How Elder Law Attorneys Choose Home Care Partners And What Wins Trust

One of the most overlooked referral partners in home care marketing might surprise you.

Elder law attorneys.

These professionals talk to families when they are dealing with some of the hardest decisions:

Mom fell.
 Dad can’t live alone anymore.
 The hospital is talking about discharge.
 The family is worried about Medicaid or losing the house.

And often the adult children have no idea where to start.

In a recent conversation with elder law attorney Bill Nolan, we talked about how attorneys choose which home care agencies they recommend.

A few things stood out.

The agencies that earn referrals are the ones that:

✔ Answer their phone
 ✔ Communicate clearly with families
 ✔ Screen and supervise their caregivers
 ✔ Handle problems honestly and quickly
 ✔ Show professionalism during stressful family moments

One thing he said really stuck with me.

No agency is perfect. Things happen. But how the agency responds makes all the difference.

We also talked about something families rarely realize.

Sometimes families think they can’t afford home care.

But legal planning can open doors like:

• VA Aid and Attendance benefits
 • Medicaid planning strategies
 • Special needs trusts
 • Financial planning that keeps someone at home longer

When home care agencies and elder law attorneys work together early, families often have more choices and less stress.

And that’s the goal.

Helping families stay home safely while protecting their future.

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Transcript

Welcome And Housekeeping

SPEAKER_01 0:10

All right. Happy Wednesday. I keep saying happy Friday, right, Lisa? I know. But it is Wednesday.

SPEAKER_04 0:19

So just quick before we start, and that does that video work for you?

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Are you seeing my slides?

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Yes.

Giveaway And Leave Behind Ideas

SPEAKER_01 0:26

Okay. Okay, so we'll just we're gonna be asking you the questions. Okay. Should we get started? I think we should. Happy Wednesday, everybody, March 11th. Everybody knows us. We have a guest speaker today, so we're not gonna go into our introductions because we think we're gonna have lots of talking and we may we want to make sure we get all the good information in today. All right. So housekeeping, lines muted, unless speaking, share stories, experience tips, ask questions in the chat, make recommendations and tell us what you want to know. All right, so this is we're doing this in the beginning of our class. So we every mastermind we give away one free set of customized leave behinds. If you can please in the chat put yes if you're interested in winning, we're gonna give be giving away April leave behinds. So put yes in the chat. Lisa's gonna take you know everybody's name down. If you do win the leave behinds, please we want you to share them, send us pictures of you out in the field. And we actually have some pictures of some people that have shared what they're doing. So we have Tess from Touching Hearts is out there for Social Work Month, and she put these great little packets together with the stickers, and then we have Skip from Touching Hearts, and he bought the little houses that I think look adorable. And he put his Touching Hearts sticker on for Happy Social Works Month. And then we have Kristen who is out there a little early, and it doesn't matter, you can start now. St. Patrick's Day is next week. Pinch protection. So just wanted to share. We love that you use these, that's what we make them for. People love these little cute leaving lines. You definitely have to be out there doing it. So thank you. So make sure you put yes in the chat.

SPEAKER_02 2:15

Yeah, love it. It looks so good.

SPEAKER_01 2:20

All right. So today, how elder law attorneys choose home care partners and how to become one. And we have our guest speaker, Bill Nolan from the Alabama Elder Care Law Firm. So glad to have you, Bill.

SPEAKER_04 2:32

Thank you. Thank you for asking me.

SPEAKER_01 2:34

Okay, so our agenda today, we're gonna be sitting down with Bill and we are gonna talk to him about what it really takes to earn referrals from legal professionals, how home care agencies can become indispensable partners in the planning process. We're gonna talk about when attorneys involve home care, understanding the referral landscape from the legal side, what builds, breaks referral trust, how attorneys choose which agencies to recommend, coordinating around Medicaid and VA planning, financial strategies that increase hours, real-world case studies, proactive planning versus crisis, and what the outcome reveal is. And best practices for professional partnerships, how to earn a preferred partner status with law firms. And then we'll have some questions and answers. Time for you to ask questions to Bill.

unknown 3:27

Wow.

Crisis Planning Versus Early Planning

SPEAKER_01 3:28

All right. So welcome to Bill. He is the founder of Nolan Elder Law, now the Alabama Elder Law Firm. 40 years of legal experience in banking, nonprofit, and elder law, focuses on elder law, estate planning, probate, guardianships, and conservative chips, former VA accredited attorney, published author on VAA and attendance benefits, active community leader, former bar committee chair and nonprofit board member. Fun fact, mastering sourdough baking, love it. Spanish chess and daily pilates. That's great, Bill. That's very cool. Good. We haven't mastered that yet. I just buy it at the bakery. One of these days I'm going to try it. All right. So why this conversation matters to home care agents, home care owners, what you want? You want more qualified referrals, families who are ready for care and can pay for it, strong professional relationships, relationships built on mutual respect and shared goals. You want to increase your private pay hours, of course, clients who understand the value of in-home care, long-term referral trust, becoming the agency attorneys call first. And what we're going to explore is how attorneys decide who to refer, what matters most from a legal perspective, what makes an agency stand out, specific qualities that separate top agencies from the rest, how legal planning increases care hours, the financial strategies families don't know about, and how to build a true partnership, moving beyond transactional referrals to real collaboration. Okay. So understanding the referral landscape from an attorney's perspective. So elder law attorneys, they interact with families at most of their vulnerable and pivotable moments of their lives, understanding when and why they bring home care into the conversation is the first step to positioning your agency as a trusted resource. And we're going to talk to Bill directly about the patterns he sees. And we talked on the phone, Bill and I, the other day, and he said a lot of times people come to him in crisis. But that's what we're going to ask you, Bill. When do families first contact an elder law attorney? Are they in crisis planning? Are they planning ahead? At what point does home care become part of the conversation? And what red flags signal a client will soon need in home care? So if you can think about those questions and give us your thoughts.

