During a wellness check in February 2023, a Cook County sheriff’s deputy discovered 92-year-old Anna Vargas lying face down on the floor near the body of her son, who had diabetes and died of natural causes.
Vargas, still breathing, was rushed to nearby Advocate Lutheran General Hospital in suburban Park Ridge. A physician diagnosed Vargas with severe cognitive impairment due to dementia and concluded she was incapable of making her own decisions.
With no other family to help the nonagenarian navigate what would come next, the hospital filed a petition asking a judge to appoint a guardian to handle her affairs.
It was the start of a very expensive 18 months for Vargas.
The law firm the hospital hired to handle her case and the private care management organization the hospital nominated as her guardian eventually billed her estate for tens of thousands of dollars in fees, on top of the money paid out to her new nursing home. After Vargas’ money started to run out, court records show, they suggested to a judge that a taxpayer-funded public guardian take over her care.
Last Sunday a Tribune investigation revealed that Chicago-area hospitals initiated hundreds of guardianship petitions in an 18-month period, a step they say is intended to protect patients who have lost the ability to make decisions and who have no friends or family willing and able to take charge. But the Tribune found the arrangement sometimes stripped families of control over a loved one and, in many cases, facilitated the patient’s discharge to a subpar nursing home.
The vast majority of these petitions involved people with little money who were placed with the Office of State Guardian at the hospitals’ own expense. But in cases where the patient had assets, a pattern emerged: A law firm that hospitals commonly hire in such cases — Monahan Law Group — named a particular organization — Midwest Care Management — as the hospital’s preferred guardian. In many cases, both parties then benefited from providing months or years of services funded by the former patient.
In interviews with the Tribune, some friends of people under Midwest’s care said they were upset or concerned about what they viewed as over-the-top fees and other choices that quickly depleted the person’s precious life savings. Former patients who sought to fight their guardianship in court paid an extra-steep price, funding not only their own lawyer but also those representing the other side, their guardian.
Some probate attorneys also expressed unease with the arrangement to the Tribune, noting that the Chicago area already has a system in place for exactly this type of situation: the counties’ public guardians, who typically provide both care and legal services at lower rates than the private firms. (Adults with $25,000 or less in financial assets are commonly referred to the statewide Office of State Guardian.)
In its review of more than 360 hospital guardianship petitions filed in the six-county Chicago area in 2023 and the first half of 2024, the Tribune found Monahan Law Group had a near-monopoly, with hospitals hiring it to handle more than 80%. Of these, the Tribune was able to identify only one case where the hospital’s petition nominated a county public guardian at the outset.
In 45 other cases where court records indicated patients owned property or had other assets, the Tribune found that the hospitals and their lawyers handed nearly all of them to Midwest Care Management, either at the outset of the case or later.
In the 18-month period the Tribune reviewed, 29 Chicago-area hospitals represented by Monahan Law nominated Midwest to the court at the beginning of a guardianship case. No hospital originally chose any other private care organization during that time, court records show.
Cook County Public Guardian Charles Golbert, whose office currently oversees the cases of more than 600 adults under guardianship, said he has long been concerned about what he called the injection of a “profit motive” into guardianship services. As the number of such corporations has risen over the last 15 years, he said, his office has seen its referrals from hospitals dwindle.
“You don’t need a Ph.D. in causation to figure out what’s happening,” Golbert said. “All you have to do is follow the money.”
The heads of Monahan Law Group and Midwest Care Management, both of whom declined interview requests, said in separate written statements that their frequent work on these cases is a testament to the high quality of the services they provide on short notice. They did not provide comments about Vargas’ case or any other the Tribune described, though Midwest noted they involve time-consuming, complex tasks such as finding suitable housing and investigating the person’s assets. Both emphasized that a judge must approve each guardianship nomination as well as reviewing and approving their separate fee requests.
