From February 2014 Takacs Newsletter
We Are All Living in a Medical Neighborhood (Part 1)
The Medical Neighborhood is an emerging concept meant to address all the care needs of an individual. The Medical Neighborhood – a group of providers in, literally, the geographic area of the patient and the patient’s family – will identify and coordinate all medical and non medical resources available to manage issues which impact a patient’s health. The aim is to improve clinical outcomes, provide a more satisfying experience of care for both patients and providers, and reduce care costs.
What does the Medical Neighborhood mean for older persons and how will it improve the experience of care they receive from their Medicare providers? Actually, it is part of a larger concept called The Patient-Centered Medical Home that the U.S. Centers for Medicare & Medicaid Services is promoting as a future model for the delivery of care to people on Medicare.
In a Patient-Centered Medical Home, a Primary Care Provider (PCP) is responsible for providing “whole person care.” Under this model, the medical provider is challenged to engage an individual in managing more of his or her own care, to make shared decisions about care with that individual, and integrate with non-medical service providers to support the individual’s efforts. The individual is challenged with knowing how to manage optimum health between office visits and staying out of the hospital.
The Medical Neighborhood includes medical specialists, pharmacies, behavioral health, residential care facilities, non-medical home care providers, and other community resources. Working together, this group will educate and guide the individual in the direction of getting all their care needs met. To ensure that the individual receives optimal care, the Medical Neighborhood strives to meet psychosocial needs, address social and environmental factors that impact the individual’s health and well-being, and address financial and legal aspects that enhance or create barriers to care.
As an essential member of the Medical Neighborhood, the Elder-Centered Law Practice should have a presence early in an individual’s care plan. Within the Medical Neighborhood itself, an Elder-Centered Law Practice is regarded as a specialty: a team of nurses, social workers, licensed therapists, public benefits specialists and attorneys, under one roof, experienced in helping individuals find, get and pay for quality care.
Here is an example of a common situation many older adults and their families face. Frank, 87, is a frail man who has been diagnosed with Alzheimer’s disease. Living by himself at home, Frank is functionally dependent upon his overwhelmed son, Paul, to bring him his groceries, take him to the doctor, pay his bills, and get his medicine.
Is Frank living in a Medical Neighborhood? Where Frank lives – that is, whether or not he lives in a Medical Neighborhood – affects how successfully he and his son Paul will manage his care. That is the subject of our next issue of Elder Law FAX.
We All Live in a Medical Neighborhood (Part 2)
In last week’s Elder Law FAX, we introduced Frank, a frail, 87 year-old man who has been diagnosed with Alzheimer’s disease. Frank lives by himself at home and is functionally dependent upon his overwhelmed son, Paul, to bring him groceries, take him to the doctor, pay his bills, and get his medicine.
How would a traditional elder law practice view of Frank’s situation differ from an elder-centered law practice approach? And, how does the elder-centered practice approach meet the aims and goals of the Medical Neighborhood?
Under the traditional elder law view, Frank currently has or is expected to have a care financing and asset preservation problem. Typically, the elder law practitioner will be retained to put a plan in place to accelerate Frank’s financial eligibility for Medicaid benefits.
For example, the attorney (in another state) of a client of the Elder Law Practice explained in the written plan developed for the client that “the purpose of Elder Care Plans is to protect the assets of persons who have entered into or are about to enter into a skilled nursing facility … The primary way to protect assets is to seek eligibility for Medicaid.”
If Frank doesn’t need immediate nursing home care, Frank will get necessary legal documents in place and counsel on repositioning assets to make them unavailable or inaccessible to the State Medicaid program. If he is a veteran, the elder law practitioner will determine whether Frank is entitled to monthly payments from the U.S. Department of Veterans Affairs (the “VA”) to pay for his care. A plan will be developed that may require Frank to restructure his assets to qualify for a VA benefit.
This may be done by making Frank’s assets legally unavailable to him. If those assets are not available to him, the State Medicaid program and the VA can’t consider them available. The asset repositioning may result in a five-year Medicaid lookback period. Usually, the elder law practitioner will counsel Frank and Paul on the advantages and disadvantages of such restructuring.
How will Frank’s needs for personal care be addressed? Or his values, or safety, or the risk that Paul will suffer caregiver burnout? The traditional elder law practitioner will make referrals to personal care agencies or geriatric care managers, but typically does not align the practitioner’s asset protection plan with the client’s personal care needs.
An elder-centered law practice aims for whole-person care, assisting Frank and his son Paul with attaining their goals of addressing issues that impact health or that enhance or create barriers to care. What level of care does Frank need and what kind of care does Frank want? A plan will be developed and implemented to help Frank find, get and pay for the care that most closely aligns with his values and his needs today. Frank will get legal documents and asset restructuring advice, but care financing—albeit critical—is only one aspect of the representation.
The elder-centered law practice will employ a team of health professionals who will coordinate care and advocate for Frank and for Paul. The practice will have a working relationship with community resources including residential and in-home care providers. The practice will offer Frank options. It is the aim of the elder-centered law practice to support older clients and their families in the day-to-day self-management of their chronic illnesses.
Elder Law Practice of Timothy L. Takacs
201 Walton Ferry Road
Hendersonville, Tennessee 37075
Voice: (615) 824-2571
Fax: (615) 824-8772