Abstract
Background
• Finances: particularly patients who are uninsured, the sole wage earner in their family, or who are seeking particular benefits/statuses such as Social Security Disability, service-connection benefits for veterans, etc. • Dependents: particularly if the patient is a single parent with children under 18 years; in a same-sex partnership in which the surviving partner does not have parental or guardianship rights for the minor children; or if the patient has disabled children of any age. • Family: particularly patients with no close relatives, or who have key relationships that are not legally recognized (e.g., unmarried couples, particularly same-sex partnerships). • Legal Status: particularly immigrants who do not have citizen status in the country they reside in.
Screening for and Responding to Distress
Clinicians can ask patients, Are there any particular financial or legal concerns you have in light of your [advanced illness]? Some concerns can be addressed with a referral to a hospital or clinic social worker, such as completion of a heath care agent/health care power of attorney document (in most states), or application for publicly supported insurance. Other concerns, such as completion of financial wills; establishing financial trusts; appealing denial of disability benefits; ensuring acceptable guardianship for minor children; and addressing immigration concerns for a dying patient or her/his survivors, will need legal advocacy. MLPs are an increasingly available method to provide legal advocacy for patients who cannot otherwise afford it.
Components of an MLP
MLPs are usually hospital-based alliances among hospital-based clinicians, social workers, institutions, and community legal advocates to assist patients with legal issues in need of rapid resolution, targeting patients who cannot afford legal assistance or whose situation is exigent. Community legal advocates generally work
Issues Addressed by MLP Consultation
• Finances: What is the usual source of household income and current source of household income? Has the patient/client applied for Social Security Disability? Are there arrears on rent or mortgage that will impact survivors? Does the patient-client have adequate health insurance? If not, has a Medicaid or other public assistance application been made? Any denial of benefits needing an appeal?
• Dependents: Are there any minor children? Is there a need for guardianship planning?
• Family: Any problematic legal relationships between patient and family members or domestic partners? Are there food and energy insecurity issues, poor environmental or housing conditions, domestic violence or family leave problems?
• Planning: Has the patient-client completed advance care planning documents? How are survivors to be provided for? What are the patient's assets, life-insurance? Does the patient-client have or want a will?
Tips on Starting an MLP
• Identify a community legal advocate. Places to start include:
∘ The Legal Services Corporation (LSC), a federally funded organization enacted by U.S. Congress with the mission to provide high-quality civil legal advocacy to low-income individuals. The LSC provides a list of all legal advocates in all fifty states by county and/or region. The LSC website is http://www.lsc.gov.
∘ The state bar association or county bar association in your region. Many bar associations support a formal pro bono program. More information can be found at: http://www.americanbar.org/groups/bar_services/resources/state_local_bar_associations.html.
∘ Law Schools with either a public interest or health care clinic for students.
∘ A local Public Interest Law firm/group providing civil (not criminal) legal advocacy.
• Once an advocate is identified, discuss the type of patient/client to be served and the range of legal advocacy needed. Clarify roles, and ensure the legal advocate does not unnecessarily duplicate services already offered (e.g., by social workers). The ideal legal advocate should be willing to meet patient/clients at the bedside, work “on call” and have experience to address a range of legal needs.
• Financial arrangements of legal advocacy vary and include volunteer work, support from grants or direct contribution from the institution.