Elder law attorneys are a vital referral source to all PGCMs and developing positive relationships are integral for any practice. PGCMs can be a vital referral source for ElderLaw attorneys, as they work more and more with long term care issues and family and senior needs. This article includes exerpts from an original article entitled: Cultivating Successful Relationships with ElderLaw Attorneys

By Steven Barlam, MSW, LCSW, CMC
Chief Professional Officer, LivHOME, Inc.

There are times older adults and or their families meet with estate planning/elder law attorneys and raise often complicated eldercare issues. As a Professional Geriatric Care Manager (PGCM), it is easy to see how care management can provide great value to all involved; however, there are occasions when these needs are raised in the attorney's office and care management is never discussed. WHY NOT? Why wouldn't an allied professional want to refer to a service that could offer real solutions to difficult problems?

When communicating to consumers about PGCM services, we often use the line: "you have your role, and we have ours." The focus of this message is that you should be able to get back to being the son or daughter and allow the professionals to deal with the personal care/nursing and management of the care.

In the same way, this message is just as potent when communicating with allied professionals about why they should make use of our services. We realize that they sometimes are called upon to provide advice and/or services that may be outside of their skill/experience set. It takes them away from what they do best - their role.

We each come to the table with distinctive skills that add value to our clients - helping them to solve their problems. We can't be everything to everyone. We need to be clear of our areas of expertise and know when to reach out to allied professionals.

Most clients want user friendly "one-stop" shopping, and therefore, they will ask for advice from a trusted source. Sometimes the traditional boundaries are stretched so that the professional can provide one's valued clients with the information and services they seek. This can result in the best case, spending extra time researching the resources; and in the worst case, providing the client with less than expert advice/service.

PGCMs are learning steps to take to involve themselves in more people's lives, to reduce strain on families, and to provide expertise to other professionals involved with the client, such as attorneys. The three steps include: 1) understanding both our and the attorney's unique roles/domains of expertise; 2) understanding the needs of the attorney; and 3) understanding what the potential obstacles may be and be prepared to address them with examples that demonstrate value to the attorney.

I. UNDERSTANDING THE ROLES:

PGCMs understand our unique roles, and domains of expertise. Our appeal comes from outlining for other professionals the VALUE that we each bring to the situation- and the increased value of collaboration. It is impossible at best to enter into a meaningful discussion about VALUE, if we are not clear about our own respective roles.

THE PGCM's ROLES (domains of expertise):

• Comprehensive psycho-social assessments
• Care needs assessment
• Care plan of treatment
• Care coordination
• Resource expert
• Liaison between elder/family and community based medical, social, legal, and financial services
• Facilitating communication amongst all involved professionals
• Screening for risk factors (depression, nutrition, falls, abuse, home safety, and mental status/capacity)
• Monitoring for medical changes and symptoms of deterioration
• Arranging for in-home care and/or alternative living arrangements
• Client advocacy
• Counseling, support and education to the elder and involved family

THE ELDERLAW ATTORNEY'S ROLE (domains of expertise):

• Assessing for legal needs
• Estate planning (tools include: wills, trusts, powers of attorney, etc.)
• Public benefits planning
• Conflict resolution and/or mediation services
• Assisting at the time of lost capacity
• Tax planning
• Petitioning for conservatorship/guardianship
• Elder custody issues
• Property matters
• Counseling, support and education of the elder and involved family
• Post death estate management

II. UNDERSTANDING AND IDENTIFYING THE NEED

After being clear about our respective roles, we can start to identify what is the NEED/PROBLEM facing the Attorney. The needs fall into three primary categories:

A. Wanting to best serve the client .

No one person can meet all of their clients' needs. Trying to do this alone can lead to less than superior quality. Reaching out to allied professionals can help you better serve your clientele. Once an eldercare problem, is recognized, why wouldn't anyone want to offer a solution to best respond to the client's need?

