What should I know before taking my mom to an elder care attorney?
August 11, 2021 7:53 AM
My mom has mild cognitive impairment due to Alzheimer’s. She and I have an appointment next week with an elder care law firm to set up a durable power of attorney and, perhaps, to consider how else the firm might be of help at this stage in her life. However, I have no experience in working with attorneys, and I am a bit surprised by the kind of information they’re asking for before the consult—SSN, bank account numbers, etc. What should I know before this visit? (And,yeah, there are lots more details inside.)
Early this year, my mom was diagnosed with Alzheimer’s. Her neurologist says my mom currently has mild cognitive impairment. The neurologist’s office recommended that I (her only close relative) take steps to plan for her safety in the future, including getting a durable power of attorney and ensuring that her finances are safe and in order. They gave me recommendations for several elder care attorneys as a starting point.
I’ve been in contact with a firm they recommended that calls itself an Elder Care Law Firm. My initial inquiry call lasted about 30 minutes, and the person I spoke with—their client services director—seemed to have a very clear list of things to ask me, often anticipating things I had questions about. I made an appointment for a consult next week, and I’ve received a package from the firm in anticipation of that visit. It includes:
- Three self-published books written by the firm’s founder and/or the firm itself—two “resource guides,” and one memoir-ish book about the founder’s personal journey to becoming an elder care attorney.
- A thick packet of forms that ask about things like her health insurance, her doctors’ contact info, and her bank account numbers. It also includes a request to bring any wills, trusts, deeds, leases, titles, ban statements, and investment statements. There are also several newsletters from the firm that discuss issues such as paying for long-term care, home modifications for older adults, and a review for a recent trade book about Alzheimer’s.
From what I was told on the phone, we can decide the parameters for what the firm might help us with—from just doing a durable power of attorney to what the person on the phone called “one-stop-shopping,” which seems to include management of healthcare and other issues. We would pay them according to that agreement; they don’t bill hourly. I doubt that the “one-stop-shopping” is something that my mom can afford, but I’m assuming that we’ll get something of a sales pitch for it at the consult nonetheless.
On one hand, I am impressed by how well the firm seems to know this field. The neurologist’s office called them “excellent.” They have offices both in the state where my mom lives and the state where I live (we live an hour apart, but it’s across a state line). I am the only person who is looking out for my mom’s care. While I’m trying to do my best to be informed and to make decisions in my mom’s best interest, my mom does not believe that there’s any need for my help, so I really am going this alone. I’m also a mom, and I’m also the breadwinner in my family. I’ve seen firsthand what happens when well-meaning folks don’t know how to navigate elder care—my grandmother’s final years were difficult, and her illness ripped our family apart. The idea of having an ally that knows the ins and outs of elder care is very, very tempting.
On the other hand, my experience so far with the firm feels discomfortingly slick, and this is a field that is full of people like me—folks who aren’t experts and who are trying to navigate high-stakes, emotionally-charged territory and who are, as a result, good targets for fraud or at least overcharging. Yeah, the firm has a strong communications operation, but does that make them a good choice, or does it just mean that they’re really good at marketing? Do they really need all of the information they’re asking for in that packet just for a consult?
So, I’m asking for your collective wisdom: How does this sound to you? What advice can you give me about dealing with elder care lawyers in general? What would you advise when it comes to this firm, specifically?
Early this year, my mom was diagnosed with Alzheimer’s. Her neurologist says my mom currently has mild cognitive impairment. The neurologist’s office recommended that I (her only close relative) take steps to plan for her safety in the future, including getting a durable power of attorney and ensuring that her finances are safe and in order. They gave me recommendations for several elder care attorneys as a starting point.
I’ve been in contact with a firm they recommended that calls itself an Elder Care Law Firm. My initial inquiry call lasted about 30 minutes, and the person I spoke with—their client services director—seemed to have a very clear list of things to ask me, often anticipating things I had questions about. I made an appointment for a consult next week, and I’ve received a package from the firm in anticipation of that visit. It includes:
- Three self-published books written by the firm’s founder and/or the firm itself—two “resource guides,” and one memoir-ish book about the founder’s personal journey to becoming an elder care attorney.
