By Emily Rock and James Bhandary-Alexander
On August 9, legislators introduced a new bill in Congress that allocates funding to the development of Medical-Legal Partnerships (MLPs), in recognition of the important role MLPs can play in the lives of older Americans.
As attorneys with the Medical-Legal Partnership program at the Solomon Center for Health Law and Policy at Yale Law School, we strongly encourage Congress to act quickly to pass this legislation.
MLPs offer an innovative, interdisciplinary approach to addressing patients’ unmet legal needs and pursuing health justice. In an MLP, lawyers work alongside healthcare providers to screen for and treat legal issues which negatively affect health, and which cannot be resolved solely through medical care.
Studies have shown the wide-ranging impact that MLPs can have on patients, including less frequent hospital admissions for patients with chronic illness, improved access to housing, reduced stress, and improved access to education and employment needs.
However, despite their efficacy, MLPs are currently underutilized when it comes to older adults, and only a few MLPs nationwide focus on this vulnerable population.
The recently introduced Elder Justice Reauthorization and Modernization Act of 2021 (EJA) addresses this gap. The EJA creates new programs and devotes additional funding to better assist aging adults. Among various other provisions, the proposed bill would create a grant program to support states in developing MLPs, defined in the legislation as multidisciplinary teams comprised of clinical staff, social workers, and lawyers who work together to address patients’ social and legal needs. This interdisciplinary approach supports clinicians in “address[ing] structural problems at the root of so many health inequities impacting older adults.” The MLP provision of the EJA allocates $500 million in funding over the next four years for this purpose.
This new allocation of funding will surely be of help to low-income older adults, who are especially in need of assistance with legal issues. While 56% of this population experienced a civil legal problem in the past year, 87% of those problems received either no professional legal help or inadequate help. MLPs can assist in such areas as advance care planning, financial planning, and food insecurity. In one striking example of a successful interdisciplinary approach, a team at the San Francisco Veterans Affairs Health Care System saw an almost 40% reduction in inpatients with prolonged hospitalizations over a six-month period after they began weekly meetings convening inpatient and outpatient services and lawyers to brainstorm solutions for discharging older patients with complex needs.
In our work with the Solomon Center’s MLP, we have seen firsthand the benefits for patients. MLPs connect low-income patients with the legal help they otherwise could not access or afford and often enables them to resolve legal issues preventatively, before litigation is necessary. For example, we have negotiated issues of employment, discrimination, and access to housing, assisting patients in resolving these issues without a lawsuit. In our longstanding palliative care MLP, typical cases involve assisting patients with end-of-life legal issues like wills, power of attorney, and/or guardianship documents. Our new geriatric MLP will screen for issues including income, housing, health insurance, consumer fraud, and elder abuse. Law student interns in these MLPs also collaborate with medical providers on research, structural advocacy, and building enduring community relationships.
“COVID-19 has laid bare the risks of abuse, neglect and exploitation faced by vulnerable seniors and folks with disabilities,” EJA co-sponsor Ron Wyden explained. MLPs are a valuable resource in countering these risks. As Representative Richard Neal, a co-sponsor of the EJA, noted, “[b]y putting an end to chronic underfunding and strengthening elder policy, this bill will enhance existing programs and make it easier to seek justice.” We urge Congress to pass the EJA, and we look forward to seeing the new MLPs that will emerge as a result of this important legislation.
Emily Rock is the Medical-Legal Partnership Fellow at the Solomon Center for Health Law and Policy; she previously practiced at a plaintiffs’ law firm and earned her J.D. from Yale Law School.
James Bhandary-Alexander is the Medical-Legal Partnership Legal Director at the Solomon Center for Health Law and Policy at Yale Law School.