The statement from Joseph Monahan, founding partner of Monahan Law Group, described his team as “subject matter experts in guardianship matters. We have been doing the work for decades and are proud of the formidable reputation we have earned.”
Midwest Care Management’s owner and managing director, Ben Topp, wrote in his statement: “We have put in the work to become experts in the field, and often the preferred provider when the need for a private guardian is identified. We are incredibly proud of the work we do and the confidence that medical and legal professionals have in our team.” Topp’s organization is registered as a not-for-profit; he also operates a similarly named corporation.
Both statements said the two organizations do not have a financial relationship. Monahan’s statement also said it is the hospitals, not his law firm, that choose to nominate Midwest as guardian.
The Tribune asked several hospitals to describe why they nominated Midwest, a private guardianship organization, instead of the Chicago-area county guardians in cases where patients have financial assets.
The University of Chicago Medical Center, which the Tribune found to have filed the most guardianship petitions overall during the 18-month period, said in a written statement that it chooses private guardians in only a small number of cases, where “patients have particularly complex needs mandating the extra support a private guardian can provide.” A Northwestern Memorial Hospital spokesperson sent a statement saying the hospital system has worked with Monahan and Midwest for many years, values their work and has “found their bills to be fair and reasonable,” noting that Northwestern pays those bills in most cases because it is unusual for patients who need guardians to have assets.
Topp’s written responses also said hospitals often choose Midwest because they “need immediate engagement.” By contrast, Golbert told the Tribune his office requires a meeting with the patient before taking on a guardianship to ensure his staff agrees it is warranted, a step that may delay discharge from the hospital. He said little research exists comparing outcomes of private versus public guardianships and characterized assertions that private guardians are better suited to the emergency nature of such cases as “self-serving nonsense.”
Cook County Circuit Judge Daniel Malone, who presides over the probate division, said judges weigh a number of factors in determining whether to approve fee requests, including the size of the disabled adult’s estate and skill level needed for the work performed. Court records show judges do not always approve fee requests in full.
Last year, and again in January, a state representative concerned by the steep fees in a 2022 DuPage County private guardianship case introduced a bill requiring the appointment of a county public guardian or the Office of State Guardian in cases initiated by hospitals, nursing homes and similar institutions.
The bills failed amid strong opposition from Midwest Care Management, Monahan Law, hospitals and others.
Bills and more bills
When Midwest Care Management was appointed as Vargas’ temporary guardian in February 2023, she had about $122,000 in the bank, court records show.
Within a year, records show, the organization had sold her Nissan Altima and her home in unincorporated Des Plaines — netting about $145,000 — and threw away or auctioned off most of her other belongings.
Nursing homes are expensive, regardless of who is serving as guardian, and the Glenview facility where Vargas was discharged — which had an above average star rating from the Centers for Medicare and Medicaid Services — cost her nearly $9,000 a month in room and board.
Vargas was also responsible for paying the legal fees Monahan Law Group accrued while representing the hospital and Midwest Care Management, which as Vargas’ guardian billed $130 an hour for tasks ranging from communicating with nurses to collecting mail to ordering shoes on Amazon. By contrast, the Cook County public guardian bills at $95 an hour for similar services.
In May 2024, with Vargas’ savings rapidly vanishing, Midwest Care Management recommended to a judge that “given the value of the estate” the Cook County public guardian would be a better fit going forward, records show. Golbert’s office took over in early June of that year.
Monahan Law Group then filed its own fee petition at an hourly rate up to $325, compared with $135 for the attorneys on staff with the public guardian. In total, Midwest and the law firm rang up nearly $49,000 in total hourly fees and costs over roughly 18 months. By August of this year, when the county guardian filed its first fee petition for Vargas, she had less than $14,000 left.
A spokesperson for Advocate Lutheran General, which initiated the guardianship petition for Vargas, did not answer the Tribune’s written questions but sent a statement saying: “We sincerely regret that situations like this may arise and will continue to review our internal processes to ensure guardianship cases are handled with the utmost care and diligence.”
