Beyond
Guardianship
Massachusetts Guardianship Policy Institute
October 2026
In this issue, we explore healthcare, guardianship, and individual rights, spotlight concerns in nursing home care, welcome new leadership, and share updates from the guardianship community.
Beyond the Hospital Bed
Positioning Public Guardianship Advocates as Strategic Partners in Default Surrogate Decision-Making
By Paul J. Lanzikos, former Secretary of the Executive Office of Elder Affairs, founder of the Dignity Alliance Massachusetts and member of the Massachusetts Guardianship Policy Institute.
As health systems face mounting pressures around patient throughput, acute-care capacity, and discharge bottlenecks, a familiar friction point continues to strain relations between hospitals and vulnerable populations: the "unbefriended" or unrepresented patient. When an adult with diminished capacity is admitted without a designated health care proxy, family member, or advance directive, acute-care hospitals find themselves in an untenable position. Lacking a legal mechanism for substitute consent, clinicians face delayed discharges, extended stays, and administrative gridlock.
In response, legislative and clinical discussions across many states increasingly gravitate toward "default surrogate" or statutory family-consent hierarchies to streamline medical decision-making. However, in states that already maintain or are actively building public guardianship systems, positioning the advocacy community correctly within this landscape requires a strategic shift. We must move beyond viewing public guardianship and hospital operations as competing entities and instead reframe public guardianship advocates as indispensable partners in solving the systemic crisis of unrepresented patients.
In the News:
Boston Globe Spotlight Investigates Nursing Home Care in Massachusetts
A new investigation by The Boston Globe Spotlight Team raises serious concerns about nursing home ownership, quality of care, and regulatory oversight across Massachusetts.
The investigation found that nine nursing home chains, many of which had limited operations in the Commonwealth before the pandemic, now control 61 facilities, nearly one in five nursing homes statewide. The investigation found that quality ratings have declined at many of these facilities, while families reported troubling conditions and inadequate care.
The Globe describes what families witnessed:
“There were unanswered call bells, residents left for hours in soiled diapers, dangerous medication errors, devastating falls, and loved ones deteriorating in homes where they felt they had nowhere else to turn.”
The findings underscore the importance of accountability and strong oversight in protecting vulnerable older adults, particularly those who depend on others to advocate for their care and well-being.
Our People:
Welcoming Calene Richards, Esq., to Public Guardian Services
We're excited to welcome Calene Richards, Esq., as the new Executive Director of Public Guardian Services (PGS)!
As our team continues to grow, Calene brings valuable legal and human services experience to support our mission of providing high-quality, person-centered guardianship to some of the most vulnerable people in the Commonwealth.
A graduate of New England School of Law | Boston, and a member of the Massachusetts Bar, Calene has extensive clinical experience working with individuals with disabilities and other vulnerable populations. Prior to joining PGS, Calene supervised services to persons with disabilities in three DDS-funded group homes at Jewish Family & Children's Services.
We're delighted to have Calene on the team and look forward to the experience and perspective she brings to our work!
Around the Guardianship Community
October Conferences Bring Guardianship Professionals Together
National Guardianship Association Conference October 17–20
The National Guardianship Association's annual conference brought together guardianship professionals, advocates, and experts from across the country to exchange ideas, explore best practices, and discuss developments in the field.
Elder Justice Fellow Wynn A. Gerhard, Esq., of the Massachusetts Guardianship Policy Institute and PGS Executive Director Calene Richards, Esq., attended on behalf of our organizations, connecting with colleagues working to advance high-quality guardianship.
Massachusetts Guardianship Association Conference October 15 & 22
The Massachusetts Guardianship Association held its annual conference virtually over two half-day sessions on October 15 and 22.
The conference offered opportunities to hear from professionals working across guardianship law and practice, including a keynote address by Hon. Brian J. Dunn, Chief Justice of the Massachusetts Probate and Family Court, on October 15. Institute Member Wynn A. Gerhard, Esq., also participated in the conference, with additional insights and highlights to be shared in an upcoming issue.
Promoting Guardianship Rights and Alternatives
In the Fall 2026 edition of Disability Issues, Massachusetts Guardianship Policy Institute member Wynn A. Gerhard, Esq., is interviewed by Sandy Alissa Novack about the importance of protecting individual rights in guardianship proceedings and considering less restrictive alternatives whenever possible.
The conversation explores supported decision-making, healthcare proxies, and the continuing need for stronger protections and access to qualified guardians for vulnerable adults.
Never Miss a Story.
Learn More About Us
Massachusetts Guardianship Policy Institute — research, policy, and advocacy
Guardian Community Trust, Inc. — funding and care coordination
Public Guardian Services (PGS) — person-centered guardianship in practice