Background. Issues such as cognitive impairment, developmental disability, substance abuse and addiction, and mental health conditions may render older people unable to manage their daily lives independently. Under these circumstances, a legal guardian is appointed by a probate court to make decisions about the older adult’s medical needs, finances, and living arrangements. The high rate of population aging is resulting in an increasing need for adult guardians, yet the body of research on managing adult guardianship is not robust. Our study will examine county-specific promising models of practice that address challenges to managing adult guardianship. Method. Focus groups were completed in five counties in Ohio (Butler, Cuyahoga, Franklin, Lorain, and Stark). In each county, focus groups included probate court judges and other court staff, guardianship program staff, and various types of guardians, including volunteers, family members, and professionals. The transcribed interviews were analyzed in Dedoose software using a thematic analysis approach. Findings. We identify the following challenges: financial constraints for courts and individuals, high and complex caseloads, lack of guardians and volunteers, exploitation of older adults, substance abuse, higher demands on monitoring care reported by guardians and the courts because of Rule 66, and families’ unwillingness/inability to serve as guardians. Counties adopted innovative approaches to address some of these challenges. Conclusion. Some of the findings are consistent with previous studies, but to inform better strategies for improving guardianship programs at the local level, it is important to understand how to respond to the challenges identified from the focus group discussions.