that a statutory probate court must review filings as part of the annual  determination of the continued need for a guardianship, but provides that  courts of general jurisdiction may use any appropriate method determined  by the court according to the court’s caseload and resources available” in  order to assess the continued need for a guardianship.
Apart from requirements for review of the submitted reports, some states’  statutes require a periodic review of the guardianships to ensure that  guardians are adequately fulfilling their responsibilities and there is a  continuing need for the guardianship. In some states, an investigator will  visit the incapacitated person to determine whether there is a continuing  need for a guardianship or if the current guardian should be terminated  and a new one appointed. For example, Alaska requires courts to evaluate  incapacitated persons every 3 years. Some states hold a hearing to assess  the continuing need for a guardianship. For example, Connecticut law  requires a hearing every 3 years to determine if any changes need to be  made to the guardianship appointment.
Many states’ laws authorize penalties that courts can impose to enforce  guardianship responsibilities. These most frequently include termination  of the guardianship appointment or imposition of fines for failure to fulfill  responsibilities. Some states have statutes providing for the denial of  guardianship fees while others authorize penalties against negligent or  ineffective guardians, including charging the guardian with contempt of  court, imprisonment, restitution for mismanagement of property, recovery  of assets and surcharges, or loss of bond. Many other state statutes allow  hearings at the court’s discretion or in response to a petition.
Some states are reluctant to recognize guardianships originating in other  states, leading to jurisdictional complications. The 1998 Uniform  Guardianship and Protective Procedures Act has been adopted into many  states’ statutes. This act gives courts the power to exercise jurisdiction  when an incapacitated person is moved or travels from one state to  another. However, these provisions may not sufficiently address all  complications that arise in guardianships for the elderly such as when  more than one jurisdiction is asked to appoint a guardian for the same  incapacitated person. For example, a guardian appointed in one state that  attempts to sell an incapacitated person’s real property located in another  state may need to travel to that state and petition a court there in order to  establish authority to act on behalf of the incapacitated person. Interstate  jurisdictional issues also arise when the guardian or the incapacitated  person needs to move to another state. Issues may also occur in cases  involving the physical removal of an incapacitated person from one  jurisdiction to another in an effort to gain control over the incapacitated  person.
section_title: Courts’ Procedures for Implementing State Laws Vary
paragraphs: While some state statutes specify minimal requirements for overseeing  guardians, individual courts may set their own, sometimes more stringent,  requirements and standards. The courts in the 3 states we surveyed  (California, Florida, and New York) implemented their state laws through  reporting and oversight procedures. (See app. III for a state-by-state  compilation of survey results.)
Within the 3 states, court procedures varied for the submission and review  of reports guardians are required to submit. Most courts responding to our  survey require an initial inventory of assets, income, and liabilities, and  courts in Florida and New York typically require annual financial  statements or accountings. Most courts in Florida and New York require  some or all guardians to submit a financial plan detailing how the guardian  will manage the financial affairs of the incapacitated person. Most of the  responding courts in California and Florida and all of the responding  judicial districts in New York indicated they require some or all guardians  to petition or inform the court if plans for the incapacitated person’s care  change. Nearly all of the courts responding to our survey in each state  indicated that judges, court personnel, or court examiners review  guardians’ reports, and a few courts use volunteers.
In each state surveyed, when guardians receive pay for services, the pay  varies. We asked courts about compensation approved in the last   12 months before responding to our survey. Most courts indicated that  some guardian compensation was based on an hourly rate. In New York,  rates typically ranged from $25 to $400 per hour, in California they ranged  from $7 to $250 per hour, and in Florida they ranged from $8 to $85 per  hour. In other cases, guardians’ compensation was based on the value of  an elderly incapacitated person’s estate but, while most judicial districts in  New York had allowed this, few courts in Florida and about one-quarter of  the courts in California had. In each state, most courts responding to our  survey required all guardians to submit time and expense records to  support petitions for compensation, but other courts in each state only  require these reports for some guardians.
In all 3 states, responding courts reported a variety of measures for  guardianship oversight. Most California courts indicated that court  personnel visit all or almost all the incapacitated people, and several  responding Florida courts and two New York judicial districts indicated  they had court personnel visit some or most of the incapacitated people.  Most responding courts reported that they ask questions raised by  guardians’ reports, send follow-up letters to conservators, or send notices  or orders to appear in court when reports are late, incomplete, or  inaccurate.
Most responding courts in each state indicated they had imposed some  kinds of penalties when guardians failed to fulfill their responsibilities. The  most commonly used measures included withholding or reducing  guardianship compensation, terminating guardianship appointments, and  contempt of court citations. Several courts indicated they had done one or  more of these things more than 10 times during the past 3 years. A   1999 California State law established a statewide registry of private  professional guardians and requires courts to notify the registry when a  complaint against a guardian is valid. Only one court indicated it had yet  notified the registry of a guardian’s resignation or removal for cause.  Eleven responding courts in California and 9 in Florida indicated they had  convicted guardians of a crime against the incapacitated person. In New  York, 2 judicial districts had notified the state registry of a guardian’s  resignation or removal for cause and 1 had convicted a guardian of a crime  against an incapacitated person.
section_title: Most Courts Surveyed Do Not Track the Number of Active Guardianships
paragraphs: In each state surveyed, some information needed for effective oversight of  guardianships, such as the number of people with guardians, was generally  not available. In each of the 3 states, one-third or fewer of the responding  courts tracked the number of all guardianships for adults that they were  responsible for monitoring, and only a couple of courts in each state  provided us with the number of these guardianships that were for  incapacitated people aged 65 and older. (See table 2.) California courts  report the number of probate and guardianship filings they handle each  year, including guardianships, probate of decedents’ estates, and trusts— for a total of 50,786 filings in fiscal years 2001-2002. The state court  administration does not, however, require a separate count of  guardianship filings for adults or the elderly.