To date, a Tribune analysis found Monahan Law Group and Midwest Care Management have asked the courts to approve a combined $1.2 million for hospital-initiated guardianship petitions launched in 2023 and early 2024, with much of the billing still ongoing. The fee requests varied from as little as about $5,000 for a disabled adult who ended up having limited financial assets to a combined more than $84,000 for about 18 months of services on a different case.
Candace Hilderbrand, a childhood friend of 70-year-old Lynn Newton, said Newton’s money would already be gone had she not stepped in to take over the private guardianship.
Newton, who had a decades-long career in the business sector, including a stint at the Tribune, wound up under guardianship thanks to a petition from Northwestern Medicine Lake Forest Hospital filed by Monahan Law Group. That petition nominated Midwest Care Management to become her guardian.
When Hilderbrand visited Newton at a nursing home following the hospitalization, she was worried, she told the Tribune. She said Newton had no possessions and was paying nearly $10,000 per month for a shared bedroom and bathroom. Because of her dementia, Newton likely didn’t understand her situation, Hilderbrand said.
It took almost 10 months before Hilderbrand was able to obtain guardianship of both Newton’s person and estate. As the case was unfolding, she petitioned to move Newton to a more affordable nursing home closer to where she lives in Indiana.
Along the way, Hilderbrand filed an objection in probate court disputing some of the fees the lawyers and private guardian requested. For example, court records show Midwest continued to pay for a storage unit in Indiana for months after the organization’s employees had decided the unit held nothing of value. Records show Midwest also knowingly left Newton’s Subaru in an impound lot for two months, where it racked up nearly $4,500 in fees. Midwest reported to the court earlier that year it did not have the money needed to retrieve the car for those months. Eventually, the car was sold at a loss to Newton’s estate, records show.
After Hilderbrand filed an objection contesting Monahan Law Group’s request for nearly $39,000 for its work, the firm agreed to reduce its fees and costs to $25,000.
“I could see where a lot of people would say, ‘I can’t put any more time into this. You guys just do what you’re going to do with her and let me know where she is,’” Hilderbrand said. “And I think they bank on that.”
In his written statement, Midwest’s Topp noted the organization “reduced or deferred” its fees in several of the cases the Tribune described and estimated about 10% of its services are delivered pro bono.
“Everything we do is documented, itemized, and transparent,” Topp’s statement said. “We will always present the time and effort required to help the person, understanding that we may need to respectfully and collaboratively work to reduce fees in some situations.”
Monahan said in his written statement that any fee reduction “is not a function of the quality of the work, but rather the size of the estate and the ongoing needs of the individual.”
Standing up for a neighbor
Jack Oestreich couldn’t stand what was happening to his neighbor, Sylvia Del Vecchio.
Del Vecchio had lived in her ranch-style Oak Brook house for decades as she grew a successful business, cared for her elderly mother and raised generations of rescue dogs — all on her own. Del Vecchio, who never married and did not have local relatives, placed a high value on her independence and wrote in legal documents that she wanted to remain in her home as long as possible.
Now she had no control over her own life, having been placed under temporary private guardianship at 86 after a hospitalization at Endeavor Health Linden Oaks Hospital in Naperville. And to Oestreich, Midwest Care Management was “squandering” her life savings so fast, it wouldn’t be long before she would end up “penniless in a nursing home.”
When Del Vecchio returned to her house in August 2023 after a short stint in an assisted living facility, Midwest hired a home health care company to staff workers for two 12-hour shifts, seven days a week. Oestreich, who held Del Vecchio’s power of attorney for health care, said he complained about the steep price tag to Midwest and was able to switch her to an option that reduced the cost substantially: a live-in health care worker.
In another example of what Oestreich described as wasteful spending, court records show Midwest charged Del Vecchio’s estate about $850 for pest control after a caregiver spotted mice. Oestreich told the Tribune setting traps would have handled the issue for far less.
