Stories from the Field

Stories from the Field

We are all just a car crash,
a diagnosis,
an unexpected phone call,
a newfound love
or a broken heart away
from becoming a
completely
different
person.
 
How beautifully fragile are
we that so many things can
take but a moment
to alter
who
we are for
forever.
 
Samuel Decker Thompson, poet


Some of the lives of the people served by the OPG, as the poem above describes, were changed forever in a moment, or through an event, or by a diagnosis.  The stories also highlight the people who serve vulnerable adults through the OPG- staff, council members, court visitors, attorneys, and students.   

Warren's Story

Warren's Story
Warren's Story

Warren G. Martin was born June 13, 1943 in Dalton, Georgia.  He graduated from Berry College, located in Rome Georgia with a Bachelor of Science degree in history in 1965. Warren graduated from the Walter F. George School of Law at Mercer University in Macon, Georgia in 1970 and was admitted to the practice of law in Nebraska on February 28, 1972. Warren’s classmates indicated that Warren specifically chose to serve as a lawyer in Nebraska because he observed a shortage in the field at the time.  In 1979, Warren served the Eighth Judicial District of Nebraska as an associate county judge.  Due to his health, Warren retired from law practice in 1985.  In the years following Warren devoted himself to independent study of classic Greek and Roman History.

While living independently for many years Warren managed his physical health but slowly experienced a decline in his memory and cognitive skills.  His age-based dementia led to behavioral disturbances, schizophrenia, Bipolar Disorder, Major Depressive Disorder and Generalized Anxiety Disorder.  Warren became increasingly frequently involved in incidents in his community where he was unable to perform activities of daily living despite his best efforts.  Eventually Warren was assigned a lawyer as Guardian and Warren was transferred to an Assisted Living Facility where his environment could be managed to allow him to still interact safely with others.  Following the formation of the Office of Public Guardian, Warren was appointed as a ward of the OPG in late 2016.

During the OPG’s time with Warren he consistently represented himself as an intelligent and kind individual.  While he was often unable to accurately identify the current time or place, he could discuss his personal care succinctly and consistently identified staff and peers by their relationship to him even when he could not recall their name.

The greatest challenge experienced while working with Warren was early in the summer of 2017 when Warren’s health took a sudden turn for the worse.  He was no longer able to clearly communicate and struggled with basic mobility and balance.  His physician identified a short prognosis.  Warren’s designated Associate Public Guardian (APG), Fred Graves, and explored possible treatment and, after speaking with Warren’s family and doctors, it was decided hospice was the best option.  It’s important to recognize this decision wasn’t based on simply making Warren comfortable as he passed.  The transition to hospice care actually meant Warren’s medication profile could be drastically simplified.  Within a week of switching the standard of care to hospice, Warren showed improvement.  Warren was able to communicate clearly and verbally again he regained much of his mobility although his balance was still unreliable.  Most importantly though, this recovery allowed Fred to discuss the nature of hospice care more fully with Warren directly.  Warren was able to lift a massive burden from the APG’s conscience when he was able to not only indicate he was comfortable with hospice care but that he felt comfortable with the fact his life was coming to an end.  Warren continued to remain active for months as Fred would visit with him and tell Fred about things he’d done and places he’d seen, as well as people he cared about.  When Warren finally passed it wasn’t a painful process.  Following the Thanksgiving holiday he simply declined to eat or drink, his breathing slowed, and he stopped actively responding until he passed away peacefully.

Warren had arranged for his own humble funeral prior to his decline in mental health.  Following Warren’s death the OPG was contacted not only by his sole remaining family, in North Carolina, but also by his classmates who wished to honor and remember him.  They shared stories about how intelligent and kind he was.  They recounted how Warren had always worked to serve a greater good; had fostered a love of the classical world, strived to appreciate art in all its forms, as well as valued the glory of nature. Warren had asked Fred to read at his funeral, which Fred did.  While it would be easy to feel sad that, when Warren was laid to rest, only OPG staff were able to attend his funeral; Fred stated that it was an honor to provide Warren the respect he had earned through a lifetime of service, to be the representative of those who remember him so fondly, despite the distance and passage of time.  

