Institutions nationwide are piloting new ways to take care of patients’ needs beyond the hospital bed. That task took on added urgency when Republicans on the Joint Economic Committee released the results of their investigation into social networks among the elderly earlier this year. The analysis: social networks are declining and America is going to pay for it – probably in higher healthcare costs.
“[A]n increasingly inadequate level of informal care . . . would necessitate a greater amount of institutional care outside the home and away from loved ones, reducing, for many, their quality of life,” the Committee wrote. “[I]nstitutional care often entails burdensome expenses,” including individuals spending down their assets and the public paying for costly nursing home care.
For many seniors, informal networks of friends and family help them perform household chores, organize their finances, and navigate their medical appointments. These informal care networks are vital to addressing, as the CDC put it, “conditions in the environments in which people live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks,” or “social determinants of health.” According to scholars at Yale Law School’s Solomon Center, “25 percent of individual health is determined by genetics, medical care, and health behaviors, while 75 percent of health is determined by social and environmental factors.”
Some states, such as North Carolina, and the federal government, through the Medicare Innovation Lab’s Accountable Health Communities Model, are funding demonstration projects that refer patients to local social services organizations. For example, Yale New Haven Hospital in Connecticut launched a program last April to seamlessly integrate screening for social determinants of health into regular emergency room and primary care visits, though Medicare rules prohibit the program from directly providing social services.
To date, however, many such programs have left out a substantial and often overlooked factor that affects health outcomes: patients’ legal needs. After all, seniors who come home from the hospital to unstable housing, unpaid bills, and unresolved Social Security claims will have trouble recovering and getting back to their lives. More than 300 charity-supported medical-legal partnerships (MLPs) have stepped into this breach.
MLPs are partnerships between healthcare and legal services providers. Doctors and hospitals refer low-income patients with unmet legal needs to attorneys, who are often embedded on site and see patients at the same time their doctors do. MLPs serve immigrants, formerly incarcerated individuals, veterans, and numerous other at-risk groups, including the elderly. Critically, these populations often do not realize they have legal needs or trust lawyers to assist them. Pairing lawyers with doctors in settings of confidentiality and trust gives these populations access to critical support.
Elder care and end-of-life MLPs can help address the challenges that shrinking social networks pose for seniors. The growing number of MLPs focusing on the elderly assist clients in ways which both complement and replace services and supports that social networks may, in the past, have provided.
For example, a major issue among patients at or near the end of life is selecting someone to help make their healthcare and financial decisions. The Palliative Care MLP in New Haven, CT, sends law students - under the supervision of licensed attorneys and working alongside the New Haven Legal Assistance Association – to meet with low-income cancer patients based on referrals from Yale-New Haven Hospital’s social work team. The MLP helps patients draft documents, called advanced planning documents or directives, that appoint a trusted relative or friend to make major financial decisions or life-and-death healthcare choices.
These services not only save money – a systematic review found facilitating advanced care planning saves thousands of dollars per patient in healthcare costs annually – but they also support the mission of palliative care itself by easing patient stress at the end of life.
Distance and a lack of social supports, as the Joint Economic Committee’s report points out, take the difficult situation that elderly patients and their families face and make it worse. How can families pay their loved ones’ bills or monitor their bank accounts? How can patients obtain food or housing, especially if they lack transportation and support to apply for public benefits?
The MLP for Seniors Clinic at the University of California-Hastings helps elderly patients apply for federal and state public benefits. University of Florida Health works with Three Rivers Legal Services in northern Florida to help seniors address issues with housing, employment, public benefits, and other legal matters. Through both organizations, patients who only leave home for medical visits can get help applying for public benefits while they receive medical care. And, by obtaining stable housing, food stamps, and other social services, seniors can afford to stay in their own home when moving in with a nearby relative – or having a relative check on them regularly – is not an option.
Second, MLPs can help families bridge distances. When Yale’s Palliative Care MLP helps patients spell out formal relationships in legal documents, family members can more easily assist far away relatives with healthcare and financial tasks. For example, seniors can identify a healthcare decision-maker before a crisis hits. Relatives and friends across the country can get access to online banking and bill pay accounts.
According to an AARP survey, “[o]nly 10 percent of older adults with no social needs were in fair or poor health . . . , compared to 80 percent of those experiencing six or more [unmet] social needs.” MLPs offer a low-cost, proven model to supplement the social services families provide. As America confronts an aging population with less community support, caring for the whole patient will become more and more important.
Joseph Liss is a member of the Class of 2020 and a Student Fellow at the Solomon Center for Health Law and Policy at Yale Law School. He graduated with a Master of Public Policy from the Frank Batten School of Leadership and Public Policy at the University of Virginia in 2015, where he served as Senior Online Editor of the Virginia Policy Review.
The views expressed above are solely the author's and are not endorsed by the Virginia Policy Review, The Frank Batten School of Leadership and Public Policy, or the University of Virginia. Although this organization has members who are University of Virginia students and may have University employees associated or engaged in its activities and affairs, the organization is not a part of or an agency of the University. It is a separate and independent organization which is responsible for and manages its own activities and affairs. The University does not direct, supervise or control the organization and is not responsible for the organization’s contracts, acts, or omissions.