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The Doctor’s New Prescription: A Lawyer

March 21, 2013, 6:00 am
The Doctor’s New Prescription: A Lawyer
Courtesy of Yvonne Troya Maureen Lao, a student at the Hastings College of the Law in San Francisco, assisting a patient at the Lakeside Senior Medical Center outpatient clinic.
Consider the geriatricians working at the Lakeside Senior Medical Center, an outpatient clinic at the University of California, San Francisco. Many of their patients, despite multiple chronic diseases and advanced age, have never filled out power-of-attorney documents or appointed someone to make health care decisions if they are unable to.
Sometimes, the doctors suspect their patients might qualify for public benefits they are not getting, like food stamps or MediCal, the state’s version of Medicaid. Perhaps they face problems with landlords or appear to be victims of financial abuse, or they ought to have a simple will.
In other words, they need lawyers. But trying to get frail, low-income seniors to consult an elder attorney can seem an insurmountable problem. How will they travel to a law office? Or pay a fee that can reach $300 an hour? Even if the doctors can refer them to a legal aid office, will their elderly patients actually make an appointment? Then remember to go?
At Lakeside there is a simpler solution, said Sarah Hooper, who teaches at the University of California Hastings College of the Law. “The physicians do the initial screenings, hear what their patients’ problems are, take the history — and they essentially write a prescription: ‘Go down the hall and see my friends at U.C. Hastings for help with this housing issue,’ ” she said.
Each semester, eight Hastings law students spend 12 to 15 hours a week at the clinic, the Medical-Legal Partnership for Seniors. Supervised by both the law school and the U.C.S.F. faculty, the clinic “reduces so many barriers to getting legal help,” said the legal director, Yvonne Troya.
Since the partnership began in September, her second- and third-year students have worked with about 40 elderly clients. “They don’t trust lawyers,” Ms. Troya said, a bit ruefully. “But they really trust their doctors.”
One client was eligible for S.S.I., Social Security disability payments, but “we noticed she was only receiving about $600 a month when in California you can get $866,” Ms. Troya said. “She’d been just scraping by, living with relatives who are also very low-income.”
After Hastings students documented all her expenses and the error she had made in reporting them, and accompanied her to the local Social Security office, the woman’s monthly benefit rose by a third. “Such a practical difference for this person,” Ms. Troya said.
Her team is also working with a man with severe dementia and his wife, whose own health is deteriorating as she struggles to care for him. He receives 100 hours of paid home care a month through the state, which was sufficient for a while but not anymore. “This woman stays up all night when she really needs her sleep,” said Amanda Hamilton, a second-year student working with the couple. “The children come over and take time from their own families. It’s draining everyone.”
So Ms. Hamilton and her student partner have applied for more home care help, up to the maximum of 283 hours monthly. “It’s fairly complicated,” she said. “It has to be a really strong case.” But they think they have one.
Most clients, however, need advance directives, something even sick people in their 90s can be reluctant to think about. Sometimes, the lawyers-in-training find, it helps to make house calls. “Visiting them in their homes makes them a lot more comfortable,” Ms. Hamilton said. The students also participate in a seminar, taught by Ms. Troya and Ms. Hooper, and meet with clinic physicians.
Close to 100 medical-legal partnerships are already functioning at health care institutions and universities around the country, reflecting the idea that “there are so many social and economic factors that contribute to health,” Ms. Hooper said. “Focusing only on the biological factors isn’t going to solve anything.”
But the great majority of those partnerships work with children. The U.C.S.F.-Hastings clinic is one of a handful specializing in the elderly, along with programs at the University of Miami, Wake Forest University and the University of St. Thomas in Minneapolis.
You would think there would be more. In fact, Ms. Troya said she thought there soon would be.
On the one hand, we have an aging population, for whom understanding a legal document and getting it witnessed and notarized can be daunting — even if people don’t have to do battle over benefits. On the other, we have law schools scrambling for ways to give their students hands-on experience . These folks need each other.
“It’s a complicated area of law, with many overlapping issues — psychology, health care, family relationships,” Ms. Troya said. “It’s important for young lawyers to become knowledgeable about it. And practitioners tell us it’s a very rewarding field.”
Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”
The Doctor’s New Prescription: A Lawyer

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