Ignoring a situation doesn't help, in fact, it may negatively impact your elder client's day-to-day situation.

There are times that the PGCM is called in to evaluate the care situation for an elder client receiving inappropriate levels of care. Through our expert knowledge of community resources, we can help recommend solutions that can ultimately save the client time and money while additionally providing them with a greater sense of "peace of mind."

1. Wanting to grow and sustain your client base.

PGCMs can help you address the eldercare issues effectively, reflecting well on you. Clients' satisfaction is essential; if you don't address the issues at hand, a situation can deteriorate, leading to dissatisfaction and client attrition.

Having a PGCM making regular visits helps you keep a finger on the pulse of the situation. Without the PGCMs professional eyes and ears, problems arise with no one to keep you in the loop leading to lost business.

 

2. Wanting to reduce your liability

PGCMs can provide you with a professional assessment complete with specific suggestions to support your recommendations and help strengthen your counsel to elder clients and/or their families. Without support from appropriate experts, you can potentially open yourself up for undue liability.

 

III. UNDERSTANDING THE OBSTACLES

There are real reasons and obstacles that face our profession as to why elder law attorneys may choose not to refer. The first step in overcoming the obstacles relates to understanding them. The following examples of "real" client situations are used to demonstrate a sampling of underlying obstacles, and specific approaches to the obstacles that have proved to be effective.

SCENARIO I:

Sam, a long-time estate planning client meets with his attorney to update his will, prior to a trip. The attorney notices that there have been some noticeable changes in the client's appearance and behavior since the last visit one year prior -- Sam appears more slovenly dressed and his memory seems to be failing. When the attorney asks Sam about how he is managing, Sam's responds, "everything is FINE!" At the end of the meeting Sam talks about how he is sure he will be winning the sweepstakes, after all he is in the finals of at least 30 different sweepstakes. The client's only daughter (Sam's agent for his DPoA) lives across the country and is not actively involved in her father's affairs. The attorney has Sam's permission to speak with his daughter.

OBSTACLES:

THAT'S NOT WHAT I WAS CALLED IN TO DO and besides that I DO NOT WANT TO UPSET AND POSSIBLY LOSE MY CLIENT BY CHALLENGING HIS VIEW OF HIS SITUATION

Value of referring to a PGCM :

Sam trusts you and that's why he has come to see you. In a "matter of fact" non-threatening manner, the elder law attorney can introduce the idea of a trusted colleague that he wants Sam to meet when he returns from his trip. The key here is to create trust without raising the elder adult's anxiety. Can the attorney think of any need that Sam might "buy into," with which the PGCM could be helpful, i.e. help with finding a housekeeper, or help with arranging for transportation services. If that doesn't work, if the attorney is truly concerned about the potential financial abuse, would s/he contact the client's daughter giving the PGCM's number to the daughter? The referral to a PGCM will reflect well on the attorney, while providing the client with quality professional assessment and care.

Consequences of not making a referral to a PGCM:

Because of a possible change in Sam's mental status, he may become a victim to financial abuse. His daughter may decide to get involved after the fact raising the question - Why didn't the attorney do something? At this point, there is more to lose than just one client.

SCENARIO II:

A new client's daughter, Betty comes into the office to discuss estate planning for herself and for her mother, Louise. Louise is exhibiting the early signs of Parkinson's Disease and is absolutely intransient when it comes to accepting care. Betty is frantic, wanting to be a good daughter, while at the same time wanting to respect her mother's wish for independence. Louise is not a candidate for a conservatorship and Betty is looking to the attorney to help convince her to agree to accept care.

OBSTACLES:

I DON'T REALLY KNOW WHAT THE ANSWER IS SO I BETTER NOT GET INVOLVED. And I DON'T REALLY HAVE TIME FOR THIS.

