Joan Harris, LSW, MBA, CMC

Over the years at Symphony Care Management, I have been fortunate to build strong, reciprocal working relationships with dedicated professionals who bring both expertise and compassion to the clients we serve. Among the most essential of these partners are Trust & Estate Attorneys, particularly those who also practice Elder Law.

When older adults become medically vulnerable, estate documents move from being theoretical paperwork to being the foundation of protection.

The Critical Role of Advance Directives

As part of every initial assessment, we ask:

• Do you have updated advance directives?
• Do you have a current Health Care Proxy?
• Do you have a durable Power of Attorney?

These documents are not administrative formalities. They are the framework that ensures:

• Trusted decision-makers are empowered
• Financial resources are protected
• Health care decisions reflect the client’s wishes
• Quality of care can be secured when the client cannot advocate for themselves

Life brings unexpected health events. Falls. Hospitalizations. Cognitive decline.
Every adult needs updated advance directives — ideally reviewed every 3–5 years.

When these documents are thoughtfully drafted and regularly updated, they allow Care Managers and attorneys to act decisively and collaboratively when crisis strikes.

When Legal Authority Meets Clinical Advocacy

Three years ago, Attorney Curt Bletzer, Esq., a Trust & Estate and Elder Law attorney with Bletzer & Bletzer, PC, asked us to manage the care of a long-time client of his. Over time, we built a trusted professional partnership grounded in shared values: dignity, safety, and client-centered decision-making.

A few weeks ago, Attorney Bletzer contacted me urgently about another client, we’ll call her Susan.

Susan was a solo ager. She had no viable support system of family or close friends. This is a growing phenomenon we are seeing more frequently: older adults aging without immediate advocates.

Her designated Health Care Proxy had resigned. Attorney Bletzer, as the backup proxy, had stepped in.

Susan had suffered multiple falls, was in and out of the hospital, and was showing increasing confusion and memory decline. After a recent hospitalization, she was discharged to a short-term rehabilitation facility.

Attorney Bletzer visited her there and knew immediately something was wrong.

Within days, Susan had fallen again. She was declining rapidly.

She had no advocate at her bedside.

What We Found

We mobilized immediately.

We gathered all available clinical information and visited Susan at the facility. We approached the situation in our collaborative, non-confrontational style, but what we observed was deeply concerning.

• Susan had not been showered.
• She was largely left in bed.
• Staff reported she was having increasing difficulty walking.
• She expressed persistent pain in her right upper thigh.

Although she had been sent to the emergency room after her fall and x-rays were negative for a hip fracture, her pain was not being addressed adequately.

When we called to advocate, we encountered:

• Nurses who were “new”
• Staff unfamiliar with her history
• No clear accountability
• No skill set for best practices in working with someone who has dementia.

Without an active advocate, vulnerable adults can easily slip through systemic cracks.

Coordinated Action

On our very first day working with Susan, we began the process of transferring her to a high-quality rehabilitation facility known for strong interdisciplinary care and responsiveness.

It took four days to obtain the necessary clinical documentation from her current facility.

Attorney Bletzer completed all required legal and financial paperwork to facilitate the transfer. While he managed the legal authority and documentation, we:

• Advocated for pain management
• Ensured increased supervision
• Addressed dignity and hygiene concerns
• Coordinated communication among providers
• Began discharge planning

Five days after we met Susan, she was accepted to the new facility.

That same day, she was sent back to the hospital due to escalating pain.

This created a critical inflection point.

Because Attorney Bletzer was legally empowered as Health Care Proxy, he was able to clearly inform the hospital that Susan was not to return to the prior facility.

Imaging revealed the true source of her decline: a spinal compression fracture.

Her worsening pain and limited mobility now made clinical sense. She did not require prolonged hospitalization, but she did require:

• Appropriate pain management
• Careful transfer coordination
• An appropriate rehabilitation environment

Medicare discharge pressures are real. Hospitals are incentivized to discharge patients who are not receiving acute interventions.

We collaborated closely with hospital Case Management and physicians to:

• Provide updated clinical information to the receiving facility
• Advocate for an overnight stay to ensure safe transfer
• Prevent a rushed discharge back to an unsafe environment

The Outcome

Susan is now at a high-quality facility where:

• She is comfortable.
• Her pain is managed.
• She’s engaged in programming.
• She is socializing.
• She is regaining strength.

We are assessing her rehabilitation progress and exploring whether a transition to assisted living may ultimately be appropriate.

For now, she is safe.

And she is not alone.

Why This Collaboration Matters

This case illustrates why the partnership between Care Managers and Trust & Estate Attorneys is so powerful.

The attorney provides:

• Legal authority
• Protection of financial resources
• Execution of advance directives
• Decision-making clarity

The Care Manager provides:

• Clinical oversight
• Systems navigation
• Facility evaluation
• Bedside advocacy
• Ongoing coordination

Together, we create a safety net.

Particularly for solo agers, this collaboration can mean the difference between neglect and appropriate care.

A Growing Population: The Solo Ager

We are seeing a rising number of adults aging without immediate family support.

Without:

• Updated legal documents
• Identified proxies
• Professional oversight

These individuals are at significant risk during hospitalizations and rehabilitation stays.

This is where proactive estate planning and proactive Care Management intersect.

Not at crisis, but before it.

Our Deep Gratitude

We are deeply appreciative of Trust & Estate planning attorneys who:

• Truly care about their clients
• Recognize when clinical advocacy is needed
• Value interdisciplinary collaboration
• Invite Care Management into the circle of protection

When legal authority and Care Management expertise work together, vulnerable adults are protected with dignity, safety, and respect.