After months of debate, legislation inspired by a Tribune investigation into some Chicago-area hospitals’ questionable use of the state’s guardianship system has advanced from the Illinois House as supporters seek to strengthen court oversight and other protections for the rights of vulnerable adults.

Earlier versions of the bill would have banned the appointment of private professional guardians in cases where a hospital, nursing home or similar institution has asked a judge to rule that a person needs court-ordered oversight because he or she is unable to make medical, financial and other personal decisions.

The Tribune’s investigation, published in November, revealed that when the patients in question owned property or other financial assets, hospitals typically recommended that a private guardianship organization rather than a county public guardian be put in charge of their lives. Paying for that organization’s work, along with fees billed by lawyers on the case, sometimes drained people’s savings at a rapid pace, the Tribune found.

But the proposal to bar private guardians completely drew objections from hospitals and others who argued it would force some patients to remain hospitalized beyond medical necessity. The amended bill would allow private guardianship appointments but enact requirements aimed at giving probate court judges more authority to hold the entities accountable.

The measure has yet to gain the approval of a longtime opponent, the Illinois Health and Hospital Association, but after advancing to the Senate on a recent 81-28 vote in the House it has survived longer than earlier attempts and has turned several past opponents into supporters.

In its investigation, the Tribune found that Chicago-area hospitals had initiated hundreds of guardianship petitions in an 18-month period. Hospital representatives said the petitions were intended to protect incapacitated patients who are too disabled to make their own decisions and who have no family or friends willing or able to take charge.

But the Tribune found many cases where the petitions eased the way for hospitals to discharge patients to subpar nursing homes, sometimes bypassing family members who disagreed with the hospital’s choice or were slow to make other arrangements.

The hospital association also had expressed opposition to similar legislation introduced in previous sessions by former state Rep. Terra Costa Howard, now a judge. State Rep. Marti Deuter, an Elmhurst Democrat, worked with AARP Illinois on the latest bill, which picked up 14 other sponsors in the House before the April 16 vote.

After months of discussions with opponents, supporters say the amended version of Deuter’s bill represents a compromise but still would set important safeguards around private guardianship appointments.

For example, the bill would require employees of private guardians to undergo criminal background checks every five years and get the education necessary for national certification. And a private guardian corporation would have to submit to annual independent audits if it manages more than $1 million in assets.

The bill also seeks to prohibit private guardians from having financial ties to other for-profit entities involved in the person’s case and would give the court more information through annual budgets and fee schedules.

Also, in certain cases where a private entity is seeking to pass the case to a public guardian as successor, which typically happens when the estate is running out of money, a 120-day minimum notice to the court would be required.

The hospital association still objects to the part of the bill that would require the private guardian to meet with the hospital patient prior to accepting the appointment, citing concerns that such a requirement may slow the process as well as timing issues concerning medical consent.

To address the possibility that a person may be too incapacitated to meet with the guardian or be unwilling to meet, supporters changed the bill to specify that if the meeting is “not reasonably possible” the prospective private guardian must certify in court that “they will meet with the respondent as soon as feasible after the appointment.”

In response to Tribune questions, a spokesperson for the hospital association said the organization will continue working with the bill’s sponsors on the language.

“IHA supports the goal of strengthening existing protections in the guardianship statute and is committed to working through any remaining unintended consequences of the proposed legislation on patients, like the previously mentioned delays in obtaining timely consent for treatment that directly impacts patient outcomes,” Paris Ervin said in a statement.

Cook County Public Guardian Charles Golbert, whose staff oversees the cases of more than 600 adults under guardianship and has helped champion the bill, said face-to-face meetings are standard practice in his office prior to appointment and are crucial to properly assessing the person’s needs.

He said more than 20% of all cases in his office involve people under a limited guardianship that allows the person some control over their life. In the Tribune’s 18-month review, only seven of the hospital-initiated guardianships, or roughly 2%, were limited rather than full guardianships.

“That’s scandalous in my mind,” Golbert said, “and that’s what happens when guardians accept appointments with people who they have never met.”

Another compromise supporters made to advance the legislation was deleting language that would have temporarily prevented private guardians from collecting court-approved fees if it meant the person had to sell their home for nonmedical reasons. Supporters said the proposal was met with skepticism by lawmakers who recognize the private entities do not have taxpayer funding like their public counterparts and need to be paid for their services.

Under the latest version of the bill, fees may be collected but the private guardian would be required to notify the court as soon as “it estimates the estate of the person with a disability can no longer afford the services” or “if the sale of (the person’s) residence would be required for the continued services” within 36 months.

The hope is the court would step in at that point to either reduce fees or appoint a public guardian, such as Golbert, who said his office delays fee collection when doing so allows a person to remain in their home.

Besides the hospital association, the bill had faced opposition initially from other important voices, including the Catholic Conference of Illinois, which runs a private guardianship program for elderly people that receives hospital referrals. The group dropped its opposition after the bill recognized a place for private guardianships, said Marilou Gervacio, director of social services/social justice.

The vast majority of the hospital guardianship petitions reviewed for the Tribune’s investigation involved people with little money who were placed with the Office of State Guardian at the hospitals’ expense, rather than under a private guardian or a county public guardian like Golbert.

The Illinois Guardianship and Advocacy Commission, which operates the state guardian’s office, said it initially opposed the bill because of a provision that would have required the office to receive notice if a facility determines that someone may need a guardian.

“That provision would have created an administrative obligation without a clear purpose or authority to act, and no additional resources to manage the volume of notices,” the commission said in a statement. The language was removed in the amended version of the bill.

Despite the compromises, supporters say the legislation still would go a long way toward improving the system. Other changes would require private guardians to attest to the court that their efforts to locate family or friends were exhausted prior to appointment. And the petition would need to name the private entity’s president, director or other corporate officer as the preferred guardian, rather than a business name, with the goal of encouraging more personal responsibility.

Besides Golbert and AARP Illinois, other backers include the Illinois State Bar Association and the Illinois Long-Term Care Ombudsman Program.

“The bill moves Illinois closer to a system that respects independence, protects savings and prioritizes dignity for older adults,” Philippe Largent, AARP Illinois’ state director, said in a statement.

Added Golbert: “These are really commonsense types of safeguards and protections for truly our most vulnerable people — we are talking about people with advanced dementias — who don’t know what’s going on and don’t understand what’s happening to them or who either have no family or have family that is financially exploitative or otherwise unavailable. These guardrails are just critical for our most vulnerable people.”

Sen. Michael Halpin, a Rock Island Democrat, has picked up the bill in the Senate. The spring legislative session is scheduled to adjourn May 31.

cmgutowski@chicagotribune.com