HD Quilt Square

In March I was privileged to speak at the Illinois Conference on Huntington’s Disease.

I learned that Huntington’s Disease (HD)—like Alzheimer’s Disease, ALS, and Parkinson’s Disease—all originate from damaged brain cell mutations.  Sitting in the conference room with me were those who have been diagnosed with the disease, the loved ones who care for them, and family members who live with the threat of developing the illness themselves.  You see, the greatest horror of Huntington’s is that it is a hereditary disease that passes from parent to child, often striking up to 50% of family members!  At-risk young people live in dread of “crossing over” to becoming stricken with Huntington’s symptoms like involuntary muscle movement and cognitive decline.

I was especially moved by a display called the Huntington’s Disease Memory Quilt.  The quilt is an ongoing project, pieced with squares to commemorate the lives of those lost to HD.  Because Huntington’s Disease is hereditary, there were many quilt pieces arranged together for multiple family members afflicted by the disease. The effect was moving and staggering.  The top row contained a number of pieces in honor of the lost loved ones from just one family.  Another square which brought a lump to my throat and tears to my eyes depicted a semi-barren tree shedding its leaves, and read:

O Lord, I ask that you please
Let no more leaves fall
From our family’s tree.
May those who investigate
Find a cure.
Help those who care
Have strength to endure.
Hear our prayer, Dear Lord!

It went on to read, “Four fallen leaves—Bill, Billy, Ken, and Vera.”

Although Huntington’s Disease is a relatively rare disease that affects about 1 in 10,000 persons, the families that suffer from this killer often sustain a 50% casualty rate.  Here at Law ElderLaw, we have decided to help work toward a cure.  There is a “Team Hope Walk for a Cure” taking place in Wheaton, IL on Sunday, May 17, 2009.  I am going to be there with some of our team.  If you would like to join us, we would love to have you on our team!  Click here to join us or to create your own team!  If you live outside of Illinois but still want to help, you can find a walk in your state by clicking here.  We hope many of our friends will be able to come join us on May 17th and help us Walk for a Cure!

Have you ever had what you thought was a quick and friendly conversation with your attorney, and then been surprised by a bill in the mail?  That was the result of hourly billing (as opposed to value billing).

Value billing is not the usual way that lawyers bill their clients.  Value billing is based on the idea that one should charge a fee that is appropriate and ethically reasonable for the value provided to the client.  It is my viewpoint that both clients and lawyers can enjoy better relationships if lawyers charge value-based fees.  Read on to see how we might make value-billing work…

Lawyers have charged by the hour since time began.  Unfortunately, hourly billing can easily poison the relationship between attorney and client, and both attorneys and clients wish there was a better way.  The burdens of hourly billing record-keeping and delayed cash flow are a nightmare in almost every law firm.  But a few lawyers have found a better way—and many estate planners, business lawyers, and elder law attorneys have begun to abandon the hourly rate.  Instead, they embrace value billing—a concept that both clients and attorneys can learn to love.

Clients are suspicious of lawyers’ billing practices and frequently complain, “How could that have taken you so long?”  From the client point of view, hourly billing creates an apparent disincentive to provide a quick solution.  On the attorney side, hourly billing creates a disincentive to investing in modern technology and electronic research tools.  After all, once a law firm is more efficient, it could lose money due to increased efficiency and productivity.

Clients like fee certainty—and although it is not an option for every law firm, it can be offered for some transactional legal work.  Value billing provides a great way to get out of the hourly billing hamster cage.  Law firms can quantify commonly repeated legal tasks such as estate planning, and then determine what would be a reasonable bill for a specified package of legal services.  Those specified packages of legal services can then be offered to the public at a predetermined rate which covers a justifiable overhead cost as well as profit. 

At Law ElderLaw LLP, we have found that value billing greatly enhances our attorney/client relationships.  Clients loathe receiving bills after telephone conferences and incidental conversations.  We want to enhance our client relationships for repeat business and referrals—so it makes dollars and sense to improve our billing practices.

Last week, I had a telephone call with the daughter of a dying client.  Our elderly client had taken a surprise downturn, and hospice services had begun.  The client’s daughter needed a sounding board, a friend, and a trustworthy legal guide to help her in the uncharted end-of -life process.  We spent thirty minutes discussing the client’s physical care needs, funeral needs, and other important issues.  After the call, both of us were united in our concern for the client.  Nonetheless, if I had been forced to send a bill for thirty minutes of legal time, my relationship with the client and the client’s family would have been wounded. 

Obviously there are many types of legal work which attorneys must bill by the hour.  We are governed by the ethical rules of the Supreme Court of the State of Illinois.  But if you are an attorney and value billing is something you think your firm could offer, Law Firm Fees and Compensation: Value and Growth Dynamics by Edward Poll provides wonderful practical help on how to make a smooth transition to value billing.

Connie Schreiner and Rick Law

Celebrating New Year’s Day after a kayak run on the Fox River, I was just about knocked to the floor when I overheard someone say, “I’ve seen some wonderful deaths.”  When I recovered from hearing this statement and recognized the sparkling eyes of the nurse who said it, I asked if I could meet with her at another time to learn about “wonderful deaths.”

Several weeks later I met up with Connie Schreiner, the effervescent and popular Director of Health Services at Provena Fox Knoll, an assisted and independent living community located along the Fox River just north of downtown Aurora, IL. 

