Stand By Me: Volunteer Public Guardian Program Helps Frail, Low-Income Seniors
From 1997 to 1999, Sage Services of Connecticut, located in New Haven, recruited and trained volunteers to serve as "conservators of the person" and as court visitors, who assist conservators, for elderly people living in four metropolitan areas in Connecticut.
For senior citizens incapable of caring for themselves and/or their property and who have no family or friends to rely on, the probate courts appoint public guardians called conservators of the person. In Connecticut the courts had experienced difficulties identifying qualified conservators, thereby placing vulnerable elderly people at risk for social isolation and health problems.
- Sage Services prepared volunteer training manuals, set performance standards, and provided technical assistance for certain subcontracting Area Agencies on Aging, which recruited and trained volunteers as court visitors and conservators.
- By the end of the project, 223 volunteers had been recruited and 85 volunteer court visitors and 12 volunteer conservators had been matched with clients in the New Haven, Waterbury, Bridgeport and Hartford areas.
- Also under the grant, the New Haven Legal Assistance Association conducted seminars and offered legal services in creating advance medical directives.
The Robert Wood Johnson Foundation (RWJF) supported this project through a grant of $297,843.
For frail senior citizens incapable of caring for themselves and/or their property and who do not have family and friends to rely on, the probate courts appoint public guardians called conservators of the person. Conservators are generally attorneys who see to the food, clothing, housing, and safety needs of clients and who make decisions regarding clients' medical care.
Without enough conservators, vulnerable elderly people are likely to become physically and socially isolated and their medical problems are apt to be overlooked. This is the case in Connecticut, which has a large aging population and a shortage of qualified conservators.
In 1988 the Connecticut Office of Court Administration created a Task Force on the Appointment of Conservators to study the need for conservators in the state. The report from the task force found that more than one-third of the courts experienced difficulty in identifying qualified people to act as conservators. In some cases, court-appointed conservators were responsible for up to 500 clients each.
In response to the task force report, Sage Services of Connecticut, Inc., in collaboration with the Yale University School of Medicine Program on Aging and the Saint Regis Health Center, established an eight-month pilot project to train volunteers to act as court visitors and serve as an aid to existing conservators in handling the latter's large number of cases.
Court visitors visit their clients twice a month, establish rapport, and act as liaisons between clients and their conservators. Information thus gained enabled conservators to address clients' potential personal and medical problems before they escalated.
Sage Services was already providing a variety of home care, financial management, and employment and training services for people older than age 55. Under the pilot project, Sage Services recruited and trained 23 volunteers as court visitors to clients living in nursing homes in greater New Haven. The pilot project improved the effectiveness of the conservators, but it did nothing to reduce the underlying problem of long court backlogs in naming conservators and high caseloads for conservators.
In 1994 Sage Services set up a larger, demonstration program called the Court Visitor/Conservator of the Person (CV/CP) program. With funding from the State Department of Social Services, it expanded the number of courts and nursing homes served in greater New Haven. It also trained the most effective court visitors to become conservators of the person, thereby reducing the backlog of requests for conservators.
Under the demonstration model, court visitors were matched with one client each and conservators were matched with three to six clients each. By December 1995, Sage Services had trained approximately 50 volunteers to become court visitors, and of them, 12 had been trained to become conservators.
This grant from RWJF funded Sage Services:
- To expand its CV/CP program beyond residents of nursing homes in New Haven County, Conn., to residents of nursing homes and the homebound elderly in the greater New Haven, Bridgeport, Waterbury, and Hartford, Conn., areas.
- To encourage low-income senior citizens in Connecticut to develop advance directives regarding preferences for medical care (advance directives are statements in which people declare their preferences for medical care should they become unable to make those decisions on their own).
- To develop a model of the CV/CP project for replication.
In its expansion of the CV/CP program, Sage Services collaborated with four of five Connecticut Area Agencies on Aging (AAAs), which are entities funded by federal and state government to oversee and coordinate care for the elderly. In this model, AAAs both determined areas of project operation and acted as operators. Sage Services also worked with the Connecticut Office of Probate Court Administration and courts in the New Haven, Waterbury, Bridgeport, and Hartford areas of the state.
With the RWJF grant, Sage Services collaborated with the South Central AAA to expand the latter's CV/CP program in New Haven. It contracted with the Western Connecticut AAA (Waterbury area) and Southwestern Connecticut AAA (Bridgeport) to both administer and operate the program in those areas. A Hartford location was added later, separately supported by funds from the Hartford Foundation for Public Giving and administered by the North Central Connecticut AAA.
The AAAs recruited and trained, secured probate court referrals of clients, and served as liaisons between nursing homes, courts, and conservators. Sage Services provided technical assistance for AAA staff, developed training curricula, and helped design training activities. Sage Services staff also prepared training manuals and set performance standards for volunteers.
