Life Care Planning

Hi there.

And thank you so much for watching us here on PBS Fort Wayne.

I'm Sandy Thomson, the host of the show.

But the real star is my guest.

And you've met him before.

He has been here numerous times to talk about elder law.

And tonight, we're going to be expanding that a bit and talk about some life care planning.

There's a kind of a new program in that legal arena.

Please meet Bryan Nugen.

He will look familiar to you, I'm sure, if you're a regular viewer of us here on Life Ahead and right.

I have to say that you're always a popular guest.

You always get a lot of questions and you always have a lot of good answers.

Thank you.

But you always tell us something new.

And tonight, we're going to talk about life care planning.

That's a new term to me.

What it is it mean?

So what I can say is that law firms that traditionally have practiced in just estate planning or elder law are recognizing that their clients need more assistance than just preparing a document or achieving a task where estate planning, elder law attorneys are dealing with folks that are aging and going through the aging process.

So I can speak for myself and that I was feeling like I was letting my clients down a little bit when I didn't have this life care planning as part of my office and how we help our clients and other attorneys were feeling the same.

So the concept behind life care planning is that not only are you coming to the attorney for estate planning or protection of assets, etc., but life care planning firms will have on staff someone like a social worker or a nurse, so that if their clients have declining health or have needs for having a hospital stay or a rehabilitation stay that they have assigned to them, an elder care coordinator is part of this life care planning concept.

So that elder care coordinator is assisting them, attending those meetings at the hospital, attending meetings at an assisted living facility, a nursing home, coordinating with family so that with the life care planning firms they're assigning to their clients, elder care coordinators.

And those coordinators typically are working with those clients for a period of time, a year, two years, however long the client needs to work with that elder care coordinator.

So the concept behind that life care planning is not only are you coming to your estate planning or your elder law attorney to have those documents prepared, protecting assets, getting you a public benefits, but also taking a much more broad step and working with the client.

It's an ongoing relationship and really being the touchstone for the family and the client as they're needing, but they have questions regarding their health care, are looking to bring health care into the home.

Who should we speak with?

We need an advocate at the nursing home who goes into the meeting with us and explains what's going on.

Who is it that explains This is what my Medicare pays for.

This is what my Medicaid pays for.

This is how my long term care insurance works.

So those elder care coordinators, those life care planning law firms, they're doing all of that for their clients and family members of the clients.

That sound revolutionary and it sounds like much needed because there's so much more than just making your will and naming your power of attorney and your health care representative.

And obviously, when you know one of the family members of yours, a loved one, is facing those elder law decisions.

It's so confusing.

And again, it's confusing not only with what is Medicare paid for and what does your insurance pay for, but if you have to begin to think about going into assisted living or a nursing home, where do you begin?

How do you begin to make those decisions?

So this is a person that will help me make those decisions or at least provide the information.

So the person, when we use the phrase elder care coordinator, you're assisting the client, the family members in coordinating that care.

So typically the elder care coordinator will meet with the client where they are, so come to their home.

Okay, I have a meeting with them, assess what's going on with that client, what their needs are.

Take that information back to the office, establish a care plan, and then have a meeting with the family regarding that care plan and say, this is what we're doing.

You know, we've seen Mom's starting to fail and mom is recognizing she needs a little bit more help at home.

So we're going to maybe start with a little bit of personal service coming into the home.

And home health care sort of.

Thing.

Well, home health care is actually nursing care.

So, yes, it could be that we have home health care.

What I was referring to is more attendant care.

So this is someone that might help with preparing a meal, getting dressed, bathing, being reminded to take your medication, those types of things.

So we're going to start there and see how that goes.

We may look at a buttons like Life Alert Buttons, and we think, Oh, this is a good idea for us to implement.

Let's bring that into the person's home.

Perhaps we need to have grab bars installed.

Let's look at having grab bars, installed carpets on the floor, let's pull up the rug so we avoid tripping hazards so that elder care coordinator is assisting the family in coordinating that care in the home.

And then if the family gets to the point where mom can't stay at home anymore or and, you know, she maybe she has a fall and she's going to have a procedure done.

And then going into rehab, that elder care coordinator is making recommendations and referrals to facilities, hospitals that we've had good experiences with other clients have had good experiences with their scores or high.

Right.

So we're going to be coordinating that care for the client and saying we recommend you're reaching out to these folks.

We're recommending you reach out to these folks.

Even something as simple as transportation, let's say a client of an elder care coordinator needs transportation.

That that elder care coordinator can make recommendations for transportation inside the community.

Where there are so many needs that people have.

As you can anticipate and probably maybe even have some experience with.

But again, it's not knowing where to go.

I mean, Fort Wayne is a wonderful community and there are so many opportunities and services that are available if you know about them.

