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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.
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• 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
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• 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
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• 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.
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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
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Janis CarneyLeslie Yarnes SugaiSheri Sudweeks
Thank you for coming
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