SPEAKER_04 5:58

Thank you. I wish more clients would come to us in a proactive place, but too often we end up meeting clients who are in crisis mode. And our goal is always to move to try and see clients earlier and earlier, because quite frankly, you can save the client and the family a lot of money that way, and their options are much greater the earlier you can get into the conversation. And certainly you can involve the caregiving community much more earlier on. So I wish we asked clients more often more sooner than we actually do. We typically meet clients in crisis mode. They'll come to us and say, Mom broke her hip. She's been in the hospital, she developed pneumonia, they released her to rehab, and now the rehab is telling us that they have she has three more days of rehab before Medicare ends, and she's got to go to a nursing home. So we'd like to learn how we can protect mom's house from being lost to a Medicaid leak. You can imagine. That doesn't leave you much options in terms of protecting. That's crisis planning now. We'll I want to talk a little bit later on about what you could do there. But uh some clients will come to us and say, Mom broke her hip, she's back home, we're busy working, we need some care around the house. Mom doesn't want anybody coming in the house, but we know better. We'd like to find someone who can help. And we'd like to also learn about what we can do now to protect mom's benefits in the future should her condition continue to decline. So we see them both ways. I wish we could see more earlier, to be honest with you. And I think that's where developing a relationship with a caregiving uh company comes in handy for us. Because you see clients much sooner, much earlier in the process than we do. And so we have opportunities there to maybe develop a relationship with a client that we might not otherwise see until much later in the process.

SPEAKER_01 7:56

True, true. There was a lot of clients that I would interact with that they didn't have wills, they had no power of attorney. And I was connected with a couple elder law attorneys in our area when I worked for a home care agency, and we would connect them. We you better get something set up here. That's true. All right.

SPEAKER_03 8:13

Yeah, yeah.

When Home Care Becomes Urgent

SPEAKER_01 8:14

All right. So now we're gonna talk about when attorneys refer to home care. So not again, not every legal consultation leads to home care referral. Many should understanding the specific situations, client profiles that trigger a referral helps agencies position themselves in the right place and the right time. So we're gonna explore that. So specific situations, in what specific situations do you recommend home care to your clients? Urgency signals, what signs tell you a client needs care immediately versus near the future?

SPEAKER_04 8:47

I think your experience may be different, but my experience is a lot of adult children who are arranging, organizing care for mom are in a state of denial about mom's situation. And they don't want to that mom is slipping or declining or is losing capacity. They like to think that once mom gets better, everything's gonna be back to normal again. And I think we've all seen many situations where normal never returns. That's just some semblance of normalcy. So uh trying to get beyond that state, that denial in the adult kids' minds is a big challenge. The uh reality is that a lot of people, both husbands and wives, are working. You know, daughter, who's typically the one shouldered with the responsibility for care, even if she has ten brothers, she's the one who gets the job. She's working. She's got a husband of her own. Her kids are maybe at high school age or college or getting ready to be married. She's got her hands full already. She doesn't have 25 to 40 hours a week to contribute towards mom's care, but be with mom every minute of every day. Having someone that they could trust, they could count on is important. It may very well be the very first time the adult daughter has ever dipped her toe in the waters of home care. She doesn't know who to call, she doesn't know what services are available, how those services might be built, who's ultimately responsible, whether there's any benefits to pay for those. So helping them understand the big picture is one of the one of the opportunities we have to develop the relationship.

SPEAKER_01 10:19

Sure. And everything you're saying, I know we could all relate to because we get the when somebody calls a home care agency, we hear the same thing. And some this might be the first call that they make and they just don't know. They don't know what it costs and they're working, and all of a sudden their mother fell and broke her hip. What are they going to do? Does she have money? Doesn't she have money? So everything you're saying, we all relate to it. I can tell you that. Do you refer to? I know usually we were talking on the phone bill, and you had mentioned you wish people would come to you earlier. Would you say that there are times when you do refer to a home care agency if they come early enough where maybe they're proactively planning?

