LINCOLN — The 38-year-old woman suffered from cerebral palsy and epilepsy, as well as developmental disabilities.
She required 24-hour care because she was blind, couldn’t talk and was confined to a wheelchair.
The already tiny woman had dropped to 58 pounds, and was reportedly malnourished and dehydrated, when she was removed from her parents’ home based on complaints from her day care provider. She died a few days later.
The case of “Angel” is a tragic example of statewide problems that remain with helping and intervening in cases of vulnerable adults, according to a recent state report.
“There’s a lot of questions. Unfortunately, I don’t think Angel is an isolated incident,” said Michelle Chaffee, who directs the Nebraska Office of Public Guardian, which was assigned to oversee the woman’s care after she was removed from her home.
The office’s 50-page annual report, released recently, told several stories, like the story of Angel, in which the assignment of a public guardian helped, or was unable to help, a vulnerable adult.
The office was created three years ago to provide a court-appointed guardian, as a last resort, for vulnerable adults with mental or physical illnesses or handicaps who can no longer care for themselves and have no trusted family members or friends to step in.
Several stories in The World-Herald have highlighted cases of abuse by private guardians, including one in Omaha who took more than $350,000 from several wards and another in Gering who embezzled thousands of dollars intended for her elderly, blind and disabled clients.
Chaffee said the case of Angel raised a lot of questions about the capacity of State Adult Protective Services workers to check into reports of a vulnerable adult in trouble. Had a public guardian been assigned sooner, she said, a tragedy might have been averted.
“Multiple reports” of concern had been received by Adult Protective Services officials before that office, and Grand Island police, checked on the woman’s welfare on Jan. 29, 2018, the report says.
The concerns came from workers of a contractor, Mosaic, that was hired by the Nebraska Department of Health and Human Services to provide day care services for developmentally disabled adults. Adult Protective Services, another wing of HHS, is supposed to check into reports of abuse, neglect and exploitation involving adults.
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“Angel” was the name used for the woman in the report, but The World-Herald later identified her, via court records, as Andrea Bartlett of Grand Island. Bartlett died on Feb. 9, 11 days after she was removed from her parents’ home.
HHS officials said their options to intervene were restricted because Bartlett was her own guardian, and, despite her disabilities, was in charge of her own care.
Courtney Miller, director of HHS’s Division of Developmental Disabilities, said that it was clear Bartlett was medically fragile but that it appeared that officials reacted “relatively quickly” once the urgency of the case became clear. Miller said the agency has service coordinators who make sure that contractors, like Mosaic, are offering quality services.
The legal request to remove Bartlett from her parents’ home, filed by the Hall County Attorney’s Office, claimed that she was receiving substandard care and had been abused and neglected.
Bartlett’s mother, Kathy, disputed that in a telephone interview. She blamed Mosaic, the day care provider. Kathy Bartlett said that she packed a substantial breakfast and lunch for her daughter every day but that “someone was stealing her food” and it was not fed to her daughter.
“She was always small, but she ate a lot,” the mother said. “She was not malnutritioned.”
Mosaic officials did not respond to phone messages left Friday seeking comment.
No charges were filed in connection with Bartlett’s death. Deputy Hall County Attorney Sarah Hinrichs said there wasn’t enough evidence to prove that her death was linked to her treatment. An internal investigation by HHS concluded that Bartlett had received “appropriate services” and that nothing further could have been done to “prevent or foresee” her death.
“She had a great number of medical problems, which were going to take a toll on her and were taking a toll on her,” Hinrichs said.
The Office of Public Guardian has 17 associate guardians scattered across the state who are assigned cases after judges determine that people cannot handle their own affairs and have no other choice but to be cared for by a public guardian.
But the 2018 report said the office has exceeded its limit of 20 cases per associate guardian. Because of that, 40 people were placed on a waiting list in 2018, the report said, and six people died while waiting for help. The problem is worst in the eastern and southeastern parts of the state, according to the report.
“It definitely indicates that there’s more need than we have the ability to serve,” said Chaffee.
High staff turnover is partly to blame for the waiting lists, she said. It’s a stressful job, Chaffee said, that has staff on call 24/7 to confront emergencies involving multiple problems like mental illness, developmental disabilities, dementia, substance abuse and exploitation.
The right kind of care facility isn’t always readily available, Chaffee said. Hospitals and other existing care facilities sometimes refuse to take on complicated cases involving mental illness, the report said.
The Nebraska Supreme Court, which oversees the guardian office, is now letting staff earn compensatory time or overtime, which Chaffee said should help the turnover problem.
State Sen. Sara Howard of Omaha, who chairs the Legislature’s Health and Human Services Committee, said the report highlighted a broader problem in the state, the lack of mental health care.