Charles Donelon, 91, had an estate of nearly $300,000 when the public guardian took his case in 2003. In almost two years, Donelon has made less in interest ($2,309.52) than his expenses eat up in a single month ($5,708).
It draws fees from the state Medi-Cal program for visiting impoverished wards living in board-and-care homes. The payments came to more than $462,000 last year.
Though less than 20% of the agency's wards live in board-and-cares, they now get more than 40% of the visits.
Fierro said that the agency checks on those clients more frequently in part because their facilities provide less supervision than hospitals or nursing homes.
But he acknowledged that employees have gone out to see the same wards over and over to pack in the maximum number of visits covered by Medi-Cal. Meanwhile, some wards not eligible for the program went six months or more without visits, records show.
In 1993, at the urging of county Supervisor Mike Antonovich, the public guardian struck a deal with a network of about 25 private hospitals. The hospitals needed a way to transfer patients who were ready for discharge but could not manage on their own. The public guardian agreed to give those cases top priority in return for a fee, currently $977 per case.
Last year, the agency took two of three cases referred by private hospitals that pay fees, looking into them within a few days.
It rejected nine out of 10 cases from community senior-service groups and nursing homes, sometimes after months of delay.
Living in Squalor
The public guardian does not follow up on the elderly people it turns away. They sometimes end up living in squalid conditions, unable to clean their homes, buy food, go to the doctor or pay their bills, social workers with the county and area senior centers said.
"People say, 'Oh, well, they're old, they're going to die anyway,' " said Oleeta Igar, a former county caseworker who chairs an advisory committee of the Area Agency on Aging. "But the things we're talking about are not just part of the aging process. It's not OK for elderly people to live in filth."
In early 2004, social workers told the public guardian that Mid-City resident Easter Moon needed a conservatorship. They said the 68-year-old was unkempt and emaciated, with almost no food in her refrigerator. Her memory was impaired from alcohol abuse.
As it had twice before, the public guardian declined to take her case, records show. Asked why, Fierro said: "We did not believe the criteria for conservatorship were met." He declined to elaborate, citing privacy restrictions.
Months later, social workers found Moon sleeping on a mattress in the living room of her house, too weak to go upstairs. She had no phone service or power, they said. She was placed in a nursing home, the social workers said, speaking on condition of anonymity. Moon died in January.
A nursing home referred 80-year-old Koichi Tagami to the public guardian in April 2000, saying dementia had left him unable to manage his retirement benefits or make healthcare decisions. Months passed. The public guardian never responded, the nursing home said.
In a statement, agency officials said they did not intervene, because "Mr. Tagami's needs were apparently being met."
Tagami's nursing home later transferred him to another home where staff members could help handle his finances. But state and federal inspectors had repeatedly cited that facility for unclean conditions and substandard care.
Three months later, Tagami died of a massive infection after contracting gangrene that required doctors to amputate his right leg.