Medicaid Eligibility And Special Needs Trust

SPEAKER_04 10:56

Absolutely. In fact, we refer people even up until they after they qualified for Medicaid and they're in a nursing home, still opportunities for home care to become involved. People don't think about it. But and I know every state's different. We probably have people here from all 50 states on the phone call. So every state could be slightly different. But here in Alabama, even after a person's qualified for Medicaid, they often I don't know how it is in your state, but nursing homes provide some base level of care for the residents there. Many families wish their the care were more personalized, more hands-on. But that's what they're gonna get. That's what the nursing home industry can deliver these days. So having someone additional in the room with mom or dad can make all the difference in the success the person has in the nursing home. They don't think for example, here in Alabama, we have we have I don't mean to go too far off the subject here, but when you apply for Medicaid, Medicaid here in Alabama says you can have up to$2,000 in resources and qualify. That's not much money. If a family goes to a nursing home and says, what can we do to get qualified for Medicaid, the nursing home industry will almost always say, spend mom's money down to$2,000 and then we'll submit a Medicaid application. The truth is, you can apply for Medicaid even if you have$100,000 in the bank. You just have to use a step called a special needs trust to hold that money, which makes mom immediately eligible. Now, that special needs trust, that$100,000 has to be spent on mom. It can't be spent on anything else. It's a great way to have a resource available to provide for a caregiver to sit with mom in the nursing home. And it's allowed by Medicaid. It's a great way to use mom's money, and the nursing won't mention it. So I like to get people when they still have a uh a lump sum that we can help them do that because they can qualify for care, they can get a better experience in the nursing home, and certainly get qualified for Medicaid much sooner than otherwise.

SPEAKER_01 13:08

Yeah, and a lot of people don't know that. I'm in New York State and I'm aware of those. And we would have clients that were had that money that they had already applied for Medicaid and they had that trust, and then they were able to pay for the home care at home. So that's why it's so important that people connect with elder law attorneys, especially when they're getting to the point where they're worried about the nursing home taking all their money where they can apply it the right way for their parent. And that money, like you said, has to be used for that care. So I think that's good information.

SPEAKER_04 13:40

It's supposed to an adult daughter. I'm I continue to use the adult daughter because that's who seems to be the caregiver. Usually calls. Uh she feels guilty if her mom's in the nursing home and nobody's visiting her. She feels guilty. She doesn't want to go on a vacation with her family. If she knows that there's a resource available to pay for 24-7 care while she's on her cruise with her kids, it's a lot easier for her to leave town. And so it it makes sense for everybody, really, to use the special needs trust planning and qualify for Medicaid sooner rather than at the last minute.

What Makes Attorneys Refer You

SPEAKER_01 14:11

Yeah. And absolutely they do. The family feels guilty. Nobody wants to have to put their family member in a nursing home. And we all know that no matter where you are, there's just not enough staff to have that one-on-one attention. Good information. All right. So, how attorneys choose which agency to recommend? So, the question every home care owner wants to know is you know, what actually earns referrals? Attorneys put their professional reputation on the line. Of course, every time you recommend an agency, you want to make sure you recommend a reputable agency that's going to help this your clients. So we're we wanted to ask you, Bill, your selection criteria. Like, how do you decide what agencies to refer to your clients? What makes you feel confident recommending a specific agency? And are there any red flags that make you hesitant to refer?

SPEAKER_04 15:00

We we're unusual. After we, when we first meet with the prospect, after we exchanged the niceties, how are you doing? Nice day, blah, blah, blah. I ask, in fact, everybody here says, How in the world did you call this firm as opposed to the other 10,000 lawyers of this state? And people will tell you, I found you on Google or my neighbor recommended you, or right-at-home care said I should call you guys. So we keep up with all of the referrals for everybody that comes in this door. That's important to us because we want to thank those. We want to remember those companies or individuals who refer business to us so we can reciprocate. But how would I decide if I were if a client came in and said, I need home care, what do I do? I think the knee-jerk reaction for a lot of people, a lot of adult daughters again, is to find the cheapest provider of care they can. Some lady at church or somebody down the street who does it on the side, who's not licensed, bonded, trained, insured, and for$18 to$20 an hour, they think that's a much better deal than$25 an hour from a licensed, bonded, insured company. So the silverware disappears and all the oxycontin disappears out of and things go missing. That$2 an hour you're saving really doesn't add up to that much. So I try to impress upon her that there's certain benefits to using a legitimate company as opposed to someone who just moved here from out of state because the police are looking for them in that state. And I think it makes sense. People realize that it does make sense to use a company that has a reputation to maintain. We had to work with one of our referral companies because one of the caregivers allegedly walked away with some jewelry. And which was unfortunate. But that happens. No matter how good the company is, you can go in disp desperate situations. In fact, people who are providing care in the home, they may have two or three other jobs too that they're handling. They may have kids who get sick. They may have a car that has 300,000 miles on it and it breaks down. They may get sick. They may have over at their previous job. They may go to sleep while they're providing care. So it's not necessarily whether there are problems that develop, because everybody's going to have problems developed. No matter how good your company is, no matter how good your law firm is, problems do develop. It's how you deal with those problems that matter. Preemptive, do you deal straight up with the with your client or do you try to avoid it? How you deal with it really means a lot to me because that shows that you're honorable and you're trying to protect your company's reputation and all that. So when I hear that a company has had a problem but dealt with it successfully, that means a lot to me. Really does.

