Adult guardianship can be viewed as having a “front end” (the determination of incapacity and appointment of a guardian) and a “back end” (accountability of the guardian and court monitoring). The Associated Press, in its landmark 1987 report Guardians of the Elderly: An Ailing System disparaged both. It charged that guardianship in the United States “regularly puts elderly lives in the hands of others with little or no evidence of necessity, then fails to guard against abuse, theft and neglect.” The guardianship system cannot function effectively unless both “ends” are in working order. This paper is about the “back end.” The Authors review the Associated Press’s charge, the 1988 American Bar Association (ABA) Wingspread conference recommendations on guardianship monitoring, and what has occurred since then. It asks where we stand now, what barriers block effective monitoring, and what imaginative, yet practical steps we can take to bolster guardian accountability.