When asked permission to share Warren’s story as part of this annual report Warren’s brother told Fred, “Yes, you may use ‘Warren's Story’ as you desire for the State of Nebraska.  As I see it, they (the State) were there when nobody else could help him.  For this I am grateful.”

Anna's Story

Anna's Story
Anna's Story

“Anna’s” need for the Office of Public Guardian began prior to its inception. Anna’s guardian was suspended and removed by the Court after a State Auditor’s investigation uncovered flagrant financial exploitation. A staff member at her nursing facility was appointed as temporary guardian, the only option due to the lack of available guardians. The temporary guardian went to great lengths to alleviate the obvious conflict of interest, but unless Anna moved, or the guardian left employment, there was no way to completely eradicate the risk. The Office of Public Guardian (OPG) was nominated as part of its pilot program in November 2015, and an Associate Public Guardian (APG) was designated in January 2016.

 

Anna was born and raised in western Nebraska, but spent most of her adult life receiving developmental disability services from various providers across the state. She moved into a nursing home after she was diagnosed with dementia and required a higher level of care. Anna’s dementia was pretty far advanced accordingly, obtaining information directly from her was difficult, if not impossible. Anna was almost completely nonverbal and her mobility was limited to pushing herself around in her wheelchair. The APG spent time with Anna learning about her preferences for Dr. Pepper, chocolate, and stuffed animals. Despite the circumstances, she lived the best life possible due to the supportive and loving staff at her nursing home. She was a figurehead among the residents and staff often remarked, “We’re not supposed to have favorites, but Anna is a favorite.”

 

The APG learned more about Anna with the help of her former providers, case managers, and through genealogy resources online. The APG was able to locate Anna’s family’s cemetery plot near her hometown. Anna’s preneed funeral had not been fully funded, and her assets were extremely minimal. The APG scrimped and saved every extra penny for Anna, with the intention of getting Anna and her brother, Joseph, “home” when the time came (Anna had been given her brother’s urn when he passed away). That time would come sooner than anticipated.

 

In late November 2016, Anna’s medical insurance refused to pay for one of her crucial dementia medications. Additional medical consultations and appeals were done, but Anna went without her dementia medication for nearly a month before the insurance company approved the doctor’s orders. Anna’s “sundowning” symptoms increased dramatically during the time period and her physical decline became more apparent. Her blood sugars were much higher than normal and her body was cold and clammy most of the time. Anna declined rapidly over the next few days and, in the midst of an ice storm in January 2017, Anna passed away.  She died peacefully and without pain, surrounded by staff who loved her. The APG negotiated with the funeral home to make arrangements with Anna’s available funds.  OPG Administration granted the APG permission to transport Anna and Joseph’s urns to western Nebraska. Anna’s funeral was simple, with the APG and a representative from the cemetery in attendance. She was laid to rest, with her brother and parents, on a rolling hillside on the Nebraska prairie, finally returning home, and reunited as a family. 0“Say not in grief that she is no more

But say in thankfulness that she was.

A death is not the extinguishing of a light,

But the putting out of a lamp

Because dawn has come.”

-Rabindranath Tagore

Carol's Story

Carol's Story
Carol's Story

In January 2016 the Office of Public Guardian (OPG) became “Carol’s” temporary guardian.  Carol had been in the hospital for a couple of weeks and was refusing to comply with treatment options. Carol had a history of leaving facilities against medical advice and returning to her apartment where there was no one who could care for her. Carol lacked the ability to care for herself. She previously had a temporary guardian who placed her in a facility to get physical therapy and build her strength, however the temporary guardianship was terminated after placement. Once the temporary guardianship was terminated, Carol again left against medical advice. When the OPG was contacted, Carol did not want a guardian, nor did she believe she needed one (any more than she believed she needed medical care). Accordingly, she was unpleasant to hospital staff, health providers, and staff in facilities who tried to assist her and her Associate Public Guardian (APG). Carol had the reputation of being an extremely mean woman. She did not have any relationships with extended family and did not have any friends.

