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Guardian service helps those without support

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Kai Ryssdal: It's a sad fact that someday, most of us won't be able to take care of ourselves. We'll count on relatives or friends to help.

But in some thankfully small number of cases, those people won't. They'll slough off their responsibilities. Or worse, they'll steal from the ones they're supposed to be looking out for. It's unfortunately not an uncommon scenario.

But Marketplace's Alisa Roth tells us about a pilot project in New York that's looking at alternatives.


Alisa Roth: On a late spring afternoon that feels more like summer, case manager Lindsey Hurd is making an unannounced visit to check up on one of her clients.

Her client is an elderly African American woman who can no longer take care of herself, and whose family couldn't agree on who should take responsibility for her.

Hurd does the sorts of things an adult child might do for an aging parent. Or an ailing family member.

Lindsey Hurd: I would check on what the current medications are, make sure that there are medications. Check the refrigerator, make sure there's plenty of food and things are OK. Does the apartment look clean? Does the client look clean? Do they look well taken care of?

She also found this client an apartment and a home health care worker. She makes sure there's a spending allowance and that a doctor visits every couple of weeks.

Hurd works for the Guardianship Project. It's a not-for-profit that's been appointed guardian of this client and about a hundred others. The court appoints a guardian when a person is left unable to care for him or herself because of age, illness or disability.

Mary Joy Quinn directs the probate department of the California Superior Court in San Francisco. She says the job requires a delicate approach.

Mary Joy Quinn: We really don't want to take away rights, but we still need to do protection for those who are frail and those who cannot care for themselves or those who are being taken advantage of by others.

Sometimes, it's the caregivers who take advantage of their positions. Abuse, theft and simple neglect are not uncommon. Depending on the state, there may be little oversight of the process. And in many states, guardians are paid a percentage of their wards' assets, so there's a severe shortage of people to look out for the poor.

The Guardianship Project started three years ago as a pilot. Like any guardian, the group is responsible for all of its wards' needs — from legal matters to finding an exterminator. The idea was to see whether an organization would be more effective than an individual at doing the job.

Jean Callahan directs the project. She says she and her colleagues try to give its clients as much freedom as possible. That often means taking a person out of a hospital or institution.

Jean Callahan: There's an apartment, there's an infrastructure, there are family and friends and we can get that person back home out of the nursing home with home care.

As Callahan and her colleagues started getting people back into the community, they found an unexpected benefit.

Callahan: I mean, not only is it sort of like the right thing to do and, you know, nice to be able to provide that service, but that's where the really huge cost savings are. Especially for Medicaid.

It's like this: the average nursing home costs more than $9,000 a month. Home care, even around-the-clock, only costs about half that.

So home care is not only good for the patient, it benefits the state, too. Institutional care is so expensive that even many patients with savings eventually end up on Medicaid. So the state ends up paying. The longer patients are home, the longer those savings last and the less they cost the government.

And if a patient's already on Medicaid, getting him home starts saving the state an average of $50,000 a year right away.

Those economics changed the project's original business plan. Callahan and her colleagues had thought the project would eventually be funded by guardianship fees.

Callahan: In the meantime, we've discovered that we have an even better business model, which is we're saving millions of dollars for the state. And that's real, hard dollars — it's not future theoretical dollars.

Callahan thinks those savings could fund the whole thing if the project goes beyond the test phase.

Now in the last year of the pilot, the Guardianship Project is still being funded by grants. But Callahan says the group's already talking to both the city and the state to make the program permanent.

In Brooklyn, I'm Alisa Roth for Marketplace.

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