He and another neighbor, Frank Spizzirri, a retired Illinois State Police commander, noted to the Tribune that Midwest charged for every small task — at a rate of $140 an hour — and yet failed to pay some bills. Court records show Del Vecchio’s caregivers arranged with Midwest to get her electricity bill paid after her power was shut off.
“It was really obvious to us right away that things could be done a lot more affordably and efficiently,” said Oestreich, a retired software consultant with a degree in accounting. “I knew we needed to fight to take over guardianship or Sylvia was going to be out of money in no time.”
In all, Midwest Care Management received more than $22,000 for about five months of work on Del Vecchio’s case, court records show. A fee petition from Monahan Law Group, which represented the hospital, sought about $11,000 from her estate for its services and costs over seven months. After Oestreich balked in court at some of the law firm’s fees, a judge ultimately awarded $10,000.
Hospitals in the collar counties filed far fewer guardianship petitions than those in Cook County during the period the Tribune examined. In Del Vecchio’s case, the hospital nominated Midwest instead of DuPage County Public Guardian Matt McQuaid, whose fees are lower. “My experience is how do I stretch every dollar?” he said in an interview.
Oestreich acknowledged to the Tribune that he initially declined to step in as Del Vecchio’s guardian. But after growing incensed over the way her money was managed, he said he hired an attorney to intervene in the guardianship case and took over as her full guardian in October 2023.
To help reduce Del Vecchio’s expenses, Oestreich said in an interview that he stays with her on overnight weekend shifts. Spizzirri pitches in with tasks as well. Still, they said, Del Vecchio likely has about a half-year of savings left before she can no longer afford to stay in her home.
As her neighbors seek a solution, they said Del Vecchio, who turns 89 in March, seems content for now, watching “Lassie” reruns on television and soaking in the warmth of her sunroom, with her beloved dog Rumor nearby.
Golbert, the Cook County public guardian, told the Tribune his office’s goal is to keep people in their homes as long as possible. To that end, in addition to a “substantially lower” fee structure, he said they routinely delay collection of court-approved guardianship fees to postpone the day that poverty forces the person into an institution.
“We want to keep all of our people in the least-restrictive setting possible and the setting that will maximize their independence, and their happiness, and their well-being,” Golbert said.
“These private guardianship corporations obviously are not in a position to defer collection of fees for years and years, or even waive fees, so that people can get the best care they need or to be able to stay in their homes and community.”
Monahan’s statement acknowledged its fees “can be higher than the publicly subsidized” Cook County public guardian. Both he and Topp, in statements, said they in some cases work to reduce fees, all of which are subject to a court’s approval.
A costly fight
Sometimes, the former hospital patient is aware enough to object to a guardianship or the actions of a private guardian. It is a costly battle, as the person must fund both sides of the argument. They pay for their own lawyer, and they pay for the lawyer representing the guardian.
A legal showdown over one former patient’s money began in 2024 when she objected to paying nearly $99,000 for about 12 months in the nursing home where she landed after being treated for coronary artery disease at Ascension St. Joseph in Chicago.
Her guardianship had started in 2023 after the hospital, through its Monahan Law Group attorneys, nominated Midwest Care Management to make the woman’s decisions and discharged her to the Warren Barr Lincoln Park nursing home in Chicago. There, her health improved over time.
Through an attorney she hired on her own, she argued in court records that the guardian’s request to pay the balance owed to the home “implicitly asks the court to ratify” Midwest’s decision to keep her at a nursing facility with a level of care she did not need or want and could not reasonably afford.
The woman also paid for an independent medical examination that concluded the facility was not the least restrictive environment possible for her. Yet the private guardian didn’t attempt to move her to a less expensive and more appropriate facility until she retained her own legal counsel, court records state.
In response to a motion the woman filed to terminate the temporary guardianship, Midwest Care Management, again represented by Monahan Law Group, contended they were caring advocates for the woman when no one else in her life was willing to accept the appointment and they had “listened to her concerns and wishes,” court records show.