Initially, after the OPG was appointed, it was determined Carol required a consistently higher level of care and would not be able to safely return to her apartment. This was particularly hard for Carol since never going back to independent living meant disposing of her possessions because she could not afford to store her belongings. Carol spent approximately eight months at the hospital because all facilities in the state refused to accept her due to her unpleasant disposition and her history of refusing medical care. During these eight months she called at least daily to yell at the APG.  Very few interactions with Carol were pleasant.  The APG began the heart wrenching task of deciding what items should be kept and what should be sold from Carol’s apartment.  Carol was very private, angry and refused to divulge personal information and history to the APG.  However, during the process of cleaning out Carol’s apartment, the APG learned many things about her. Carol was a lover of romance novels, evidenced by the thousands of books in Carol’s office.  Carol also loved high-end kitchen utensils and infomercials. It seemed she had nearly every gadget sold on QVC. Additionally, the APG learned how deeply she loved her late husband and how much she missed him. She and her husband had met when they both were in the Navy and stationed in San Diego. They did not have any children.  Thirteen years after his death, Carol still had all his clothes hanging in the closet. This shed some light on Carol’s unpleasant disposition, maybe the root cause of her anger and bad temperament was loneliness and a broken heart. The majority of Carol’s items were sold from the apartment. The only items kept were some of her pictures, clothing, her late husband’s military flag, and a “hope chest” size trunk.  It was locked and the key could not be located. When asked about the trunk, Carol chastised the APG to stay out of her personal items stating she had no right to get into the chest.  Additionally, Carol told the APG she did not want the chest in her assisted living with her, but wanted it stored.  As a result the chest remained locked and secured in the OPG storage unit. 

In August 2016 Carol was accepted to a facility in the southeast corner of the state and the APG traveled once a month to visit her. Carol was initially excited to get out of the hospital but was soon calling the APG with the request to be moved to another facility. The facility tried many things to make her happy and to participate with physical and occupational therapy but still Carol refused. Carol was at the facility for less than a year before she passed away.

Shortly after Carol passed, the APG was determining how to handle her possessions, requiring her to gain access to the locked trunk. In the trunk underneath pillows and blankets was Carol’s will, her wedding ring, and boxes of gold coins and rare coins. Upon further investigation it was discovered the coins were worth a small fortune- approximately $100,000!

Though Carol could be unpleasant, she still was a very interesting person. She was a Veteran of the Navy. She was smart and strong willed; very independent. She previously worked as a book keeper in her younger days. In her will Carol specified many, many family members who were not to get any of her estate; instead she left all of her estate to the San Diego Zoo- evidently a place that represented special times and memories of Carol, and her husband’s, life together. She did not have any family she was close with but she did have the fortune of finding the love of her life and that love never wavered even after he had passed away.

Michael's Story

Michael's Story
Michael's Story

“Michael” was diagnosed with acute encephalopathy after a fall at work at a meat packing plant caused his health to decline.  He was found malnourished and unconscious in his apartment in central Nebraska and taken to the hospital. He was in critical condition, and required transfer to Omaha for surgery.  Doctors explained to Michael the seriousness of his condition and the potential consequences of his brain surgery; he was asked what level of intervention he wanted.  Michael stated that he wanted a full medical response including resuscitation and life support (full code).  Michael did not have any family in Nebraska; accordingly, after surgery the hospital identified the need for a guardian and petitioned for the Office of Public Guardian (OPG) to be appointed Temporary Guardian.  Michael was on a ventilator.  The OPG assisted with Michael’s discharge from the hospital to the ventilator unit in a long term care facility. 

The Court ordered a Court Visitor report for Michael’s case to determine whether Michael had any family or friends, rather than the OPG, to serve as a permanent guardian.  The OPG learned Michael was a lawful permanent resident of the U.S., who originally was from Nicaragua.  The Court Visitor reported Michael’s estranged son lived in Florida.  The OPG contacted Michael’s son for more information regarding Michael and his family.  His son was willing to help, but was only 18 years old at the time.  He was not willing to serve as guardian.  No other family or person known to Michael were identified, so the OPG was appointed as permanent guardian.

