Nov. 20, 2019 – Thanksgiving and the winter holidays are just around the corner, bringing with them social gatherings and expressions of gratitude. The season also reminds many people that time hasn’t paused while they’ve been busy with their lives: everyone is still getting older.

Be ready to help family and clients with aging-related legal concerns with Advising Older Clients and Their Families, published by State Bar of Wisconsin PINNACLE^®.

Here are a few examples of the concerns that might arise for you and your clients:

Should Mom or Dad Still Be Living at Home?

Holiday gatherings can be an ideal time to find out if older family members are still capable of residing in their own house with no outside aid or whether they would benefit from some (or a lot of) assistance. If the answer is “help is needed,” Advising Older Clients will guide you through the types of assistance that are available and how to pay for these services.

Signs that a person might need help with daily activities include difficulty walking up or down stairs, poor personal hygiene, spoiled food in the refrigerator, and not turning off the stove after use. If you notice any of these signs and are new to elder care, turn first to Chapter 3 of Advising Older Clients, which provides an overview of Wisconsin’s elder support network.

The sections on information and assistance are particularly useful when you are at the very beginning of the elder care journey. These sections identify the Wisconsin and national entities you or a client can call or visit. Often, it’s not clear whether an older person actually needs help or which kinds of help are appropriate, so it might be worthwhile to have a geriatric assessment done.

If it is obvious that a person can no longer live alone or without assistance, Chapter 17 (Community-Based Long-Term Care Programs) and Chapter 18 (Long-Term Care Facilities: Regulation) help

determine the type of care necessary, and how to evaluate the safety and appropriateness of various programs and facilities.

Care is Needed, But How Do We Pay?

Perhaps it’s already obvious that health care or long-term care is needed: Dad’s knee is causing him excruciating pain; Uncle Joe grouses every year about his diabetes; Grandma has been calling to ask if you can check her house for intruders, and she has stopped going to the grocery store. When you ask why Dad hasn’t had knee-replacement surgery or Joe isn’t taking medication to lower his blood sugar or Grandma doesn’t have any outside help, the answer may be, “We can’t afford it.”

When hearing these types of comments, delve into Advising Older Clients Chapter 10 (Medicare), Chapter 11 (Medicaid), and Chapter 14 (Selected Estate Planning Issues for Older Clients) before holiday gatherings.

Chapter 10 will help guide you through Medicare enrollment and coverage. You’ll learn that the costs of knee-replacement surgery will almost certainly be covered 100 percent, but that post-surgery rehab in a residential facility might not be (see discussion of the three-day rule in sections 10.63 and 10.67), so Dad should anticipate recovering at home with an unpaid caregiver’s help or check his secondary insurance (if any) for coverage. You likely won’t be able to magically eliminate the cost of diabetes medications, but you should be able to provide guidance on the ins and outs of Part D prescription drug plans, discussed in sections 10.179-221.

Issues such as Grandma’s can be especially challenging to resolve, because the solutions are indisputably expensive. But you can possibly help save her tens or hundreds of thousands of dollars by learning how much long-term care actually costs, familiarizing yourself with Medicaid divestment (discussed in chapters 11 and 14), discouraging spending or investing that might result in Medicaid ineligibility, and providing the names and phone numbers of colleagues who focus on elder law or estate planning.

Who Will Make Decisions for Us When We Can No Longer Do So?

Holiday get-togethers often bring up memories of previous gatherings and hopes for the future. They can be a thoughtful atmosphere for talking about end-of-life planning. Often, this is not a comfortable conversation. But remember: Powers of attorney for health care (POAHC) are designed to be used when a person lacks capacity to make his or her own decisions, and if the person waits until they’re incapacitated, they probably will also no longer be competent to create the document.

Chapter 15 of Advising Older Clients covers this and many other issues related to health care powers of attorney and advance directives that you might bring up when starting or continuing this essential conversation.

Perhaps everyone at your table will be on board for the why but confused about the what and the how. Based on your study of sections 15.72-83, you’ll be able to explain that a POAHC should cover topics such as a person’s feelings about use of life-support devices and artificial nutrition (such as feeding tubes), admission to long-term care facilities, and receipt of hospice services.

You’ll also be able to tell people where to obtain the state-approved POAHC form or suggest that they hire a lawyer to create a custom-designed document instead. In addition, you can outline the procedural requirements, including which categories of individuals can and cannot, under state law, serve as health care agents; who can be a witness; and how to revoke a POAHC.

Find Both Time-tested Guidance and Up-to-the-minute Developments

Whether you focus solely on elder law or deal with aging-related legal matters on an as-needed basis amid a more general practice, you’ll save time and increase your value to clients by consulting Advising Older Clients and Their Families.

Along with the topics above, recently supplemented volume II of Advising Older Clients covers:

• veterans’ benefits (Chapter 12);

• other health care financing options (Chapter 13);

• guardianships and protective placements (Chapter 16); and

• the basics of evaluating negligence claims for older adults (Chapter 19).

Volume I, currently being revised, contains an overview of elder law practice, discusses special ethical considerations when clients might have age-related impairments, highlights many of the public and private elder-support resources, and surveys housing and family law issues and governmental income-security programs that are relevant to aging adults.

How to Order

Advising Older Clients and Their Families Volume I and Volume II is available in print or online via the PINNACLE subscription-based online library, Books UnBound^®. The print book costs $235 per volume for members and $295 for nonmembers (plus tax and shipping). The prices for the set are $349 (members) and $439 (nonmembers).

Annual subscriptions to Books UnBound®, the State Bar’s interactive online library, start at $175 per title and $869 for the full library (single-user prices; call for law-firm pricing).

For more information or to place an order, visit the WisBar Marketplace or call the State Bar at (800) 728-7788 or (608) 257-3838.