Connie and I talked about assisted living and what a wonderful living arrangement it is for residents who no longer feel safe living at home alone or need assistance with medication management or help with routine tasks that, with age or illness, have become more difficult to manage.  Connie and I both liked the idea of being provided three meals a day as well—we considered residency ourselves!

“It is very difficult for a resident to leave the comfort and familiarity of his or her home and make a new home somewhere else.  Therefore, we make every effort to ensure that they can live the rest of their lives at Provena Fox Knoll,” said Connie.  “When our independent living residents can no longer live independently, they can transition to assisted living.  When illness causes a resident’s health to decline, or a resident is diagnosed with a terminal illness, the opportunity exists to contract with palliative or hospice care.  It is not uncommon for a resident to tell us that they don’t want to go to the hospital again.”  One resident said to Connie, “You know, I’m 95 years old and don’t want to see the inside of a hospital again.  If my time comes to be with the Lord, then let it be.”

As Director of Health Services, Connie provides residents and family members with the basics of hospice care, specifically:

• That it is important for the resident and the family be comfortable and in agreement with the decision to elect hospice care.
• That the resident’s primary physician must agree and write an order for hospice care. 
• That certain criteria must be met to qualify for hospice.

Connie then recommends they contact Provena Home Care-Hospice for an assessment and the details of care. 

Hospice provides lavish support for both the ill person and his or her loved ones.  Hospice care includes nurses, nurse aides, social workers, and pastoral care—all who work alongside the family and the Provena Fox Knoll staff in support of the resident.  In addition to frequent visits, a hospice nurse is always on call to ensure needed care and comforts are afforded the resident—not only managing physical well-being through medication, but also caring for emotional and spiritual needs. “We currently have a resident on hospice, and her best medicine is a visit from pet therapy.  Provena Fox Knoll is blessed to have three women who visit with their dogs.  It is truly heartwarming to see the excitement on our residents’ faces when these dogs visit,” Schreiner remarked.

Provena Fox Knoll is licensed by the Illinois Department of Public Health (IDPH), as are all assisted living communities.  Schreiner explained that IDPH limits the scope of nursing care that she and her staff can provide.  However, hospice nurses are authorized to provide care that is beyond the scope of their assisted living licensure.  Additionally, most of the hospice costs are covered by Medicare.  

Connie remarked, “The three essential elements to provide a wonderful death are the collaborative efforts of the family, the assisted living staff, and the hospice personnel—which then allows our residents to stay in their home environment with friends and familiar caregivers and peacefully live out the end of their lives.  I have been part of several end-of-life decisions with our residents.  I am richer for it and tremendously grateful to have shared with the resident and his or her family, some wonderful deaths.”

More information on Provena Fox Knoll can be accessed at www.provena.org/foxknoll and Provena Home Care at www.provena.org/homecare.

Page Williams with her horse

When I started practicing elder law, the only people I saw as clients were of my parents’ generation.  But now my own boomer generation is also coming through the doors.  Some are afflicted with early onset Alzheimer’s or Parkinson’s, and they are surprised that they now need long term care.  In 1921 Charlie Chaplin and Mary Pickford dreamed that the movie industry folks would always “take care of our own” and started The Motion Picture & Television Fund, which in turn funded the Motion Picture & Television Country House & Hospital (commonly referred to as Motion Picture Home)—a home that is now closing due to bankruptcy.

My friend and fellow boomer Page Williams recently sent me an e-mail which expressed her anxiety about her own long term care prospects. She is a board member of a union representing theatrical, stage, movie, and TV show workers who are not actors, producers, or writers.  But what’s really bothering her is that “Like millions of boomers, I chose not to marry or have children.  But I don’t think that we unmarried boomers fully realize that there’s a lot more to worry about now than just long term care for our geriatric parents.”  As an entertainment worker, the closing of the Motion Picture Home has her scared. “I always used to joke with my friend Terry as we were riding along on our horses that some day we would be old and gray and sitting around the MP Home having a drink and remembering these days.  Now I wonder what’s going to happen to us.” 

Like other boomers, Page sees promises of retirement era benefits vanishing long before the boomers themselves even arrive at the gates.  Members of her union have paid into the Motion Picture & Television Fund for years with the expectation that if they needed it, that senior home would be there for them.  In great contrast to ordinary nursing homes, the Motion Picture Home has benefited from high profile pre-Oscar fundraising events generating up to $15 million in contributions per year.  Nonetheless, the hospital board says they just can’t carry the alleged $10 million per year nursing home deficit any longer.  They, like other facilities around the country, are receiving insufficient reimbursement from Medicare and Medicaid, the primary sources of governmental health care funding for North American seniors.  Jim Lott, executive director of the Hospital Association of Southern California, complained that Medicare provides reimbursement for only about 87 cents of each dollar that the hospital spends on care. Medicaid reimbursement is even worse, with the state only delivering about 78 cents for each dollar cost of care. 

All over the country, hospitals and nursing homes are closing due to inadequate and long-delayed reimbursement dollars owed to them by both the state and federal governments.  The closing of Motion Picture Home is one more warning that both seniors and boomers must work together to insist that our government provide health care reforms that ensure quality end-of-life care.  As we listen to government claims that they are going to provide universal coverage, it would be nice to see examples of our government actually providing excellent care.  Unfortunately, those examples do not exist. 

What this means for our readers is that it’s time to get serious about your own long term care security, especially if you’re a boomer. Do not delay investigating—and investing in—long term care insurance. There are some new “hybrid insurance products” that will pay out with either a life insurance death benefit or a long term care health policy. Call your trusted financial advisor today.