While he took office under unusual circumstances, Cole County Public Administrator Ralph Jobe said he knew what he was getting into when he took on the role.
Jobe has been public administrator since July 1, 2020, when the Cole County Commission appointed him to complete the remainder of previous administrator Joe Kuensting's term following Kuensting's resignation in June. Jobe was the only candidate to run for the office last fall and was formally elected in November.
The public administrator is the guardian of last resort for county residents who cannot take care of themselves and have no one else to watch out for their needs and interests.
"Whoever runs for this office should be willing to accept the fact that it's not a job, it's a way of life," Jobe said. "You have 210 individuals for which you are guardian. You have to make their critical decisions, and you're their lifeline. You have to be accessible to them 24/7."
The average caseload for public administrators in the state is 91, according to the Missouri Association of Public Administrators.
Jobe works in his office in the basement of the Cole County Courthouse and from home.
"Hospitals call anytime, 24/7, wanting consent to treat clients because they won't treat them until I give them the OK," Jobe said. "There's not a weekend that goes by that I don't get 20-25 calls. That's just the nature of the job."
The majority of his clients are in settings where they can't get out, and the COVID-19 pandemic has been hard on many of them, he said.
"We get many calls from these folks asking if they can relocate to a place where they have more independence or they'd like for me to visit, but many of the facilities are still in lockdown and I can't get in," he said. "Many times, they just want to talk to somebody, and we try to lend a supporting ear to them."
Jobe said there have been several days he has received calls night and day that clients had tested positive for COVID-19 or that a client was in bad shape and the facility needed to inquire about a do-not-resuscitate order.
"All of my clients have a full-code order, which means the facility will resuscitate unless the doctor on duty invokes the principle of medical futility, which means they can be kept breathing, but they're never going to come out of it and they are still in pain and we can't relieve it.
"That's when I have to make a decision, and that is tough," Jobe added. "I have had to do that twice, and both times, it came early in the morning. This just goes to show there is no time clock in this job."
Of 210 clients he is in charge of, only 93 are actually in Cole County, Jobe said. The rest are in 26 other counties.
"There's not enough capacity of facilities in Cole County to house a lot of these clients," Jobe said. "Some of my clients require acute care, and we don't have many of those facilities in our county."
Another reason some of Jobe's clients aren't living in Cole County is that their relatives or friends are, as Jobe said, "bad news for them."
"We have to separate them so they don't try to harm our client," he said. "One of my goals this year is to identify clients I can get back to Cole County, who want to get closer to their families who are supporting them."
Jobe said he benefited from conversations with former public administrators Carolyn McDowell and Marilyn Schmutzler about what was involved in the position. He also has gotten support from the circuit judges, law enforcement and the health care community.
"So many people told me when I announced I was running that this was a thankless job, but it's not," Jobe said. "It is hectic, and it can be frustrating at times, but it can be very rewarding. You have the opportunity to make a positive difference in the lives of these clients. To do that, though, you have to be willing to make sure that they are living the best quality of life possible."
Kuensting announced in February 2020 he would not seek re-election as public administrator. He sent a letter to the Cole County Commission in May announcing his intention to step down, saying, "my family's health and lives are more important than completing the remainder of this term."
Kuensting is named in a wrongful termination lawsuit filed in April 2019 by a former staff member who claimed the public administrator's office was mismanaged. The case was transferred to Judge Cotton Walker upon the retirement of Judge Pat Joyce at the end of 2020. Walker plans to hold a status hearing on the case in February.
"I wasn't interested in what happened in the past. I pretty much figured out on my own what I needed to do and not do once I got in the office," Jobe said. "My staff was good to tell me what we needed to be doing and what we were behind in. They were very instrumental in getting our level of service at a high level."
Jobe said state government is increasing the number of transfers of individuals on guardianship to the counties to oversee, so the number of clients his office serves will increase.
"All public administrators have a huge challenge," Jobe said. "The public, for the most part, is not aware of what we do. It's a robust workload. We got a new phone system in August, and I checked to see how many calls we processed - and so far, since August, we've had almost 10,000 calls. At times, we have to administer some tough love, but in the final analysis, we are their advocates."