And where do you go to even begin about it.

So then what you're telling me is this life care coordinator will be familiar with the services and while they may not, they're not like trying to sell you on one particular one, but they will help make you aware of what is available.

Right.

So that right, that elder care coordinator, those elder care coordinator are typically paid by the client on a flat fee basis.

So you'll have an annual agreement.

Okay.

So if you work with your elder care coordinator four times a year, eight times a year, eight times a month, a dozen times a month.

It's the same cost.

The elder care coordinator and working with the life care planning law firms, they have no remuneration or no kickback from.

These businesses or.

Services that that is that is completely opposite of what's going on.

Good.

There is no there is no tit for tat or in any type of a side deal going on.

Not nothing like that.

And the elder care coordinators job is to really get to know their client, understand what they need, understand what their personal requests are, and then to coordinate that care for them, not necessarily doing it directly, but putting clients and their family members in touch with those agencies, those services that exist in our community.

You mentioned Sandy, Fort Wayne.

It could be Fort Wayne, it could be DeKalb County, it could be Noble Counties to Bend County over and Ohio could be anywhere in the PBS area.

Sure.

And many agencies, especially not for profit agencies, might even serve like the nine northern counties.

So there's a lot of bailable.

And I know we have a lot of viewers that are not just in the city of Fort Wayne, but in the surrounding counties.

So there's help for you as well.

Bryan, what about these people that go to work for a law firm as a do you call them life care coordinator, elder law.

So so life care planning is like.

Conceiving.

However, that the individual which is assigned to each client, their title as elder care coordinator.

Okay.

And it's a little deceiving with the name elder and care coordinator, the person wouldn't necessarily need to be an elderly person.

Traditionally they are.

It may not be.

It may be a younger person that have some medical concerns.

So maybe Title One has had a major surgery and they know that they're going to be homebound and need some extra help for a number of months as they're recuperating.

What kind of background do these people usually have, medical, legal or what?

So the elder care coordinator may have some background in the legal world, but really their job is not to focus on one's legal needs.

The attorney and the attorney, the paralegals and the support staff and the law firm handle that side of it.

The elder care coordinator typically has a background in social work.

It could be as a nurse, right?

So you're coming with a lot of background in having community connections, understanding medical needs, understanding social needs, those types of things.

So the elder care coordinator wouldn't be providing any legal advice.

They would be coordinating care for that individual.

It may be something that let's say that mom is starting to forget to pay her bills or grandma's struggling to remember to pay bills or what what's real mail and what isn't real mail.

Typically, with the elder care coordination, that life care planning system that's in place, bill pay can be implemented as well.

So that right the individual's bills could be paid on a regular basis.

The family can receive an accounting of what bills have been paid, what hasn't been paid.

We make sure that your insurance is current, your utilities are current so that it's really enabling the person to remain in home and their environment as long as they can successfully.

The goal is not to move people from their homes.

The goal is to have people in an environment that's appropriate for them, and sometimes that's in your home.

It could be in an independent living facility, it could be in an assisted living facility at some point.

It may be a traditional nursing home, possibly a memory care unit as well.

So it could be that your elder care coordinator is organizing all of those different types of stays.

So it doesn't care.

In each of those facilities.

So it doesn't matter whether you're still at home or with your situation, whether it's a surgery recovery or elder issues.

So in your home, you could be in a nursing home.

Yes.

And still have an elder care coordinator.

You actually let's say that you were coming to a law firm that does elder law.

And I always like to say every estate planning attorney does estate planning, but not necessarily elder law.

Every elder law attorney does elder law and estate planning.

There is a distinction.

And but overlying all of this is the concept of life care planning.

Sure.

So it could be that you would a client would go to a law firm that does elder law and they're protecting your assets in advance.

I know we spoke in the past about very unique trusts that we use to do that.

And I may not have a medical concern at this point, but the law firm would still assign to an elder care coordinator, they would check in with you, let's say, a minimum of four times a year so that you have that relationship built up.

So if in the future, if your health does change or your circumstances in life change, you have that relationship with an elder care coordinator so that they could grow with you and change with you as your health care needs are changing, your personal needs are changing.

So if you were working with a life care coordinator, they will work with you for a long time as long as you need, not just one year.

You mean you sign up for a year at a time?

So typically, life care planning law firms are having agreements with their clients there where they would work with the elder care coordinator for a period of 12 months at a time.

Okay.

And then within as you're nearing the end of that 12 months, if you wanted to renew that service, a typically a law firm, so then renewing and again for another period of 12 months.

But you'd most likely have the same person that continues with you, which is great because they are familiar with your environment if you are at home or or wherever you might be, and they would be familiar with your daily needs, whether it's bill paying or right, or you take your meds or maybe even taking them in a car or take them out for an errand to run, take them to the grocery, things that can help keep them active and a little bit social.

