The Elder Care Continuum

The Central Tool of a Life Care Planning Law Firm

What will happen to my parents’ assets as they get older and may have to move into an assisted living or nursing facility?  How will my spouse’s Alzheimer’s diagnosis affect our housing options, and how can I provide the best possible care?  What resources are available to help me stay independent at home for as long as possible without burdening my family?  All families face tough questions associated with aging and disability, and since no two situations are exactly the same, it can be difficult to find an answer that is a “perfect fit.”  Many attorneys can help to get an estate plan in place, but they may not have all the tools or experts on hand to help you develop a complete plan for the future that also accounts for changing care needs.  Developing a sound long-term legal, financial, and care plan requires a delicate balancing act among several factors, and a comprehensive plan can be developed optimally with input from professionals with expertise outside the legal realm.

A Life Care Planning law firm differs from traditional elder law practices in that it provides comprehensive planning to address the legal, financial, and care challenges associated with aging and disability.  Unlike traditional elder law firms, Life Care Planning law firms employ dedicated care coordinators who work closely with the legal team to develop a plan that addresses aging from all angles.  Some Life Care Planning law firms also employ dedicated public benefits advisors to assist clients in gaining access to Medicaid,  VA, or other public benefits.  In order to create a plan tailored to the elder’s unique circumstances, Life Care Planning law firms use a tool called the Elder Care Continuum to assess an elder’s current health and financial situation and plan for probable changes in the future.  The Elder Care Continuum addresses four components of the elder’s situation which are likely to change over time and helps the planning team, the elder, and the elder’s family members understand and plan for the progression of aging and illness, with all the uncertainties that may encompass.

Component 1:  Health & Functional Ability  

“What are the elder’s care needs?”

Continuum Health

The health and functional ability spectrum describes the degree to which an elder requires assistance with activities of daily living such as walking, bathing, and toileting along with instrumental activities of daily living such as preparing food or managing medications and finances.  Planning options vary widely depending on an elder’s level of independence with such activities.  This measure also encompasses the elder’s cognitive ability.  An individual who only needs occasional assistance with driving to appointments but who is otherwise able to take care of him or herself requires a much different approach to care than someone who may suffer from advanced dementia or be bedridden.  The costs associated with the needed level of care advise all other aspects of planning.

A care coordinator is able to assess the elder’s current health status and can work with the elder, family, and physicians to give insight about the potential trajectory of the elder’s heath for the foreseeable future.  Both current health and expectations for the future may dramatically influence which legal and financial options are available.  Depending on the care coordinator’s assessment, the attorney will recommend legal and financial solutions that take into account the elder’s current and anticipated care needs.

Component 2:  Living Situation

“Where will the elder live as care needs change?”

Continuum Living Situation

As the elder ages, for the first time he or she may be faced with the fact that his or her health dramatically influences (and may limit) his or her options for where to live.  Sometimes the elder seeking assistance is already in an ideal living situation that suits his or her health care needs, but many times he or she has reached a point where a housing transition is imminent or must be considered in the near future.  Most people would prefer to live independently at home until the end of their lives, but changing care needs may mean that this is not practical.  However, with sound planning that preserves resources and gains access to home and community-based services, an elder’s time at home may be extended beyond what would otherwise be possible.

A major part of a care coordinator’s initial assessment of an elder is an evaluation of the elder’s housing situation.  If the elder still lives at home and is reasonably healthy, the care coordinator may make recommendations for remodeling or equipment that will preserve both safety and independence.  If and when a transition to a facility does become necessary, the care coordinator will help to assess the options and find a good fit.  The care coordinator also helps the elder and family to manage the emotional strain and uncertainty often caused by such a move.

Component 3:  Cost of Care

“How much will care and housing cost?”

Continuum Cost of Care

Cost of care is what keeps a lot of elders – and their loved ones – up at night, worrying about how they will pay for the care that is needed.  The elder and his or her family have to figure out not only how to address current care needs but also how to pay for care that may be required in the future.  Usually different care options at different price points are available, but it can be confusing to navigate the options and to find the solution which is best suited to the elder’s individual needs and preferences.  Family members may feel overwhelmed by both the array of options and the expense of those options.  Adult children especially suffer as they balance their own financial needs – and the needs of their dependent children – with the care needs of their aging parents.

A care coordinator who is familiar with the network of health care providers in the local area is invaluable in helping elders and their families make good short-term and long-term care decisions and maximize the “bang for their buck.”  The care coordinator works with the legal team to develop a strategy which ensures the money doesn’t run out and the elder’s quality of treatment does not suffer.  Proactive planning before a crisis occurs is always the family’s best bet for reducing overall cost of care.  By working with the care coordinator while everyone’s health is relatively good, the elder and family members can plan for contingencies and not be caught off guard whenever an elder’s health does take a turn for the worse.

Component 4:  Available Resources

“What financial benefits and care services are available?”

Continuum Resources

Available resources include both sources of funds to pay for the elder’s needs and providers of care and other services.  Resources may include personal savings, retirement accounts, long term care insurance, and, often, the family home place or farm.  Careful legal and financial planning may be needed to ensure that the elder’s personal assets are preserved or put to wise use and that he or she gains access to any and all public benefits which may be available, such as Medicaid or VA.  Public benefits may be used to stretch the elder’s assets, to provide more flexibility to the family over time, and to offer a higher quality of life for the elder.  A dedicated public benefits advisor works with the care coordinator to determine financial and medical eligibility for benefits programs, which can supplement and preserve personal savings.  Depending on the elder’s needs and financial situation, care resources may include family caregivers, professional caregiving services, or even community nonprofit services.  When family caregivers are available, an additional challenge is finding ways to avoid caregiver burnout while dealing with the inevitable stresses of providing care for a loved one.

A lot of research and real-world experience aid the life care planning team in navigating all of the financial and care resources available.  Identifying the best options for a particular individual’s or family’s situation can be complicated.  Because of their extensive knowledge of local service providers and their close working relationship with the elder and family, care coordinators are uniquely positioned to help connect elders with care providers.  Meanwhile, the legal team knows the ins and outs of public benefits programs and planning strategies that can help save the family farm or provide for care.  That’s why coordination between the legal and care planning team is so important:  it ensures a comprehensive plan that addresses all sides of the issue and finds the best possible balance among cost and care, safety, and independence.

Conclusion

A Life Care Planning law firm staffs professionals with experience and expertise addressing all four aspects of the Elder Care Continuum.  Particular attention is given to coordinating legal and care services to ensure sound planning for the elder’s changing health and financial needs.  This is especially valuable for the elder population, for whom resources are usually finite while care needs are expanding.  Careful planning in advance can go a long way toward ensuring that the elder’s and family’s resources last as long as possible while all the elder’s care needs are met.  Having an accessible team on hand to develop a comprehensive plan, answer questions, and navigate challenges and changing circumstances along the way can help lift the burden on the elder and caregivers and assure the whole family that they are making the best choices for their loved one.