In its filing, the care organization said the former patient was “inconsistent” regarding her desired living arrangements and whether she should remain under guardianship.
Ultimately, the parties reached a settlement where the woman agreed to appoint a person to hold her power of attorney and not to bring other claims against Ascension St. Joseph or Midwest in exchange for the hospital withdrawing the guardianship petition. Under the settlement, the law firm and Midwest both agreed to reduce their fees by about 40%, to a combined $22,000.
Through her attorney, the former patient declined to comment.
Wade Jarrell, a chemistry professor who was hospitalized at Northwestern Medicine Lake Forest Hospital in summer 2023, wound up on the hook for nearly $75,000 after losing his fight against guardianship.
A doctor at the hospital had diagnosed Jarrell, then 54, with significant memory and cognitive impairment likely caused by a chronic neurological disorder, court documents show.
Jarrell had a home in the Lake County village of Green Oaks and other financial resources, so the hospital through its attorneys from Monahan Law Group helped install Midwest Care Management as his temporary guardian.
Jarrell’s objection to the guardianship petition sent his costs soaring. After a Lake County court hearing a year later, in which a judge cited a doctor’s medical diagnosis in determining that he did need full guardianship, Monahan Law Group sought about $51,000 from Jarrell’s estate for about 14 months of work. The firm’s rate of $300 an hour in the case is similar to what the Lake County public guardian currently charges for legal work. Monahan’s payment was later reduced to less than $32,500. Midwest received a reduced amount of $15,000, according to the judge’s order.
The rest of the nearly $75,000 went to pay an attorney the court assigned to represent Jarrell’s wishes and the guardian ad litem who advised the judge.
“It’s sad because with all that money (in fees) he could have at least had better care for a few years,” a former neighbor of Jarrell’s, Timothy Mahoney, told the Tribune.
Jarrell has lived at a South Elgin nursing home since late 2023, when he was moved from a previous facility. His current nursing home has an average one-star rating from the Centers for Medicare and Medicaid Services, the lowest possible.
Midwest submitted a written plan to the court to continue caring for Jarrell as his full guardian, but the judge instead appointed another private firm, court records show. That firm managed the November 2024 sale of Jarrell’s home but has yet to bill his estate.
Mahoney, who testified during the full guardianship hearing, said in a Tribune interview that the outside of Jarrell’s home appeared unkempt — with mail piling up and an overgrown lawn — while Midwest was in charge of the property.
“We never saw them there,” said Mahoney, a retired firefighter.
Without commenting on a specific case, Topp praised his staff in his statement, saying: “Families, hospitals, and attorneys rely on us because we are accessible, experienced, and principled.”
Mahoney said he still checks in on Jarrell, who does not have local family.
“I think now he’s just a forgotten soul,” said Mahoney.
‘Pretty financially lucrative’
In 2022, UChicago Medicine AdventHealth GlenOaks Hospital asked a DuPage County judge to place a 75-year-old Bloomingdale woman with severe dementia under the care of a guardian. The hospital, through its Monahan Law Group attorneys, nominated Midwest Care Management.
Court records show that Midwest approved her discharge from the hospital to a nursing home in Chicago’s West Ridge neighborhood on the Far North Side — about 20 miles from her west suburban community. Midwest said in court records that because of her financial circumstances it was the only place that would accept her when the hospital noted she “was at risk of her insurance no longer providing coverage for her stay due to her approaching the 30 day mark.”
Then came the bills: $19,600 requested from Monahan Law Group for 12 months of work on the case and $27,000 from Midwest for about 10 months of work.
Terra Costa Howard, an attorney who was serving as guardian ad litem on the case — investigating and reporting to the judge what was in the woman’s best interest — raised concerns in a court filing. Both of these organizations knew the woman had limited funds, she wrote, and Costa Howard disagreed that their fees benefited her.