Value of referring to a PGCM:

You are not expected to know all of the answers, but wouldn't it be of value to you to have access to "key" senior resource people - PGCMs. Your clients are looking for solutions, someone who will understand her mother's health issues and the appropriate plan of care. A referral to a PGCM will reflect well on you, while providing your clients and their families with the personalized attention and expert care advice. Referring to a PGCM can save you time too, allowing you to focus on the area of your expertise.

Consequences of not making a referral to a PGCM:

Betty will continue to seek help, and will either eventually get connected to the right services through other professionals, or continue to suffer. Betty may start to question, why didn't my attorney at least point me in the right direction?

SCENARIO III:

George, a 58 year old client comes in to see his attorney re: personal estate planning matters. During the course of the conversation, he mentions that he is having real difficulties with his parents who want to stay at home; however, it is becoming increasingly difficult to manage the care. His mother suffers from dementia, and his father is beginning to show signs of strain, not following through with important matters. George is looking to you for advice and counsel.

OBSTACLES:

WHY SHOULD I CALL SOMEONE ELSE IN WHEN MY CLIENT IS ASKING FOR MY ADVICE?

Value of referring to a PGCM:

No one could argue that you know your client's needs best, and as a trusted professional, you're the one to whom they come for advice. George may expect you to suggest an expert who can help - that is a true sign of trust. Resistance to service is commonplace for the experienced PGCM and you can be assured that an expert in the eldercare field will address your client and his parents' needs quickly and effectively. It is not easy to refer out, especially to a service of which you may not be too familiar; however, a referral to a PGCM can ultimately save you time, and afford you "peace of mind."

Consequences of not making a referral to a PGCM:

Your response to George is vital. He feels he is in crisis, and is looking for a timely solution. If you cannot effectively provide him with the outcome he requires, it can mean a critical delay which can negatively impact his parents' situation.

SCENARIO IV:

Sally, a 82 year old recent widow, recently been moved from Boston to Los Angeles by her two children to be closer to them. She had just sold her home. She has set up a meeting with you to have you review her current trust, will and powers of attorney. She tells you that she is interested in staying in the lovely apartment. that her children have set up for her. She accurately feels she has the finances to manage, but doesn't want to rely on her children since they each have very busy schedules. She realizes that she needs help but doesn't know where to turn. She asks you about senior activities, and medical care referrals.

OBSTACLES:

I'M NOT REALLY SURE WHAT A PGCM ACTUALLY DOES, SO HOW CAN YOU EXPECT ME TO REFER MY CLIENT TO ONE? - I GUESS I'LL REFER HER TO THE LOCAL SENIOR CENTER .

Value of referring to a PGCM:

Sally needs help, and if you cannot provide it, who will? Local senior centers may be limited as to the scope of services that they are able to provide. If you are not familiar with PGCM services you owe it to yourself to invest the limited time it would take now - it will save you much more time later. It will additionally expand your referral base, and will provide your client with the personalized service she is looking for. If there was a profession that made it its' business to know the complete range of services for older adults, wouldn't you want to know about that service?

Consequences of not making a referral to a PGCM:

Personal touches are important. Many of your clients just may not want to receive services through a public agency. By referring a client to a local bureaucracy, it can send a negative message. Clients that don't feel that they are getting personalized services are the first to leave.

In order to create VALUE for the elder law attorney, the PGCM will tailor their approach to connect with the attorney to help solve their problems and best meet their needs. Our focus is on UNDERSTANDING the needs of the elder law attorney. To this end, there is exploration as to the attorney's role. Working together, Attorneys and PGCMs can better serve the needs of their clients, increasing the value of the attorney-client relationship, freeing up time for the attorney, and ensuring that due diligence is being performed to meet every client's needs.

Debra Sorensen, MSW, LISW, CMC, is a professional care manager and owner of Debra J. Sorensen & Associates Inc., a private geriatric care management company serving Northwest Ohio and Southeast Michigan. She can be reached at 419-367-8835 or e-mail Debra@professionalcareforyou.com.