The Law Practice of Dennison Keller, LLC Newsletter

Beyond Wills, Trusts and Powers of Attorney...

   Physician, gerontologist, and Pulitzer Prize-winning author Dr. Robert N. Butler spoke recently about his new book The Longevity Revolution: The Benefits and Challenges of Living a Long Life. Dr. Butler surprised the audience by citing the U.S. in 47th place among world nations as to longevity. He contrasted the critical shortages of geriatric physicians, nurses and social workers in the U.S. with Great Britain, where geriatrics is the #2 specialty. Chronically-ill older adults, Dr. Butler advocates, need an interdisciplinary team of social workers, nurses, physicians and home health aids in order to navigate a health care system he calls "fragmented and confusing." Elder Law attorneys also advocate wholeheartedly for a collaborative approach between medical and non-medical service providers to create the continuity of care necessary to preserve the independence, safety and well-being of elders.
     Most people are not aware of the full scope of what an Elder Law attorney can do to help families, particularly upon the diagnosis of a serious chronic condition, such as Alzheimer's disease. While "elder law" often includes wills, trusts, powers of attorney and Medicaid planning, the "best practices" model of Elder Law is really about forging a relationship with the elderly client and with her family and professional support systems. The National Academy of Elder Law Attorneys describes elder law as a holistic practice focused on long-term care planning. Specifically, "locating the appropriate type of care, coordinating private and public resources to finance the cost of care, and working to ensure the client's right to quality care are all part of the elder law practice." (NAELA, 2008). This Elder Law practice model is not estate planning (planning for death) but rather "life care planning."
     This is how life care planning practice works:
     In general, our medical system masterfully treats patients with acute illnesses but does not adequately prepare patients to manage the care of chronic conditions. Patients and their families have no idea where to begin in the maze of options to get the help and care that chronic conditions demand. Most elders (85%) rely on family or friends for long-term care rather than on paid professionals, often because of quality of care or financial concerns. Accounting for $196 billion in uncompensated care annually, informal caregiving has become an accepted dimension of the public health system. Yet nursing home rehab, in-home care, assisted living and many other services are preferable and viable options for patients, when they are educated about the alternatives and understand the payment options for needed services.
     To begin representation, the elder centered law practice learns everything it can about the client/patient - from medical diagnoses and prescription panel to financial resources and family dynamics. Next, a determination is made as to where the client resides on the "elder care continuum," the timeline representing the natural progression of aging and its impact on health, mobility, housing and financial resources. The key is to accurately assess the client as to functional capacity (physical and cognitive), then identify current and anticipated levels of care (medical and custodial) needed. Based on these needs, expected costs for care are charted and resources to pay for the care are identified.
     As attorneys we can help clients navigate the financial systems, but legal training does not qualify us to advise on care regimens. The multidisciplinary practice model employs an Elder Care Coordinator (ECC) to assess the needs of the client and to recommend alternative care plans. The ECC conducts an in-home assessment of the elder client to identify care needs and other issues. The ECC does not provide any direct health care but does help the client to access appropriate services throughout the elder care network. Adding care coordination to the Elder Law practice enables us to serve as compassionate counselors and advocates, not just as transactional lawyers who prepare documents or qualify people for Medicaid.
     The elder centered law practice helps families ensure the well-being of their loved ones through the collaboration of legal, medical and social services. This is the hand that guides clients through the medical and financial maze that accompanies the diagnosis of a chronic condition and provides the peace of mind that families did not believe possible when their crisis began.

If you have questions about Life Care Planning, the role of an Elder Care Coordinator and how to access these services for your clients, friends or family please contact us at The Law Practice of Dennison Keller, LLC.

This article, written by Miles Hurley of Hurley Elder Care Law in Atlanta, Georgia, was written for the Wealth Counsel Quarterly.