You Have Your Role and We Have Ours: Cultivating Successful Relationships with Elder Law Attorneys
By Steven Barlam, MSW, LCSW, CMC
When I was asked to write an article by the guest editor on "how I work with elder law attorneys," I decided that I would focus my thoughts on how to develop successful relationships with elder law attorneys. Elder law attorneys are a vital referral source to all geriatric care managers (GCMs) and developing positive relationships are integral for any practice. In the last two years of my 15 years of practice in the for-fee care management arena, I have especially focused my attention at developing a three step process for successfully cultivating relationships with attorneys as described in the following article.
There are times older adults and or their families meet with estate planning/elder law attorneys and raise often complicated eldercare issues. As a GCM, it is easy to see how care management can provide great value to all involved; however, there are occasions when these needs are raised in the attorney's office and care management is never discussed. Why not? Why wouldn't an allied professional want to refer a client to a service that could offer real solutions to difficult problems?
When communicating to consumers about GCM services, we often use the line: "you have your role, and we have ours." The focus of this message is that you should be able to get back to being the son or daughter and allow the professionals to deal with the personal care/nursing and management of the care.
In the same way, this message is just as potent when communicating with allied professionals about why they should make use of our services. We realize that they sometimes are called upon to provide advice and/or services that may be outside of their skill/experience set. It takes them away from what they do best — their role.
We each come to the table with distinctive skills that add value to our clients - helping them to solve their problems. However, we cannot be everything to everyone. We need to be clear of our areas of expertise and know when to reach out to allied professionals.
Most clients want user friendly "one-stop" shopping, and therefore, they will ask for advice from a trusted source. Sometimes the traditional boundaries are stretched so that the professional can provide one's valued clients with the information and services they seek. This can result in the best case, spending extra time researching the resources; and in the worst case, providing the client with less than expert advice/service.
At our company, LivHOME, our professional team has invested in understanding the referral source, in order to maximize the relationship, and thus be able to expand our client base. The remainder of this article examines a process by which the GCM can most effectively cultivate successful relationships with elder law attorneys. The three steps include: 1) understanding both our and the attorney's unique roles/domains of expertise; 2) understanding the needs of the attorney; and 3) understanding what the potential obstacles may be and be prepared to address them with examples that demonstrate value to the attorney.
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I. Understanding the Roles:
GCMs must understand our unique roles, and domains of expertise in order to communicate it with ease to allied professionals, such as elder law attorneys. Our appeal comes from outlining for them the value that we each bring to the situation — and the increased value of collaboration. It is impossible at best to enter into a meaningful discussion about value if we are not clear about our own respective roles.
The GCM's Role (domains of expertise):
- comprehensive psycho-social assessments,
- care needs assessment,
- care plan of treatment,
- care coordination,
- resource expert,
- liaison between elder/family and community based medical, social, legal, and financial services,
- facilitating communication amongst all involved professionals,
- screening for risk factors (depression, nutrition, falls, abuse, home safety, and mental status/capacity),
- monitoring for medical changes and symptoms of deterioration,
- arranging for in-home care and/or alternative living arrangements,
- client advocacy,
- counseling, support and education to the elder and involved family.
The Elder Law Attorney's Role (domains of expertise):
- assessing for legal needs,
- estate planning (tools include: wills, trusts, powers of attorney, etc…),
- public benefits planning,
- conflict resolution and/or mediation services,
- assisting at the time of lost capacity,
- tax planning,
- petitioning for conservatorship/guardianship,
- elder custody issues,
- property matters,
- counseling, support and education of the elder and involved family,
- post death estate management,
- elder abuse issues.
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II. Understanding and Identifying the Need
After being clear about our respective roles, we can start to identify what is the need or problem facing the attorney. The needs fall into three primary categories:
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Wanting to best serve the client.
No one person can meet all of their clients' needs. Trying to do this alone can lead to less than superior quality. Reaching out to allied professionals can help you better serve your clientele. Once an eldercare problem is recognized, why wouldn't anyone want to offer a solution to best respond to the client's need?
