Effective use of an attorney when professional fiduciaries are dealing with taxes, accountings and debts and creditor issues.

1. Life Care
Planning
May 3rd, 2011
750 University Avenue
Suite 140
Los Gatos, CA 95032
(408) 354-0200
www.css-lawfirm.com
Leslie Yarnes Sugai, Esq.

2. Three Levels of Planning
• 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
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3. Estate Planning
• Trusts- Revocable and Irrevocable
• Wills
• Durable Power of Attorney
• Advanced Health Care Directives
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4. Long-term Care Planning
• Pre-Planning For Long-Term Care
-Financial & legal concerns
-Planning for eligibility for Medi-Cal and VA
benefits
-Long-term care insurance considerations
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5. Life Care Planning
• 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
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6. Why Life Care Planning?
How are my
parents going
to manage when
my father
can no longer
drive?
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7. Prevent Loss Reduce Family Reduce Burden Prevent
of Conflict on Duplicated,
Autonomy Support System Unnecessary
Services
Avoid
Ensure Life Inappropriate
Quality of Life Placement
Assure Safety Care in an Overly
and
Peace of Mind Planning Restrictive Setting
Help Slow Asset Getting and Resolve Issues
Deterioration of Protection Keeping Public with
Health and Planning and Government Care Providers
Level of Benefits
Functioning
A Life Care Plan Puts the Elder First 7

8. Goals of Life Care Planning
• 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
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9. Who would benefit from
Life Care Planning?
• 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
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10. Clients with:
• 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
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11. Role of the Attorney
Legal and Financial
• Attorney addresses the legal and financial
issues involved in long-term care planning
for the ill client
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12. Role of the Attorney
Legal and Financial
• 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
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13. Role of the Attorney
Legal and Financial
• Evaluates client’s eligibility and need for
– VA benefits
– Medi-Cal benefits
– Other public benefits & community resources
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14. Role of the Attorney
• 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 documents
Irrevocable Trusts
Personal Care Contracts
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15. Role of the Financial Team
• Examine current asset structure with
CPA/financial planner
• Consider options for financing care
utilizing resources available
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16. Role of the Care
Coordinator
Health and Personal Care
• 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
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17. Care Coordination
• 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
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18. Role of Care Coordinator
Comprehensive Assessment (cont.)
• Psychosocial Assessment
• Emotional concerns
• Cognitive concerns
• Socialization
• Support system
• Legal and Financial Assessment
• In coordination with legal team members
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19. Role of Care Coordinator (cont.)
• Personalized Care Plan
– Overall care goal
– Concerns
– Goals
– Recommendations
– Plan of action
– Outcome/progress
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20. Coordinating
Environmental
Concerns Care Needs Mental Health
Safety
Falls Cognitive
Difficulties
Driving
Social Support Fire Hazards Emotional
Isolation Difficulties
Transportation
Caregiver Difficulties Meals /
Complex Family Nutrition
Dynamics
Communication Shopping
Difficulties Cooking
Clean Up
Community Legal and Financial
Resources Concerns
Bill Paying
Public Benefits
Trusts
Personal Care Private Assets
Medical Issues Advance Health Care
Dressing Directives
Hospitalizations Power of Attorney
Bathing
Toileting Multiple Diagnoses for Finances
Grooming Allergies
Incontinence
Housekeeping
Cleaning
Multiple Doctors
Laundry Multiple
Medications
Yardwork
Garbage
Pet Care
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21. Role of Care Coordinator (cont.)
• 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
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22. Role of Care Coordinator (cont.)
• Caregiver Education and Resources
• Family Meeting Facilitation
• Short Term Crisis Management
– Hospitalization
– SNF discharge
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23. 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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24. The Life Care Planning Process
Meet with
attorney and Assessment Financial
elder care of needs Planning Estate
coordinator Planning
Medi-Cal 6 month
application follow up
Change in Action
Financial
Transition to Plan
situation
ALF / SNF
Continue
follow up Address
problems
Annual with care
assessment 6 month
follow up
Address VA
problems
Benefits
with care

25. Thank you for coming
Janis Carney
Leslie Yarnes Sugai
Sheri Sudweeks
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