March 8, 2008

 

Caring for the elderly is one of Florida's growth industries — nearly a quarter of the state's population is over 60 and almost 10% is at least 75.

But caring for the poor among them is a different story — particularly when a patient becomes unable to make his or her own decisions.

To take care of them, Florida, like many states, has a public guardianship system — a government entity that works through the courts to appoint guardians for those without the means to pay for their own.

But it's a skeleton entity, and only about half of Florida's 67 counties are covered. And even in those, there's a waiting list of seniors — 254 people, according to the most recent figures from the Statewide Public Guardianship Office. That was up from 225 in the office's 2007 annual report and 132 people waiting in 2006.

Even then, that might just be a fraction of the problem — the state public guardian estimated in 2004 that 5,000 to 10,000 people who needed its services weren't getting them. That population of endangered adults is expected to rise as more baby boomers age and head here for retirement.

Terry Hammond, a Texas attorney who also serves as executive director of the Pennsylvania-based National Guardianship Association, estimated fewer than 25 states have a public guardian program at all. Florida is ahead of those without one, he said, but barely. Without broad legislative support, it amounts to an unfunded mandate that raises equal protection concerns, he said.
Hammond said he knew of only one other state, New Mexico, with a waiting list for public guardians.

"The question ultimately is, 'What are we willing to pay in human cost to save money for the budget?"' Hammond said. "And if the government isn't willing to spend money on people who need assistance, what is the purpose of that government?"
A guardian is essentially a surrogate decision-maker, appointed by a judge after someone is found incompetent to care for him or herself. To qualify for public help, a person must have limited means and no family or friends willing or able to provide care.

"It's really the office of last resort for the most vulnerable of the vulnerable," said Michelle Hollister, executive director of the SPGO. "They're incapacitated, they have no money and they're basically alone."

Florida does have its success stories.

In 2006, a 69-year-old from Immokalee was suffering potentially fatal septic shock while his wife was out of the country. An emergency guardian was appointed, approved treatment and the man recovered.

A 63-year-old woman with dementia and mild retardation was saved from an abusive caregiver after an Adult Protective Services investigator found her hiding in some bushes. She was appointed a public caregiver and placed in a safe home.

But cases must be referred into the system, and that only happens if someone thinks an individual is exhibiting signs of incapacity. Because the state's wards are by definition alone, the first call often isn't made.

Florida's public guardian system is also chronically underfunded, relying on a county-by-county melange of charities, partnerships and sheer good will.

Some, like the Guardianship Program of Dade County, are almost entirely funded by the county. Others, like the Fifth Circuit Public Guardian Corp., which serves Marion County, rely heavily on the United Way, despite being a "public" agency.

The localities with waiting lists can't simply accept an additional ward or two, because state law limits how many people each guardian can have.
The SPGO is asking for a $1.3 million increase over its roughly $2.3 million budget this year, which would enable it to care for an extra 150 people. It isn't even trying to get the estimated $24 million it would take annually to serve everyone who needs help.

The most severe cases can be taken on by Adult Protective Services, but there are real effects of the waiting list limbo. Perhaps the most tangible is higher public health care costs, because hospitals must keep some patients until the system can accept them.

"As long as we know that they're taken care of," said Andrea Wolfkill, a case manager in Marion County. "If they're in a facility, I don't move as quickly — if they're in a hospital. They've had people two or three months because they don't have a guardian."

That problem — and expense — prompted Martin Memorial Health Systems in Stuart to initiate its own public guardian program for Martin County. Linda Hake, a senior attorney for the hospital who now oversees the program, said she had been trying since 1999 to start a public entity. It opened in 2006, with no county funding.

"Trying to find guardians for people who have no money is impossible," Hake said. "And those are the people that need them, because they're the ones typically that don't have the family resources. They're estranged from their family, they're alcoholics."