by Janice Bressler
“Access to legal help can sometimes be as important for an older adult’s health and well-being as any doctor’s checkup or surgical procedure,” according to Yvonne Troya, J.D., legal director of the Medical-Legal Partnership for Seniors, a free legal clinic for older adults with two outposts in the Richmond District.
“But, the obstacles to getting that legal access can be insurmountable for older San Franciscans with limited mobility and restricted income,” Troya said.
The Medical-Legal Partner ship for Seniors, or MLPS as it is known, is working to help seniors overcome those obstacles by using a new model for delivering legal help to vulnerable populations.
Started as a collaboration between lawyers at U.C. Hastings Law School and doctors at the University of California, San Francisco Medical Center (UCSF), MLPS reaches seniors who need legal help by working with doctors and health care providers at UCSF and SF Veterans’ Administration Medical Center (V.A.).
“We partner with V.A. and UCSF health care providers and help them learn to identify situations where a legal intervention could improve a patient’s health,” explains Troya, a law professor at U.C. Hastings. “If the patient is interested in speaking with someone from our program about legal help, the doctor submits the patient’s authorization to us and then we reach out to the senior.”
This outreach method is a key component of the program’s success, according to Troya. “On our first visit with a client we do a comprehensive legal checkup. We look at the client’s overall situation, long-term as well as immediate, and identify legal tools that could benefit them, including advanced care directives and financial planning, eligibility for benefits and strategies for maintaining those benefits. Many of our seniors are eligible for benefits that they didn’t even know about.”
Meetings with clients are often done at the senior’s home or hospital room, but MLPS advocates also see clients in offices at the V.A. Medical Center on Clement Street and the Institute on Aging, located on Geary Boulevard.
Alba Estela Perez-Gomez, a resident of the Richmond District for more than 40 years, is one of the more than 500 seniors who have received legal help from MLPS. Perez-Gomez is currently working with MLPS advocates on an insurance coverage problem, but she has already been successfully represented by MLPS on a number of different issues.
“I trust the MLPS lawyers, Yvonne and her students, very, very much,” she says.
Clients at MLPS receive counsel and representation from advocates on a wide range of civil legal problems, including benefit issues; landlord-tenant disputes; nursing home discharge issues; conservatorship proceedings; advance health care planning; and financial planning.
According to Troya, advance health care directives and durable powers of attorney for finances can help an older adult avoid serious problems should they ever become incapacitated or unable to care for their daily needs.
“When our clients can appoint a trusted person to make financial and/or health care decisions on their behalf they can often be spared the expense and heartache of going to court in a conservatorship proceeding, or having to leave their own home for an assisted living or skilled nursing facility,” she said.
The MLPS Veterans Project, also known as MLPS-VA, is a special project of the MLPS program which focuses on older veteran patients at the V.A. Medical Center.
Sara Huffman, a graduate of U.C. Hastings law school, is the project’s managing attorney.
“I help my veteran clients access or increase the health care benefits that they need to stay safely in their homes,” Huffman said. “For example, public benefits and some private insurance policies can provide an ill or disabled older adult with a caregiver or home health aide to prepare healthy meals and to assist with dressing, bathing and walking. If someone has access to those benefits, institutional care can be prevented or delayed and hospital stays can be shortened. Care at home costs far less than a hospital or nursing home stay.”
Troya and Huffman are the only full-time salaried attorneys on staff at MLPS.
While the program gets support from volunteer attorneys in the community, the bulk of the representation is provided by UC Hastings law students, under Troya’s and Huffman’s supervision.
Troya describes the MLPS legal clinic as a “win-win” for students and clients.
“Students get important experience in real world legal work and seniors who might otherwise never be able to see a lawyer get legal representation,” she said.
One of the unique features of the MLPS model is the close working relationship that legal advocates have with their clients’ health care providers. Participating doctors, social workers and nurses do more than just refer clients. They support and participate in individual cases by writing letters regarding their patients’ medical history, medical needs or diagnosis. Those letters can play a key role in legal disputes, including applications for, or appeals, involving benefit programs, nursing homes and insurance. Legal and medical providers also hold mutual training sessions where they exchange information and experience from their respective fields.
“Clinicians learn the importance for our patients of legal planning for the future, advocating for legal and housing rights and how legal advocacy and action can allow our patients to accomplish their health goals,” said Anne Fabiny, M.D., the associate chief of staff for geriatrics, palliative and extended care at the San Francisco V.A.
The MLPS-VA project is made possible by grants and donations.
“The legal services provided to veteran patients by the MLPS-VA project is estimated to have saved the V.A. health care system more than $800,000,” Troya reported. “It’s done that by delivering access to benefits and preparing legal instruments, like durable powers of attorney for finances. That allows our veteran clients to stay at home and avoid prolonged hospitalization.
We’re hoping to keep the project going for many years to come.”
For more information about the Medical Legal Partnership for Seniors, go to the website at http://www.ucconsortium.org/our-work/training-and-services/medicallegal-partnership-seniors-clinic.