In 1999, amendments to California law established a statewide registry of  private professional guardians, providing courts information about  prospective guardians’ experience and a record of complaints and cases in  which they have had a guardianship appointment terminated for cause.  (The names of people on the registry are available to the public.) Florida  also maintains a statewide registry of most professional guardians, but  registration is not required of nonprofessional guardians. New York also  maintains a list of private professional fiduciaries, including guardians.  However, most of the courts responding to our survey in each state  indicated that less than half of the guardians they appointed were on the  state registry. Many of the guardians appointed are family members or  friends of the incapacitated elderly person.
Most courts surveyed said they did not have sufficient funds for  guardianship oversight. Often the courts handling guardianship matters  handle several kinds of cases. In each state, one-fifth or fewer of the  judges who hear guardianship cases in the responding courts spend a  majority of their time on them. Judges who spend little of their time on  guardianship cases tend to focus on each case as it comes up on their  calendar and find it difficult to devote the time and resources needed to  develop an effective guardianship program, according to some officials at  courts recognized as exemplary, but others disagreed saying that general  jurisdiction courts can also provide good oversight of guardians. In  Florida, about one-fifth of the judges in courts responding to our survey  spend the majority of their time on guardianship cases. While in California  and New York 17 percent and 12 percent of judges, respectively, spend a  majority of their time on these cases.
section_title: Courts Recognized as Exemplary Focus on Training and Monitoring
paragraphs: Each of the four courts recognized as exemplary went well beyond  minimum state requirements for guardianship training and oversight. Each  court provides training of guardians, even though training is only required  in one of the state’s statutes. (See table 3.) The courts also actively utilize  computerized case management, court visitor programs, in-depth review  of annual reports, or investigations by court employees to oversee  guardianship cases. Two court officials told us that specialization allows  courts to focus on issues specific to guardianships and try new strategies  to improve the court’s oversight of guardians.
subsections: section_title: Courts Recognized as Exemplary Provide Training and Sources of Information Resources for Guardians
paragraphs: The courts recognized as exemplary provide training and/or information  resources for guardians. (See table 4.) Of the 4 states in which the courts  recognized as exemplary are located, only Florida requires guardians to  receive training, but Broward County provides training beyond what is  required in state law for nonprofessional guardians and provides  supplemental reference materials, such as a software program for  preparing guardianship reports. The courts in San Francisco and Tarrant  County, Texas, also provide independently developed training for  guardians. For example, as of January 2004, the San Francisco court  required professional and nonprofessional guardians alike to complete  formal classroom training. Working in partnership with a group of  professional guardians, the court developed a required half-day training  course that nonprofessional guardians must complete within 6 months of  their appointment.
section_title: Courts Recognized as Exemplary Actively Oversee Guardianships
paragraphs: Each of the exemplary courts uses at least one means to actively oversee  guardianships, and while each will penalize guardians who fail to fulfill  their responsibilities, two courts dedicate extra resources to enforcement  activities. These two, Rockingham County and Tarrant County, oversee  guardianship cases through computerized case management systems. The  system in Rockingham County automatically notifies court staff when  reports are due for each guardianship case. For example, when a  guardianship of the estate is established, the system prints a notice to the  guardian that an inventory of the incapacitated person’s assets must be  submitted to the court within 90 days. If the court has not received the  inventory, the system notifies court staff that an inventory default notice is  needed. This system also tracks the number of new guardianship cases  and the total number of active cases. Similarly, Tarrant County enters  information about each new guardianship case into a database. Each  month the court generates a list of annual reports that are due and mails  the guardians the required report form. The court also enters the date the  report is received into the database.
Two of the courts have developed procedures for in-depth review of  guardians’ reports. In Florida, the state statute requires that the clerk of  the court review each guardianship report to ensure that it contains the  appropriate information. Broward County has implemented a three-tiered  sampling system for reviewing the reports from the substantial caseload of  approximately 5,000 guardianships. All reports are subject to the first level  of review, which is conducted by the Audit Division of the Clerk of the  Court’s office. A further sample of reports is selected, and the Audit  Division conducts a more intensive second level review. At the third level  of review, a further sample of reports is selected, and the audit division  conducts detailed in-house and field audits of supporting documentation  to verify the information in the reports. If these reviews indicate any  irregularities, the Audit Division sends a memorandum to the judge to  review the report and the auditor’s findings. Tarrant County also employs  an auditor who is responsible for monitoring guardianships of the estate.  The auditor uses a database to track when guardians’ reports are due.  Twice a month, the auditor checks this database to ensure that no reports  are overdue or overlooked.
As shown in table 5, each court recognized as exemplary uses a visitor  program to support guardianship oversight. Tarrant County is required by  state law to have court visitors monitor the status of people under  guardianship, so the court provides visitation internships to social work  students who work as court visitors. A licensed Master Social Worker on  the court staff acts as program manager and trains and supervises the  interns. The students receive course credit, and the program is of little  cost to the court. There are typically 4 or 5 interns making an average of  60-70 visits each month. The visitors submit a report of the visit to the  program manager for review, and the judge reviews these reports to guide  his or her decision on whether to continue the guardianship for an  additional year.