- A thick packet of forms that ask about things like her health insurance, her doctors’ contact info, and her bank account numbers. It also includes a request to bring any wills, trusts, deeds, leases, titles, ban statements, and investment statements. There are also several newsletters from the firm that discuss issues such as paying for long-term care, home modifications for older adults, and a review for a recent trade book about Alzheimer’s.
From what I was told on the phone, we can decide the parameters for what the firm might help us with—from just doing a durable power of attorney to what the person on the phone called “one-stop-shopping,” which seems to include management of healthcare and other issues. We would pay them according to that agreement; they don’t bill hourly. I doubt that the “one-stop-shopping” is something that my mom can afford, but I’m assuming that we’ll get something of a sales pitch for it at the consult nonetheless.
On one hand, I am impressed by how well the firm seems to know this field. The neurologist’s office called them “excellent.” They have offices both in the state where my mom lives and the state where I live (we live an hour apart, but it’s across a state line). I am the only person who is looking out for my mom’s care. While I’m trying to do my best to be informed and to make decisions in my mom’s best interest, my mom does not believe that there’s any need for my help, so I really am going this alone. I’m also a mom, and I’m also the breadwinner in my family. I’ve seen firsthand what happens when well-meaning folks don’t know how to navigate elder care—my grandmother’s final years were difficult, and her illness ripped our family apart. The idea of having an ally that knows the ins and outs of elder care is very, very tempting.
On the other hand, my experience so far with the firm feels discomfortingly slick, and this is a field that is full of people like me—folks who aren’t experts and who are trying to navigate high-stakes, emotionally-charged territory and who are, as a result, good targets for fraud or at least overcharging. Yeah, the firm has a strong communications operation, but does that make them a good choice, or does it just mean that they’re really good at marketing? Do they really need all of the information they’re asking for in that packet just for a consult?
So, I’m asking for your collective wisdom: How does this sound to you? What advice can you give me about dealing with elder care lawyers in general? What would you advise when it comes to this firm, specifically?
It's really helpful for anyone involved in estate planning or dealing with Powers of Attorney that (particularly if there is some cognitive impairment) they know at the start exactly what the assets and liabilities are. So although it might seem like - whoa! this is a lot they're asking for - it's a hell of a lot easier to go through all this now than to try to locate account numbers or documents if your mom's cognitive capacity has deteriorated.
Also, if your mom is resistant to help, it's important to have professionals dealing with, or involved with, her affairs. This should help alleviate any later allegations of undue influence, especially if she becomes (as, sadly, many people with Alzheimer's do) paranoid and suspicious. Generally someone who knows their stuff will want to talk to your mom by herself, to make sure she's not being strong-armed by you into doing something she really doesn't want to do. At the same time, they should explain precisely why it's important for her to set things in place now, as any choice might be out of her hands at a later stage.
posted by essexjan at 8:31 AM on August 11, 2021
Also, if your mom is resistant to help, it's important to have professionals dealing with, or involved with, her affairs. This should help alleviate any later allegations of undue influence, especially if she becomes (as, sadly, many people with Alzheimer's do) paranoid and suspicious. Generally someone who knows their stuff will want to talk to your mom by herself, to make sure she's not being strong-armed by you into doing something she really doesn't want to do. At the same time, they should explain precisely why it's important for her to set things in place now, as any choice might be out of her hands at a later stage.
posted by essexjan at 8:31 AM on August 11, 2021
You might not want to do it on the first consultation but you will need all of these things documented well.
My grandfather recently needed to go into long term care, his dementia got worse fairly suddenly or we didn't know how bad it was. My family asked me to come down to help out and I ended up needing pretty much all of that in the space of a week to apply him to specific programs.
There were important things to note (my moms disability changes the look back for medicaid and their home!) That needed to be sorted and fast.
I have experience in this and got it done. But I spent hours going through filling cabinets, more hours going through forms, more hours asking about quirks of their finances to the best of my other grandparents recollection. It was not easy. (There was a lawyer consultation in there too)
But when I left there was clear understanding of what he qualified for, the interaction with federal resources, what that meant for his spouse, what that meant for the assets long term.
posted by AlexiaSky at 8:42 AM on August 11, 2021
My grandfather recently needed to go into long term care, his dementia got worse fairly suddenly or we didn't know how bad it was. My family asked me to come down to help out and I ended up needing pretty much all of that in the space of a week to apply him to specific programs.