Ignoring a situation doesn't help. In fact, it may negatively impact your elder client's day-to-day situation.
There are times that the GCM is called in to evaluate the care situation for an elder client receiving inappropriate levels of care. Through our expert knowledge of community resources, we can help recommend solutions that can ultimately save the client time and money while additionally providing them with a greater sense of "peace of mind."
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Wanting to grow and sustain your client base.
GCMs can help you address the eldercare issues effectively, reflecting well on you. Clients' satisfaction is essential, if you don't address the issues at hand, a situation can deteriorate, leading to dissatisfaction and client attrition.
Having a GCM making regular visits helps you keep a finger on the pulse of the situation. Without the GCMs professional eyes and ears, problems arise with no one to keep you in the loop leading to lost business.
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Wanting to reduce your liability.
GCMs can provide you with a professional assessment complete with specific suggestions to support your recommendations and help strengthen your counsel to elder clients and/or their families. Without support from colleagues, you can potentially open yourself up to undue liability.
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III. Understanding the Obstacles
There are real reasons and obstacles that face our profession as to why elder law attorneys may choose not to refer. The first step in overcoming the obstacles relates to understanding them. The following examples of "real" client situations are used to demonstrate a sampling of underlying obstacles, and specific approaches to the obstacles that have proved to be effective.
Scenario I:
Sam, a long-time estate-planning client meets with his attorney to update his will, prior to a trip. The attorney notices that there have been some noticeable changes in the client's appearance and behavior since the last visit one year prior — Sam appears more slovenly dressed and his memory seems to be failing. When the attorney asks Sam about how he is managing, Sam's responds, "everything is fine!" At the end of the meeting Sam talks about how he is sure he will be winning the sweepstakes, after all he is in the finals of at least 30 different sweepstakes. Sam's only daughter (Sam's agent for his DPoA) lives across the country and is not actively involved in her father's affairs. The attorney has Sam's permission to speak with his daughter.
Obstacles:
That's not what I was called in to do and besides that I do not want to upset and possibly lose my client by challenging his view of his situation.
Value of referring to a GCM:
Sam trusts you and that's why he has come to see you. In a "matter of fact" non-threatening manner, the elder law attorney can introduce the idea of a trusted colleague he wants Sam to meet when he returns from his trip. The key here is to create trust without raising the elder adults anxiety. Can the attorney think of any need that Sam might "buy into," with which the GCM could be helpful, i.e. help finding a housekeeper or help arranging for transportation services. If that doesn't work, if the attorney is truly concerned about the potential financial abuse, would the attorney contact the client's daughter giving the GCM's number to the daughter? The referral to a GCM will reflect well on the attorney, while providing the client with quality professional assessment and care.
Consequences of not making a referral to a GCM:
Because of a possible change in Sam's mental status, he may become a victim to financial elder abuse. His daughter may decide to get involved after the fact raising the question, why didn't the attorney do something? At this point, there is more to lose than just one client.
Scenario II:
A new client's daughter, Betty, comes into the office to discuss estate planning for herself and for her mother, Louise. Louise is exhibiting the early signs of Parkinson's Disease and is absolutely intransient when it comes to accepting care. Betty is frantic, wanting to be a good daughter, while at the same time wanting to respect her mother's wish for independence. Louise is not a candidate for a conservatorship and Betty is looking to the attorney to help convince her to accept care.
Obstacles:
I don't really know what the answer is so I better not get involved, and I don't really have time for this.
Value of referring to a GCM:
You are not expected to know all the answers, but wouldn't it be of value to you to have access to "key" senior resource people: GCMs. Your client is looking for solutions, someone who will understand their mother's health issues and be able to prepare the appropriate plan of care. A referral to a GCM will reflect well on you, while providing your clients and their families with the personalized attention and expert care advice. Referring to a GCM can save you time too, allowing you to focus on the areas of your expertise.
Consequences of not making a referral to a GCM:
Betty will continue to seek help, and will either eventually get connected to the right services through other professionals, or continue to suffer. Betty may start to question, why didn't my attorney at least point me in the right direction?
