"Quite frankly, the difference between having money and not having it matters a lot," said Elizabeth Wilson, a longtime geriatric care manager in West Los Angeles. "When there isn't any, those are the people who are really up a creek."
A secretary at the Department of Veterans Affairs, Lubin worked for years in Washington, D.C., before transferring to the VA's Westwood office in the 1980s to live closer to her brother and his family.
By the time Lubin's health began to falter, however, most of her California relatives had died. So reclusive and tightfisted that she chose not to have a phone, she fell out of touch with the last of them, Renee Morley, a niece.
In 2000, the county's Adult Protective Services program responded to a report that Lubin, then 89, seemed confused and had lost her medical insurance after falling behind on the premiums. The agency referred her case to the public guardian.
An investigator visited Lubin and concluded that she could still feed and groom herself and was up to date on her bills.
Two years later, the public guardian received new reports that Lubin was deteriorating.
When a caseworker from a senior-care group visited her, Lubin greeted her at the door naked from the waist up. Asked to finish dressing, Lubin wandered into her bedroom, then returned in the same state. Her apartment was filthy and her vision was failing, another social worker told the public guardian.
Again, the agency did not act.
In October 2002, Lubin had hip surgery at County-USC Medical Center. The hospital asked the public guardian to assist her, concerned that she could not manage on her own.
The public guardian rarely offers assistance to people referred by county hospitals, which do not pay fees for each referral. It did not in this instance, closing Lubin's case when she agreed to move into a nursing home.
Three months later, Lubin was referred yet again. This time, she had suffered a near-fatal series of seizures. And this time, paramedics rushed her to Northridge Hospital Medical Center — part of the fee-paying network.
The public guardian took the case. "I'm grateful they stepped in," Morley said. "I just wish she'd had someone to care for her sooner."
Visiting the Wards
When Lubin was entrusted to the public guardian, she become part of a "file" — one of up to 90 wards overseen by a single case administrator.
Los Angeles County's administrators have long juggled the heaviest caseloads in the state.There have been persistent complaints that the crush of cases has led to lapses in both day-to-day care and financial management.
The agency has been consistently late in filing court reports showing how it has handled wards' money, often missing deadlines by a year or more. As of August, reports were overdue in 192 cases.
The agency's goal is to see clients roughly every three months, a crucial element in ensuring their well-being. In a recent performance audit, consultants said many wait far longer. At least one had not been visited in a year.
Deputy Public Guardian Anne Bell tries to make visits one day a week, leaving her house at 7:30 a.m. and packing in seven or eight stops in quick succession.