A century ago, Americans could expect to live, on average, to 47. Sure, those who survived childhood illness, wars and other large-scale killers could live to be white-haired grandparents and great-grandparents – but even they rarely saw an 80th birthday.
Today, about 45,000 Rhode Islanders have celebrated their 80th, and some 7,300 have reached 90 – four-fifths of them women. Medical advances are stretching life expectancies a bit more each day, and new technologies are allowing seniors to live independently for longer.
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But longer lives mean more years to squeeze out of that nest egg, more years to pay for expensive assisted-living facilities, more time for the body and the mind to become frail, making it necessary for relatives to step in and manage finances and health care.
Lillian M. Jacquard, a lawyer at Visconti & Boren in Providence, devotes the bulk of her practice to addressing those concerns. In an interview last week, she said the need for elder law expertise keeps growing as the population ages and the laws evolve.
“There’s just this tremendous need,” said Jacquard, who will speak at an elder care workshop this Thursday at the R.I. Convention Center as part of the R.I. Bar Association’s annual meeting.
“There are just so many people who are ill every day,” she said. “There are so many children who are taking care of their ill parents. They take over their finances. They want to know, ‘How do I do this for my parent?’ ”
Elder law is particularly important in Rhode Island, which has one of the largest percentages of seniors in the nation, Jacquard said (13.9 percent compared with a U.S. average of 12.5 percent as of 2000). To a great extent, it’s a part of generalists’ daily practice, she said, but with the more complex issues, specialized knowledge is key.
As Jacquard describes her practice, law is only a part of her work. Just as often, she’s providing financial advice, recommending insurance coverage, securing veterans’ benefits, discussing health care issues, finding continuing-care providers and assisted-living facilities.
Sometimes she’s also a bit of a watchdog, ensuring no one is abusing a senior.
“It’s very, very satisfying,” she said. “You just perform such a tremendous service for your clients.” At the same time, however, Jacquard acknowledged that she sees “a lot of misery and a lot of suffering every day” – primarily from ailing seniors with scant resources. A great deal of her work involves trying to avoid such situations by planning ahead.
Mark Iacono, an associate at Salter, McGowan, Sylvia & Leonard who focuses on estate planning, said he talks with elderly clients and their families to determine how well their resources will support them, how to divest resources without risking ineligibility for Medicaid if they end up needing nursing home care, how to draw income from their house to pay for assisted living, and when to get long-term care insurance.
Some seniors will want to stay in their homes for as long as they can, for example, Iacono said, while others may find it’s not realistic because of stairs and other challenges, and it might pay to sell and put the money in a fund to cover living expenses.
Iacono also offers to draft a living will and/or a durable power of attorney – a document that gives a loved one the legal authority to make financial and other decisions in the event that the client becomes too sick or frail to fend for herself.
“Good durable powers of attorney are vitally important documents,” Iacono said. “A properly drafted durable power of attorney will help you avoid the need to go to probate court and get guardianships approved, which can cost a lot.”
In the last year or so, changes to Medicaid eligibility rules due to the Deficit Reduction Act of 2005, which became effective last February, have made a dramatic impact on elder law, Jacquard said, making it even more important for seniors and inexperienced lawyers to get expert help.
The whole question of what’s OK for a generalist and what requires a specialist will be a major part of the discussion this Thursday, Jacquard said.
“Whenever one of your clients says, ‘Mom or Dad is going in a nursing home,’ they should have a face-to-face consultation” with an expert, she said.
