by Stephanie Garcia
The veteran who suffers from PTSD and combat-related injuries. The elderly woman who suffers from dementia and a recent stroke. The person in their 20s living on the streets, incapacitated by mental illness or a traumatic brain injury.
Lacking family support, resources and stable housing, this medically fragile population doesn’t have a voice. There is no one there to advocate on their behalf to ensure their safety and well-being.
To respond to the growing rate of indigent and incapacitated adults — a population estimated at up to 3,736 individuals in Colorado — the state legislature funded the Office of Public Guardianship four years ago. These guardians secure appropriate housing/placement, medical and mental health care, assist with end of life medical care decisions and provide any other essential support and care necessary while safeguarding the client’s individual rights and independence whenever possible.
These extremely vulnerable individuals span every age group, although the average age range is 60 to 75 years old, and the most common diagnoses related to their loss of capacity are Alzheimer’s, dementia or other neurocognitive disorders or mental illness. More than 85% have at least one additional medical condition, and 44% have multiple medical problems. By the time a guardian is appointed, the majority of clients are either in high acuity settings such as hospital beds or experiencing homelessness. Some are at the end of their life when we are first appointed, soon passing away in a hospital or nursing home under the direct care and supervision of medical professionals.
As a newly created independent agency operating in seven counties, we have served more than 105 clients in the past two years with a small staff of four guardians and a case management aid. Clients are seen monthly and guardian-to-staff ratios are within best-practice standards. We have helped clients with mental health challenges and cancer find hospice care. We've helped a woman suffering from severe psychosis make a successful transition from a private home after a parent’s death to an assisted living facility. We've helped remove a client with dementia and other medical problems from her unsafe environment with her family to a skilled nursing facility. And we've provided emotional support and appropriate placement for a client in his 20s with severe mental illness, traumatic brain injury, substance abuse issues and multiple arrests.
Not only does appointing a guardian improve the quality of life for clients but it also helps ensure taxpayer money is used effectively and efficiently. For instance, by moving only nine clients from mental health institutions to assisted living and nursing homes, the state saved more than $3.5 million and opened up beds for those individuals who truly needed them. Guardians have decreased average days in the hospital by 57% for their clients and placed 15 people who were chronically homeless into stabilized housing. Beyond the costs avoided through placement of clients into appropriate housing settings, guardians also relieve some of the burdens borne by emergency rooms, 911 operators and calls to law enforcement.
Our guardians are on call 24/7 throughout the week and alternate on-call weekends. Like first responders and health care workers, guardians are underpaid, overworked and operate in crisis mode at all times, which can take a toll. Though some guardians have left during the last two years, others have joined, and we have long-term staff. We are actively recruiting more as our agency has a mandate to expand statewide by 2030. We face the same hurdles in recruiting and retaining employees as other public agencies since the pandemic. The state of Colorado had a 23% vacancy rate across the board last year and a 13% turnover rate overall. In human services, which also works with some of the state’s most vulnerable populations, that turnover rate was 20%.
We are confident we will be successful in expanding our services to people across the state, because in all honesty, we must be.
To thousands of Coloradans, our guardians are their last hope.
Full Article & Source:
Nascent state Office of Public Guardianship confident in expansion | OPINION
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