LENOX -- Paula Almgren and Louise Kodela are leading the way for life-care planning in the Berkshires. Almgren, a Williams College alumna, is among a growing number of elder law attorneys nationwide who have incorporated alternative methods in helping senior citizens navigate the complex territory of health benefits, estate planning and other issues that accompany aging.
Life-care planning is a holistic approach to helping those those with chronic health problems identify and pay for long-term support. While most elder law attorneys provide little or no continued support for chronically ill clients, Almgren has teamed up with Louise Kodela, a registered nurse, to work with families over the course of a year as they transition either to nursing homes or community-based care.
"It’s really different," Almgren said. "Most lawyers are transaction-goodbye. We are in this relationship with these people for the long-term."
Kodela, who lives in Williamstown but works throughout Berkshire County, makes an initial assessment of each client’s health needs, and then collaborates with Almgren to develop a comprehensive plan that addresses their legal, financial and health-related issues.
She maintains contact with the clients throughout the year, making sure the plan is working and facilitating any necessary changes.
"It’s a very unique program as a nurse," Kodela said. "I do that standard kind of thing, see what’s going on, what are their problems, what are their needs, but
Among the services they commonly provides is helping clients obtain and navigate MassHealth or VA benefits. Under MassHealth, example, the Frail Elder Home and Community-Based Services Waiver (HCBS) may provide funding so that residents canreceive care in their home or community rather than in a nursing home.
In many cases, one spouse is healthy while the other has a chronic illness, so the health status of each partner needs to be taken into account as part of a long-term plan. Almgren will guide clients through the process of designating the well spouse as the sole owner of the couples’ assets, enabling the ill spouse to qualify for the HCBS waiver.
The client may be eligible for 40 hours a week of care, Almgren said, "but that’s 40 hours a week of care that isn’t coming out of their savings." "So it’s helping them stretch out their money."
While some clients work with Almgren and Kodela to transition into nursing homes, clients more frequently want to remain at home. Much of the team’s work is aimed at providing clients with options that will allow them to maintain as much independence as possible. Almgren mentioned that even people with dementia are often better off at home because it is a familiar environment.
The high cost of living in a nursing home, she said, is another reason why people prefer homecare. The average yearly cost of nursing home care in Massachusetts is between $104,000 and $120,000, while a live-in caregiver is usually paid $69,000 to $100,000 per year. Homecare professionals typically charge $21 - $25 per hour. "The future is all going to be community-based care," Almgren said. "I don’t think it’s going to be nursing home care because it’s just too expensive."
A network of national and state-run elder care organizations support life-care planning. Almgren serves on the Board of Directors of the Massachusetts Chapter of the National Academy of Elder Law Attorneys (NAELA), and is a member of the Massachusetts NAELA Public Policy Committee. She is also a member of the Life Care Planning Law Firms Association, the Alzheimer’s Association and the Berkshire County Estate Planning Council. All of those groups offer support for both families and professionals.
In addition to a number of MassHealth programs, Elder Services of the Berkshires, various home care agencies and the Personal Care Attendants program administered by Adlib in Pittsfield are among the many resources available to elder law clients.
Almgren majored in political science at Williams College and received her law degree from Albany Law School of Union University. She first realized the potential benefits of a life-care approach to elder law at an annual NAELA conference in Dallas. While she is currently the only practicing life care attorney in the Berkshires, there are many others around the country, whose example she wanted to follow. "I came home from that meeting and I hired a social worker, like Monday," she said, since a big part of her practice was community-based care.
She was particularly interested in ways to enable more clients to live at home in their later years. "I know the nursing home rules and I do nursing home applications, but when we look at the numbers, most people can be home and most people want to be home," she said.
The "ball was getting dropped," she said, since at the time she was not offering the kind of continued support required for a families living at home. Kodela’s nursing experience provided the missing link to a sustainable life-care practice. "So now it all just works so much better," Almgren said. "People are happier and people are getting care sooner."
When clients first arrive in the office, Kodela said, their anxiety is noticeable. They face a maze of possibilities and questions that only an expert can answer. Not only are the options often unclear to someone facing the process for the first time, the state regulations and the requirements of various programs are constantly changing.
"So there’s a whole flurry of activities, and then all of a sudden you see it calm down," she said. "And then when you’re following up with people they come back in and there is a sense of relief. You really see it." At the end of the year, she said, nearly all of their clients end up renewing for a second year.
Another element of the team’s practice is community outreach. From time to time Almgren or Kodela is asked to speak publicly about elcer law, estate planning the life-care planning process. In April, Almgren spoke to a crowd of about 40 at Williamstown Commons. She covered the basics of the planning process, including Medicare Law, Medicaid and VA benefits eligibility.
Enhanced communication is partly what sets life-care planning apart from conventional elder law services. Almgren and Kodela base their practice on the development of long-term relationships that take the whole person into account. "Every family who we’ve started with is still our client," Almgren said.
"And we just keep them in the game, in control, help them stretch out their dollars, help them stay independent and strong," she said. "It’s like we can look at the whole person and the whole situation."