Rockingham County recruits volunteers from AARP to serve as either  visitors or researchers. Researchers prepare files for the court with  contact information, case background, and the last annual guardian’s  report. The visitors then contact the guardian and arrange to visit the  incapacitated person. They assess the ward’s living situation, finances,  health, and social activities, and recommend follow-up actions to the  court. A court employee serves as the volunteer coordinator. According to  the volunteer coordinator in Rockingham County, costs are minimal  because volunteers use court telephones, and the state provides supplies.  According to the court, the detailed, first-hand information provided about  the incapacitated person’s environment and condition helps the court  make better decisions when the case is reviewed.
When guardians fail to fulfill their responsibilities, the courts have legal  authority to penalize guardians, and two of the courts recognized as  exemplary have staff dedicated to investigating these types of cases.  Broward County employs court monitors to investigate abuse allegations  involving guardians, or problems discovered due to annual background  checks, report review, or other tips. A study of statewide guardianship  monitoring practices found that Broward County conducts about 400 field  investigations a year, some of which have resulted in referrals to the state  attorney for prosecution.
section_title: State Courts and Federal Representative Payee Programs Serve Many of the Same Incapacitated Elderly People, but Collaborate Little in Oversight Efforts
paragraphs: Federal agencies and state courts’ representative payee programs  collaborate little to protect incapacitated people and prevent misuse of  federal benefits. Although overlap is known to occur among the  incapacitated populations they serve, the extent of this overlap is not  known. Some state courts and federal agencies share certain information  on a case-by-case basis. However, the absence of a systematic means for  compiling and exchanging pertinent information may leave many  incapacitated people at risk and result in the misuse of benefits and  increased federal expense. State courts and federal agencies lack  consistent and sustained compilations of data needed to assess options for  improving oversight of guardians and representative payees.
subsections: section_title: Beneficiary Populations Overlap, but Coordination Is on a Case-by-Case Basis
paragraphs: The incapacitated populations served by state courts and federal agencies  overlap to some extent. Because we focused on incapacitated elderly  people, we did not assess overlaps between agencies’ general beneficiary  populations. (See table 6.) An estimated 95 percent of all people 65 and  older are SSA recipients, and elderly recipients of OPM or VA benefits  often also receive SSA payments. An estimated 96 percent of VA  beneficiaries aged 65 and older are also SSA recipients and about   9 percent are OPM beneficiaries. Also, an estimated 82 percent of OPM  elderly beneficiaries are also SSA beneficiaries. While there are no data on  the number of beneficiaries who are incapacitated in each category, it is  likely that a number of incapacitated people are beneficiaries from more  than one federal agency, and a number could also have court-appointed  guardians.
Like many courts that oversee guardianship programs, federal agencies  collect certain information from representative payees. SSA annually  sends each representative payee (whether a court-appointed guardian or  not) a two-page report form asking for certain information—-for example,  whether the representative payee was convicted of a felony, whether the  beneficiary continued to live in the same circumstances, how much of the  benefit payments were spent on the beneficiary’s behalf, how much was  saved, and in what kind of account the funds are held. Similarly, OPM  biennially sends its representative payees a brief survey asking for similar  information, though those who are court-appointed guardians are not  required to complete the survey. OPM leaves it to the courts to monitor  these payees. VA also requires its representative payees to submit a two- page accounting report, but asks payees who are court-appointed  guardians to submit the same accountings that they submit to the court.  Each agency sends follow-up mailings, and SSA and VA visit payees as  needed in cases where payees fail to submit a report. In addition, VA sends  field examiners to visit each incapacitated beneficiary. Agency officials  indicated that these efforts often help identify cases in which beneficiaries  or representative payees have moved or cases where a payee may need to  be replaced for a variety of reasons. For example, they may no longer be  living close enough to the beneficiary or they themselves have become  unable to handle the benefit payments. Typically, however, cases of abuse  come to the agencies’ attention by way of tips from individuals who know  of the beneficiary rather than from report and survey follow-up efforts.
Some state courts and federal agencies share certain information about  some beneficiaries on a case-by-case basis. Some state court officials that  we spoke with indicated that they have established a rapport with staff in  local offices of federal agencies, such as SSA and VA, and are able to  obtain information concerning incapacitated beneficiaries or their  representative payees. (See table 7.) For example, upon request, federal  agencies will sometimes provide them with information to allow the court  to determine all sources of the incapacitated person’s income and whether  the guardian needs to coordinate with a payee. State courts may also offer  information to federal agencies. For example, some courts send  occasional notices of guardianship appointment to SSA, allowing SSA staff  to identify which of their beneficiaries is incapacitated and determine if  the guardian can be designated as a representative payee.
While coordination is often case-by-case, some takes place more  systematically and is based on previously established agreements. For  example, about one-third of the states have adopted the Uniform Veterans’  Guardianship Act that requires state courts to notify VA when they appoint  a guardian for a veteran. According to this act, VA must receive copies of  court orders and accountings related to the veteran’s case. The act also  gives VA the right to appear in court during guardianship proceedings  involving a veteran.