SPEAKER_01 17:56

Yeah. And it does happen to the best of agencies. Things happen. And as long as just like you said, as I know the agency I worked in, we had a couple little situations. If you handle it right, then it that means a lot. I find that you refer to one home care partner or multiple agencies, or you match the client to the certain agency, or instead of when you're referring.

SPEAKER_04 18:21

That's a good question. Some agencies have a defined geographic footprint and they just can't provide or some people might need it. But in general, we have two or three larger companies in the Jefferson Shelby County area here. And they may employ dozens of caregivers. And they have great reputations. They have a full-time marketing person. I never really get a chance to work with the actual care provider. They're in the house, they're they're doing their thing. I usually work with the owner of the company or the marketing person. So I tend to get more I have more contact with people who have marketing representatives than I do sole owners. The sole owner. And we see those by the way. They'll stop by here and want to share their brochure and ask for referrals, and I'm happy to meet with them. And I quite frankly, I don't know how they do it. You can't be providing care eight to twelve hours a day and then also marketing your company the rest of the time. I don't know how they do it. But I'd say in general, the larger companies are the ones that we typically refer people to, but that's probably because they have a marketing person who's calling on us as opposed to the smaller companies that don't.

SPEAKER_01 19:33

Okay. That's good. Do you recall if you ever stopped referring to an agency that you had a really bad situation? It sounds like more of those little mom and pop places you're not too crazy about because, like you said, the caregivers aren't bonded or insured. But did you ever find yourself in that situation where you had to stop referring to somebody?

SPEAKER_04 19:50

Yes. I think the uh the situation early on I learned that, and I don't know how it is in your state, but here in Alabama, we have two categories of caregiving companies. One would be the typical that we're thinking of licensed, bonded, insured. The caregivers are employees of the company and they report directly to the company. The other is the job posting type, where it's basically a switchboard, in fact, where they will refer callers to a caregiver, but you're really not licensed bonded, you're not screened, you're not insured. You're just taking a percentage off of the top. And I don't have as much confidence in those companies as I do a company that that hires and supervises their own employees. When I find out a company that's just a more or less a job posting board, I typically don't use them anymore.

Responsiveness And Professional Standards

SPEAKER_01 20:42

Yeah, I agree. Okay, great. All right. So what makes a home care agency stand out? So from a legal professional's perspective, the agencies that earn referrals share specific traits that go beyond simply providing good care. These are operational, relational qualities that signal true professionalism. This is a big one for everybody's lit, everybody listening, responsiveness and communication. Please make sure somebody is answering your phone when somebody calls your agency. Yes, please.

SPEAKER_02 21:14

We even called some clients this week ourselves. We didn't have their telephone number, called the main line and nobody answered, guys. You have to answer live.

Follow Up That Feels Salesy

SPEAKER_01 21:25

You have to answer live. Okay. Answer your phones. And if there is a message, call them right back. But absolutely. So how quickly you answer, follow up, keeping all parties informed, professionalism with families, how your team presents itself to families during sensitive moments, just like Bill said, things happen. You may have somebody that takes something or some unusual situation that happens with a caregiver. It happens. You could have the best agency, the best caregivers. But how you handle it and with the families makes a big difference. Documentation and reporting, thorough records that support legal planning, benefit applications, quality care and consistency, reliable service delivery that families and attorneys can count on, knowing that when they hire your agency, your caregiver Are going to show up. If somebody doesn't show up, you have a replacement. Crisis management, again, how your agency handles unexpected situations and emergencies. These all happen every day. We know this is it, this is home care. Ethical standards and compliance operating with integrity, integrity, and within regulatory boundaries. Bill, what kind of follow-up from an agency makes you feel confident in the referral and what crosses the line into feeling inappropriate or sales y?

SPEAKER_04 22:38

Great question. We there's a company that operates in the Birmingham market, but also has headquarters in Nashville, not 200 miles north of here. And the regional salesperson is in charge of both territories. And she met with us once, and we she's nice and nice company, good company. But it became every time she's in Birmingham, she wanted to stop by and visit. And that was every other week. There's not a whole lot we can share every other week with somebody. It wasn't the same way it was two weeks ago. So it it became, I don't know, maybe a lack of recognition of our the value of our time when she wanted to actually come by here and meet and take time away. Happy to meet, happy to email with her and talk on the phone, but it just it seemed to be a little bit more intrusive than we wanted it to be. That would be more salesy than I would like, to be honest with you. In terms of I'm happy to meet though with the smaller companies, the startups, because I had to start up at some point. I had to get doors and knock on doors and meet people. So I understand the challenge. And if there's some detail that that makes them stand out over the rest, whether it's a low minimum hours or bathing people at no extra cost or whatever it might be, I'm happy to keep that in mind. I think for the most part, most of the companies are they offer the same services at roughly the same cost, same territory. So there's not much difference in the actual delivery of care from one company to the other. I think the difference is, like you said, how responsive they might be, how the marketing people, the the office people, if a problem develops. That's where the difference comes in.

