Warren was born in 1943 in rural, northwest Georgia. He graduated from college with a Bachelor of Science degree in history in 1965. Warren graduated from law school in 1970 and was admitted to the practice of law in Nebraska in 1972. Warren specifically chose to serve as a lawyer in Nebraska because he observed a shortage in the field at the time. In 1979, Warren began serving as an associate county judge in Nebraska, but due to health issues he retired from the practice of law in 1985.

Warren devoted himself to independent study of classic Greek and Roman History during his retirement years. Warren was able to manage his physical and mental health treatment for many years, but slowly experienced a decline in his memory and cognitive skills as time went on. Warren became increasingly involved in incidents in his community where he was unable to perform activities of daily living despite his best efforts. Eventually, Warren's ability to self-managed deteriorated to the point where he could no longer make decisions for himself, and he had a guardian appointed. Warren moved into 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 to its care 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. Warren’s health took a sudden turn for the worse during the summer of 2017. He was no longer able to clearly communicate and struggled with basic mobility and balance. His physician identified a short prognosis and ultimately Warren went onto hospice care. The transition to hospice meant that Warren’s medication profile could be drastically simplified. Within a week of switching the standard of care to hospice, Warren showed improvement. He was able to communicate clearly again, and he regained much of his mobility. Most importantly though, this recovery allowed his Associate Public Guardian to discuss the nature of hospice care more fully with Warren. Warren was able to participate in his care once again, and to make peace with the fact that his earthly life was coming to an end. A few days after Thanksgiving in 2017, Warren declined rapidly and passed away peacefully.

Prior to Warren's illness and the appointment of a guardian, he had made his own funeral arrangements. Following Warren’s death, the OPG assisted with the final arrangements and previously estranged family and friends came forward. Family and friends shared stories about how intelligent and kind Warren was to them, as well as how Warren had always worked to serve a greater good. Warren’s brother, when asked for permission to share Warren's story, stated, “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” 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 conflict. 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, and obtaining information directly from her was difficult. 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 after 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 a few days and, in the midst of an ice storm in January 2017, she 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. Anna's APG transported 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.

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

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. 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, staff, and Associate Public Guardian who tried to assist her. Carol 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 her 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.

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, many items unopened. Additionally, the APG learned how deeply she loved her late husband and how much she missed him. Carol had met her husband while they both were in the Navy and stationed in San Diego. They never had 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 her loneliness and a broken heart. The majority of Carol’s items were sold from the apartment and helped pay for her care. The only items kept were some of her pictures, clothing, her late husband’s military flag, and a “hope chest” sized trunk. The trunk 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 remaining 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, smart and strong-willed, and very independent. She worked as a bookkeeper 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, a place that represented special times and memories of life with her husband. Carol 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 was diagnosed with acute encephalopathy after a fall at work at a meatpacking 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 Michael was deemed unable to make medical decisions and the hospital identified the need for a guardian. Michael was on a ventilator and sedated. The OPG, after becoming temporary guardian, 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 or able to serve as his father's guardian. No other family or persons known to Michael were identified, so the OPG was appointed as permanent guardian.

Michael did not speak English. His health began to deteriorate with the prolonged dependence on the ventilator. He was unable to communicate due to his decreased cognitive functioning as a result of the brain surgery. Michael’s care providers had to gauge his pain levels through facial grimacing and other physical cues. He was unable to track consistently with his eyes. Michael's medical team recommended changing his code status to “Do Not Resuscitate” and to begin “compassionate weaning” off of the ventilator. The OPG reviewed Michael's medical records, seeking documentation of Michael’s wishes at the time that he had capacity to communicate such, and found the documentation of Michael’s indication that he wished to be full code and that he understood the potential outcome of the brain surgery. Additionally, Michael’s wallet had information indicating that Michael 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.

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 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; his health and functioning capacity would never 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.

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 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 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 western movies. 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. At the 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. A few weeks after these initial improvements, Jeff’s health took another bad turn and hospice began focusing on pain management. 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 wanted: 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.

In September of 2017, the Nebraska Office of Public Guardian (OPG) was appointed as temporary guardian for Verdel. 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 him, 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 ongoing 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.

Verdel's Associate Public Guardian 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" was too high. 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 additional 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 to facilitate the transition. 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 in October 2017. Verdel did not have any assets to pay for final arrangements, so the APG worked to obtain county assistance to pay for Verdel’s final arrangements. 

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.

In June 2016, the Office of Public Guardian became temporary guardian/conservator for Kyle. Four months prior, Kyle had been hospitalized as a result of intervention by his VA primary care provider due to his frequent falls, dizziness, and weakness. Records indicated that Kyle told doctors that his "knees were going out from under [me] at home” and “[I] knows [I] need help.” Kyle's diagnoses included mental health issues that manifested with hallucinations and delusions; progressive supra-nuclear palsy (similar to Parkinson's), 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. After the OPG was temporarily appointed as guardian/conservator, the Associate Public Guardian 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 that no one was going after him and the floors did not have holes, Kyle’s hallucinations and paranoia evoked true terror and a "flight" response. The APG also began working to discover Kyle’s assets and debts in order to address his ongoing financial issues. The APG discovered Kyle had prepaid funeral arrangements and, through communications with Kyle’s daughter, obtained a hand written Will that Kyle had drafted in 2009.  

OPG staff worked to secure Kyle’s house and his belongings. Kyle's house was a two bedroom, one-and-one-half story home built in 1905. Kyle had worked hard on the house, replacing the roof, putting in new windows, and updating the siding. Kyle had developed good relationships with his neighbors, who had been helping with lawncare while Kyle was hospitalized. The APG was able to meet with the neighbors and update them on Kyle's progress. The home inside also showed that despite Kyle’s medical, mental, and physical challenges, he worked hard to keep the house clean and orderly. Kyle's dishes were done, bed made, and laundry 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. The APG set out to continue doing right by Kyle, and to keep him involved in decision-making for as long as possible.

Shortly after the OPG took responsibility for Kyle, he was hospitalized again. For a second time, the VA health provider intervened with his care, being concerned that Kyle was losing weight, dehydrated, and seemed more disoriented than normal. The eventual 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 ordered. Kyle learned of his prognosis and at that stage 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, and 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/personal needs 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.

The OPG was appointed as temporary/emergency guardian for 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 nursing home 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. John was in need of a higher level of care and could not sustain living out of his vehicle. After assessment, he was approved for a nursing home level of care. He was accepted at same nursing home as Mary, his significant other of 12+ years.

Mary was the only “family” John had. She had been taking care of John in their low-income apartment prior to her illness, which required a nursing home level of care for her. 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.

In early July of 2017, Mary suddenly became ill and passed away. John began declining rapidly himself, his dementia accelerated and his physical health deteriorated rapidly. Staff feared that John would abscond from the facility. John became very angry with staff and other residents at the facility at times. On many occasions, he talked about wanting to hitchhike to other communities in the state. John's Associate Public Guardian began looking for possible family members. 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. John’s family had no idea where he had been all of these years, and his nephew stated that John had a son in Blair. 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. John's APG brought him a cup of coffee at every visit. Later in September 2017, John was diagnosed with colon cancer. Initially, John refused all medical care and would not go to any appointments, despite encouragement from his 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 refused to go and his health continued to deteriorate.

John began to fall, resulting in several trips to the emergency room. Additionally, he was rapidly losing weight. In early November, staff found John in his room in mental distress: he was threatening himself and staff with a knife. John was taken to the emergency room where 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 memory care 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 and placed on life support.

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 John’s niece, to take John’s cremains and have John laid to rest near John’s father in the Blair Cemetery.