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Addressing Practicalities: Integrating a Medical Legal Partnership into the care of the Palliative Care Population Kate Mahrer Rogers, LMSW Palliative Care Social Worker Medical University of South Carolina Charleston, SC. Disclosures. No disclosures to report. Objectives.

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  1. Addressing Practicalities: Integrating a Medical Legal Partnership into the care of the Palliative Care Population Kate Mahrer Rogers, LMSW Palliative Care Social Worker Medical University of South Carolina Charleston, SC

  2. Disclosures • No disclosures to report

  3. Objectives • Identify interconnectedness of health and legal issues • Discuss different models of Medical Legal Partnership • Identify ways in which addressing legal issues can ease suffering the Palliative Care population.

  4. Medical-Legal Partnership “Medical-legal partnerships embed lawyers as specialists in health care settings. When some of the most complex and intractable problems—like an illegal eviction—are detected, clinical staff can refer patients directly for legal services. And like other members of the health care team, legal staff are available to consult with clinical and non-clinical staff about system and policy barriers to care.” (medical-legalpartnership.org)

  5. “The Causes of the Causes” (Marmot 2007) • -The Social Determinants of Healthcare-the environmental, social, political, cultural, or economic that affect a persons health regardless of access to high-quality healthcare. • -As all health providers become more aware of how a person’s well-being is affected by factors outside of the walls of the hospital, it begs the question, • “What do I do now that I know it is a problem? Call your social worker!

  6. History of Medical-Legal Partnerships • -Casual relationships between hospital systems (often through referrals initiated by social workers) and legal organizations have long existed • -The Medical-Legal Partnership concept was formalized by Department of Pediatrics at Boston Medical Center and Boston University School of Medicine in 1993 • (Gilbert & Downs 2015) • -MLPs have been established in 294 healthcare institutions in 41 states (medical-legalpartnerships.org)

  7. At its core a MLP is defined as a collaboration between a legal professional and a medical professional which can look different in different settings MLP Models • Legal professionals developing curriculum for medical professionals and students to encourage awareness of legal barriers to health • Formal Partnerships between Legal Services and Healthcare institutions • Harnessing Pro Bono networks to serve in both hospital and primary care settings • Law student clinics within hospitals and medical practices • (Cohen et al. 2010)

  8. Palliative Care Program Overview • Primarily inpatient consult service with 2 half days of outpatient clinic/week • Adult and Pediatric team-9 physicians, 4 advanced practice nurses, 2 social workers, 1.5 chaplains, 1 Program and Volunteer coordinator • Approx. 200 Adult inpatient consults/mo; 25 Pediatric consults/mo

  9. Palliative Care and MLP • Potential for distress for patients with serious illness • Financial • Public benefit applications and/or denials • Denial of coverage from Medicaid/Medicare • Creditor harassment • Bankruptcy • Planning for care of dependents including guardianship/conservatorship of adults • Child visitation • Housing • Housing insecurity-Eviction; Foreclosure; Loss of Public Housing, Loss of Section 8 voucher • Landlord Issues-Not making repairs, turn of electricity/water, will not return security deposit • Advanced directives for Healthcare • Financial Power of Attorney • Will

  10. MLP and Palliative Care at MUSC • -Formalizing a Medical-Legal Partnership was initiated by Office of the General Counsel • -Initially envisioned as a partnership between MUSC, SC Legal Services, Charleston School of Law, and Charleston Pro Bono network. • -The formal arrangement is between the MUSC and SC Legal Services • -Pilot project with Palliative Care population before opening access to wider hospital population

  11. What Has Worked -Working relationship with SC Legal Services • Response time • Advice from assigned lawyers • Multiple face-to-face meetings with SC Legal Services to review progress and process • Flexibility within application process • Encouragement to refer all cases for consideration -Consistent Volunteers -Most importantly, Palliative Care patient and families who are having legal issues addressed

  12. Limitations • -No dedicated space within MUSC or onsite medical clinics for law students to meet with patients • -Volunteers are only available certain days and hours; goal is to staff a full working week. • -Understaffed at social worker position for full assessment of all Palliative Care consults to determine who has legal concerns, therefore limited referrals to MLP • -Effective use and training of volunteers

  13. Where Do We go? • Embedding MLP volunteer and/or staff at cancer center with specific focus on Neuro-Oncology patients • Developing partnership with Pro Bono network • Active recruitment of law student volunteers • Increase referrals to warrant embedded Legal Services staff at hospital • Evaluation of effectiveness

  14. Reference • Hallarman, L. Snow, D. Fast Facts and Concepts #245. The Medical-Legal Partnership: Addressing Medical-Legal Suffering for Patients with Advanced Illness. September 2011. Available at: https://www.mypcnow.org • National Center for Medical-Legal Partnership. (n.d.). Retrieved January 25, 2018, from http://medical-legalpartnership.org/ • Rodabaugh K, Hammond M, Myszka D, Sandel A. A Medical-Legal Partnership as a component of a palliative care model. J Palliat Med. 2010; 13(1): 15-19 • MEDICAL LEGAL PARTNERSHIP FOR SENIORS: INTEGRATING MEDICAL AND LEGAL SERVICES , The Gerontologist, Volume 55, Issue Suppl_2, 1 November 2015, Pages 249, https://doi-org.ezproxy-v.musc.edu/10.1093/geront/gnv566.19 • Amy Lewis Gilbert & Stephen M. Downs (2015) Medical legal partnership and health informatics impacting child health: Interprofessional innovations, Journal of Interprofessional Care, 29:6, 564-569, DOI: 10.3109/13561820.2015.1029066 • Shelley L. Craig PhD LCSW, Raluca Bejan MSW & Barbara Muskat PhD RSW (2013) Making the Invisible Visible: Are Health Social Workers Addressing the Social Determinants of Health?, Social Work in Health Care, 52:4, 311-331, DOI: 10.1080/00981389.2013.764379 • Cohen, E., Fullerton, D. F., Retkin, R., Weintraub, D., Tames, P., Brandfield, J., & Sandel, M. (2010). Medical-Legal Partnership: Collaborating with Lawyers to Identify and Address Health Disparities. Journal of General Internal Medicine, 25(Suppl 2), 136–139. http://doi.org/10.1007/s11606-009-1239-7

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