Federal agencies may also establish agreements with one another to  exchange information. For example, SSA allows a limited number of VA  service representatives nationwide to electronically access some SSA  information about veterans’ SSA benefits. This SSA data system includes  the amount of SSA benefits veterans receive, whether SSA has identified  them as incapacitated, and the identity of a representative payee, if one  has been designated. VA officials regularly look at SSA’s information  before conducting a field examination to help determine incapacity and  choose a fiduciary, according to a VA official responsible for managing the  agency’s fiduciary program. VA is not, however, notified when SSA  changes a beneficiary’s representative payee. Many VA representative  payee program staff that do not currently have access to the database see  it as a useful tool and have expressed a desire to be able to use it in order  to more efficiently assess beneficiaries’ needs.
section_title: Lack of Systematic Coordination Weakens Oversight of Incapacitated People
paragraphs: The lack of systematic coordination weakens the oversight of both elderly  and non-elderly incapacitated people and may leave incapacitated people  at risk of not being assigned a representative payee or guardian despite  having been identified either by a state or federal entity as a person who  needs one. For example, if a federal agency has identified one of its  beneficiaries as incapacitated and assigns a representative payee, the  agency does not systematically notify the courts or other agencies. (See  table 7.) The other agencies making payments to the same person may not  learn that they may need to assign a representative payee to handle their  benefit payments to the person. Such notification could also be useful to  state courts in assessing the need for a guardian. This lack of coordination  could leave the incapacitated person who needs a representative payee or  guardian without one.
Insufficient interagency coordination may also leave incapacitated elderly  people more vulnerable to abuse or neglect. For example, when an agency  identifies a representative payee who is abusing or neglecting an  incapacitated person, it does not automatically notify the state court or  other federal agencies that have assigned a guardian or representative  payee. Without such a notification, the court or other federal agency may  be unaware of the need to replace an abusive or negligent guardian or  representative payee.
If agencies and courts do not communicate with each other concerning  incapacitated beneficiaries, they may unknowingly assign different people  as representative payees or guardians with overlapping responsibilities.  However, in some cases, agencies and courts intentionally select different  people or organizations as representative payee or guardian. Although  most Old Age, Survivor, and Disability Insurance beneficiaries with both a  guardian and SSA-designated representative payee, have the same person  serving in both roles, for an estimated 19 percent of these beneficiaries the  guardian is not their representative payee. Some guardians choose not to  be the representative payee, so SSA designates someone else. (See fig. 3.)  Sometimes VA designates a nursing home as a representative payee, even  though a court has appointed a family member or other person to be the  incapacitated resident’s guardian. The guardian and the nursing home may  get into conflict over the use of the incapacitated person’s benefit  payments. Additional coordination among federal agencies and courts and  cooperation among guardians and representative payees may be necessary  to avoid conflicts and better protect the incapacitated person.
Federal officials have recognized the need for better exchange of  information regarding incapacitated beneficiaries. In response to  provisions in the Omnibus Budget Reconciliation Act of 1990, SSA and VA  studied the feasibility of collaborating in serving veterans who were also  SSA beneficiaries. In 1993, several agencies participated in a discussion  group on representative payee programs. Two of the agencies—SSA and  VA—signed an agreement calling for each agency to notify the other when  it had information that could be helpful to the other agency’s oversight of  its representative payee. However, according to VA and SSA officials,  efforts to implement the agreement failed due to changes in management  personnel, concerns about costs, and issues concerning nondisclosure of  confidential information.
Not only is it likely that the lack of coordination limits the protection of  incapacitated people and their federal benefits, it may also result in  increased federal expenditures. The recently enacted Social Security  Protection Act of 2004 requires SSA to repay the benefits in certain cases  of misuse. For example, if a representative payee that is an organization,  or an individual serving 15 or more beneficiaries misuses the benefit  payments, SSA will have to reissue the misused benefits to the  beneficiaries or to an alternate representative payee, resulting in increased  federal expenditures. Before the passage of this act, SSA was only required  to replace benefits if SSA was negligent in its oversight of a representative  payee. Annually, SSA has found fewer than 1,000 cases of misuse, and only  in a small percentage of those cases was SSA found to be negligent.  However, according to an SSA official, the new provisions may mean that  more benefits will have to be reissued.
section_title: Statistical Data to Analyze Options for Improving Oversight Not Available
paragraphs: Certain data, such as the number of active guardianships and incidence of  abuse, could help courts and agencies determine the effectiveness of  efforts to protect incapacitated people but are not currently available. The  courts we surveyed generally do not compile aggregate data such as the  number of incapacitated people, or elderly incapacitated people, with  guardians. Often the only records concerning guardianship appointments  aside from a calendar of upcoming hearings and due dates for required  reports are in individual paper files. Some states, however, are making  efforts to compile statewide data on guardianships. In Vermont, for  example, the Supreme Court compiles reports from each court on the  number of open guardianship cases, but without any information on the  age of the incapacitated people. In New York, the state court’s Guardian  and Fiduciary Services is working on the development of a statewide  database on guardians, fiduciaries, and the people they were appointed to  serve.
The federal agencies that we examined, SSA, VA, and OPM, do more to  compile data on representative payees than most courts responding to our  3-state survey do for incapacitated people with guardians. All three of the  federal agencies that we examined have databases that keep count of the  different types of representative payees for incapacitated people. Neither  SSA nor VA, however, consistently compiles information showing how  many beneficiaries with representative payees have a court-appointed  guardian who is not the representative payee.