A statewide Ad Hoc Planning Committee guided the operations of the overall CV/CP program, and local Ad Hoc Planning Committees were convened in each program site. (See Appendix 1 for details.) Eight funders in addition to RWJF supported this project. (See Appendix 2 for details.)
With RWJF grant funds, Sage Services also contracted with the New Haven Legal Assistance Association (LAA) which provides pro bono legal services for clients in need, so that LAA could operate an advance directive initiative in the New Haven area.
- Sage Services expanded the court visitor (CV) program within New Haven and into Waterbury and Bridgeport, including people living in their homes as well as those living in nursing homes. By the end of the project, court visitor services were available to all probate court districts in the three areas covered by the grant. Program operators had recruited 223 volunteers to serve as court visitors and had trained and matched 85 with clients: 25 in greater New Haven, 20 in greater Waterbury, and 40 in greater Bridgeport. The figures do not include those who had been trained prior to the beginning of the RWJF grant and who continued to serve under the grant. Only 16 percent of clients lived in private homes. It was found that most people who lived at home had friends or family members to serve as conservators and generally did not need volunteers to help them.
- Sage Services expanded the conservator of the person (CP) program within New Haven and into Waterbury and Bridgeport. Some 12 additional court visitor volunteers were trained as conservators and matched with clients, for a total of 24 conservators: 20 in greater New Haven and 4 in greater Waterbury. By the end of the project, the CP program was available in all probate court districts in the three areas covered by the grant. The program was slow in developing in Waterbury and Bridgeport because local probate judges were not familiar with it and initially had concerns that the project represented additional oversight of their work, according to the project director.
- Court visitors and volunteer conservators provided services that enhanced the capacity of court conservators to serve their wards, according to the project director. During their visits, court visitors identified client needs in such areas as cleanliness, medication, or religious interests and advocated on behalf of clients to have those needs addressed. In addition, reports filed by visitors were sent to court conservators, facilitating their decisions on behalf of their wards.
- The New Haven Legal Assistance Association informed senior citizens about advance directives and encouraged them to develop directives. LAA conducted a survey to determine whether senior citizens were aware of advance directives and whether they were interested in preparing directives for themselves. LAA used the results of the survey to design seminars for senior citizens. LAA made nine presentations to groups of senior citizens, attended by a total of 189 people. LAA also offered the services of nine attorneys to explain advance directives and to prepare advance directives for seniors on a sliding-fee scale. Sage Services was unable to determine how many advance directives had been prepared, because the seniors vigilantly guarded their privacy, because the lawyers could not accurately determine whether the presentations resulted in clients' coming to them, and because some advance directives may have been developed later using lawyers not involved in the project.
- Sage Services prepared training manuals, the "Court Visitor Training Manual" and the "Conservator of the Person Training Manual" that can be used by states that wish to replicate this model. Approximately 500 copies of each were printed.
The project director and project staff from the AAAs presented the CV/CP project at four national conferences, including the 1999 National Conference on Aging. In 1997 the New Haven Register reported on the project, and the project was covered in a segment of "Evening News" on WTNH-TV, a New Haven television station. Sage Services held a miniconference in the New Haven area at the start of the project in 1997 to acquaint residents with the CV/CP project and to recruit volunteers. The miniconference was subsequently staged again in the Bridgeport and Waterbury areas. A total of 155 people attended the conference and its two follow-ups. Two training manuals were produced. (See the Bibliography for details.)
- More time spent making sure probate court judges were familiar with and committed to the program might have increased the numbers of clients assigned to volunteer conservators. Although local probate court judges had long waiting lists of people requiring conservators and the court administrator was supportive of the project, judges were not forthcoming in making referrals to the Court Visitor/Conservator of the Person program.
- Marketing the Court Visitor/Conservator of the Person program in the communities might have enhanced the numbers of clients assigned to volunteer conservators. The established New Haven program was well-known by social service agencies, nursing homes, and local probate judges. However, this was not true of other project communities whose numbers did not match levels achieved in New Haven.
- The frustration felt by some volunteers and some Court Visitor/Conservator of the Person program operators could have been reduced by training only the number of volunteers that could be matched with clients within a reasonable period of time. Because of delays in referrals, there were a large number of volunteers who had been trained but who could not be matched with clients.
- Early discussions about project goals, expectations, and the extent to which local operating programs could adjust the model to local needs could have reduced some early confusion in the project. The Court Visitor/Conservator of the Person project was expected to phase in concurrently in all locations, using New Haven as a model. In fact, local projects scaled up at different paces and modified the model in different ways to meet their own needs. As sites came on-line, this caused some confusion about project goals and expectations.
- Seniors may know more about advance directives than is generally assumed. Sage learned that the presentations on advance directives were often the third or fourth that seniors had heard. A quick community scan on this subject before beginning a project to disseminate information on advance directives seems warranted.
