Ginnie is sitting like a statue in the lobby of a Sandy nursing home when Pattijean Sanchez breezes in, all good will and cheer and genuine concern.
"Do you like vanilla?" she asks the woman, who is blind, reaching to take her hand. "Smell this. I brought you some lotion."
Ginnie sniffs, then nods. "It's nice," she says. So Sanchez takes her hand and puts a little lotion on it, rubbing it gently into the fingers as she examines them to be sure the nails are trimmed, the cuticles smooth. Those are indicators of the kind of care Ginnie is getting, and Sanchez is vigilant about that.
"It's yours, a gift," she says with her Texas drawl, curling the woman's hand around the tube. "Have you had any company?"
She knows the answer a perpetual "No" but she still always asks, part hope and part small talk.
Pattijean Sanchez is the only regular visitor from "outside" for Ginnie and for Mr. H and Mrs. C and a dozen or so others for the simple
reason that they have no one else.
Perhaps they had no family left as they aged. Or maybe they were estranged from their children or siblings. They may have outlived friends, or perhaps they simply led private, solitary lives. Their stories are all different except for this one fact: They are now each wards of the state of Utah. Sanchez is one of a half-dozen deputy public guardians in the Office of Public Guardian, so it's her job to look after them, to guide the decisions they aren't competent to make for themselves, to see that they are clean and well-fed and cared for.
The day the Deseret News meets Sanchez to go on her rounds of area nursing homes, she's in her cubicle doing paperwork. A placard in front of her reads, "We are expected to keep an eye always on the deeper meaning and value of life." She borrowed it from her parish newsletter, and it now serves as one of her personal philosophies. Another is also posted: "Don't mess with Texas women."
Sanchez used to be a program compliance auditor who kept track of Medicaid waivers, but she decided she wanted to have a direct impact on someone's life, so when she saw an ad for a public guardian, she applied.
It's a "human relationship without trappings," she says of her connection to the people she is now responsible for, and in that way it's not so different from a lot of relationships built on need rather than on a shared history or shared interests, she says. Indeed, she often doesn't know the back story of the people she visits, and they are no longer capable of telling her about themselves.
But this professional relationship, like others that may start out of a sense of obligation, can evolve to include genuine caring and affection, she says, adding that even families may not put a person's best interests first. She and her co-workers do, though, she says. It's both the job description and her personal credo.
"I put my mother's face on them," she says of her charges.
Donna Russell, executive director of the Office of Public Guardian and Sanchez's boss, says that because the state has limited resources, her office spends a lot of time making sure there's no one else who can step in to become a person's guardian. The state is the "guardian of last resort" and intervenes only in the most egregious cases, when it's clear that a person is incapable of making even basic decisions, she says. Acting on referrals from nursing homes, health-care providers and law enforcement, the Office of Public Guardian petitions the court, which then decides in which areas medical care, for instance the state will have decisionmaking authority.
While people have a right to make bad decisions about their lives and we all do it, Sanchez says for these folks, the situation has moved beyond quirkiness and eccentricity into "trouble."
As she makes her rounds, she finds Mr. H curled up in his bed at a Bountiful nursing home, his feet in fuzzy slippers to protect his heels, which he tends to pound idly on the foot of his bed. When he talks, it's usually about the award that's hanging where he can always see it. It's a citation given by the Disabled American Veterans, honoring his efforts as a volunteer working with former soldiers. Sometimes, when he tells his story, he's one of those soldiers.
Sanchez isn't sure Mr. H was ever in the military she didn't know him before, of course, and when she and a social worker contacted the Veterans Administration to see if he was entitled to any burial benefits, they were told he never saw active duty. She thinks maybe he's absorbed the stories of some of the soldiers he worked with and now, in his confusion, thinks they were his experiences. Regardless, he loves that plaque. "When I got that, I felt big," he says, then launches into a story about his day with the military police, running convoys.
When she visits him, she always asks him about the award and tells him how much she admires it. "I like them all," she says of her wards but adds that he is a particular favorite. "I would like him even if I were not paid to see him."
As she will do at every stop that day, she asks him questions designed to elicit information about his care and see how confused he is today. He has some dementia. "What'd you have for lunch?" she asks him. "Was it soft? Hard? Warm? Cold?"
"I ate ice water," he tells her.
Later, as she pulls into the parking lot of a Salt Lake nursing home, she talks about Mr. and Mrs. C. Mrs. C is a ward of the state, but Mr. C isn't. Normally, a husband would have responsibility for his wife if she were declared incompetent, but Mrs. C became a ward of Utah when some of the decisions he made on her behalf did not serve her best interests. So now, even though the couple shares a room, the nursing home staff defers to Sanchez when it comes to decisions about Mrs. C's care.
At each stop, Sanchez spends a few minutes with the social workers, seeing if there are issues or concerns, talking about changes. She knows that between paperwork and caseload, she will see the state's wards only for a few minutes this month; these front-line workers see them all the time.
During her brief visit with Mrs. C, Sanchez notices that she has a bruise on her finger and asks her what happened. Mrs. C says she slammed it in a dresser drawer. She points, and Sanchez opens the drawer, which is stuffed with a dozen apples that Mrs. C. has apparently hoarded. On the way out, Sanchez stops by the nurses station.
On the drive back, Sanchez tells stories. Her mother once carved up two chickens, a black one and a white one, then laid their hearts on the table. Tell me which is which, she demanded, knowing that you can never tell a heart by the way a creature looks on the outside. Her mom taught her that.
Her job has taught her this: At the end of their lives, people are sometimes all alone. They've outlived their families and friends, or maybe, through anger or neglect, important relationships have been severed. If there's a chance strangers will be in charge of your life at the end, she says, you have to put your house in order now.
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"You will age," she warns. "You need to know who and what, from property to resources to decisions. If you're 26, do it now. If you're getting old, do it now. Put your wishes in writing and give them to someone."
People who are hesitant to get a lawyer for estate planning should at least write things down, she says. You can't expect your wishes to be honored whether you want to be on life support, who gets your stamp collection if you've kept them secret.