BALTIMORE -- The 80-year-old man was sick and alone. His home was a psychiatric hospital. He was taken there after he tried to commit suicide. And now he needed treatment for lung cancer.

But it was determined that he was not alert enough to consent to medical care. And his daughter, according to court records, refused to get involved. The man needed help.

The Maryland Office of Aging stepped in, filing a petition to become his guardian. A judge approved an order limiting the agency's authority to make decisions on the man's medical treatment.

The case was a typical one for the agency, which, under Maryland law, can become guardian for those over the age of 65 who have no one else willing or able to take the job.

When this petition was filed in 1980, the office handled all public guardianships in the state out of its central Baltimore office.

But during the past three years, the state office has decentralized, calling on area agencies on aging in each of the 23 counties and the city of Baltimore to handle local public guardianship cases.

The aging office received a $242,000 state allocation this year for its guardianship unit. It generally pays local aging offices $1,000 a year for each case in which the ward lives at home, in foster care or in a community shelter, and $500 annually for hospital or nursing home cases, said Joyce Thompson, who until this summer headed the agency's public guardianship unit.

That money is used for salaries of case management workers. The amount is usually adequate, although some large jurisdictions with heavy caseloads believe that they need more money, said Janice Brzezinski, the Office on Aging's manager for institutional and protective services.

Suzanne Wilbur of the Montgomery County Division of Elder Affairs said her office receives $9,300 in state funds annually for guardianship work but pays a full-time social worker a salary of up to $30,000. The office is responsible for about 20 wards, she said.

Montgomery County provides additional money, she said, but other areas do not have the money.

About 220 elderly people are under public guardianship across the state, and about three-fourths are in nursing homes, Brzezinski said.

As many as 85 percent of elderly people under public guardianship have families, Thompson said.

Officials in the public program say they also conduct investigations and, when possible, make sure that prospective wards understand what is at stake under guardianship.

"Our philosophy is {that} the need for guardianship is not a black-and-white issue and that the person's dementia may enable {him} to make some decisions and not other decisions. So the determination that the person has dementia is not an automatic matter for guardianship," said Marjorie Richmond of the Baltimore County Department of Aging, which acts as public guardian in that jurisdiction.

Once a public guardianship is established, it comes under the scrutiny of a Disabled Persons Review Board in the jurisdiction, which makes recommendations to a court.