Scenario III:
George, a 58-year old client, comes in to see his attorney regarding his personal estate planning matters. During the course of the conversation, he mentions that he is having real difficulties with his parents who want to stay at home; however, it is becoming increasingly difficult to manage the care. His mother suffers from dementia, and his father is beginning to show signs of strain, not following through with important matters. George is looking to you for advice and counsel.
Obstacles:
Why should I call someone else in when my client is asking for my advice?
Value of referring to a GCM:
No one could argue that you know your client's needs best, and as a trusted professional, you're the one to whom they come for advice. George may expect you to suggest an expert who can help is a true sign of trust. Resistance to service is commonplace for the experienced GCM and you can be assured that an expert in the eldercare field will address your client and his parents' needs quickly and effectively. It is not easy to refer out, especially to a service of which you may not be too familiar. However, a referral to a GCM can ultimately save you time, and afford you and your client "peace of mind."
Consequences of not making a referral to a GCM:
Your response to George is vital. He feels he is in crisis, and is looking for a timely solution. If you cannot effectively provide him with the outcome he requires, it can mean a critical delay that can negatively impact his parents' situation.
Scenario IV:
Sally, an 82-year old recent widow was recently moved from Boston to Los Angeles by her two children to be closer to them and sold her home. She has set up a meeting with you to have you review her current trust, will and powers of attorney. She tells you that she is interested in staying in the lovely apartment, that her children have set up for her. She accurately feels she has the finances to manage, but doesn't want to rely on her children since they each have very busy schedules. She realizes that she needs help but doesn't know where to turn. She asks you about senior activities, and medical care referrals.
Obstacles:
I'm not really sure what a GCM actually does, so how can you expect me to refer my client to one? I guess I'll refer her to the local senior center.
Value of referring to a GCM:
Sally needs help, and if you cannot provide it, who will? Local senior centers may be limited as to the scope of services that they are able to provide. If you are not familiar with GCM services you owe it to yourself to invest the limited time it would take now it will save you much more time later. It will additionally expand your referral base, and will provide your client with the personalized service she is looking for. If there was a profession that made it its business to know the complete range of services for older adults, wouldn't you want to know about that service?
Consequences of not making a referral to a GCM:
Personal touches are important. Many of your clients just may not want to receive services through a public agency. By referring a client to a local bureaucracy, it can send a negative message. Clients that don't feel they are getting personalized services are the first to leave.
In order to create value for the elder law attorney, the GCM must tailor their approach to connect with the attorney demonstrating how we can help solve their problems and best meet their needs. There is clearly no one right approach, it truly depends on the specific needs. At LivHOME, we take a lot of time listening and assessing the needs of the elder law attorney. We are careful not to sell too quickly. Our focus is on understanding the needs of the elder law attorney. To this end, there is exploration as to the attorney's role. Once the GCM can identify the top one or two needs, the next step is anticipating and understanding potential objections. By taking the time to identify roles, understand needs, and anticipate potential objections, the GCM will be armed with "real case examples" to demonstrate the value of our collaborative approach, which will ultimately lead to an increased client base.
Steve Barlam, received his advanced degree from UC Berkeley and has worked for the last 15 years exclusively in the field of geriatric care management. He is certified (CMC) and licensed (LCSW). His experience has been drawn from work in both the non-profit family service arena as well as his own private, for-profit care management firm. He is a current board member of the Stroke Association. And he also sits on the board of directors of the GCM as Treasurer, as well as presiding as regional chapter president of the same organization. He is actively involved in the professional credentialling process for care managers (NACCM). Mr. Barlam is a well-recognized leader and lecturer in the field of geriatric care management and is professionally active at both the local and national level. He currently is the Chief Professional Officer of LivHOME a "one-source" eldercare solutions company, a company that he co-founded with offices in Los Angeles, Orange County, Santa Barbara, and Ventura County.
Reprinted with permission by the National Association of Professional Geriatric Care Managers. Originally printed in the GCM Journal, Winter 2001 Edition.
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