There were important things to note (my moms disability changes the look back for medicaid and their home!) That needed to be sorted and fast.
I have experience in this and got it done. But I spent hours going through filling cabinets, more hours going through forms, more hours asking about quirks of their finances to the best of my other grandparents recollection. It was not easy. (There was a lawyer consultation in there too)
But when I left there was clear understanding of what he qualified for, the interaction with federal resources, what that meant for his spouse, what that meant for the assets long term.
posted by AlexiaSky at 8:42 AM on August 11, 2021
Keep in mind that what you are asking them to do is a pretty bog-standard thing for lawfirms these days, to where they mostly have it down to an assembly line of standardized forms and wording. You will need all of that info to give them if you decide to contract them to do this.
I wouldn't give them any of it until you agree to go forward. They just want to make sure you have everything in-hand in order to make the process quick and painless.
As an aside, you might also want to have a Medical POA drawn up for you, as well. Often, hospitals will not recognize a standard POA as giving you authority to make serious medical decisions for your mom.
posted by Thorzdad at 8:50 AM on August 11, 2021
I wouldn't give them any of it until you agree to go forward. They just want to make sure you have everything in-hand in order to make the process quick and painless.
As an aside, you might also want to have a Medical POA drawn up for you, as well. Often, hospitals will not recognize a standard POA as giving you authority to make serious medical decisions for your mom.
posted by Thorzdad at 8:50 AM on August 11, 2021
It sounds like some of what's being perceived as slickness is just pre-answering a lot of questions most people coming into their office are going to have, and giving you a clear picture of what information you will need to collect in order to undergo anything but the most basic of options. If this is what they do, I would expect to be handed a bunch of planning materials before the consult. If they don't bill for the consult, they probably also don't want to spend 4 hours explaining what "long term care" entails, or "home care", or all those other concepts that most of us don't need to know about in detail right up until we do.
posted by Lyn Never at 8:56 AM on August 11, 2021
posted by Lyn Never at 8:56 AM on August 11, 2021
The neurologist is not your only friend. We're on different continents but, if it's similar to our Alz Society, then the Alzheimer's Association will have a local chapter who may be able to apply 'objective' advice and information including a To Do List. You didn't mention advance health care directives (because you're in lawyer mode) . . . but Thorzdad did. My FiL almost got snookered when a locum GP decided FiL was no longer capable to signing such a doc. We waited a week for the regular doc to come back.
posted by BobTheScientist at 9:02 AM on August 11, 2021
posted by BobTheScientist at 9:02 AM on August 11, 2021
Wait, are you going for a consult, or to set up the estate plan? If you talked to someone from the office for 30 minutes, do you have further questions or other firms to evaluate before moving forward? Because you will need all the info / documents they are asking for and more, regardless of whom you and your parent choose. Durable power of attorney doesn't help much if you don't know where the accounts are located. My impression (as someone who is looking into doing the same thing) is that elder law lawyers often combine durable power of attorney with a will- or trust-based estate plan but whether you want to do the latter depends on your level of assets and your state's probate laws. For what it's worth, both the firms I was recommended have flat rate fee structures to set up an advanced health care directive, durable power of attorney, and a will or trust. It seems more common because a lot of the work is the same for everyone. I personally am wary of flat rate, because I want the firm to have an incentive to look after my interests, not just move me through an assembly line. But it does also fix your costs.
posted by wnissen at 10:27 AM on August 11, 2021
posted by wnissen at 10:27 AM on August 11, 2021
Collecting the relevant data will be useful to you in any case, because you will likely need that info once you become a client of a firm (even if it’s not this firm). And you’d need it even more so if you go it alone.
So this firm has already done something useful in giving you a checklist of what info to collect. I’d meet them and see.
posted by nat at 10:30 AM on August 11, 2021
So this firm has already done something useful in giving you a checklist of what info to collect. I’d meet them and see.
