An example of how a life resource planning team works together
By Thomas Day
The National Care Planning Council
The success of any life resource plan — whether for individuals who are wealthy or individuals who are not — relies on two key advisors. They are a geriatric services specialist (often called a care manager) who provides case management for aging seniors and an individual who understands finances and estate planning directed towards the final years of life.
The key advisors — geriatric services specialist and financial/legal specialist — dovetail their knowledge and experience to provide comprehensive solutions for the final years of life.
However, the multitude and diversity of aging services in the community makes it impossible for these two individuals alone to have the experience or knowledge to provide all services needed to support aging seniors. The key advisors will work with a cadre of other providers and advisors who can help fill in the needs a life resource plan will uncover.
The two key advisors provide a gateway to an entire team of professionals for care planning, financial analysis, legal work, additional sources of funding, support in the home, maintenance and yard work, downsizing, fiduciary services, home renovation, medical equipment and so on.
Mary is taking care of her aging husband at home. He has diabetes and is overweight. Because of the diabetes, her husband has severe neuropathy in his legs and feet and it is difficult for him to walk. He also has diabetic retinopathy and, therefore, cannot see very well.
She has to be careful that he does not injure his feet since the last time that happened, he was in the hospital for four weeks with a severe infection. Because of his weight and the neuropathy, she is having difficulty helping him out of bed and with dressing and using the bathroom. She relies heavily on her son, who lives nearby, to help her manage her husband's care.
A friend tells Mary about a local alliance of advisors and professionals that provides life resource planning. The cost of an initial assessment and plan from the life resource planning team is $950. Mary thinks this cost is excessive and she is content to press on and solve her problems herself.
One day, Mary is trying to lift her husband and injures her back severely. She is bedridden and cannot care for her husband. Her son, who works full time, now has two parents to care for. On the advice of the same friend, he decides to bring in the team and pay the fee himself.
The key advisors of the life resource planning team consist of the following:
Jim — a Certified Life Resource
Sharon -— a geriatric services specialist
Jim initially meets with Mary and her son and goes over the concept of life resource planning and shows them a sample plan. They agree that this sort of planning will be extremely useful to helping them manage Mary's increasing challenges. The plan will also uncover funding sources and sources of services of which Mary and her son are completely unaware. Jim does an intake questionnaire and starts the process of analyzing and completing the plan. In the meantime, Sharon, the geriatric services specialist, does an on-site assessment of the family's needs. Based on Jim's planning survey and questionnaire and Sharon's assessment, a plan is put together and presented to Mary and her son. Jim and Sharon uncover a myriad of issues and have a number of specific recommendations. Because of the nature of this particular case, Sharon, the geriatric services specialist, must be involved in directing the support services of the other members of the life resource planning team.
Sharon has been in the home and been paid part of the planning fee to do a thorough assessment of the needs. She will be paid additional money by Mary for providing ongoing case management. She arranges for Mary's doctor to order Medicare home care — another member of the life resource planning team — during Mary's recovery. Therapists come in and help Mary with exercises and advice on lifting.
Sharon advertises for and finds a private individual who is willing to live in the home for a period of time to help Mary with her recovery and watch over her husband. Sharon is diligent, ensuring the new caregiver is reliable and honest and that taxes are paid for the employment. Sharon makes sure, with the help of the team attorney, that a proper care contract is in place for the services. Sharon enlists the support of the local area agency on aging and makes sure all services available are provided for the family.
Sharon also calls a meeting with Mary's family and explains to them the care needs and how they need to commit to help with those needs. Because other members of the family seem to be in dispute, another member of the team, a mediator, is scheduled to help the family come up with a family care agreement and provide their support and resources.
Sharon makes arrangements with another member of the life resource planning team to rent or purchase medical equipment for lifting, moving and easier use of the bathroom facilities. Medicare will pay much of this cost.
Sharon suggests using a geriatric care physician she works closely with to help Mary in the care of her husband. The geriatrician meets with Mary and her husband and spends a great deal of time explaining the proper treatment and care of elderly individuals with diabetes.
He rearranges medications and puts Mary's husband on a new insulin regimen to better control his blood sugar. The physician starts a strict diet and insists on weight loss and exercise. The previous doctor seemed more interested in treating symptoms than in changing lifestyles. The geriatric physician feels that Mary's husband has a chance of improving his health with proper treatment.
Sharon arranges for a private duty professional home care provider to come in on weekends to spell off Mary and her employed caregiver and give them both needed rest.
Sharon also recommends another member of the life resource planning team, who provides a medical alert device in case Mary has to leave the home and is not there when her husband is having difficulties or falls. Yet another member of the team, a remodeling and repair specialist, comes in to install handrails and widen doorways so that Mary's husband can use a motorized scooter instead of relying on Mary directly for his ambulation. Sharon helps Mary with the Medicare application for the motorized scooter.
Jim, the certified life resource planner, is also working with Mary and her son to solve financing, asset preservation and legal needs. He arranges for an appointment with Kevin, the team attorney specializing in elder law, to prepare documents for the family including powers of attorney, a living will and to provide advice and assistance on preserving Mary's remaining assets.
Jim recommends a reverse mortgage specialist on the team to help Mary and her husband tap unused assets in their home's equity. Jim has also discovered that Mary's husband is a veteran and his planning analysis has uncovered that Mary's husband will qualify for additional income from VA. Jim engages the appropriate specialists to help the family get the additional cash income benefits from VA as well as VA health care services and a VA home renovation grant.
Some reverse mortgage proceeds are used to pay off debt. The remaining proceeds are converted into income with a single premium immediate annuity in order to provide Mary adequate income when her husband is gone and she loses one of the Social Security payments. Still more reverse mortgage money is set aside for a Medicaid funeral trust that will protect those assets from Medicaid spend down.
Jim discusses with Mary the possibility of other living arrangements for her husband in the event his care cannot be managed any longer at home. This potential move might require the services of other members of the team, such as help with downsizing and moving and selling the property if necessary and finding the right advice about where to live. Jim goes into detail on end-of-life planning, which could include planning the funeral and burial, the need for other services from the team, such as a hospice provider and so on. All of these additional services are provided by members of the life resource planning team. All other private and government funding options are also addressed. If Mary's husband needs to go to a nursing home, this is addressed also, as well as the potential need for a Medicaid application.
Jim has put together a plan for Mary and her son to deal with Medicaid and the implications on her assets and property. Mary is very interested in preserving what few assets she has left from Medicaid spend down and recovery. She is extremely grateful for Jim's assistance in this area.
With the help of the life resource planning team, Mary's life and future have been significantly improved. Her husband, as well, if he adheres to the care plan, may end up having a better quality of life for his remaining years.
In the above example, medical services, legal and financial services, case management services, government aging services and government VA and Medicare came together to provide improved conditions for the final years of life with numerous unexpected bonuses for Mary and her husband.