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  • InsideTrack
  • November 02, 2022

    An Aging Nation: Advising Older Clients on Long-Term Care

    As the number of people age 65 or older continues to rise in the U.S., more lawyers are needed to assist older Americans on issues of health care.
    advising older client

    Nov. 2, 2022 – The population of people age 65 or older will continue to rise in the coming decades, according to projections from the U.S. Census Bureau. For the first time in U.S. history, according to the agency, “older adults are projected to outnumber children by 2034.”

    According to the Wisconsin Department of Health Services, Wisconsin’s population of residents age 65 or older is approaching 1 million and will increase to 1.5 million by 2040.

    Melanie Cairns

    Melanie Cairns, Disability Rights Wisconsin, co-author of a State Bar of Wisconsin PINNACLE® book on Advising Older Clients and Their Families (Vol. II).

    That means more older people will need lawyers to help them on various issues related to elder law, from Medicaid and Medicare, to health care financing and decision-making.

    More will rely on community-based long-term care, or senior living communities that are governmentally funded or subsidized. Others may seek living arrangements, such as assisted living or independent living communities that cater to older people with more resources.

    “Wisconsin has an international reputation for innovative programs that permit older persons and persons with disabilities needing long-term care to remain in a community setting,” according to Melanie Cairns, a co-author of the State Bar of Wisconsin PINNACLE® book, Advising Older Clients and Their Families (Vol. II).

    “As of March 1, 2021, nearly 55,000 individuals were enrolled in the various managed long-term care programs,” noted Cairns, who cites Family Care, Program of All-Inclusive Care for the Elderly (PACE), Family Care Partnership, and IRIS (Include, Respect, I Self-Direct). A number of programs operate under federal Medical Assistance (MA) waivers.

    “Elderly clients with long-term care needs may find Wisconsin’s array of waiver and nonwaiver programs confusing,” notes Cairns, an attorney for Disability Rights Wisconsin.

    “In advising such clients, the attorney may find it helpful to focus on the services available to eligible persons under Wisconsin’s community-based long-term care programs. The waiver programs can perhaps best be explained as funding sources for those services.”

    Jessica Liebau

    Jessica Liebau, Wessels & Liebau LLC, co-author of Advising Older Clients and Their Families (Vol. 1).

    In chapter 17 of Advising Older Clients, Cairns explains the financial aspects of the programs, including cost sharing, estate recovery, and financial requirements.

    She also discusses each program’s functional requirements. “To be eligible to participate in any waiver program, an MA recipient must meet the level-of-care requirements for MA reimbursement in a skilled nursing facility or intermediate care facility,” she notes.

    Advising older clients on community-based, long-term care may give rise to other issues that must be addressed.

    “[I]n the course of seeking an appropriate facility, the attorney may find that a host of other nonfinancial issues should be addressed, such as the existence or efficacy of advance directives, powers of attorney, or guardianships,” noted Jessica Liebau, co-author of Advising Older Clients and their Families (Vol. 1) and an elder law attorney at Wessels & Liebau, LLC in Mequon.

    More on Referenced PINNACLE Book

    Advising Older Clients and​ Their FamiliesVolume I and Volume II from State Bar of Wisconsin PINNACLE® are available both in print and online via Books UnBound, the State Bar’s interactive online library.

    Each print book costs $275 for members and $343.75 for nonmembers. The two-volume print book set is $425 for members. For more information, or to place an order, visit the WisBar Marketplace or call the State Bar at (800) 728-7788 or (608) 257-3838.


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