They would coordinate any of that so they would be able to coordinate those social outings to recognize events that are happening in the community that may be of interest to them.

Yeah.

Now I did reference Bill Penn.

I want to make sure that we're both on the same page there.

The elder care coordinator wouldn't necessarily themselves be paying the bills and monitoring that, but they would be coordinating that care.

Typically through the law firm so that inside the law firm, they would be helping the client manage their their their mail manage, making sure that things are paid so that the word coordinator and the title elder care coordinator.

Working between the two.

Of them are coordinating all of that.

Exactly right.

Do they meet with the attorney then that they're associated with?

Do they meet with them on a regular basis?

I can say in my firm and I'm assuming other firms do the same thing, we have no less than once per week.

We meet and review every single file that's going on.

We're touching base with what's happening with our clients and making sure that the entire team that's caring for the client is up to speed.

And I'm certain that other life care planning law firms are doing the same thing where it isn't that the elder care coordinator is working in an independent silo, the attorney is working an independent silo.

The client of these firms really have a whole team around them.

And so, yes, to your point, there are regular and ongoing meetings where we're talking about those clients, what their needs are, and identifying solutions to issues that they may have.

That makes so much sense, Bryan, because, you know, if you are in need of some assistance, well, again, it is just coordinating your daily life, making sure that you are living appropriately and that you have medications, that you have food, all of that.

But then again, the legal services.

Let me follow up on that, if you don't mind.

Normally with those agreements where you're working with that life care planning law firm for a period of 12 months, if there are changes that need to be made to your plan during that time, if there are all of that as.

Part of your service changes.

As your condition changes, let's say that you've identified a child to be your attorney.

In fact, under a power of attorney, and we need to change that.

So historically, you would have paid for that additional document to be prepared.

But when you're working with that life care planning firm, the idea is if there are any changes during the year, those changes would be made as part of the payment that that was made for an annual basis.

I will also say that the life care planning firms are also typically having ongoing educational events for their clients.

So it might be well, we could have a presentation to folks that are serving as trustees, reiterating what you do as a trustee, what your duties are.

Here's how you sign checks.

This is these are your obligations.

It could be that we're introducing, again, an elder care coordinator.

We want to speak with those folks that are using the elder care coordinators, talk to them at a group setting about what's going on.

If there's a new medication that's been released regarding a dementia treatment of an Alzheimer's, it may be that those clients that are working with those firms would come in and would be able to engage with professionals in that arena and speak to them about what is the new medication, how is that something that might be interesting to me?

So again, that elder care coordinator would be coordinating those presentations, not necessarily being the speaker, but would be coordinating for the benefit of their clients.

I get that.

Okay.

That makes sense.

Now, can this elder care coordinator do things like go to the pharmacy and pick up a prescription that's been ordered or take the client to a meeting, whether it's with their attorney or with their doctor, how does that all play into?

It could happen.

But really so imagine if an elder care coordinator has 50 clients or 70 clients, 75 clients.

Their availability to do the direct transportation, their availability to go to the pharmacy isn't realistic.

It's more likely that elder care coordinator would coordinate for the client how to have the medication delivered directly to the home to make sure that the medication is there on a timely basis.

That elder care coordinator would organize with community services to make sure that they have transportation available to them.

So it's more that the individual would be responsible for structuring that to take place, making sure that the transportation is there rather than actually physically doing it.

The got it.

Okay, but good to know that they would be familiar with those different services so that they could.

And that's the hard thing I think when you're in that position to to assist somebody in your life is you know, if with so many people working full time now, it's like there isn't always somebody in the family that can take them to appointments or or pick up prescriptions or get groceries form or check that they've made.

They're not only locations.

But, you know, it used to be that, right?

You were born on the farm and and you moved no more than five miles from the farm.

And that was your.

But people are living, you know, far and wide.

So especially for those folks that have parents that are living locally in the child's in Wyoming, Florida, California, and they don't have boots on the ground here locally.

That elder care coordinator is a lifesaver.

It's a huge bridge of communication between the family and the local parent.

But even if the children are local, it's the same service that's being provided to them.

It's been historically heartbreaking for me is an elder law, an estate planning attorney.

When a client comes to me after the fact and I say, oh, it's a shame you didn't know about this, you didn't know about this, could have helped you.

And the idea of bringing in that life care planning concept and that elder care coordination is that we don't have to have those sad times anymore.

Right.

That those clients are engaged and know exactly what's going on, what services are available to them so they don't have those sad times after the fact.

So you mentioned people now not only working more, but a little more transient.

So maybe the son or daughter who might be the power of attorney or health care representative or just a loving child.