Monahan Law and Midwest Care ultimately withdrew their requests for fees. But Costa Howard, who was also a Democratic state representative, had apparently seen enough. In both 2024 and 2025, she proposed bills that would require the appointment of a state or county public guardian when hospitals, nursing homes or similar institutions file adult guardianship petitions.
The Bloomingdale woman’s case, she told her fellow legislators at an April 2024 committee hearing, “demonstrated a systemic issue with a business model that preys on, I would argue, our most vulnerable.”
At the hearing, Midwest Care Management’s Topp came to the microphone to defend his organization, calling the legislation “an unnecessary, misguided change” that would delay medical interventions and stress the system.
In response to questions from another legislator, Topp said Midwest Care Management and Monahan Law Group had no financial relationship.
“OK, so there is no relation in any capacity between whatever you do for a living and they do for a living? No money is transacting at all?” state Rep. Curtis Tarver II, D-Chicago, asked during the hearing.
“Correct,” Topp said.
After further pressing, with Costa Howard pointing out the fees that had been requested in the Bloomingdale woman’s case, Tarver said: “OK, so there is some financial relationship.
“You all are not just holding hands singing in the rain; that’s not the relationship,” Tarver said, adding later: “I’m not trying to be funny, but it kind of is comical because we’re dancing around the fact that there is some kind of relationship here.”
Topp told legislators it would reduce “choice” if private guardianship organizations were cut out of hospital-initiated guardianships. Monahan told the Tribune that he opposed the legislation because it would result in “limiting choice based solely on the petitioner and removing judicial discretion.”
When the Tribune asked Topp to comment, noting that the patients involved do not have a choice in the selection, he wrote that he believes it is essential that the petitioner — namely, the hospital — be able to “assess all available options.”
A number of hospitals, as well as the Illinois Health and Hospital Association, also publicly expressed opposition to the bills.
Hospital association spokesperson Paris Ervin said in an email to the Tribune that the changes could cause “delays in patient access to care” and “would have led to stays in hospitals beyond medical necessity.” Ervin said hospitals need assurances that courts can quickly appoint guardians to make decisions that support patient care and appropriate discharge planning, partly to ensure “availability of care and space for other vulnerable patients.”
The Tribune found Midwest Care Management has accepted hospitals’ guardianship nominations without ever meeting the patient, which differs from the stated practices of both McQuaid and Golbert.
“Assessments, evaluations, diagnoses, reports and the like are important, but are not a substitute for in-person interaction with the individual,” Golbert told the Tribune.
Court records show that when Midwest Care Management accepted an 88-year-old retired teacher as a client in February 2023, they spent time reading her file, researching the properties she owned and building her estate profile. But a worker from Midwest didn’t visit the woman until the day the organization was appointed as her temporary guardian.
By then, the woman had already been discharged from the University of Chicago Medical Center to a “not very clean” room at a nursing home where the case worker “observed (a) mouse run across the floor,” records show.
For the next 18 months, Midwest Care billed $33,000 in costs and fees. Monahan Law Group separately requested $51,000 in hourly fees and costs from the woman’s estate but was awarded a reduced amount of $44,000.
At the 2024 hearing, the committee’s chair, state Rep. Jennifer Gong-Gershowitz, said she was concerned that much of the bill’s opposition seemed to stem from “a pretty financially lucrative arrangement.”
“I think that we’ve got to have some guardrails here around this process which seems to be, in certain instances that are observed by practitioners in this space, not to necessarily be in the best financial interests of the clients that are being served,” Gong-Gershowitz said.
Despite concern voiced by the legislators, that bill and a nearly identical one brought in January 2025 failed to pass through the House. Costa Howard, who was recently named a DuPage County judge, declined further comment this month.
For the hospitals, Monahan Law Group and Midwest Care Management, business has continued as usual.
Chicago Tribune’s Hope Moses contributed.
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