How To Find Elder Law Partners

SPEAKER_02 24:29

Great. Okay. Did you have something to share, Don? Or I was just gonna say, yes, in home care, we do go every eight to ten days, but we're not supposed to expect a face-to-face every time. That's the difference. And so I had a marketer that my social worker called a plopper. She would come in and lock down and sit in front of her and social workers are just like, yeah, they're busy. They don't have time for someone to just so we we can't demand and expect a face-to-face every time we go by. You leave something educational behind, and we've been through this before, but I just wanted to address that. It's good for all of us to see a referral source staying at because that it is too much to expect that they're going to see you every time you come into the building. And I do have a question or for Bill in the chat. What should the home care agency look for when trying to partner with an elder care attorney or elder law attorney? How do we find the right ones? So how do they find someone like you, Bill, in their area to market to or to partner with?

SPEAKER_04 25:27

Yeah, the uh some firms, most elder law firms, at least in the South, tend to be small. Just one or a few lawyers. We have three, but I think we're, believe it or not, we're the largest elder law practice in Birmingham with three lawyers. So they're they tend to be less formal than a large downtown law firm might be. I think certainly just doing a quick search online. Elder Law Nashville, Elder Law Jackson, whatever it is, and you'll see who provides those services. And at that point, call the receptionist and say, Hey, I'm with so-and-so company. I'd like to meet your lawyers and explain what we do. When would be a nice time for me to come by one morning? I'll even bring bagels and meet people. Most people love muffins or bagels, donuts. They who's gonna turn that down. That's a great way to get in the door. And you can then size up the law firm and they can check you out and stay in touch from that point forward. I would focus on law firms that specialize in elder law. Some if you do a search online, you'll find lawyers who advertise personal injury, divorce, criminal defense, real estate closings, bankruptcy, elder estate planning, probate, and let's face it, that you can't be good at everything. Find people who focus and specialize in elder law and focus on them, because that's where you're going to get the most bang for your buck, I think.

Paying For Care With Planning

VA Aid And Attendance Explained

SPEAKER_01 26:52

True. Good. Okay. All right. So this is a big one. Financial planning and paying for home care, like you talked about in the beginning. We can't afford it. We can't afford care. This is one of the most common objections that families raise. What's one of the biggest reasons home care agencies lose potential clients? Often families can afford care with the right legal planning in place. And we're going to explore, ask you a few questions. I know we're working with the older generation, they're from that time period where they're saving for a rainy day. They're sometimes saying I want to save money for my kids. Those are all the things that I used to hear. So it's hard for them to spend that money when it's that time, it's that rainy day for them to use it. So a couple things, Medicaid, in fact, how can Medicaid planning open up care options? Like you, you, I think you explained that with the spending down. And then VAA in attendance. A lot of people don't know about VAA and attendance. I didn't learn about it until I was working in senior living and realizing, wow, this is a wonderful benefit that for veterans who fit the criteria can get an additional income each month and help pay for their care. So can you maybe talk a little bit about the how early planning and prevent can help prevent premature facility placement, how you can keep clients at home longer with Medicaid planning and the VA aid and attendance?

SPEAKER_04 28:16

Sure. We have a cheat sheet. It's a one-page question-answer kind of thing to help caregivers determine whether their prospect or their client is or might become qualified for the aid and attendance benefit. It's just a one-page or just yes or no kind of decision tree kind of thing. And we give that and say, look, when you're meeting with your client, call us on the phone, literally. If you're in their house, call us. One of us will answer your questions about aid and attendance and help clarify whether your client, your customer is or might become qualified. Because, like you said, an extra$2,500 a month goes a long way to pay for$100 here in Birmingham. That's 100 hours a month of care, 25 hours a week of care. That's a lot of care that Uncle Sam will pick up the tab for if you qualify. The problem is to qualify for aid and attendance, you have to have unreimbursed medical expenses that meet or exceed your monthly income. And a lot of veterans who are at home, even though they're just on Social Security, their unreimbursed medical expenses are fairly low because their Medicare, TRICARE, whatever's covering it. So they can't qualify for the aid and attendance benefit. The only way they might is to move to assisted living, which is considered an unreimbursed medical expense, and get the care they need as part of the assisted living package. But if you ask a thousand veterans, would you rather stay at home or move to assisted living? Every one of them is going to say, I'd rather stay at home. With the aid and attendance benefit, if they're paying for care at home,$2,500 a month, that's enough to offset their monthly income and let them qualify for the benefit. So really, their out-of-pocket, net out-of-pocket doesn't change the VA's paying the first$2,500 a month of caregiving, and it hadn't affected the veteran one bit, hadn't hurt his cost of living or his standard of living a bit. So mentioning aid in attendance as a care provider makes a lot of sense because it's basically finding a source of payment that didn't exist otherwise. Helping companies understand how to size up a veteran, whether they qualify or not makes a lot of sense. As far as Medicaid is concerned, there's the crisis standard. After a person's qualified for Medicaid, using the special needs trust to pay for it makes a lot of sense. But even if you meet with a client long before they move to skill care, let's say they're still at home and they have a substantial amount of money. For example, let's say that they have their home and they have a big IRA, and they would like to protect the home from having to be lost to a Medicaid lien, but they don't know how. They can place their home into a Medicaid trust, which is probably too in-depth to go into here, but it's something we do a lot of. Now, an IRA can't be placed into a trust. Unfortunately, you can't do that. But you can use your IRA to pay for home care because that's a medical expense and it provides a deduction that you can offset any additional taxes with, so you net out the taxes. So if a family understands we can put the house in a trust and then wait five years, and meanwhile, while mom's here in the house, we can spin down her IRA, which is going to be spent one way or the other, let's face it. But we can spend on home care to keep her at home as long as possible. That makes sense to the family. So explaining that to people is something we spend a lot of time with when we can get in front of people early enough.