AFTER THE GRANT
The CV/CP project is currently operating with contributions from each probate court and private donations. Sage Services is attempting to secure permanent funding from the state general assembly starting with the July 1, 2001, fiscal year.
In addition, the Fielding Institute, a graduate school based in Santa Barbara, Calif., is working in Nevada, California, and Arizona to develop the program model in those states. In February 2000 Nevada started a program of court visitors.
GRANT DETAILS & CONTACT INFORMATION
Expansion and Replication of a Volunteer Public Guardian Program for Frail, Low-Income Seniors
Sage Services of Connecticut, Inc. (New Haven, CT)
Dates: March 1997 to May 1999
State Ad Hoc Planning Committee
Executive Director, Western Connecticut Agency on Aging
Patricia R. Kaplan
Attorney, New Haven Legal Assistance Association, Inc
New Haven, Conn.
Hon. F. Paul Kurma
Probate Court Administrator, Office of the Probate Court Administrator
West Hartford, Conn.
Executive Director, Elderly Service
Connecticut State Department of Social Service
Program on Aging
Yale University School of Medicine
New Haven, Conn.
Attorney and Legal Services Developer
Connecticut State Department of Social Services
Edith M. Serke
Executive Director, Southwestern Connecticut Agency on Aging
Neysa Stallmann Guerino
Executive Director, South Central Connecticut Area Agency on Aging
West Haven, Conn.
North Central Connecticut Agency on Aging
Additional Funders of the CV/CP program
- Area Agencies on Aging, $100,000
- State of Connecticut Department of Social Services, $2,500
- Jones and Phelps Foundation, $7,500
- Greater Bridgeport Area Foundation, $12,000
- Community Foundation of Fairfield County, $30,000
- Sage Services, $26,000
- Hartford Foundation for Public Giving, $131,900
- Community Foundation of Greater New Haven, $50,000
- Total funds other than RWJF, $359,900
(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)
Books and Reports
"Conservator of the Person Training Manual." Sage Services of Connecticut, Inc., 1998.
"Court Visitor Training Manual." Sage Services of Connecticut, Inc., 1997.
(The combined production of these manuals is approximately 500.)
Brochures and Fact Sheets
"Court Visitor Conservator of the Person Program." Sage Services of Connecticut, Inc., 1997.
"Western Connecticut Court Visitor/Conservator of the Person Program." Western Connecticut Area Agency on Aging, 1997.
"Court Visitor and Conservator of the Person Mini Conference," September 15, 1997, Hamden, Conn. Attended by 70 people. Organizations represented included the State of Connecticut Probate Court and New Haven Legal Assistance Association. One keynote and six speakers.
- Hon. Rosa DeLauro, Congresswoman, Third District of Connecticut.
"Court Visitor and Conservator of the Person Mini Conference," Shepardson community Center, October 15, 1997, Bridgeport, Conn. Attended by 44 people from Home Care Solutions of Danbury and Middlebury, Woodbury Probate Court, Waterbury Hospital (Gero/Psych unit), WCAAA/NCAAA, and Protective Services of Torrington. One keynote and four speakers.
- Hon. James Maloney, Congressman, Fifth District of Connecticut
"Court Visitor and Conservator of the Person Mini Conference," Housatonic Community College, October 21, 1997, Bridgeport, Conn. Attended by 40 representatives of home care agencies, DSS Nursing Home Ombudsmen, Bridgeport Housing Authority, Stratford Clergy Association, and Elder Law of GB Bar Association. One keynote and four speakers.
- Hon. Edith Praque, State Senator, Connecticut.
Presentations and Testimony
Louis Zaccaro, "The Court Visitor/Conservator of the Person Program," at the National Association of Area Agencies on Aging Conference and Tradeshow, July 19, 1997, Norfolk, Va.
Louis Zaccaro, "The Court Visitor/Conservator of the Person Program," at the Governor's Elderly Services conference, December 3, 1997, Austin, Texas.
Christina Fishbein, Carol Starr, and Louis Zaccaro, "The Court Visitor/Conservator of the Person Program," at the National Association of Area Agencies on Aging Conference and Tradeshow, July 21, 1998, Tulsa, Okla.
Louis Zaccaro, "The Court Visitor/Conservator of the Person Program," at the National Conference on Aging, April 19, 1999, San Diego, Calif.
"Some Sage Advisors," in the New Haven Register, October 19, 1997.
"Volunteers Help Elderly When No One Else Can," in the Bridgeport News, October 19, 1997.
"Coordinator Named to Lead Conservator/Visitor Program," in the Herald, November 7, 1997.
"Evening News," WTNH-TV, New Haven, Conn., November 7, 1997.
Report prepared by: Mary Nakashian
Reviewed by: James Wood
Reviewed by: Richard Camer
Program Officer: Judith Whang