To keep these databases current, all three agencies require most of their  representative payees to submit periodic reports. SSA, VA, and OPM  compile and maintain basic information, such as contact information,  about the representative payees they designate. They also ask whether an  incapacitated beneficiary has a court-appointed guardian before  designating a representative payee. They do not, however, compile and  maintain more detailed information that could contribute to more effective  oversight of representative payees. For example, none of these agencies  consistently records information about a beneficiary’s court-appointed  guardian in its computerized records system or updates the information  unless the agency also designates the court-appointed guardian as its  beneficiary’s representative payee. Although SSA compiles some  information about the reasons it replaces representative payees, such as  the assignment of a more suitable payee, misuse of benefits, or fraud, for  example—OPM and VA do not. This information might be useful in making  future assignments.
Sufficient data are not available to determine the incidence of abuse of  incapacitated people by guardians or representative payees, nor the extent  to which guardians and representative payees are protecting incapacitated  people from abuse. Current efforts to compile aggregate national data on  elder abuse do not identify cases when a guardian or representative payee  has been assigned to the victim of abuse, or whether a guardian or  representative payee commits the abuse. States compile statistics on  incidence of abuse and neglect, including information on the age of  victims. National associations collect these statistics from Adult  Protective Service agencies and Area Agencies on Aging. Generally, states  track types of abuse and some of the relationships between perpetrators  and victims, but they do not track instances where the victim had been  assigned a guardian or representative payee or had granted a power of  attorney to someone. As a result, federal agencies lack national data  concerning the incidence of elder abuse by guardians and representative  payees or the incidence of abuse with and without the assignment of a  guardian or representative payee. Similarly, national crime statistics, such  as crime victimization surveys, identify various relationships between  victims and perpetrators, and the age of victims, but fail to identify cases  involving guardians or representative payees. SSA tracks the number of  cases in which representative payees are found to have misused benefits— fewer than a 1,000 cases each year for beneficiaries of all ages. SSA  officials agreed, however, that since SSA largely relies on tips from third  parties to discover cases of misuse, their records of misuse might be  incomplete.
section_title: Conclusions
paragraphs: Although state and local courts have primary responsibility for protecting  incapacitated people, including the elderly, by appointing and overseeing  guardians, federal agencies also have responsibilities to help protect many  of the same incapacitated people through representative payee programs.  Yet, courts and federal agencies collaborate little in the protection of  incapacitated elderly people and the protection of federal benefit  payments from misuse. Court and agency efforts to improve protection of  the incapacitated is limited by their failure to systematically compile and  exchange data—by, for example, promptly notifying each other when an  incapacitated person is identified or a representative payee or guardian is  appointed or needs to be replaced, due to their failure to fulfill their  responsibilities, or for other reasons. However, the extent to which the  courts and agencies leave elderly incapacitated people at risk is unknown.  Neither the states nor the federal government compile data concerning the  incidence of abuse of people assigned a guardian or representative payee  or even the number of elderly people with guardians. Without better  statistical data concerning the size of the incapacitated population or how  effectively it is being served, it will be difficult to determine precisely what  kinds of efforts may be appropriate to better protect incapacitated elderly  people from exploitation, abuse, and neglect.
Improvements in oversight of guardians and representative payees depend  in part on additional efforts by states, state and local courts, federal  agencies, state area agencies on aging, and HHS. Although the focus of our  review was elderly incapacitated people, state guardianship and federal  representative payee programs also serve other incapacitated adults.  Improvements could be of benefit to all incapacitated adults, particularly if  they are designed with both the elderly and non-elderly in mind. However,  certain actions that would improve oversight are not currently being  undertaken. For example, the various entities responsible for oversight do  not collaborate to compile, on a continuing basis, consistent national data  concerning guardianships and representative payees. Without such  statistical data, the extent of preventable abuse and neglect of  incapacitated elderly people is unknown. Finally, the states have done  little to collaborate on interstate recognition and transfer of guardianship  appointments. Few states have adopted procedures for accepting transfer  of guardianship from another state or recognizing some or all of the  powers of a guardian appointed in another state. This can be a problem  when an incapacitated elderly person needs to move to another state or  the guardian needs to conduct business in another state on his or her  behalf. The need to establish a new guardianship in another state because  of these gaps in states’ law can make it difficult for guardians and the  courts that supervise them to ensure that they fulfill their responsibilities.
The prospect of increasing numbers of incapacitated elderly people in the  year’s ahead signals the need to reassess the way in which state and local  courts and federal agencies work together in efforts to protect  incapacitated elderly people.
section_title: Recommendations
paragraphs: To increase the ability of representative payee programs to protect federal  benefit payments from misuse, SSA should convene an interagency study  group that includes representatives from HHS, federal agencies with  representative payee programs, including VA and OPM, and state courts  that wish to participate in order to study the costs and benefits of options  for improving interagency cooperation and federal-state cooperation in the  protection of incapacitated elderly and non-elderly people. Options may  include:    prompt and systematic sharing among federal agencies’ representative  payee programs of information such as the identity of individuals who  are incapacitated, the identity of those individuals’ designated  guardians and representative payees, the identity of guardians and  representative payees who fail to fulfill their duties, and the assignment  of successor guardians and successor representative payees; and     prompt and systematic sharing of similar information among federal  agencies and courts responsible for guardianships that choose to  participate.