SPEAKER_01 31:50

It's so true. And people just, I used to always say, Are you a veteran? And they had no idea of aid in attendance. And I we actually had a one of our clients sign up for aid in attendance, and they like backtracked, she got a check for$20,000 because when they were qualifying her and she the daughter called me and she goes, My mother doesn't want the money. She doesn't think this is right. They're sending her$20,000. They were that from the time she signed up until she was qualified, they gave her that money and it helped her stay with us.

SPEAKER_04 32:18

Uh-huh. It makes perfect sense. And it's something that the veteran earned. It doesn't go to everybody. It goes to the veteran. So it's something he or she earned as a result of their service. But I do have a lot of veterans who say, I'd like to leave this for a more deserving veteran. The money's set aside. It's set aside for you just as much as it is the other veterans. And why walk away from it if it's already, you know, set aside for you or your loved ones.

SPEAKER_01 32:43

And the spouses qualifies too. So the spouse of a veteran, correct?

SPEAKER_04 32:47

The spouse can qualify for about$1,500 a month.

SPEAKER_01 32:51

Okay. Yeah.

SPEAKER_04 32:52

Very good. Helps out, really does.

Avoiding Medicaid Penalties And Mistakes

SPEAKER_01 32:55

It absolutely does. Okay, great. All right. So increasing care hours through legal planning. One of the most powerful and least understood dynamics in home care the industry is legal planning and the number of hours, you know, that a family can afford just from talking to you or realizing when agencies and attorneys can work together maybe to help a client to if they for care hours. So the benefits of early involvement, how can agencies benefit when an attorney is brought in early in the care planning process? When should they suggest legal counsel? At what point should agencies recommend families consult an elder law attorney? I could speak when I worked in home care, when I found that I was working with somebody that had no family, had no will, they couldn't do their finances. I would always refer to an elder law attorney, but you may have some more suggestions. What specific documentation from agencies help attorneys support specific support benefit applications? And how can agencies and attorneys stay coordinated throughout the planning process? Lots of questions. If you can give us a little synopsis of what you think.

SPEAKER_04 34:03

One of the biggest mistakes families make when Medicaid is a reality is for the previous five-year period, they have not had any guidance about how to manage mom's finances, manage mom's property, and they don't know any better. Medicaid is the least the compassionate agency out there. The IRS looks like a big baby compared to Medicaid. Yes. We had a client last week who whose mom needed Medicaid, and she had sold mom's home, which was$150,000. That's not a lot of money, but sold it for$75,000 to one of these we buy ugly house companies because they needed the money. She didn't realize that Medicaid treats a sale of an asset for less than fair market value as a gift. So what she's actually done was made a$75,000 gift of mom's money to this We Buy Ugly House company. Medicaid's going to penalize her for 10 months of benefits. In other words, the first 10 months of mom's Medicaid or nursing home care is going to be private pay, and then Medicaid picks up on month 11. That's expensive. That's maybe what$20,000 times$80,000 that they weren't expected. But not only did she do that, she had said with mom's$75,000 that she actually did generate, she said, I paid myself for back for all the care that I had been providing mom over the last five years. Alabama Medicaid doesn't allow that kind of payment. They allow you to pay monthly going forward, but they don't allow a lump sum payment. So she had essentially penalized mom for maybe 16 months of Medicaid penalties because she didn't know any better. So that's a an expensive mistake. Helping families avoid those expensive mistakes is really what we do for a living. But we can't help them if we don't get into the conversation early enough. If a care provider is involved early on, it never hurts to say in our experience, people make mistakes. If you want to avoid those mistakes, you probably ought to talk to an elder law attorney. It's money well spent. And we can oftentimes save people a lot of headaches that way. Sure can. We another thing is a lot of people will hire the cheapest person who wants to be paid in cash because they don't want to compromise their social security check or whatever they're getting. Medicaid doesn't allow payments in cash to caregivers. They want to see an invoice from your company to the family for every month of care that itemizes the hours and all that stuff. People don't know that. So they've been paying the lady down the street for years for mom's care, and none of those payments are considered legitimate by Medicaid. So now mom gets penalized. So helping our job is to explain to families you need to hire a legitimate company, even if it costs you a little bit more money, because I can guarantee you it's not going to cost you more money than the Medicaid's penalty is going to cost you down the road when the time comes.