Michael did not speak English.  His health began to deteriorate.  He was unable to communicate due to his decreased cognitive functioning and use of a ventilator.  Michael’s care providers had to gauge his pain levels through facial grimacing.  He was unable to track consistently with his eyes.  His medical professionals recommended changing his status to “Do Not Resuscitate” and begin “compassionate weaning” of his ventilator.  The OPG reviewed medical records, seeking documentation of Michael’s wishes at a time that he had capacity to communicate such, and found the documentation of Michael’s indication that he wished to be full code. Additionally, Michael’s wallet had a card with a picture of the Virgin Mary, suggesting Michael’s religious preference was Roman Catholic.  Accordingly, the OPG was able to utilize substituted judgment model of decision-making for Michael’s end of life wishes.  “Substituted judgment” requires the decision maker to substitute the ward’s wishes (communicated when they had capacity) for the usual “best interest” standard of guardians.  The OPG was aware of specific, documented instances of Michaels’s wishes on this matter, and took actions to ensure Michael’s desires, and directives when he was competent, were followed. The “compassionate weaning” of the ventilator was not initiated; his code status remained a full code. 

The months passed, and Michael’s health continued to decline, resulting in a “minimally conscious” state.  The APG continued to update Michael’s son on Michael’s condition.  Michael’s son and Michael’s son’s mother (Michael’s ex-wife) traveled to Nebraska to visit Michael.  They were extremely disheartened at his condition. The APG met with them, and an interpreter, to discuss Michael’s health status and share the medical opinion of the doctors regarding Michel’s prognosis   the doctors indicated there was no hope for Michael’s recovery; Michael’s health and functioning capacity would not improve.  His family indicated that they believed Michael would not want any additional heroic actions taken to keep him alive, should his condition continue to deteriorate-that Michael would not want to live in his present condition for a long period of time.  Accordingly, after months of stagnation of progress regarding his condition; the communication from his family about what they believed Michael would have wanted given his current status and prognosis; and the professional opinion of his medical providers, the OPG changed Michael’s status to “Do Not Resuscitate”.   Michael continued to be on life support, but the decision was made that, should Michael’s condition result in his heart stopping, he was not to have CPR.  Subsequently, Michael lived peacefully for a few months before passing away in his sleep. 

Jeff's Story

Jeff's Story
Jeff's Story

In March 2016 the Office of Public Guardian (OPG) became Temporary Guardian/Conservator for “Jeff.” Jeff was referred for guardianship/conservatorship by a mental health facility for seniors who were in need of psychiatric care. He had been placed at the facility months prior to the creation of the Office of Public Guardian; it was here he was told he could not return to his previous assisted living facility. At the previous assisted living facility Jeff had stabbed another resident with a fork.  As a result, Jeff was evicted and placed in his current facility.

The issue regarding Jeff’s placement was that Jeff had already stabilized with the help of medication and mental health treatment, but he was stuck between two worlds – unable to go back to a lower level of care due to the lasting fear over his prior assaultive behavior, but lacking the need for continued intensive psychiatric care.  Jeff reported to the Associate Public Guardian (APG) that he was bored and frustrated at his own inability to do something more than “sit around all day.” After the OPG was assigned to his case, through the work of APGs, Jeff was discharged to a regular assisted care facility. 

Jeff thrived at the assisted living facility! He made quick friends and often discussed with them his love of Westerns. He was a regular participant in the center’s social activities and became a favorite of the staff.  Jeff was able to regain the sense of dignity and self he had lost while stuck in the mental health facility waiting for discharge to an appropriate level of care.

Unfortunately, within a few months at the new assisted living facility, Jeff suffered a stroke that left him almost completely nonverbal and extremely limited in cognition and movement. Due to lessening fears of any psychiatric outbursts, the APG was able to move Jeff to an equal level of care facility in Omaha – where Jeff was from, and where he previously expressed hope of returning to. At this new facility in Omaha, he was put in hospice care. Jeff saw a brief increase in quality of life once hospice started. His cognition improved, he was more responsive, and he was more physically able to perform tasks like feeding himself.

Disappointingly, a few weeks after these initial improvements, Jeff’s health took another bad turn and he began the end of life process. Hospice began focusing on managing his pain and making him comfortable. Three weeks later, a little over nine months after the OPG received Jeff as a ward, he passed away.

During those nine months, APGs were able to piece together some information about Jeff. He was often seen as a loner – an independent, educated, hard working person who desired to fend for himself and live in peace. APGs were able to track down a fully funded burial trust that Jeff had set up earlier in his life. This allowed the designated APG to aid in planning a funeral that Jeff would have deemed fit- a nice suit, a proper burial in a casket, and prayers to be said over him.

