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Essential Resources for an Elder Law Practice

In this era of specialization, attorneys, much like physicians, are more effective if they concentrate their practice in a specific area.  As a former medical malpractice attorney, my need to keep current was concentrated much more in the medical aspects of my case, rather than the legal aspects.  Most medical malpractice and personal injury attorneys do not need to reach out to other attorneys or other professionals to assist them in their representation of their client.  In fact, there is not that much client contact in a personal injury/medical malpractice matter.  The field of elder law is completely different.  Not only do we have a tremendous amount of client contact, our clients look to us for resources to assist them.  As such, we are much like primary care physicians or ‘gatekeepers’.   These contacts and resources can be broken down into two categories:  professionals and resources directly related to elder law issues and those that are not directly related to elder law issues.   Resources directly related to an elder law practice:  
  1. Facilities.  Since many of our clients come to us because a loved one needs care, we not only counsel them in regard to the legal issues, but our clients look to us for information about skilled nursing facilities, assisted living facilities, assisted living programs, and home care agencies.  We need to be able to tell them which are geographically desirable for them and the weak and strong points of each facility.  In particular, it is important to know which facilities have dementia units.  The reputation of each facility changes often and keeping current is important.
  2. Home care agencies and home care aides.  Having been the caregiver for my mother for years, I had direct contact with many aides.  As a result, I often make recommendations for private aides, rather than having a client go through home care agencies.  In my experience, many of the aides that came from agencies were not up to par.  Thus, a recommendation to a good home care agency and/or good aides is essential.
  3. Geriatric Care Managers.  Many children either do not live in close proximity to their parents or do not have the wherewithal to oversee their parents’ care.   Geriatric Care Managers provide an essential service in terms of taking the place of the child as well as providing evaluations so that the family better understands the person’s needs.
  4. Hospice providers and facilities.  I have learned through my clients and then through my personal experience, that hospice programs provide many wonderful services.  What I also learned is that many patients are eligible for hospice care much sooner than most people would think.  My mother was on hospice in the community for about four years.
  5. Bedbound patientsIf a patient is bed-bound or even home-bound, clients may need physicians who will make home visits.  There is a wonderful program that I used through North Shore LIJ Home Care Services, known as “Housecalls”, and the physicians and the support staff from that program were wonderful.
  6. Completing and submitting a Medicaid application.  Although many elder law attorneys prepare and submit Medicaid applications, there are many who do not.  As such, clients will look to us to provide the names of professionals who are competent in preparing and submitting Medicaid applications.
  7. Placement in a skilled nursing facility.  Elder law attorneys often assist and expedite the placement of clients into a skilled nursing facility.  Nursing homes are more comfortable accepting new residents who are working with an elder law attorney with whom they have confidence.
  8. Programs for young disabled.  Elder law attorneys also work with younger clients who are developmentally disabled, mentally ill, or have suffered traumatic brain injury.  There are programs that provide services to the young disabled and an elder law attorney should be familiar with those services and programs.
  9. Support Groups. Organizations, such as the MS Society, the Alzheimer’s Foundation, the Alzheimer’s Association, and Stroke Clubs in hospitals, offer support groups to family members of those suffering from these various diseases.  These support groups are of tremendous assistance and being familiar with them and educating our clients about them is a great service as well.
  10. Colleagues/List Serve.  It is imperative that we, as elder law attorneys, use all resources available to us.  This includes our colleagues. The New York State Bar Association has a list serve for elder law attorneys which is a very helpful resource to get answers to questions and keep current.
  Resources not directly related to an elder law practice:  
  1. Medical malpractice and personal injury attorneys.  A client can be the victim of medical malpractice or suffer an injury as a result of another’s negligence.  In particular, there are many accidents related to falling out of beds when in a facility or bed sore cases, as well as abuse by caregivers and facilities.  As such, it behooves us, as elder law attorneys, to be familiar with attorneys who have an expertise in medical malpractice and personal injury and in particular those attorneys who handle nursing home cases pursuant to the Public Health Law.
  2. Matrimonial attorneys. Most of my clients have not pursued divorce because of illness and disability.  Nevertheless, especially when a client is in a second marriage, it is often important to be able to refer clients to a matrimonial attorney.
  3. Criminal law attorneys.  For those clients who have been victims of abuse – physical as well as financial - by a family member, a trusted friend, or a stranger – it is often helpful to consult an attorney who is knowledgeable in these matters.
  4. Real estate attorneys.  Many of our clients need to transfer real property or sell their home when they enter a facility or when they are no longer able to live in the home.  If your law firm does not handle real estate matters, it is helpful to affiliate with an attorney who does.
  5. Investment advisors.  Children who take responsibility for the management of their parents’ finances may not be familiar with a broker or a financial advisor and may not have the ability to adequately manage the funds.  Accordingly, being familiar with a competent investment advisor is essential.
  6. CPAs and fiduciary accountants.  CPAs and fiduciary accountants are professionals with whom we often work in regard to the preparation of personal income tax returns and fiduciary income tax returns, if an elder law attorney’s firm does not prepare them.
  7. Real estate brokers.  Many of our clients need to sell their home and knowing reputable real estate brokers is helpful.
  8. Appraisers.  We often need to obtain real estate appraisals not only when the house is sold but particularly if the house is sold to a family member or in regard to the filing of a gift tax return or an estate tax return.
  9.  Business evaluations.  Some of our clients own businesses and the need for a professional to evaluate a business becomes clear when we administer an estate and/or submit a Medicaid application.
I am sure that I may have omitted essential resources from these lists.  As Elder Law attorneys, we not only need to remain current with the changes in the law, we must provide our clients with resources to get them through what is a very difficult time for them.