SPEAKER_01 37:13

Sure. Very important. And that five-year look back has been five years for a long time, I think.

SPEAKER_04 37:18

It has been since 2006.

SPEAKER_01 37:20

Yeah. Okay. A lot of people don't a lot of people don't know about that.

SPEAKER_04 37:25

Yeah.

Case Examples And Capacity Support

SPEAKER_01 37:26

All right. So this case study. So as we're talking when early collaborate collaborations worked, I think we've talked about this, like proactive planning. We've already talked about how if you can meet, meet with people sooner, talk to families, if home care agencies can, if they see some red flags where somebody could use an elder law attorney and then help with planning, that they should hopefully refer this person to an elder law attorney. Attorney and agency coordination, how did the attorney and home care agency work together to support client needs? And what was the financial impact? What was the outcome? Do you have a case study that maybe you could share, like of a current family that you met with early, planning on with somebody that you met with early, like somebody that their the family brings them in? My father has a million dollars. We want to protect this, but we want him to have money for his care. Give us an idea of somebody that comes in and meets with you early.

SPEAKER_04 38:22

One of the uh situations that seems to have come up more and more often in the last couple of years is where a senior or a married couple don't have any children. Or maybe if they do have children, their children are worthless, they'd live somewhere else and they haven't been any contact for years. They don't have anybody to take care of them. They don't have anybody to be agent under a power of attorney or healthcare proxy or executor or trustee or any of that. And so we have to loop someone in. I know we can do some of that, but the day-to-day kind of providing care, we don't do that. We can help them with managing their money and things like that. But in terms of taking them to the doctor, sitting there in the doctor's office and taking notes and all, that would be beyond what we're able to do. So there's one company in Birmingham who we will oftentimes call because the owner of the company is an RN. She has a couple of social workers who work for her and then caregivers, and they're more than willing to provide that service. It's over and above what the typical caregiving community might provide. But it really comes in handy for those families. There's not enough people doing that. We uh we've used caregiving companies to who have RNs to provide a mini-middle exam when they're questioning as to whether a person has capacity. They're maybe updating their documents, and there's some question as to whether they have capacity enough to sign these or not. We don't provide the mini-middle exam because that kind of looks like maybe we're double dealing or something. So we hire some company to come in to provide the mini-middle exam. So we have a document in the file in case the person's capacity ever did get called into question. We could say as of the date of the signing of the documents, they scored a 29 out of whatever on the test. So having that as a service is something that we found to be helpful as well.

Referrals Volume And Co Marketing Ideas

SPEAKER_02 40:21

All right. That's good. Hey, Annette, we have about 10 minutes left. Maybe we'll go. Do we want to open to questions? Let's just see before going forward if anyone has any questions that they'd like to ask Phil, just so we don't run out of time. Because if there are people that have a question, go ahead and unmute yourself. Or you can put it in the chat if you don't want to talk. But go ahead, add them if you have a question.

SPEAKER_00 40:44

Yeah, I had two questions. So it sounds like when you're talking to the legal planning, sounds like maybe that initial assessment, just asking if they have representation, is sounds like that would be like one of the first few items that you would come up with. And then building off of that, when we're approaching elder law attorneys, does it make sense to where we're asking about their qualifications to get referrals to them as we're out visiting, trying to get clients and just that service back and forth? And then the last one, the last question I had about how many referrals maybe a month would you typically do you think you get, maybe on average, to hand out to private duty agencies?

SPEAKER_04 41:29

Those are good questions. I agree with you that referrals generate reciprocal referrals. And since many people in your industry get into the conversation with the family earlier than we do, oftentimes you have the first opportunity to make a referral to us as opposed to us to you. We would certainly remember if a company referred a client to us, and we would certainly keep that in mind as we had an opportunity to refer one of our clients out again. I do think that there are ways, depending on your local bar thing. The bar associations could be all over the map in terms of what they consider to be legitimate advertising and marketing and all that. But given that it's okay, there may be some opportunities where your company and a law firm that you want to develop a relationship with could possibly piggyback off of one another. For example, if you send out a newsletter to offer to the law firm the opportunity to have a column in the newsletter answering typical questions that come up in the senior market every month. Or if you send out invoices every month, the old-fashioned way with the stamp and all that, you could possibly find a way to piggyback in that invoice something that the law firm could include in that, maybe a one-page explanation or marketing piece or whatever. They might even pay the postage for you. So there are ways that you could find to piggyback with a law firm. You just have to find the right law firm who's willing to explore that with you. What question did I not answer there?

SPEAKER_01 43:05

He was asking how many referrals. Now I'm going to speak for I worked with a lot of elder law attorneys when I was in home care. It wasn't like rehab where you can get three or four a week, but I would get a referral. Maybe I'd say every quarter, maybe a two or three. I don't know if that sounds right, but what would you say? How many referrals can a home care agency expect from an elder law attorney?

SPEAKER_04 43:27

Yeah, I don't think it would be as anything like a dozen a week or anything like that. I would think maybe one or two a week would be probably reasonable.