Information-sharing initiatives must be designed in a manner that is cost- effective, respectful of privacy rights, and consistent with federal  nondisclosure requirements concerning confidential information.
To facilitate state efforts to improve oversight of guardianships and to aid  guardians in the fulfillment of their responsibilities, the Department of  Health and Human Services should work with national organizations  involved in guardianship programs, such as the those represented on the  National Guardianship Network, to provide support and leadership to the  states for cost-effective pilot and demonstration projects to:    develop cost-effective approaches for compiling, on a continuing basis,  consistent national data concerning guardianships to aid in the  management of programs for protecting incapacitated adults, such as  the age of the incapacitated person, the type of guardian appointed, etc;    study options for compiling data from federal agencies and state  agencies, such as Adult Protective Services agencies, concerning the  incidence of elder abuse in cases in which the victim had granted  someone the durable power of attorney or had been assigned a  fiduciary, such as a guardian or representative payee, and in cases in  which the victim did not have a fiduciary; and  review state policies and procedures concerning interstate transfer and  recognition of guardianship appointments to facilitate efficient and  cost-effective solutions for interstate jurisdictional issues.
section_title: Agency Comments
paragraphs: We provided a draft of this report to SSA, OPM, VA, and HHS and received  written comments on the draft from all four. See appendixes IV, V, VI, and  VII for their responses.
SSA disagreed with our recommendation concerning an interagency study  group. It views the study we recommend as something beyond its purview.  Although SSA shares concern about incapacitated people’s general  welfare, it stated that its responsibility focuses on ensuring that any SSA  benefits incapacitated people receive are used for their maintenance and  welfare. SSA stated that systematic sharing of information among federal  agencies and state courts would be extremely difficult and a study group  focusing on such sharing would not be within SSA’s purview.  SSA also  commented that efforts to coordinate with state courts must meet Privacy  Act requirements, and in that regard they noted that there is currently no  statement of routine use allowing SSA to share representative payee  information with state courts. Because state courts, SSA, and other federal  agencies have such different policies regarding representative payees and  guardians, SSA believes that it is constrained by the Privacy Act in  releasing information.
We believe that the systematic exchange of data could help SSA better  ensure that SSA benefits are used for incapacitated people’s maintenance  and welfare. The interagency study group should be able to develop  policies allowing for the sharing of information consistent with the Privacy  Act and other applicable nondisclosure requirements. We believe that an  interagency study group could identify carefully specified kinds of  information that under specified circumstances could be shared among  limited numbers of federal and state court officials with jurisdiction over  guardianships in a manner that is consistent with the Privacy Act and  other applicable nondisclosure requirements. SSA and the other federal  agencies involved have the authority to develop statements of routine use  to provide for such exchange of information. They currently have such  agreements in place to share data with other federal agencies, such as  SSA’s sharing of information concerning its representative payees with a  limited number of VA staff. Although exchange of data among federal  agencies with representative payee programs may be easier to establish  than exchange between federal agencies and state courts, further study is  warranted to assess the feasibility of such exchange and the extent to  which it could enable courts and federal agencies to better protect  incapacitated elderly people.
VA and OPM agreed with our conclusions pertaining to their agencies,  indicating that they look forward to participating in the study group we are  recommending. VA noted wide variations in state guardianship laws and  procedures, the need for federal agencies and state courts to share  information on cases of common interest, and the current lack of  systematic information sharing among federal agencies state agencies, and  state courts relating to the protection of elderly beneficiaries. OPM  suggested that we assert that it would be to the federal government’s  benefit, either in terms of efficiency or savings, to create systems for  sharing information on guardians or representative payees. OPM also  urged that we add to the report statistics demonstrating the efficiency of  coordination with state courts.  Although adding these would strengthen  the report, data necessary to do so are not currently available. Our  findings strongly suggest that savings and greater efficiency would result  from collaboration, but the extent to which this is the case will not be  known until agencies and state courts start collaborating in efforts to  assess overlaps in the populations of incapacitated people they serve,  incidence of abuse, and the costs and benefits of data exchange.
HHS agreed that guardians should be adequately trained and monitored,  and that governmental agencies and courts should coordinate their efforts  and share information concerning guardians and representative payees.  HHS plans to carry out our recommendation to study options for  compiling data from federal agencies and state agencies concerning the  incidence of elder abuse in cases in which the victim had granted someone  the durable power of attorney or had been assigned a fiduciary, such as a  guardian or representative payee. This year the National Center on Elder  Abuse will survey all state adult protective services agencies to determine  the incidence of elder abuse reports and the characteristics of victims and  perpetrators. The center plans to ask states to cite the number or  percentage of perpetrators of elder abuse who served as the victims’  powers of attorney, guardians, or representative payees. HHS also plans to  explore cost-effective pilot and demonstration projects to develop  approaches for compiling guardianship data and to facilitate solutions for  interstate jurisdictional issues. It also agreed to serve on an interagency  study group to develop options for improving interagency cooperation and  federal-state cooperation in the protection of incapacitated elderly and  non-elderly people.
As agreed with your office, unless you publicly announce its contents or  authorize its release sooner, we will not distribute it until 30 days from the  date of issuance. At that time, we will send copies of this report to the  Commissioner of Social Security, the Director of the Office of Personnel  Management, the Secretary of Health and Human Services, and the  Secretary of Veterans Affairs. We will also make copies available to others  on request. In addition, the report will be available at no charge on GAO’s  Web site at http://www.gao.gov/.