There were four people who attended Jeff’s funeral – the funeral home representative, the pastor, the APG who acted as Jeff’s guardian when he passed, and a second APG who had moved on from the OPG but who had been a designated APG for Jeff during the OPG’s initial appointment and desired to pay respects to a great guy. This former APG would also go on to act as personal representative for Jeff’s estate -further showing the impact an APG can have on a vulnerable adult’s life but, also, showing the impact the vulnerable adult can have on an APG’s life.

Verdel's Story

Verdel's Story
Verdel's Story

In September of 2017, the Nebraska Office of Public Guardian (OPG) was appointed as temporary guardian for “Verdel Ten Bears” (name changed to protect privacy of the ward). Verdel had been admitted to the hospital a few weeks prior due to having swallowing issues, but hospital staff and attending physicians had difficulties communicating with Verdel and questioned his ability to make informed decisions regarding his medical care. The hospital petitioned for an emergency appointment of a temporary guardian to make these medical decisions.

Verdel’s swallowing issues turned out to be Stage 4 laryngeal cancer. Verdel’s physicians inserted a feeding tube to provide Verdel with nourishment, and a tracheostomy tube to help Verdel breathe due to the laryngeal mass that had developed in his neck and muscle tissue.

The Associate Public Guardian (APG) assigned to the case met with Verdel at the hospital. The APG found Verdel to be pleasant, but unable to speak due to the tracheostomy tube. The APG and Verdel communicated by having the APG verbalize questions to Verdel and having Verdel write his answers down on a pad of paper. Verdel indicated no family or friends were to be notified of his condition. His responses were fairly simplistic, in that Verdel primarily indicated his desire to leave the hospital and to eat solid food again. The APG verbalized to Verdel that he understood those desires, but that those choices would not be safe considering his medical condition. Information available through court records and hospital social workers indicated that Verdel was a long time member of Lincoln’s homeless community. No family or friends had been located or contacted by hospital staff at the time of OPG’s appointment. The APG worked to try connect with any family through contacting the Bureau of Indian Affairs and the Sisseton-Wahpeton Sioux Tribe

The APG conferred with members of Verdel’s treatment team, which included his oncologists. The oncology team had determined Verdel’s cancer had advanced to the point that treatment through chemotherapy and radiation was not a compassionate option. The oncology team’s conclusion was that, although tumor mass reduction could be accomplished through chemotherapy and radiation, “the risk of catastrophic complications is high.” The reasoning of Verdel’s treatment team was that, because the cancer had spread into Verdel’s neck muscles, treatment could destroy muscle or bone tissue along with the cancerous mass, leading to the aforementioned complications.

On the advice of Verdel’s treatment team, the APG authorized a treatment goal of moving Verdel to palliative care and worked with the hospital social worker. Because Verdel’s cancer could no longer be treated and because medical interventions had allowed him to breathe and eat more comfortably, his treatment team concluded that he was stable enough to transition to a skilled nursing level of care with hospice services provided at the nursing home. Verdel moved to the nursing home, where he died on October 2, 2017.The APG then worked to obtain county assistance to pay for cremation of Verdel’s remains. A few weeks after his death, a cousin of Verdel’s, having not heard from him for many months, contacted the Lincoln Police Department (LPD) for help in locating Verdel.  An officer from LPD contacted the OPG, who then made contact with Verdel’s cousin and other family members, who lived in South Dakota. Verdel and his family are enrolled members of Sisseton-Wahpeton Sioux Tribe. Family members of Verdel’s traveled to Lincoln and were provided with Verdel’s cremains for burial with his family back home in South Dakota.

Kyle's Story

Kyle's Story
Kyle's Story

In June 2016 the Office of Public Guardian (OPG) became Temporary Guardian/Conservator for “Kyle”.  Four months previously, Kyle had been hospitalized as a result of intervention by his VA primary care provider due to his frequent falls, dizziness, and weakness.   His medical records indicate that Kyle was a “75 year old Caucasian male” who told doctors, “his knees were going out from under him at home” and “he knows he needs help”.   His diagnosis included mental health issues that manifested with hallucinations and delusions; progressive supra-nuclear palsy (similar to Parkinson), weakness, falls, and hypertension.  The doctor also noted that he was very cooperative, pleasant and looked much younger than he was. 

