Life Care Planning: When You Need to Know the Way

by Jerold E. Rothkoff

“I need to come in right away,” Susan told our office. Her mother, Florence, has cerebral palsy and her father, Maurice, who had been caring for her mother in their home, had a stroke and was undergoing rehabilitation at the hospital. Susan had hired round-the-clock caregivers for her mother and it was costing a fortune. She did not think the money would last for very long and she did not know what to do. Should her parents live with her? Susan investigated putting an elevator into her own home and bringing Mom and Dad there.

“What should I do with my parents’ home?” she asked. “What if my dad does not get well enough to look after Mom again? How can I afford the caregivers to take care of Mom and a nursing home for Dad?”

Susan really felt the need to get things planned out. She had 50 million questions running around in her head and was searching for the answer to each one. We scheduled a first meeting for Susan, who came in and hired us for a Life Care Plan on behalf of her parents.

Florence and Maurice are two of the growing numbers of millions of Americans for whom chronic conditions are a fact of life. The prevalence of physical and mental disability among the elderly is growing rapidly along with America’s aging population. The number of Americans who suffer functional disability due to arthritis, stroke, diabetes, cancer, dementia, Parkinson’s or Alzheimer’s Disease is expected to increase at least 300 percent by 2049.*The challenge for our society is how we are going to manage the care of these increasing numbers of elderly persons with disabilities.

Eight years ago, I decided to devote my professional life to being an elder law attorney. Like many elder law attorneys, I initially focused my practice on Medicaid and asset protection planning. However, over the past few years I have grown increasingly dissatisfied with the answers or non-answers I was able to give to families who have questions about the long-term care system they were thrust into and did not know how to make their way through.

Our families had questions I could not properly answer: The skilled nursing facility is telling us our Mom needs this therapy and not that one –– what does that mean and which one should we choose? What are Dad’s housing options now that his health has improved, but he cannot return home? How do we take care of Mom during the day while both of us work? What support services are available to me as a caregiver?

These are not legal questions, but as an elder law attorney who aspired to the “holistic” approach, I needed to do better. I understood that I needed to change the way I thought about the practice of elder law. This is where the “Life Care Planning” model of practice comes in.

The Life Care Planning model places special emphasis on issues surrounding long life. The elder-centered practice incorporates traditional elder law with care management to assist individuals with chronic illness to identify, access, and pay for good care, both now and in the future. That is not as easy as it sounds, but it is the essence of what we do. Our clients need to get good care when and where they need it, and they need to know how to pay for it.

The principal goals of the Life Care Plan that we help you develop and implement are:

  • We help make sure that you or your loved one gets good care, whether that care is at home or outside the traditional home setting, such as a nursing home. This is the most important of all goals, for it goes to the very heart of your quality of life in your later years.
  • We help you make decisions relating to your health care, long-term care, and special needs. For most of our clients and their families, it is a comfort and a relief to realize that they always have a resource of experienced, supportive, knowledgeable, and objective advisors with them every step of the way.
  • We help you find sources to pay for good care. We help protect and preserve the assets you have accumulated during a lifetime of hard work, thrifty behavior, and astute investment decision-making. We work with you through the maze of choices and options to find the best, or often, the most comfortable solution to the asset protection problem created by the need to pay for quality long-term care.

Our Geriatric Care Coordinators, who are licensed social workers, will be with the client and family every step of the way.

Since we have instituted the Life Care Planning model of practice, our office now defines our professional relationship with clients not just in terms of resolving specific legal issues, but in how effectively we assist our clients in maximizing the quality of their lives. That is truly what being an elder law attorney, in my mind, is all about.

* Congressional Budget Office, Financing Long-Term Care for the Elderly,” April 2004.