If you have any questions concerning this report, please contact Barbara  Bovbjerg or Alicia Puente Cackley at (202) 512-7215. See appendix VIII for  other contacts and staff acknowledgments.
section_title: Appendix I: Scope and Methodology
paragraphs: Our review included a review of state laws on guardianship, the  development and administration of surveys of state courts in 3 states,  visits to 15 courts in 8 states, and interviews with federal officials at the  Social Security Administration (SSA), Department of Veterans Affairs  (VA), Office of Personnel Management (OPM), and the Department of  Health and Human Services (HHS). In addition, one member of the team  completed a 2-day training program for professional guardians in  Washington State and two attended a conference of the National  Guardianship Association. We conducted our review between March 2003  and May 2004 in accord with generally accepted government auditing  standards.
To determine what state courts do to ensure that guardians fulfill their  responsibilities, we studied both states’ laws concerning guardianship and  court practices, particularly those concerning court oversight of  guardians. Our review of states’ laws relied in part on the compilations  prepared by the American Bar Association Commission on Law and Aging.  To review court practices we limited our scope to courts with jurisdiction  over guardianships for the elderly in the three states with the largest  elderly populations (residents aged 65 and older)—California, New York,  and Florida. Together these three states account for about one-quarter of  the nation’s elderly population. We administered similar survey  instruments tailored to the courts in each of these states. We refined the  survey instruments based on pretest visits to court officials at three  counties in California, three counties in Florida, and two counties in New  York. We sent finalized survey instruments to California Superior Courts in  each of California’s 58 counties, to circuit courts in each of Florida’s   67 counties, and to each of New York’s 12 judicial districts. We received  usable survey responses from 42 California courts, 55 Florida courts, and  9 of New York’s judicial districts for response rates of 72 percent,  82 percent, and 75 percent, respectively. Several courts provided  responses to some items, but no responses to other items in the survey  instrument. For details on the numbers of responses to each item and a  compilation of responses by state, see appendix III. We reviewed courts’  survey responses for consistency, but did not independently review the  accuracy of the court officials’ responses.
To determine what guardianship programs recognized as exemplary do to  ensure that guardians fulfill their responsibilities we visited 4 courts to  study their procedures. We selected the four courts by contacting  members of the National Guardianship Network and asking them which  courts throughout the nation they regard as having exemplary practices.  The four courts we selected were each identified as exemplary by two or  more members of the network. We visited each of the courts and  interviewed judges, probate directors, monitoring staff, volunteers, legal  staff, and others. In two of the courts, we attended guardianship hearings.  We reviewed each of the court’s documents concerning probate  procedures including state laws, rules of court, training materials, forms,  and written and Web site documents. We also examined examples of  guardianship case files.
To determine to what extent do state courts and federal agencies  coordinate their efforts to protect incapacitated elderly people, we  interviewed court officials in each of the four courts recognized as  exemplary and in several additional courts. We attended the National  Guardianship Association’s conference including sessions concerning  guardianships and VA and guardianships and the Healthcare Insurance  Portability and Privacy Act of 1996. We met with a group of conference  attendees, including judges, probate lawyers, and guardians, to discuss  federal agencies’ interactions with guardians and courts. We also reviewed  documents provided by court officials concerning specific cases in which  federal agencies were involved in guardianship cases. We also interviewed  officials at SSA, VA, OPM, and HHS and reviewed applicable regulations  and policy manuals and handbooks.
section_title: Appendix II: GAO Surveys of Courts in California, Florida, and New York
paragraphs: The following are surveys GAO mailed to the California Superior Court in each of the  58 counties in California, the Florida Circuit Courts in each of the 67 counties in  Florida, and the 12 Judicial Districts in New York. For summary results of the survey,  see appendix III.
section_title: Appendix III: Results from GAO Surveys of Courts in California, Florida, and New York
paragraphs: Below are tabulations of survey responses received from 42 of the 58  superior courts in California, 55 of the 67 superior courts in Florida, and 9  of the12 judicial districts in New York. In some cases, respondents to the  survey did not respond to particular items in the survey.
Which of the following resources are available to guardians appointed by  your court? (Check one for each resource.)
A. Summary of statutory duties of  guardians  B. List of resources and contacts for  guardians (e.g., Area Agencies on  Aging, county/state support  agencies, etc.)
E. Guardian handbook or manual  G. Examples of model reports  H. Other (please specify)
Does your court require formal training (e.g., classes, videos, instructional  meetings) for any of the following types of guardians? (Check one for each  row.)
A. Guardians who are family members or friends  C. Guardians (not family members, friends or attorneys)  who are paid from public sources (e.g., social service  agencies, etc.)
D. Guardians (not family members, friends or attorneys)  who are paid from the income or assets of the  incapacitated person (e.g., non-attorneys on the state  registry)
Does your court require guardians of the property to submit  documentation of the following items, either separately or as part of a  report? (Check one for each item.)
Does your court require guardians of the person to submit documentation  of the following items, either separately or as part of a report? (Check one  for each item.)
How sufficient is your court’s funding for monitoring guardianships?  (Check one.)
Do courts in your county require that guardians of the property be  bonded? (Check one.)
Do courts in your county require background checks on guardians of the  property? (Check one.)
Do courts in your county require background checks on guardians of the  person? (Check one.)