posted by nat at 10:30 AM on August 11, 2021
If the neurologist gave you several recommendations, you can always call other lawyers to see if there's better fit for you. To me, nothing you've described seems shady about the law firm you're consulting with, but your (and your mom's) comfort level with the lawyers is important! I work in a related field, and wish that more people had the foresight to take the steps you're taking now. Your mom might not need or see the need for help now, but I promise you it's 1,000% easier to take the steps of getting a POA in place now, while your mom is able to have input, then when her cognition declines. Agreeing with everyone else that gathering all of the documents/statements/info now will help you in the end, whether or not you provide them to the law firm at this time. A thing to consider, especially during these pandemic times, is whether you should get a POA that's effective immediately, or a "springing" one that (for example) goes into effect once 1 or more doctors declare your mom is unable to make decisions for herself. There are pros and cons to each, but be aware that financial institutions may have different requirements for springing POAs, such as the dr declaration letter being dated within x amount of time, which could prove especially challenging to obtain with the ongoing pandemic. A good attorney should be happy to go into more details in regards to the pros/cons. You're doing the right thing by starting this process now, difficult as it may be.
posted by csox at 6:24 PM on August 11, 2021
posted by csox at 6:24 PM on August 11, 2021
I have navigated something similar and there are really three types of specialties that could be involved here and it sounds like maybe this one place is sort of doing all of it, but I'd caution that while it can be a pain to orchestrate all of these three, it's going to be good not to put all your eggs in a single basket:
1. Wills, trusts, estates lawyer which often have elder law experience. This is the person who can help you get the paperwork in order. Note that this person should be your mother's attorney (not yours!) and will judge if she's fit to decide to hire them, and make the decisions they'll 'legalize' in the documentation. You can inform this but at the end of the day this person should represent your mom's interests.
2. Eldercare service. This is a firm that's sort of a combination of non-governmental social workers, and nursing care. They can help with day to day stuff and are usually the people who feel like they know everything about how to manage anything related to the care and well-being of the elderly. A good elder care service is like gold; they will save relationships and sanity! You can hire them and pay for them but obviously need your mom's co-operation and they'll probably want copies of the kinds of paperwork the lawyer would put together.
3. Fiduciary. This is someone who you can turn the entire (or specific areas of) management of someone else for your mother's care. They might manage her money, or her healthcare needs, or practical needs but in a way that's like having a conservatorship that's voluntary, if they're put down on things like the POA as being responsible for these things.
I kind of wonder if it's this third type of person you were sent to?...
My experience is in CA and some of this may be state-specific but there are distinct areas of practice involved here.
posted by marylynn at 3:17 PM on August 12, 2021
1. Wills, trusts, estates lawyer which often have elder law experience. This is the person who can help you get the paperwork in order. Note that this person should be your mother's attorney (not yours!) and will judge if she's fit to decide to hire them, and make the decisions they'll 'legalize' in the documentation. You can inform this but at the end of the day this person should represent your mom's interests.
2. Eldercare service. This is a firm that's sort of a combination of non-governmental social workers, and nursing care. They can help with day to day stuff and are usually the people who feel like they know everything about how to manage anything related to the care and well-being of the elderly. A good elder care service is like gold; they will save relationships and sanity! You can hire them and pay for them but obviously need your mom's co-operation and they'll probably want copies of the kinds of paperwork the lawyer would put together.
3. Fiduciary. This is someone who you can turn the entire (or specific areas of) management of someone else for your mother's care. They might manage her money, or her healthcare needs, or practical needs but in a way that's like having a conservatorship that's voluntary, if they're put down on things like the POA as being responsible for these things.
I kind of wonder if it's this third type of person you were sent to?...
My experience is in CA and some of this may be state-specific but there are distinct areas of practice involved here.
posted by marylynn at 3:17 PM on August 12, 2021
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My recommendation to anyone who wants to hire a lawyer is to find someone who has a recommendation of someone they worked with directly, or find another lawyer to provide a referral. It would be up to you how much to weigh the recommendation of the neurologist's office, but there's no reason not to ask around more. Even if you have a friend of a friend who is a lawyer, try asking that person. My impression is that it is very hard for clients to assess whether a lawyer is providing effective and reasonably priced services, and so referrals from another lawyer or former client are more important. Using Google will not pick up a lot of very good options, and will mean that you predominantly get law firms who are good at this communications and sales side of things. That's not inherently bad, but could be overpriced and may not involve as much individualized attention to your mom's legal issues. Strongly consider consulting with more than one firm prior to deciding. You should feel comfortable that you are not being overcharged and you mom's interests are looked after. There will likely be lots of other good options that are not prominently advertised or as well known, and those options will likely be less costly and may provide more individualized attention.
posted by lookoutbelow at 8:27 AM on August 11, 2021