using an attorney effectively in trust administration

Life Care Planning

May 3rd, 2011

750 University AvenueSuite 140

Los Gatos, CA 95032(408) 354-0200

www.css-lawfirm.com

Leslie Yarnes Sugai, Esq.

• Estate Planning– Planning for death and incapacity

• Long-Term Care Planning– Planning your estate and for the preservation of

your assets if you need long-term care• Life Care Planning

— Planning for the quality of your life and care, Planning your estate, and protecting assets if long-term care is needed

Three Levels of Planning

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• Trusts- Revocable and Irrevocable• Wills• Durable Power of Attorney• Advanced Health Care Directives

Estate Planning

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• Pre-Planning For Long-Term Care-Financial & legal concerns-Planning for eligibility for Medi-Cal and VA benefits

-Long-term care insurance considerations

Long-term Care Planning

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• An innovative, coordinated and holistic approach for addressing long term care needs

• Customized to your loved one’s situation

• Combines legal and financial planning while addressing personal and healthcare needs

• An on-going relationship between the law firm and the client

Life Care Planning

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How are my parents going

to manage when my father

can no longer drive?

Why Life Care Planning?

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Prevent Loss of

Autonomy

Reduce Burden on

Support System

Reduce Family Conflict

Prevent Duplicated,

UnnecessaryServices

Life Care

Planning

EnsureQuality of Life

and Peace of Mind

Resolve Issues with

Care Providers

Getting and Keeping Public

and Government Benefits

Avoid Inappropriate Placement

in an Overly Restrictive Setting

Asset Protection Planning

Help Slow Deterioration of

Health and Level of

Functioning

Assure Safety

A Life Care Plan Puts the Elder First

• Quality of Life– Assistance in making decisions regarding

long-term care needs and goals

• Quality of Care– Advocacy for good care whether at home

or in a facility

• Preservation of Assets– Assistance in finding and obtaining

resources to help pay for long-term care

Goals of Life Care Planning

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• Clients with a Current Health Crisis / Complex / Chronic Health Issues– Hospitalization / Injury– Multiple diagnoses with multiple treatments– Frequent medication and/or treatment changes– Medications prescribed by 2 or more providers– Multiple health care providers– Lack of health care advocate

Who would benefit from Life Care Planning?

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• Increased Need for Caregiver Support• Complex Family Dynamics / Poor Family Communication• New medical or care providers needed

– Dissatisfied with current provider– New to area– Change in benefits

• Lives Alone / Social Isolation– Loss of interest in socializing with family/friends– Loss of interest in outside activities

Clients with:

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• Attorney addresses the legal and financial issues involved in long-term care planning for the ill client

Role of the AttorneyLegal and Financial

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• Collaborates with client’s CPA and financial planner to budget private resources

• Identify, explain and evaluate client’s asset preservation options and consequences

• Review of existing long-term care insurance policies

Role of the AttorneyLegal and Financial

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Role of the AttorneyLegal and Financial

• Evaluates client’s eligibility and need for – VA benefits– Medi-Cal benefits– Other public benefits & community resources

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• Examine client’s current estate planning documents and update/replace as needed

Will, Living Trust, Durable Powers of Attorney, Advance Health Care Directive

• Prepare long-term care planning documentsIrrevocable TrustsPersonal Care Contracts

Role of the Attorney

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• Examine current asset structure with CPA/financial planner

• Consider options for financing care utilizing resources available

Role of the Financial Team

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• Address personal and health care needs• Coordinate with legal and financial team

members to assist clients in maintaining the best possible, health, safety, and well-being

Role of the Care Coordinator

Health and Personal Care

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• Comprehensive Assessment– Medical/Health/Physical Assessment

• Diagnoses• Medications

– Activities of Daily Living/Functional Needs• Housekeeping • Personal Care• Nutrition and food prep• Transportation

– Housing / Living Arrangement / Environment• Home safety assessment

Care Coordination

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• Psychosocial Assessment• Emotional concerns• Cognitive concerns• Socialization• Support system

• Legal and Financial Assessment• In coordination with legal team members

Comprehensive Assessment (cont.)

Role of Care Coordinator

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• Personalized Care Plan– Overall care goal– Concerns– Goals– Recommendations– Plan of action– Outcome/progress

Role of Care Coordinator (cont.)

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Legal and Financial ConcernsBill Paying

TrustsAdvance Health Care

DirectivesPower of Attorney

for Finances

Meals / Nutrition Shopping Cooking Clean Up

Mental HealthCognitive

DifficultiesEmotional Difficulties

Medical IssuesHospitalizations

Multiple DiagnosesAllergies

IncontinenceMultiple Doctors

Multiple Medications

HousekeepingCleaningLaundry

YardworkGarbagePet Care

Personal Care Dressing Bathing Toileting

Grooming

Environmental Concerns

SafetyFalls

DrivingFire Hazards

Transportation

Community Resources

Public BenefitsPrivate Assets

Social SupportIsolation

Caregiver DifficultiesComplex Family

DynamicsCommunication

Difficulties

CoordinatingCare Needs

• Referrals to Geriatric Specialists and Community Resources

• Education Regarding Aspects of Long Term Care– Regulations and rights– Advantages and disadvantages of

different long term care options• Advocacy in Long Term Care

Facilities– Attendance at care conferences– Coordination with social services and

medical staff to ensure proper care

Role of Care Coordinator (cont.)

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• Caregiver Education and Resources• Family Meeting Facilitation• Short Term Crisis Management

– Hospitalization– SNF discharge

Role of Care Coordinator (cont.)

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Why is the Care Coordinator Crucial to Life Care Planning?

•The Care Coordinator works with the family and professionals to ensure follow through of your loved one’s care (i.e. make sure an appointment with a physician is made and kept following a hospital stay or medication instructions are understood

•Your loved one may divulge things to Care Coordinator that may be uncomfortable for him or her to tell you (i.e. issues of incontinence or forgetfulness in leaving the stove on)

•The Care Coordinator can uncover trouble issues that may have been occurring for a long time and are now getting worse and needing intervention.

•The Care Coordinator can help your parents to get past the ‘saving for a rainy day’ mentality and understand this is the middle of a hurricane.

•The Care Coordinator understands the language that health and legal professionals speak and will use that knowledge to advocate on loved one’s behalf.

Meet with attorney and

elder care coordinator

Assessmentof needs

The Life Care Planning Process

FinancialPlanning Estate

Planning

Action Plan

6 monthfollow up

VABenefits

Addressproblemswith care

Annualassessment

Change inFinancialsituation

Medi-Calapplication

6 monthfollow up

Transition toALF / SNF

Address problems with care

Continue follow up

Janis CarneyLeslie Yarnes SugaiSheri Sudweeks

Thank you for coming

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