Twenty years ago, health policy wonks shared a novel idea: could we make healthcare better if we put the patient at the center of care? Initial studies in person-centered care yielded intuitive yet surprising findings: if you ask people what they need and then listen, their health improves. A holistic approach, recognizing that people and medical providers can work together on shared goals, was good medicine. And 20 years later, patient-centered models of care have yielded better, higher quality healthcare at a lower cost to healthcare systems.
These innovations are not perfect — and they weren’t entirely new when policymakers started to enshrine them into laws such as the Patient Protection and Affordable Care Act of 2010 and the American Recovery and Reinvestment Act of 2009. As former CMS Administrator Don Berwick described in a Health Affairs op-ed, person-centered care can involve “radical, unfamiliar, and disruptive shifts in control and power, out of the hands of those who give care and into the hands of those who receive it.”
The push for those who receive care to be better heard has roots in patient-advocacy movements. You might pin the start in 1969 when activist Mary Lasker placed ads in the Washington Post and the New York Times: “Mr. Nixon: You can cure cancer.” Her voice and those like her spurred the President to launch the “War on Cancer” and groundbreaking legislation in 1971 to form the National Cancer Institute.
Disability advocates might look to the 1980s and 90s for more examples of how the individual’s voice transformed an industry. HIV activists, working through groups such as ACT UP (the AIDS Coalition to Unleash Power), moved the course of the FDA, the CDC, and global health organizations. Advocates for accessibility made their voices heard through the passage of the Americans with Disabilities Act and its corresponding legislation in the early 1990s. Grassroots advocacy planted the seeds that sprouted into the movement we now call “person- and family-centered care.”
Are we facing a similar paradigm shift in the practice of law? Movements like #FreeBritney, borne from public interest in complex legal structures such as guardianship, share some common threads. Legal innovators like Avvo have created directories of lawyers much more expansive than your state bar directory, including a five-star review system like Uber or Yelp. Some health systems may even plan to skip the attorney altogether — addressing advance care planning through the lens of social and behavioral health issues.
How we meet this challenge will define the role that NAELA plays as America continues to age. Perhaps more than other legal association, NAELA’s foundation in the Aspirational Standards mirrors the innovative call of physicians and policymakers at the turn of the century.
Better business in elder law means holistic models of legal service delivery. Our standards pave the way for this model of legal service delivery. Elder and special needs law attorneys should consider the “extra-legal context” in which problems exist and must be solved, considering what non-legal services might accomplish the goals of representation and how family caregivers and others can support the client’s needs. NAELA attorneys manage conflict by looking for harmony between what a client needs and wants and what is possible through legal tools.
NAELA members have an opportunity to be on the cutting edge of legal practice as our society ages. Where others might stay with the “Blockbuster” way of delivering legal services, we’re already the Netflix. The next big question is where we go from here.