Upon discharge from the hospital Kyle went to a nursing home.  The nursing home’s social worker noted he was in a wheelchair, but had frequent falls.  The falls were a result of Kyle’s delusions that the floors under his wheelchair opened up into large holes. He fell out of his wheelchair when he tried to avoid the holes.  Additionally, Kyle repeatedly experienced delusions of men in military uniforms hunting him down to kill him, “company men” or “CIA”.  Kyle said they were trying to kill him for something he did 35 years ago.  During the guardianship hearing the social worker testified regarding his finances that Kyle had been turned down for Medicaid; his mail forwarded to the nursing home indicated his bills were not getting paid, including his house payment; his Medicare payments for rehab at the nursing home had run out and his nursing home bill was over $8,000.  The social worker also testified Kyle was a Veteran, having spent 20 years in the U.S. Army.  He did not have any family or friends to assist in his care, except a daughter in California.  His daughter had agreed to act as POA for health care during his prior hospitalization, but did not want to be involved to any greater extent.  She told the nursing home she did not have a relationship with her father, “he chose to end the relationship 35 years ago.” The social worker stated that Kyle had spent time in prison, in a different state, from 1984 to 2009 for sexual assault of a minor. After prison he came to Nebraska to get a new start at life.  She concluded that the staff at the nursing home was concerned Kyle was a vulnerable adult without anyone to assist with his finances or medical care and, due to his medical issues, he was unable to appropriately care for himself or fulfill his responsibilities.

After the OPG Temporary appointment the Associate Public Guardian (APG) assigned to the case met with Kyle.  The APG indicated Kyle was open and conversational, cognizant of time and his situation, able to share information regarding his personal life, but to Kyle the delusions were very real.  Despite medication and reassurances no one was after him and the floors did not have holes, Kyle’s hallucinations and paranoia evoked true terror and flight response in him.  In addition to meeting with Kyle, the APG set about discovering Kyle’s assets and debts, and addressing his financial problems.  The APG discovered Kyle had pre-paid funeral arrangements and, through communications with Kyle’s daughter, obtained a hand written will Kyle had drafted in 2009.  

OPG staff worked to secure Kyle’s house and his belongings.  The house was a two bedroom, one and a half story home built in 1905.  Kyle had worked hard on the house, replacing the roof, putting in new windows and siding.  He and his neighbors had developed relationships that resulted in them voluntarily taking on the responsibility to mow his lawn, and keep an eye on his home while he was gone. When the APG went to Kyle’s home the neighbors came over to talk about Kyle, and inquire how Kyle was doing.  Inside the home, despite Kyle’s medical, mental and physical challenges, one could see that he worked to keep the house clean.  His dishes were done, his bed was made, and his laundry was folded. His medications and mail sat where he had left them.  It was clear that Kyle had planned on returning to his home and his life; instead APGs, as strangers (feeling almost as if they were invaders of his privacy) were there trying to decide how best to care for his things. 

Shortly after the OPG took responsibility for Kyle he was again hospitalized.  For a second time his VA health provider intervened for his care, concerned Kyle was losing weight, was dehydrated, and seemed more disoriented than normal.  At the hospital, the diagnosis was grim.  Kyle’s palsy was progressing, he had difficulty eating, and the doctors were concerned he would aspirate his food.  A Palliative Care consult was requested.  The APG and the Palliative Care provider talked with Kyle.  The APG was there when Kyle was told the prognosis was for a rapid decline leading to his imminent death. Kyle had difficulty communicating, so the APG and the medical provider went through the end of life issues with him one step at a time.  Did he want a feeding tube?  No.  Did he want a ventilator?  No. Did he want CPR?  Yes, but he would think about it and consider a different answer.  Did he understand the plan was to discharge him to the nursing home under hospice care?  Yes.  The discussion ended; to be revisited with Kyle twenty minutes later to see if he remembered, understood, and reconfirmed his answers. He did. Kyle was discharged as planned.  The APG communicated with the nursing home to ensure Kyle’s end of life wishes were respected and his medical and personal needs were addressed.  It was determined that, if Kyle became unresponsive, the nursing home would provide CPR and call for emergency response.  As expected Kyle declined rapidly in the days to come.  Kyle’s request for CPR continued and when he became unresponsive CPR was performed.  However, Kyle did not regain consciousness and was pronounced dead at the hospital.  His funeral was performed as he wanted and, as per his will, his daughter was named as personal representative of his estate.  He was a ward/protected person of the Office of Public Guardian for 32 days.  