So they live in California now.

They could call this coordinator and say, could you check on this for my dad or tell me what he needs?

Just recently, I had an experience with an elder care coordinator where the mother was living locally and the mother's health was declining and the elder care coordinator organized, getting governmental ID for the individual organized of arranging a flight for the individual so that person could fly to their child for the holidays.

But had the individual that's client needed to do that on their own, that.

When that happened.

So the thank you that we.

Received.

After that they were able to see their mother and had we not done those things that the elder care coordinator hadn't arranged, that they would have lost that opportunity.

So it's a true feel good situation and it's that holistic approach to caring for your elder care and estate planning clients.

It isn't just your coming to the attorney for a transaction.

I need you to prepare this and I will see you in 30 years when I pass away.

No, it isn't that.

It's really the holistic care of our clients.

That's an ongoing touch with them.

Now, what if a person is moving into an assisted living or a nursing home?

How does that elder care coordinator work with them?

With the with the assisted living facility?

Sure.

So, first of all, the elder care coordinator in your community should know generally what assisted living facilities exist, which ones that they have had good experiences with.

They should be making the introduction between the assisted living facility and the potential they are.

With you from the beginning.

Yes.

You better believe it.

So that elder care coordinator might recommend.

Here are three assisted living facilities that we've had good experiences with.

Clients have had excellent experiences with them.

Let's go to those three and see which one feels right for you, because the elder care coordinator is saying all of these are excellent facilities, so let's tour them together, see which one you like and make some choices that way.

Okay.

So they could even take you then for those visits and tours.

It doesn't have to rely on the family to take time off work, you know, take you for a tour.

Okay.

Now, Bryan, I know that one of your specialties and you have accreditation for veterans.

Yes.

Does that play at all within this program?

So your elder care coordinators should be familiar with Veterans Administration benefits.

So they should be familiar with programs that are needs based, programs that aren't needs based for veterans.

Veterans might be eligible for certain disability payments.

So, yes, the elder care coordinator would be aware of Veterans Administration VA benefits and would be able to work with those clients that may have a VA background or have a spouse that was a veteran should be able to identify, I call it issue spotting.

Oh, I see an issue.

And here's something that can be resolved through the VA issue.

Spotted, right?

So again, spotting.

So you're bright enough.

I shouldn't say broad enough.

You've had enough experience.

We can say, oh, you're hard of hearing.

You're a world war to vet.

Do you understand that you may be able to get disability payments from that?

So let me arrange an assessment for you to see if the VA determines you have a disability for the VA to determine it was as a result of your service and you may then be able to receive a monthly benefit as a result of hearing loss from your time serving.

Excellent.

All right.

So there are a lot of opportunities for you to make more money, if you will, or get more benefit than the cost of the elder care coordinator.

Oh, I think that when you when you look at the benefits that you're receiving, the personal guidance that you're receiving, the cost of that is far outweighed by the benefits that you're it's not what you know, it's what you don't know.

So that elder care coordinator is exposing you to all of these services, all of these things that are available to you that you may not know about.

When people really appreciate the elder care coordinator, it's when you have that event that was not planned.

You have a medical event that wasn't planned.

You are admitted to the hospital or a parent or grandparents admitted to the hospital.

We have a procedure done.

You're not even clear how long you're going to be in the hospital.

Then all of a sudden, in the morning you get the social worker from the hospital comes and says, okay, you're being discharged at 1:00 today on, by the way, you need 24 hour a day care.

You can't.

Go home.

Can't go home.

Or you're going to.

Go.

If you're going home, you need staff.

There are 24 hours a day.

So if that elder care coordinator is following, you see the whole plan, they've already there.

They're aware of when you're discharged may take place.

They're aware that you may need to go to rehab after that, they're aware of what rehab facilities that you might consider going to.

So they're guiding you through that as opposed to your waiting, your your planning in advance as opposed to it coming to you and the 11th hour.

And you're always panicking, trying to figure things out.

You know, it makes so much sense to me as a relief as well for the family who with a 24 hour notice has to run around and find a place for them to be.

Right.

And the kids have that responsibility.

Adult children usually.

So there's somebody that can help and that's wonderful.

Bryan, we love when you come on like the and I know you're going to be here again in March.

Yeah, I think the third Wednesday, as I recall, is on the schedule.

So if you have some legal things that you'd like to talk to Bryan about, we're going to take phone calls in March when you're here.

So keep that in mind again.

It's Bryan Nugent.

Thank you so much.

Thank you, Sandy.

All right.

And have a great spring.

If it ever gets here, it will.

Stay.

Positive.

Exactly.

Meanwhile, we'll be back next Wednesday night at 7:30.

And please stay safe and stay healthy.

Goodnight.