Friday, February 6, 2009

Life Care Planning

I am approaching my second anniversary with Katten & Benson, an elder law firm in Fort Worth. When I came to work here, I had never heard of life care planning in the context of an elder law firm.

Life care planning as I knew it was a concept I was more familiar with in rehabilitation settings. An example is the young person who suffers a spinal cord injury in a car accident. Depending on the exact injury, there are certain medical issues that can be anticipated, such as recurrent urinary tract infections, possible skin breakdown, or shoulder problems if the person is able to transfer independently. There are also known equipment needs: a custom wheelchair and seating system, catheter supplies, a wheelchair van, etc. Even durable equipment like the wheelchair or van will have to be replaced every few years due to normal wear and tear. The life care planner considers all these needs and helps the client manage the settlement so that the goods and services required are paid for by the settlement, for the rest of the client's lifetime.

Life care planning in an elder law firm, it turned out, is not much different. Rather than working with people who have had traumatic injuries, we are working with people who have chronic medical conditions, such as dementia, Parkinson's, diabetes or heart disease, and we try to anticipate the needs and get goods and services in place.

Now, let's think about everything that might happen if you are diagnosed with Alzheimer's disease. From a legal standpoint, you certainly want to make sure your estate planning is in order. If you've done estate planning, we review it to make sure it's what you want. Powers of attorney are particularly important , because you want to make sure you have identified the people you want to handle financial and medical decisions. You might even want to take the additional step of designating a potential guardian, in the event guardianship is needed as the disease progresses.

A good financial review and Medicaid planning might also be needed. If you have limited income or assets, it's a good idea to know what will need to be done in order to qualify for Medicaid. Medicaid is complicated, and an attorney will best be able to advise you about issues like gifting, estate recovery, and protecting assets for a community spouse.

As an Elder Care Coordinator it's not my job to provide care, but it is my job to help you get care. The options can be overwhelming: Do I need help at home? What kind of help is available, and who pays for it? When do I need to consider assisted living? What will happen to my spouse? Is the doctor listening to me, and do I really understand what the doctor is telling me? These are all things I can help with.

It can be reassuring to know that you have someone you can call and talk to about a variety of topics. Sometimes I'm going to validate your thinking, and other times I will have to tell you it's time to consider something different. And sometimes I'll just sit with you and be supportive, so you know that you're not alone.

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