The Office of the Public Guardian warns if lawmakers don't increase funding in the next few weeks it will have to drop its services for hundreds of Granite Staters in its care.The office provides public guardians to people who courts have deemed legally incapacitated and need help managing their health or finances.
NHPR Morning Edition host Rick Ganley spoke with the CEO of the Office of the Public Guardian, Lisabritt Solsky Stevens. She says the agency has reached a critical point due to chronic underfunding from the state.
Transcript
Tell us a bit more about what a public guardian does and why someone would need one?
Most of our clients have significant cognitive impairment from severe and persistent mental illness, a traumatic brain injury, developmental disabilities, and/or dementia and they struggle to make everyday decisions about their physical and financial well-being.
So it's not uncommon for our clients to be referred to us [to be] living in very unhealthy conditions, maybe without electricity, without running water. Oftentimes people [who] struggle to keep up with their housework and their homes become hoarded out and unhealthy. We have clients who are refusing to take life saving or life preserving medications or medications that help them to sort of engage in day to day life. So guardians provide consent for medical treatment because sometimes our clients aren't going to consent, even though it's in their best interest to do so.
And they don't have friends and folks who are around them that can do that for them?
Correct. There are instances where people either have no family or friends who can serve in that capacity, or those people aren't suitable options. Sometimes people come to us after a period of financial exploitation at the hands of a family member. So obviously that family member should not be put in charge of that protected person's finances. That's where we can step in. It's all the health and financial well-being.
Lawmakers are in a tough budget season. As we know, lots of departments [are] facing budget cuts. Can you make the case of why your office should get more funding? Your funding comes from the DHHS.
Yes, about 70% of our referrals come from the Department of Health and Human Services, but it only accounts for about 50% of our revenue. So it's a really big delta there that we've tried to close over the years by doing more fee-for-service work and private pay work. But right now, for every DHHS case we take, we lose $1,000. But our private pay cases only net $600. So there's just no way to close that gap.
You're operating at a net loss?
Absolutely. Year over year. And we've had to postpone all kinds of routine corporate maintenance. So our salary scale is woefully depressed. I have a $1 million gap between what my staff earn at the Office of Public Guardian and what they could make if they were part of the state of New Hampshire employee system.
What's the benefit for the state if your office gets the funding you're requesting?
People who are stuck in hospitals and incapacitated and can't participate in discharge planning now have somebody who can do their discharge planning with them. Hopefully it means that people avoid stays at New Hampshire Hospital. Hopefully it means that more people are maintained safely in community.
Hopefully it means that people have the appropriate setting of care, that all of their benefits are intact, that there are no gaps in eligibility, that they're getting the maximum benefits that they need, that all of their bills are being paid on time and in full. That they also are provided an appropriate amount of spending in light of all of their other financial obligations. So that, again, we're making sure that their basic living necessities are met, but not putting them in financial peril that comes with not paying your bills, or the peril that comes from not taking your medication or engaging in health care.
For some of our clients with severe and persistent mental illness, it is critical that they maintain connected to the community mental health center and that they take their medications. And when they don't, they can engage in antisocial behaviors that are a danger to themselves or potentially to others, unfortunately.
Certainly there's benefits there for the clients and for these folks. But what is the benefit financially for the state should you get the funding you're asking for?
So I think tip of the spear is the avoidance of uncompensated care in hospitals for those folks who are quote, unquote “stuck” because they're not able to participate in discharge planning. We estimate that there's about a $5 million offset in the avoidance of uncompensated care by having a guardian appointed at the right time to move that person to the appropriate setting of care.
And that also frees up that bed for the people who are waiting in the emergency department, who can now get the care that they need. I think that's a benefit to the state and the health care system writ large.
Say lawmakers don't give your office the roughly $2 million that you're asking for in this next budget. What would your next steps be?
So the Department of Health and Human Services – again, mad respect. I worked there for a long time. I know a lot of the people that we're having these difficult conversations with. They've proposed level funding for the next two years. And what I've signaled to them is that, regrettably, if no new money can be identified, we're not going to be able to serve as many DHHS referrals as we do today. I think we would be looking at somewhere between 150 to 200 fewer people who are currently being served not getting services from OPG and needing to find those services elsewhere.
We know the department has a waitlist for people in need of a guardian. We know the courts have a waitlist of people in need of a guardian, and there are far too few private guardians doing this work, so that's a huge exacerbation of an ongoing unmet need.
