Appointed Strangers

There is a moment in every guardianship case when a judge signs a paper and an adult stops being, in the eyes of the law, the person who decides. After that signature someone else chooses where that adult will live, which doctors may treat them, whether the house is sold, who may visit, and what happens to the money they spent a lifetime saving. The person keeps their name and their memories. What they lose is the authority to act on them.

Courts in every American state have this power, and most people never think about it until it touches someone they love. With more than 61 million Americans aged 65 and older and an estimated 7.4 million living with Alzheimer's disease in 2026, the number of people who will one day be unable to sign for themselves is rising fast.

Appointed Strangers follows the machinery of guardianship from the courtroom to the hospital bed to the nursing-home door. It looks at how a Nevada case became the largest elder exploitation prosecution in the state; how a few minutes and a pen can change a life; why nobody knows how many adults are under guardianship; the arithmetic of dementia; the unbefriended patients no family will claim; wards who wanted to live at home; the agencies and professional guardians behind the orders; multimillion-dollar abuse cases; and how other countries, including Japan, handle the same problem.

The book also examines the quieter substitutes: powers of attorney, supported decision-making and the practice of asking the person first. It is written for adult children, caregivers, elder-law and social-work professionals, journalists and anyone who wants to understand how the law decides for the old when family cannot, and what to ask before a judge ever signs.