by: Jerold E. Rothkoff

It has been sixteen years since I opened the doors to my own Elder Law firm.  As I look back, I am reminded of the events that forever altered the course of my professional career.  For the first 5 ½ years of my career, I had been practicing in the area of general civil litigation, with an emphasis in creditor’s rights and personal injury law, when I became involved in an elder law matter.

The matter involved a spouse being sued for her husband’s alleged outstanding nursing home bills.  As I began to investigate the case, I became aware that I needed to become much more familiar with Medicaid and nursing home laws in order to provide the proper representation for my client.  Coincidentally, I subsequently learned that the National Academy of Elder Law Attorneys was having its annual 1999 spring conference in Philadelphia.  Within the first two hours at the conference, I became energized in a way that had eluded me my first years in the practice of law.  I got home that night (since the conference was local) and advised my wife that I wanted to change my practice area.  I knew back then that there was something about this field of elder law that would fulfill me in ways which I never could have imagined when I went to law school and set out upon my journey to become a lawyer.  Two hours at the conference changed my life.

One early case that I handled left an indelible impression on me and characterizes the essence of what elder law attorneys do for their clients.  It involved a woman who suffered from Chronic Obstructive Pulmonary Disease (COPD).  Medicare denied her coverage for a procedure called Lung Volume Reduction Surgery.  At that time, in order for Medicare to pay for the complicated and risky surgery, the patient must have enrolled in a national trial program under Medicare.  Once enrolled in the trial program, ½ of the patients received the surgery, the remaining ½ were randomized for continued therapy, which, in essence, was a death sentence.  My client was randomized for continued therapy, and therefore Medicare would not cover the cost of the approximate $50,000 surgery.  She did not have the financial means to pay privately for the surgery, and therefore, on her behalf, I appealed Medicare’s denial.  Through my research and investigation, I learned of a world-renowned cardiothoracic surgeon in St. Louis, MO who pioneered lung volume reduction surgery.  With his assistance, my client won the administrative hearing, meaning that Medicare would cover the client’s surgery.  There were no words for the gratification I felt when I was able to explain to this family that I could help them.  It is a feeling that I never will forget.  My client and her family thanked me stating that she can now dream of the possibility of playing with her grandchildren for the first time, something that she could previously not have done due to her breathing difficulties.  For the first time in my career I felt that I had a real impact on a family that was confronted with real problems.  In an instant, life meant something more to me.  I had become a problem-solver, and it felt good.  It still feels good today.

Like almost every elder law attorney sixteen years ago, I thought elder law was about protecting assets from the nursing home, drafting estate planning documents, and guardianships.  Over the years, I have learned how narrow minded my views actually were.

Clients and their caregivers were coming to our office with typically more pressing issues than simply “protecting the money.”  Issues such as how to convince dad to leave the home to keep him safe, how to best take away dad’s car keys, and how can therapy be maximized under insurance coverage.  I realized I needed to do better to truly address our clients ever increasing concerns.

In 2005, our firm, Rothkoff Law Group, adopted the “Life Care Planning” practice model by incorporating social work to assist families in advocacy for their loved ones.  Life Care Planning has enabled us to truly provide “holistic” services that our clients need and deserve.  Over the years, we have expanded our services to include Veterans benefits, client education programs, and additional advocacy in a home and community based setting.  Most recently, beginning this year, we added health insurance advocacy via our health insurance advocate, to assist clients with the increasing complexity of coordinating Medicare and other health insurance benefits for maximum coverage.

Thus, for the past several years we have been counseling clients and their caregivers on public benefits, veteran benefits, estate, tax, long term care, care coordination, health insurance, disability planning, and many more services not found in a traditional elder law firm.

As I look back on these past sixteen years, I have probably learned more from my clients than they have learned from me.  The most important thing I have learned is to listen.  Listen to the clients’ wonderful stories about the wars they have fought, the places they have been, and the people they have met.  We have much to learn from the elderly and disabled, and they have much to share.  It has been an honor and privilege assisting seniors, the disabled, and their families.  It is a debt of gratitude that I can only hope to repay.