In the Medical-Legal Partnership for Seniors Clinic (MLPS), UC Law students develop key lawyering skills through representation of low-income elderly patients at a UCSF medical clinic. Students assist clients in legal issues related to health, such as advance health care planning, estate planning, and public benefits.

Over the course of the semester, students learn about the complex intersection of law and health, the implications for an aging population, and the role of lawyers in combating poverty and health disparities. Students develop skills in interviewing, critical thinking, document drafting, project management, and “whole person” lawyering.

San Francisco is home to over 13,000 senior veterans, a population that is particularly susceptible to mental, physical, and cognitive disability which make it difficult for them to meet basic needs and stay safely in their homes and community. The need for legal assistance to address these concerns for veterans becomes increasingly urgent in San Francisco, where there has been an astronomical rise in living costs and a displacement of middle and low-income individuals from the housing market.

The Care Ecosystem (CE) model was first designed in 2013 to help address the unmet needs of persons with dementia and their caregivers. The goals of the program include improving quality of life for persons with dementia and their caregivers, preventing unnecessary hospitalizations, and delaying admissions to long-term care institutions.

The program provides caregiver support, linkages to community-based resources, advance care planning, medication support, and care coordination via a multidisciplinary team. While the randomized controlled trial took place in two academic medical centers, the CE is now being replicated in three different settings: an integrated health system, a senior center for low-income individuals, and as a service embedded in a memory care clinic. We have developed this toolkit in response to a growing interest in the CE. This toolkit provides an overview of the CE model, how to prepare for and implement the CE model, and details of the CE protocols. In the appendices, you will find valuable resources including job descriptions, templates, and other workflow diagrams, as well as useful references.

Consortium Executive Director Sarah Hooper and UCSF Professor Rebecca Sudore collaborated with the ABA Commission on Law & Aging, American Academy of Hospice and Palliative Medicine, and the John A. Hartford Foundation to produce evidence-based guidance for lawyers to improve advance directives counseling. Access the guide here.

Professors Hooper and Sudore presented on the guide at the AAHPM Annual Assembly in March, then to the National Center for Medical-Legal Partnership network in March, as well as to ABA members in February. The latter talk is available in a free, on-demand CLE available here.

California has become the fifth state in the nation to legalize aid-in-dying through a law called the End of Life Option Act.  This law permits a competent, terminally-ill patient to request a prescription for a drug that can be used to end his or her life.  Participation in the law is entirely voluntary for physicians, patients, pharmacists and others.  Patients and physicians who choose to participate must carefully follow the steps outlined in the law in order for their actions to be considered lawful and appropriate.

The Dementia Care Aware Medical-Legal Learning Collaborative is a new statewide initiative that aims to improve care for underserved Californians with cognitive impairment. This Collaborative is embedded within a broader effort known as Dementia Care Aware (dementiacareaware.org), led by UCSF Professor Anna Chodos and funded by the CA Department of Health Care Services through a 2-year $23 million dollar grant.

The Medical-Legal Learning Collaborative is spearheaded by Professor Sarah Hooper at UC Law and brings together health care providers from five UC Health systems and lawyers from five legal aid providers from around the state: UCSF, UCLA Health, UCLA/LA DHS, UCI Health, UCSD Health, the UCSF/UC Hastings Medical-Legal Partnership for Seniors Clinic, Legal Services of Northern California, Legal Aid at Work, Neighborhood Legal Services, Public Law Center, and Elder Law and Advocacy.

The partnership is developing and implementing a statewide curriculum that trains primary care teams in the common legal needs of underserved patients with cognitive impairment, including advance care planning and conservatorship prevention strategies, Medi-Cal access, caregiver leave laws, housing and long term care, and elder abuse, among others. The partnership provides primary care providers around the state with training, tools, and resources through webinars, training modules, podcasts, and region-specific events over the next two years. 

Free webinars and resources will be available on the website at dementiacareaware.org. If you are a primary care provider interested in receiving or co-hosting a training from the network, please contact Mahnoor Yunus at yunusmahnoor@uchastings.edu.