End of Life and Aging

About Our Research

The health and well-being of older adults is an increasingly pressing area of focus as the population ages. Healthcare for older adults is bound up with the law in a broad variety of ways and the care needs of this population are often front and center in policy debates about healthcare cost and quality. In addition, health conditions that often present in old age, such as cognitive impairment and dementia, have important legal implications for patients that are not widely understood. Consortium research in these areas has included an examination of advance directive law and health care decision making in clinical context, medical-legal responses to elder financial abuse, and regulation of skilled nursing facilities.

End of Life and Aging Projects

+ Medical-Legal Partnership for Seniors (MLPS)
+ VA Expansion for Medical-Legal Partnership for Seniors
+ The Dementia Care Ecosystem
+ San Francisco Geriatric Workforce Enhancement Program (GWEP)
+ Advance Directives: Counseling Guide for Lawyers
+ California’s End of Life Option Act

About Our Research

The health and well-being of older adults is an increasingly pressing area of focus as the population ages. Healthcare for older adults is bound up with the law in a broad variety of ways and the care needs of this population are often front and center in policy debates about healthcare cost and quality. In addition, health conditions that often present in old age, such as cognitive impairment and dementia, have important legal implications for patients that are not widely understood. Consortium research in these areas has included an examination of advance directive law and health care decision making in clinical context, medical-legal responses to elder financial abuse, and regulation of skilled nursing facilities.

End of Life and Aging Projects

+ Medical-Legal Partnership for Seniors (MLPS)
+ VA Expansion for Medical-Legal Partnership for Seniors
+ The Dementia Care Ecosystem
+ San Francisco Geriatric Workforce Enhancement Program (GWEP)
+ Advance Directives: Counseling Guide for Lawyers
+ California’s End of Life Option Act


Medical-Legal Partnership for Seniors

In the Medical-Legal Partnership for Seniors Clinic (MLPS), Hastings 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.

Find out more about MLPS here


MLPS Clinic Expansion to the San Francisco VA Hospital

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.

In 2015, the UC Hastings MLPS expanded its services to include senior veterans (MLPS-V) at the San Francisco Veterans Affairs Medical Center (VA) with support from PG&E and Latham & Watkins LLP through an Equal Justice Works Fellowship.

When a physician at the VA recognizes that a patient is having a legal need, they are referred directly to the MLPS-V for support. UC Hastings alumnus Sara Huffman ’14, the Equal Justice Works Fellow who supervises the program, is at the VA every Monday while her veteran clients are visiting their primary care physicians.

Since its inception, the MLPS-V has branched out to provide services to clients living at the on-site VA Community Living Center (CLC) and has enabled UC Hastings students to participate in home visits for clients with mobility issues or who are homebound.

With this new expansion and help from UC Hastings students, the MLPS-V was able to provide legal services to around 70 veterans or spouses of veterans in 2016.

sarah huffman

Have questions?  Contact us at:

Sara Huffman
huffmans@uchastings.edu


The Dementia Care Ecosystem

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.

Download the toolkit here


San Francisco Geriatric Workforce Enhancement Program (GWEP)

The Optimizing Aging Collaborative was founded in July 2015 as a Geriatric Workforce Enhancement Program by the U.S. Health Resources and Services Administration. This collaborative includes experts and industry leaders from over 10 public, nonprofit, and academic organizations in the San Francisco Bay Area to provide education and innovative services that address older adults’ health, social, and legal needs. The UCSF Division of Geriatrics is recognized throughout the medical community as a world leader in the areas of research, education and clinical care for older adults.

For more information, click here


Advance Directives: Counseling Guide for Lawyers

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.

Download the guide here


California’s End of Life Option Act

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.

Below we have provided resources and information about the law.  These resources are intended to provide basic information only and do not constitute legal advice, nor do they substitute for the advice of a lawyer.  The Consortium does not necessarily endorse the institutional policies listed or referenced on this website- they are provided for public education purposes only.

For information about your specific situation, we recommend that you consult the policies of the institution/s at which you provide or receive care and seek guidance from institutional counsel or ombudsman as appropriate.  Note that if you provide or receive care at multiple facilities, those facilities may have different policies.

Institution-Specific Policies & Resources

The law allows institutional providers (for instance, a hospital or health system) to opt out of the law.  This means that an institutional provider (for instance, a hospital) can prohibit physicians and others working at their facilities from assisting patients with aid in dying.  Opt-out institutions cannot prevent physicians from providing information about the law, but can prevent other actions such as prescribing the drug.

Learn where California institutions stand on the law.  Note that most institutions are still developing official policies as of the implementation date of the law (June 9, 2016).  We will post information about these policies as they become public.

Institutions that Prohibit Physicians and Others from Participating

Note that these institutions cannot prohibit physicians or others from giving information about the Act to patients.