by Peter Silin

Ruth, an 82 year old, took eight months and several visits to decide to move to assisted living. A few months later she commented, “This was one of the best decisions I have ever made.” 78 year old Lena was transferred to a clean, warm and caring nursing home directly from the hospital. Her comment, a month later was “I cry myself to sleep every night.”

The difference, of course, is that Ruth was able to make a decision in her own time, which she felt was right for her; Lena was strong armed, by well meaning family and physicians due to being at high risk in her own home. Comparing the results of these two outcomes illustrates the need to understand aging as a process of practical and emotional changes through which older people (and their caregivers) are navigating. How they handle and are handled during this transition process is what decides whether the outcome is as positive as possible.

Lawyers whose clients are older people and their family members or caregivers will increasingly be involved in decisions arising out of the transitions of aging. Serving these clients will call upon specific skills and knowledge.

What specific knowledge is needed? First, an understanding of cognitive changes which can result in memory loss or what is termed executive function – the ability to make decisions, plan out tasks, and make appropriate judgments. Why these happen, what are the subtle clues, what can be done are essential to understand. Along with the cognitive changes, knowledge of some of the physical changes is important also. They affect everything from how an office is set up, documents, the time, and duration of appointments to deciding how to approach a client and situation.

Often people seek help around eldercare issues when in crisis. The crisis can be triggered by changes in the physical, cognitive, or emotional status of the older person, or because of changes in the family/caregiver system. The time when they need to make decisions is exactly the time it is difficult to make them. The result is fear, anxiety, confusion, guilt, burnout, and conflict. While this at times triggers legal intervention, it may indicate also a need to engage other services and supports.

Conflict is often a reflection of problems in family systems which are usually relatively well managed but aggravated by crisis. These dynamics may be historical or situational; they may be about an individual or the family as a group. These are also some of the issues it is helpful to understand when working with older people and their families.

It is also helpful to have an understanding of the public and private care systems as many decisions will be made around which ones to use, and when and how to use them. Trying to fit people to the services can be daunting. The undertaking of using these services may be what leads to conflict and visits to the lawyers’ office.

The above illustrate some of the issues complicating eldercare. Whereas it is may not be practical for lawyers to become experts in aging, they can educate themselves for a broad understanding. This will help in formulating a plan of action – where to start, what are the limitations, when to act as a broker for other services for their clients, or when to use a “multidisciplinary team” approach.

Peter Silin, MSW, RSW is president of Diamond Geriatrics, Inc., a Vancouver based geriatric care management and eldercare consulting company. Contact him at 604-874-7764 or through www.diamondgeriatrics.com.

This article was published in the April 2007 issue of BarTalk and is subject to the copyright by the British Columbia Branch of the Canadian Bar Association, 2007, all rights reserved.