Other than relying on reports by guardians, which, if any, of the following  strategies does your court use after the initial hearing to assess the  personal status of people who have guardians appointed by the court?  (Check one for each strategy.)
Who reviews financial and personal status reports submitted by guardians  appointed by your court? (Check one for each type of reviewer.)
B. Court personnel other  than judges  D. Government agencies  other than the court  E. Other (please specify)
B. Court personnel other  than judges  D. Government agencies  other than the court  E. Other (please specify)
B. Court personnel other  than judges  C. Court examiner or other  compensated person  appointed to review reports  E. Government agencies  other than the court  F. Other (please specify)
What steps, if any, are taken to verify information in financial and personal  status reports? (Check one for each step.)
A. Information in personal  status reports is verified.
B. Information in financial  reports is verified.
C. Supporting  documentation for financial  information must be  submitted (e.g.,  bank/brokerage  statements).
D. Other (please specify)
A. Information in personal  status reports is verified.
B. Information in financial  reports is verified.
C. Supporting  documentation for financial  information must be  submitted (e.g.,  bank/brokerage  statements).
D. Other (please specify)
A. Information in personal  status reports is verified.
B. Information in financial  reports is verified.
C. Supporting  documentation for financial  information must be  submitted (e.g.,  bank/brokerage  statements).
D. Other (please specify)
Is your court required to document approval of financial and personal  status reports? (Check one.)
Does your court use a computer(s) to track when financial and/or personal  status reports are due and when they are filed? (Check one.)
About how many of the required guardianship reports for the elderly are  filed on time? (Check one.)
In the last 12 months, has your court approved any guardian compensation  that was based on a percentage of the value of an elderly incapacitated  person’s estate? (Check one.)
If “Yes,” what is the range of percentages typically approved?
In the last 12 months, has your court approved any guardian compensation  that was based on a percentage of an elderly incapacitated person’s  income? (Check one.)
If “Yes,” what is the range of percentages typically approved?
In the last 12 months, has your court approved any guardian compensation  based on an hourly rate? (Check one.)
If “Yes,” what is the range of hourly rates typically approved?
How does your court handle petitions from guardians for compensation?  (Check one for each row.)
C. Guardians are required to submit time and  expense records to support their compensation  petitions.
D. Petitions are approved by court personnel or  judge unless a problem surfaces.
E. Final approval is required by circuit or state  office.
How many judges in your court hear guardianship petitions for the  elderly? (Enter number.)
Of the judges in your court who hear guardianship petitions for the elderly,  how many work more than half the time on guardianship matters? (Enter  number less than or equal to that given in Question 20.)
How frequently is the elderly respondent (aged 65 and over) to a  guardianship petition present at the appointment hearing? (Check one.)
Does your court keep counts of the number of people, elderly and non- elderly, who have guardians appointed by the court? (Check one.)
Currently, how many people, elderly and non-elderly, have active or  continuing guardians appointed by your court? (Please provide actual  numbers, if possible. If they are not available, check the box under  “Information is not available.”)
Does your court keep counts of the number of people with active or  continuing guardians appointed by your court who are elderly (aged   65 and over)? (Check one.)
If “Yes,” currently, how many elderly have guardians?
Currently, about what percentage of the people with guardians appointed  by your court are elderly (aged 65 and over)? (Check one.)
In the last 12 months, about what percentage of petitions for guardianship  of elderly people resulted in the appointment of a guardian? (Check one.)
Does your court keep counts of the types of guardians (e.g., family  members, attorneys, or other guardians who receive payment from either  public sources or the income and assets of the incapacitated person)  appointed for elderly persons?
How frequently does your court appoint each of the following types of  guardians for elderly persons? (Check one for each type.)
A. Guardians who are family members or friends  C. Guardians, other than family members, friends, or attorneys,  who receive payment for services from public sources (e.g.,  social service agencies, etc.)
D. Guardians, other than family members, friends, or attorneys,  who receive payment for services from the income or assets of  the incapacitated person   A. Guardians who are family members or friends  C. Guardians, other than family members, friends, or attorneys,  who receive payment for services from public sources (e.g.,  social service agencies, etc.)
D. Guardians, other than family members, friends, or attorneys,  who receive payment for services from the income or assets of  the incapacitated person   A. Guardians who are family members or friends  C. Guardians, other than family members, friends, or attorneys,  who receive payment for services from public sources (e.g.,  social service agencies, etc.)
About what percentage of the guardians appointed by your court are on  the state registry? (Check one.)
In the last 12 months, which actions has your court taken to enforce  requirements for guardians for the elderly? (Check one for each action.)
Over the last 3 years, about how often has your court imposed the  following penalties on guardians for the elderly for failure to fulfill their  responsibilities? (Check one estimate for each penalty.)
section_title: Appendix IV: Comments from the Office of Personnel Management
section_title: Appendix V: Comments from the Department of Veterans Affairs
section_title: Appendix VI: Comments from the Department of Health and Human Services
section_title: Appendix VII: Comments from the Social Security Administration
section_title: Appendix VIII: GAO Contacts and Staff Acknowledgments
subsections: section_title: GAO Contacts
section_title: Staff Acknowledgments
paragraphs: Carolyn M. Boyce, Nicole E. Gore, Jill M. Johnson, Corinna A. Nicolaou,  Daniel A. Schwimer, Derald Seid, and John E. Trubey also contributed to  this report.