SPEAKER_01 43:37

That's pretty good. Yeah.

SPEAKER_04 43:38

I can't say that would actually convert to a an actual call, but we have a resource board in our conference room where we have brochures from different providers. Home care companies are there, mortuaries, ambulance, patient transport, durable medical, financial advisors, reverse mortgage people. We have their materials in there. So we hand them out when an opportunity comes up. So it's right there. And we always encourage people to bring their materials by so we can display them. the resource board.

SPEAKER_01 44:12

Great.

SPEAKER_02 44:13

Is there any other questions? Anyone else? See any in the chat. Does anyone, if you want to unmute yourself and ask the question, I just want to make sure everybody gets to ask Bill all the things before we keep going and run out of time.

SPEAKER_01 44:27

We're doing good. I think you talked about the we talked about the approach in what turns you off if somebody's too salesy, but is there any co-hosted events like educational seminars or community events that a home care agency can partner with an elder law attorney in?

SPEAKER_04 44:44

We have a group called MSSO in this part of Alabama. I think it's called something social service organizations. And it's a group of nonprofits that have bonded together churches and synagogues and various nonprofits. And they all serve seniors. And I don't know if they have an organization like that in in your area, but that's a great place to to meet other people in your industry but also to invite people like elder law attorneys to come along to join in that group. Another potential source would be the here in Alabama we have probate courts but in I think Mississippi they have chancery courts and I think it's called what the common court in New York, I forget, the courts that focus on probate, conservatorships, guardianships, those kind of things. Every state has some court that focuses on that. Those courts also have people who serve as guardians and conservators who are hired by the court often. And those would be great places to to try to develop a relationship with if you haven't looked at that option because they don't the court doesn't provide the care that you guys provide. They may manage a person's money but they don't take them to the doctor. They don't go over and help them bathe and change and remember to take their meds and all that. It'd be a great place to to try to develop some relationships through whatever the appropriate court might be in your state I think.

SPEAKER_01 46:11

Okay. And it sounded like you're what if somebody offers to come in and say they'd like to introduce their agency to your team if they bring some bagels or some treats you're welcome to to listen to them and have them we have sales training classes we talk to agencies across the United States. We want them to meet do in-service meetings, lunch and learns educate referral sources on how they can you can help each other. So it sounds like you're open to that.

SPEAKER_04 46:37

Oh absolutely and we meet with people even if they don't bring bagels. Okay food always we do a webinar once every quarter for one company who provides he's not caregiving what he does is his company finds it's a placement company. You call him and say mom needs this assisted living she's got$3,000 a month and a little dog and she smokes what's available he helps the family find that without money. So we do a webinar for him and he has 50 or 100 social workers on his webinar and happy to do it. Maybe something else that you can offer if you have a webinar or the opportunity to do a webinar.

SPEAKER_02 47:15

Sure. Bill what would you want to hear from a home care agency when they come in do you want to hear how they stand out how they're what differentiates them do you want to their hours their rate what is it that that you're wanting to hear so that you will refer to them I would love to hear how they are how they distinguish themselves from the competition.

SPEAKER_04 47:35

I'm experienced there's a lot of commonality in terms and it should be let's face it you can't really it's hard to compete if you're you can't be compared directly to the competition. So I'd love to hear that find out who's available after hours if the client has a problem on a Saturday night who gets what kind of responsiveness do they have and what how they might screen their caregivers. Do they do background checks or do they just hire whoever comes in off the street? That kind of thing.

SPEAKER_02 48:06

Are you interested in it all in the caregiver training or if they focus on memory care dementia more than maybe or Parkinson's does that kind of steer your thoughts or no that that really hasn't come up to be honest with you.

SPEAKER_04 48:21

Although it's a great question to ask is do you focus on a particular niche? I know that some companies might deal with special needs individuals of any age. They don't have to be seniors.

Final Questions And Wrap Up

SPEAKER_02 48:31

So you're more focused on safety the caregiver kind of have we done the background check a germ test or whatever the case may be and responsiveness it sounds like those are two perfect okay perfect we've got some action steps for home care owners you're going to you're going to be getting the slides with the replay of this great presentation.

SPEAKER_01 48:51

Such good information Bill this has been great. Does anybody have any other questions? We will have a replay of this presentation we're going to send you all the slides. We don't have time for the leave behinds. We have the March and April leave behinds but you're going to get them in the PDFs so we're not going to be hearing Lisa explain our fun leave behinds but reminder it is social work month.

SPEAKER_02 49:14

So make sure you're out there giving some those social workers some treats but any questions before we we sign off it is also Annette's birthday everyone I put it in the slides but she did not upgrade the slides what is it called I wouldn't surprise you it's in there but you it's in the chat if you look in the chat it's in the chat now in that you put it in here okay I did you just don't have you had an I don't older version yeah you had the older version yeah getting old getting old and I appreciate the opportunity to speak to everybody thank you so much wonderful wonderful all right thank you everybody we appreciate you your attendance we make sure you put yes in the chat if you're interested in winning the April leave behinds we're going to pick a winner okay all right have a great rest of your day everybody take care everybody bye bye