John's Story

John's Story
John's Story

The OPG received temporary/emergency guardianship over “John” in May of 2017.  John was an 83 year old man who was hospitalized after being found living in his van in the parking lot of a Care and Rehabilitation Center where his significant other, Mary, had been living since January of 2017.  Adult Protective Services and law enforcement became involved at that time. 

John was diagnosed with cognitive decline/dementia with agitation and was considered by physicians as an individual will the functioning capabilities similar to a young teenager.  John was in need of a higher level of care.  After assessment he was approved for a nursing home level of care.  He was accepted at the Care and Rehabilitation Center where the administration had approved for John to move into the same room as his significant other, Mary, even though they were not married. 

John and Mary had been together for over 12 years.  Mary was the only “family” John had.  Mary had been taking care of John in their low income apartment prior to her illness which required a nursing home level of care.  When Mary left, John was alone and unable to care for himself.  He spent many days at the facility with Mary. Instead of going home at the end of the day, he would spend the night in his van. 

The arrangement with John and Mary living in the same room worked very well.  John was improving and seemed to be adapting to life in the nursing home.  In discussions with John the APG learned that he loved a good cup of coffee, and fishing.

Then, suddenly, in early July of 2017, Mary became ill and passed away.  John did not handle this well.  It appeared his heart was broken and he started to decline.  His dementia seemed to accelerate and his physical health deteriorated quite rapidly.  Staff feared that John would abscond from the facility.  There were many days where John became very angry with staff and other residents at the facility.  On many occasions he talked about wanting to hitchhike to other communities in the state.  It was at this point that the Associate Public Guardian (APG) began researching to try to locate possible family members for John.  The APG was able to locate a nephew in Kansas who reported John had cut ties with all of his relatives many, many years ago.  The only family member John had kept in contact with was his father, who passed away in 1985.  Accordingly, John’s family had no idea where he had been all of these years.  John’s nephew stated that John had a son in Blair, Nebraska.  The APG had no luck finding that individual.

The Office of Public Guardian was appointed as permanent full guardian of John in September of 2017. The Guardian ad Litem report recommended the Office of Public Guardian as full guardian because John had no other person available in his life to serve in this capacity. The APG visited John, each time bringing him a cup of coffee.

 Then, in September, John was diagnosed with colon cancer.  Initially John refused all medical care and would not go to any appointments, despite encouragement from the APG.  Finally, the APG was able to persuade John to attend an appointment to discuss his options regarding the cancer.  After the discussion with his physician, John decided he would have surgery for the cancer.  However, on the morning of the surgery, John, again, refused surgery.  His health continued to deteriorate. 

John began to fall, resulting in trips to the emergency room.  Additionally, he was rapidly losing weight.  In early November, staff found John in his room in distress- apparently having a psychotic break.  John was threatening himself and staff with a knife.  He had cut most of his clothing off.  He was transported to the ER, The hospital assessed him, but did not admit him and he was taken back to the facility.  The facility made the decision, for John’s safety and for the safety of others, to move John to the locked Alzheimer’s Unit where he could be watched very closely.  Three days later, John was found in his room experiencing a respiratory emergency.  He was rushed to the hospital where he was placed on full life support. 

Subsequently, the APG and OPG were confronted with decisions regarding John’s medical treatment.  The OPG reviewed John’s prior end of life statements, his past medical history, and the doctor’s medical opinion regarding his treatment options and medical prognosis.  As a result of this information and in accordance with medical advice, it was determined that artificial life supports would be removed. John did not regain consciousness. The APG sat with him in the days to come. John passed away four days later. The APG contacted John’s nephew who agreed, along with his sister (John’s niece), to take John’s cremains and have John laid to rest near John’s father in the Blair Cemetery.