Charles Lavine: The importance of good guardianship

By Charles Lavine

I’ve been hearing a consistent and concerning message from constituents, judges, hospital leaders and advocates across my district and throughout New York: Our state doesn’t have enough nonprofit guardians to meet the growing need.

Guardianship is meant to be a last resort — a carefully tailored legal intervention used only when necessary to protect those who cannot safely manage essential decisions about their health, finances or living arrangements. When it works as intended, it helps people stabilize their lives, access critical services and live safely in the least restrictive settings possible.

But too often, I’m hearing about what happens when no guardian is available.

Judges are struggling to identify qualified guardians for people who lack financial resources or family members able to serve. Hospital administrators and discharge planners tell me about patients who are medically ready to leave but remain stuck in beds because no one is legally authorized to arrange home care, apply for benefits or consent to placement. Families and service providers are left trying to navigate an already complex system without the authority they need to help.

This isn’t an abstract problem. It is a systems challenge with real consequences for health care capacity, court efficiency and the well-being of vulnerable New Yorkers. Across the state, patients who no longer require acute medical care are remaining in hospitals for months because a guardian cannot be identified. Nearly all of these people have limited financial resources, and many have no family able or willing to step in. Without a legally authorized decision-maker, even routine steps toward discharge become impossible.

I’ve heard directly from providers about the toll this takes. Extended hospital stays can lead to isolation, functional decline, infections and other preventable complications. Hospitals aren’t designed to serve as long-term residential placements, yet that is effectively what they become when no guardian is available.

The financial impact is also significant. A single hospital bed can cost more than $7,000 per day. When patients remain hospitalized solely due to the absence of a guardian, it strains our health care system and is an unnecessary costs for taxpayers.

We don’t have enough nonprofit guardians, and those we do have are unevenly distributed across the state. Existing providers are doing extraordinary work, often serving thousands of New Yorkers, but many programs are operating at or near capacity. In some regions, courts have few, if any, nonprofit guardians available to appoint.

To close the “guardianship gap,” I am sponsoring the Good Guardianship Act in the Assembly. This bill would establish a statewide initiative of nonprofit guardians that would allow us to build on existing expertise while expanding services to underserved areas. It would help courts make timely appointments, support consistent standards of care, and reduce unnecessary delays that ripple across systems. In addition, the legislation is structured to allow the state to support implementation through future budget appropriations and existing nonprofit guardianship infrastructure.

This approach also aligns with the goals of Gov. Kathy Hochul’s Master Plan for Aging, which calls for coordinated support that allows older adults and people with disabilities to live safely and with dignity in their communities.

Nonprofit guardians play an essential role in that continuum of care, coordinating medical treatment, securing stable housing and preventing financial exploitation. Their work often helps people avoid unnecessary institutionalization.

Let me be clear: Investing in nonprofit guardianship isn’t about expanding guardianship unnecessarily. It must always remain a last resort. But when it is needed, the system must be able to respond — responsibly, equitably and without delay.

This initiative would alleviate prolonged hospital stays, delayed transitions to community care and fragmented decision-making. It is also a matter of fairness. Access to a qualified guardian should not depend on where someone lives, what resources they have or whether a family member is available.

If we fail to act, these gaps will continue to place pressure on our courts, our health care system, and families already navigating difficult circumstances. If we act, we have an opportunity to strengthen accountability, improve efficiency, and ensure that vulnerable New Yorkers receive the support they need.

As the legislative session’s conclusion draws near, I urge my colleagues and the governor to support a statewide initiative of nonprofit guardians. When guardianship is necessary, it should work as intended — protecting rights, promoting independence and helping people move from crisis toward stability. This investment will help us get there.

Charles Lavine represents the 13th Assembly District.

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Charles Lavine: The importance of good guardianship