But the Massachusetts Department of Public Health has yet to produce that report, and as of this week it is a year overdue.

“It’s like the bombs are going off around us,” said Dr. Eric Dickson, chief executive of UMass Memorial Health. “For whatever reason, there’s no sense of urgency.”

Currently in Massachusetts, the position of legal guardian is effectively a volunteer job, yet they play a crucial role: not only do they aid people in need, they also help rationalize the health care system.

Those hospital patients who can’t represent themselves but are medically ready to be discharged to a rehabilitation center, long-term care facility or a skilled nursing home need a guardian to sign off on their transfer. Otherwise, they occupy hospital beds intended for more acute patients, contributing to overcrowding and lengthy wait times, health care providers said.

DPH officials told The Boston Globe their recommendations to improve and expand guardianship is coming but would not provide additional details, including how much they have spent developing their findings.

Even the state representative who sponsored the law requiring the study of guardianship said he has not heard from DPH why its recommendations are late.

“It’s not uncommon for any state agency to delay,” said Thomas Stanley, a Democrat from Waltham. “I think the common refrain is that they have all sorts of work to do and there’s not enough time or resources.”

But Stanley added it’s crucial for the Legislature to have recommendations from DPH if it wants to fix the current system.

DPH’s findings are expected to include a deep dive into the financial impact of state-supported professional guardians, including an evaluation of the possibility of paying guardians through MassHealth, the state Medicaid program.

Early in 2026, Paul Lanzikos, a coordinator for the senior advocacy group Dignity Alliance Massachusetts, petitioned the secretary of the Commonwealth to compel DPH to produce records related to the report.

The secretary’s public records division told DPH in a March 6 letter that it failed to cite a compelling reason to not release the records, and ordered the agency to reply to Lanzikos. He said DPH has yet to respond to him.

He described the delay as “totally unacceptable.”

“This fall is when new bills get submitted to the Legislature,” Lanzikos said. “We want the benefit of this report that the Legislature asked for a year and a half ago to inform proposed legislation.”

In a meeting last week with DPH officials, including public health Commissioner Robbie Goldstein, officials told Lanzikos the report was done and was awaiting vetting by the Executive Office of Health and Human Services.

DPH did not respond to a request to confirm Lanzikos’s statement.

Often, people in need of guardians are those with conditions including brain injuries, strokes, or dementia. But they can also include those with severe mental illness or developmental disabilities.

Known in the industry as “boarders,” patients who are ready to be discharged but do not have anywhere else to go, cost hospitals in Massachusetts $400 million a year, according to a 2024 report from the trade group for the industry. In a May point-in-time count, the Massachusetts Health and Hospital Association identified 1,152 patients at 45 hospitals who were eligible for discharge yet stuck in hospitals.

Massachusetts is among just 14 states without a professional guardian program, Lanzikos said.

Guardians are appointed by Probate and Family Court to represent the best interests of a person who isn’t able to represent themselves. A family member can be appointed as a guardian.

Hospital petitions often start the process for patients who are boarders. Along with medical decisions, guardians may coordinate clients’ housing, financial decisions, and social services. A guardian is often responsible for their clients until the end of their lives.

An estimated 3,000 to 4,000 people in Massachusetts need a guardian but can’t easily get one, according to a 2025 report from the Massachusetts Guardianship Policy Institute.

Overall, about 29,000 people statewide were subject to guardianship as of 2025.

Madeline Feist, a staffer for Public Guardian Services and one of the state’s few full-time guardians, carries a caseload of 18 to 22 people at any time. Complicated cases require up to 20 hours of work a week.

Feist described her history with a client she named with the pseudonym “Jack.” Now 57 years old, Jack was homeless in Randolph and living with untreated schizophrenia when she became involved with him in 2023. Initially, she said, he was hostile and refused to work with her.

Over the past two years, she has found him a home through the Department of Mental Health, coordinated neurology and psychiatric appointments, and guided him through cancer treatment while navigating his Christian Scientist faith that makes him wary of medical interventions. She sees Jack up to four times a month, she said.

“This really allowed me to do the case management I wanted,” said Feist, a social worker with 30 years of experience in human services. “It’s very important work.”

Guardians can receive compensation from the state, but that typically amounts to no more than $1,500 a year, according to the Massachusetts Guardianship Policy Institute report. (Feist is one of four guardians whose full-time salaries are supported by a private endowment through Public Guardian Services.)

Too few people are willing to do the work for that little compensation. Some that do manage to see their clients just once or twice a year, Feist said.

And the process of appointing one can drag on for months, said Caryn Sullivan, director of social work at UMass Memorial Medical Center.

Without a guardian’s approval, hospitals can’t even transfer patients to long-term care facilities within their own health care systems, said Dickson, of UMass Memorial. One recent day, the hospital had 35 patients ready for discharge instead occupying beds, many in neurological or trauma units. Those beds are needed to admit patients from the emergency department. In a domino effect, patients instead remained stuck in the emergency department, which in turn limited the department’s ability to take in new patients quickly.

“This is harming patients in terms of their health, hurting emergency department patients, hurting the finances of the hospital,” Dickson said.

Jason Laughlin can be reached at jason.laughlin@globe.com. Follow him @jasmlaughlin.