<P>UCSF geriatrician Carolyn Welty, MD, sometimes sends her patients to see a different kind of specialist – a lawyer-in-training. The unusual referrals stem from a collaboration between UCSF and UC Hastings College of the Law. Called the Medical-Legal Partnership for Seniors (MLPS) and launched in 2012, its one of just a few such programs nationwide that provide health-related legal assistance to older adults. Weltys patients at the UCSF Center for Geriatric Care may need help with powers of attorney, advance directives, or estate planning. Or she may suspect that they qualify for public benefits they arent receiving. A lawyer can help with any of those endeavors. But for many older adults, consulting an attorney is a daunting prospect – and most simply cant afford the fees. Instead, Welty, who is medical director of the MPLS, and other physicians point their patients to participating law students from UC Hastings. Each semester, eight students spend 12 to 15 hours a week advising older patients, either at the center or in the patients homes. While some patients are wary of lawyers, they usually agree to the visits because they trust their doctors, says Yvonne Troya, JD, legal director of the MPLS and a UC Hastings clinical professor of law. The students mostly help clients complete advance health care directives, durable powers of attorney for finances, and simple wills, and they also perform a full legal check-up, explains Troya. For example, some clients dont realize that they may be eligible for food stamps or that they can appeal reductions made in their Social Security or Medicare home health benefits. But serving clients isnt solely about filling out legal forms, says Melis Atalay, a third-year law student who participated in MLPS last semester. Its to eliminate stress in their lives. Ive seen it time and again, where patients havent planned ahead and some crisis occurs, concurs Welty. The stress can affect their health. For students, the partnership offers an opportunity to work directly with clients and to learn about the growing field of health care law. And it can mean much more besides. It was the best part of my law school experience so far, says Atalay. It taught me a lot about myself and who I want to be. their health outcomes. In addition, hes shown that functional status – especially mobility – can reveal more about patients health than their diseases can. One of the first things I look at with patients is how they get from the waiting room to the clinic, he says. Before I even start thinking about their diseases, Im thinking about how they function and what they need to function better. Yet even the complex mix of functional ability, diseases, medica- tions, and life expectancy still only tells part of an older persons health story. A slew of psychosocial conditions can interact with illness to leave an individual impaired, says Kao, the geriatric clinical programs medical director. All these myriad pieces must be viewed through an essential lens: the patients own goals. We really try to balance what is available in our medical arma- mentarium with what is going to help the patient achieve their goals, explains Kao, who is also a resident alumna. We might be able to do some procedure, but it may never really benefit them and might actu- ally cause harm. HOME TEAM In the end, no one health care provider can do it all. When you think about trying to address the kinds of issues older adults face, the perspectives of multiple disciplines become increas- ingly valuable, says Margaret Wallhagen, RN, PhD. An alumna of UCSFs School of Nursing, she directs the UCSF/John A. Hartford Foundation Center of Gerontological Nursing Excellence. Kao, too, understands the wisdom of casting a wide net. Last year, she partnered with UCSFs primary care clinics to create a dream team of sorts to focus on patients with complex psychosocial medical needs. Most of the participating patients were older adults, and all ended up frequently in the hospital or emergency room – a major red flag for geriatricians. You could pin it on our lapels: do whatever we can to keep patients out of the hospital, says Kao. One such patient – a 71-year-old woman with coronary artery disease, hypertension, asthma, recurring vertigo, breast cancer, and a brain lesion – visited the emer- gency room 10 times in 12 months and was hospitalized twice. To determine why, and to avoid such patterns in the future for these patients, Kao brought together health care providers from across UCSF: primary care physicians, geriatricians, nurse practitioners, and pharmacists. And through UCSFs community partner, the Institute on A DOSE OF LEGAL HELP In 2004 (the most recent data available), the 65-and-over demographic accounted for 34 percent of US health care expenditures, while making up only 11 percent of the population.</p> <UL><LI><a href="http://www.mzines.net/publication/618/aelvmorax/1/1/">Front-Cover</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/2/2/">Inside-Front-Cover</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/3/3/">Page-1</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/4/4/">Page-2</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/5/5/">Page-3</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/6/6/">Page-4</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/7/7/">Page-5</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/8/8/">Page-6</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/9/9/">Page-7</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/10/10/">Page-8</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/11/11/">Page-9</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/12/12/">Page-10</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/13/13/">Page-11</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/14/14/">Page-12</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/15/15/">Page-13</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/16/16/">Page-14</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/17/17/">Page-15</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/18/18/">Page-16</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/19/19/">Page-17</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/20/20/">Page-18</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/21/21/">Page-19</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/22/22/">Page-20</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/23/23/">Page-21</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/24/24/">Page-22</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/25/25/">Page-23</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/26/26/">Page-24</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/27/27/">Page-25</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/28/28/">Page-26</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/29/29/">Page-27</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/30/30/">Page-28</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/31/31/">Page-29</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/32/32/">Page-30</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/33/33/">Page-31</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/34/34/">Page-32</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/35/35/">Page-33</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/36/36/">Page-34</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/37/37/">Page-35</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/38/38/">Page-36</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/39/39/">Page-37</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/40/40/">Page-38</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/41/41/">Page-39</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/42/42/">Page-40</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/43/43/">Page-41</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/44/44/">Page-42</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/45/45/">Page-43</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/46/46/">Page-44</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/47/47/">Page-45</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/48/48/">Page-46</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/49/49/">Page-47</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/50/50/">Page-48</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/51/51/">Page-49</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/52/52/">Back-Cover</a></LI> <LI><a href="http://www.mzines.net/publications/618/x/sitemap.xml" target="_blank">site map</a></LI> </UL>

 

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