Imagine being elderly and alone, without savings, adequate income or known family, and too ill to consent to life saving treatment, or to communicate your financial wishes. Imagine further that a court is ready to appoint a guardian for you, but no one is willing to serve, because you are indigent. Unfortunately, this is a reality facing many incapacitated older adults suffering from degenerative health conditions that affect their cognition some or all of the time. Without a guardian, these “unbefriended” seniors are left without a lifeline.
In Massachusetts, a guardian can be appointed to someone who, for any of a number of reasons, lacks the ability to make critical decisions regarding his/her own physical health, safety, or self-care. In the best-case scenario, guardians are family members or friends, but that is not an option for who are most isolated and impoverished. Public guardianship programs, so-called guardians-of-last-resort, offer an alternative to familial advocates – but these services are often targeted during spending cuts for social services.
The Massachusetts Guardianship Policy Institute (the “Institute”), a collaboration of three non-profit organizations – Guardian Community Trust, Greater Boston Legal Services, and the Northeast Justice Center – is an NGO that hopes to resolve this problem through a public-private partnership. The Institute strives to provide private funding for a non-profit Public Guardian, while creating a new state agency to oversee this guardianship program, in order to ensure quality care for the seniors that it serves.
The Institute draws inspiration from two states who have taken innovative approaches to public guardianship services: the Florida Office of Public and Professional Guardians (OPPG) and Indiana’s Volunteer Advocates for Seniors or Incapacitated Adults (VASIA). In Florida, OPPG is responsible for providing guardians-of-last-resort, but does so through outsourcing to 17 different NGOs across the state who serve as public guardians. The OPPG oversees the public guardians and distributes state funds amongst them.
The model proposed by the Institute differs from OPPG in the matter of state funding. Unlike Florida or any other state, the NGO service-provider would be completely privately funded. In addition to reducing the need for public financing, the Institute’s model is expected to be cost-efficient, as compared to other states, by consolidating the service into one NGO with multiple offices throughout Massachusetts. This approach will avoid redundant administrative costs and it will prevent the problem of similar NGO’s competing for the same charitable grants to cover operating expenses — a problem that some public guardians in Florida are currently facing.
Indiana’s VASIA program also influences the Institute’s model, particularly in their use of volunteers. VASIA pairs each elder client to a specific volunteer to handle the majority of their casework in a one-to-one relationship; though the volunteer receives supervision by trained staff and is not named the formal guardian. This system allows elders to receive personalized attention while ensuring they are protected from being taken advantage of.
Understandably, many people are apprehensive about public guardianship, specifically as it relates to issues of autonomy. The Institute is aware of these concerns and plans to offer Supported Decision Making services, in which a freely-chosen team of friends, family and/or clinicians enters into a written agreement to help the individual in need make his or her own decisions, as an alternative to guardianship in its pilot program.
Providing guardians for 400 people throughout three counties, the initial pilot of the program will require funding of about $900,000 for the NGO service-provider, more than half of which has already been pledged by Guardian Community Trust. Over the next five years, the institute plans to raise five million dollars annually and expand to the entire state.
For its part, the state will need to come up with $500-600,000, in order to create the Office of Adult Guardianship to oversee services provided by the NGO. One of the Institute’s arguments for the state to come up with this money is that the cost of public guardianship is offset by savings that are realized by having guardians for those who need them.
The Institute reports that one private hospital in Massachusetts found costs of more than $900,000 annually that are related to having older adults remain in hospitals past the ready-for-discharge date, in part because the facility is unable to find a guardian for the individual. If this cost to one hospital is extrapolated to all hospitals in Massachusetts, the costs of not having a public guardian easily could exceed $10M per year. Not all of this cost is borne by the state and a preliminary review of cost-savings research in Florida, New York, Virginia, and Washington State concluded that “[a]ll studies showed a net savings for public guardianship programs.”
This legislative session in the Massachusetts House of Representatives, Rep. Paul Brodeur of Melrose filed An Act relative to Adult Guardianship and Decisional Support (Bill H.3027), which was matched in the Senate by a bill of the same title filed by Sen. Cynthia Creem of Newton. These bills call for a public-private partnership very similar to the one proposed by the Massachusetts Guardianship Policy Institute. A joint hearing occurred on May 8, 2017, and Pioneer looks forward to seeing what comes of these legislative efforts to address this critical issue.
 Levine, Eliot, “Fiscal Implications of Establishing a Public Guardianship Agency in Massachusetts: Evidence from Four State Studies,” April, 2017 (UMass Donahue Institute, Dept. of Applied Research & Program Evaluation).