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How civil legal aid assists older adults

This post was first published on Huffington Post.

By Lonnie Powers

The president of the United States is a 71-year-old reality TV star. One of his fiercest critics is the acid-tongued Rep. Maxine Waters, age 79. At age 81, public radio host Diane Rehm married a 78-year-old. At a relatively youthful 68, rock god Bruce Springsteen’s solo acoustic show is one of the hottest tickets on Broadway, while celebrated fiction writer Amy Tan, 65, is earning acclaim for adeptly tackling the art of memoir with “Where the Past Begins.”

These influential older Americans are emblematic of the cultural shift that began in our country when the baby boom generation (those born between 1946 and 1964) reached retirement age in 2011—and will continue for decades to come. Census figures show that the number of U.S. residents ages 65 and over grew from 35 million in 2000 to 49.2 million in 2016. The Population Research Bureau says that between 2020 and 2030 the number of seniors will increase by 18 million; by 2060, close to one quarter of Americans will be 65 or older.

The graying of the U.S population affects all areas of our society—from the economy and the labor force to our health care system and federal safety net programs like Medicare and Social Security. A recent POLITICO story about a brewing crisis in the U.S. hospice care system, for example, sounded the alarm on the urgent need for the health care field to quickly adapt if we are to effectively meet the needs of our country’s rapidly ballooning and long-lived senior population.

“With baby boomers aging and likely to live with serious illness for several years, understanding how best to take care of the aged and the dying is becoming an ever more pressing issue in America—emotionally, morally, and financially,” writes POLITICO Health Editor Joanne Kenen. Reinforcing that point, geriatrics expert Joan Teno has said, “We need to address this very quickly. The tsunami of frail elderly people with complex multiple illnesses is coming.”

Indeed, not every older American enjoys the abundant resources of the likes of Bruce Springsteen or the health care and financial security provided by a Congressional retirement plan. Right now, about 6.4 million older Americans live in poverty—defined by the federal government as an annual income of $12,060 or less. While the poverty rate among the elderly has declined over time, senior care experts project that millions of seniors will struggle financially in the coming decades due to cuts to safety net programs, shrinking employee pension programs, longer life spans, rising health care costs, inadequate retirement savings and other demographic and lifestyle factors. Justice in Aging, a civil legal aid organization dedicated to elder issues, projects that by 2030, 72 million seniors will be living in poverty and that senior homelessness will increase by 33 percent by 2020.

Preventing a crisis of elder poverty and helping older adults live safe and fulfilling lives will require greater advocacy from and on behalf of seniors, creative policy making, and new community partnerships. We must also strengthen existing programs that have proven effective in helping vulnerable elders—Social Security, Medicare and Meals on Wheels—and, of course, civil legal aid.

Civil legal aid, which provides free legal assistance and representation to low-income people facing non-criminal legal issues, is a potent tool to assist vulnerable seniors in securing proper health care and housing, to protect them from physical abuse and financial exploitation, and to get access to other benefits and services to help keep them solvent.

In Massachusetts and around the country, many legal services organizations have units dedicated exclusively to addressing the legal needs of the elder population. For example, Greater Boston Legal Services’ (GBLS) Elder Abuse Prevention Project, in addition to providing direct services to elder clients, provides training for care providers, community members, and seniors to raise public awareness of the forms such abuse can take. GBLS is playing a role in assisting the increasing number of elders who are falling victim to abuse by opioid addicted family members, a side effect largely overlooked until recently.

The organization recently helped “Pauline,” a 77-year-old Chelsea woman, avoid eviction after her daughter’s unwanted presence in her apartment drew the attention of the woman’s landlord. The daughter had originally moved in with Pauline after GBLS helped the family qualify for a federal stipend that compensated the daughter for caring for Pauline. Unfortunately, the daughter took advantage of the situation, using the apartment for activities prohibited in the lease. Pauline made her daughter move out.

Pauline was injured shortly afterward, requiring hospitalization followed by a stay in a nursing home rehab unit. Unbeknownst to her, Pauline’s daughter had moved back into her apartment during this time, prompting the landlord to initiate an eviction. GBLS, however, negotiated an agreement that enabled Pauline to keep her apartment provided she received care from a different family member and her daughter stayed clear of the premises. GBLS also advocated on Pauline’s behalf to ensure she received proper follow-up care upon discharge from the nursing home. These arrangements enabled Pauline to spend the last two weeks of her life back in the home that she loved and fought so hard to keep.

MetroWest Legal Services’ (MWLS) Senior Citizen’s Legal Project assists elders in central Massachusetts with housing needs, health care directives, nursing home issues, domestic relations, and other issues. In one instance, they prevented Florynce, a senior living alone in Watertown, from becoming homeless after a $500 rent increase forced her to seek a new place to live. Before a MWLS attorney began advocating on Florynce’s behalf, her landlord was refusing to negotiate a lease extension to give Florynce time to obtain senior housing through the local housing authority. The attorney negotiated the lease extension and brought Florynce to the attention of the housing authority director, who approved a measure to give Florynce priority on the housing waiting list. A few weeks before her lease extension expired, an apartment opened up and Florynce made a smooth transition to her new home.

These are but two examples of the life-sustaining assistance that civil legal aid can provide to low-income seniors. As we face a future of assisting and caring for a disproportionately large population of senior Americans, we’ll need innovations in health care, housing, transportation and other infrastructure to adequately and safely meet their needs. But we must also continue critical existing services. Civil legal aid has long been an effective means of advocating for the needs of vulnerable seniors individually and systemically. Given all the looming challenges, now is an opportune time to strengthen and expand our country’s network of civil legal aid programs.

Lonnie Powers is executive director of the Massachusetts Legal Assistance Corporation.

Want justice? Don’t be shy—grab the spotlight

By Lonnie Powers

Civil legal aid organizations are in the business of advancing one of the biggest, boldest ideas ever conceived in our nation: justice for all. It’s an idea with roots in our country’s founding principle that we are all equal participants in our society and thus deserving of equal rights, opportunities, and the protections of the law.

Of course, implementing big, bold ideas requires persistence, imagination, and money. The problem with civil legal aid, which provides legal advice or representation to people struggling to make ends meet, is that it has been severely underfunded since its inception in the late 1800s. Consequently, poor people facing non-criminal legal matters such as eviction, foreclosure, access to educational accommodations, or assistance to escape domestic abuse are left without help. Sadly, this exclusion of millions of Americans from justice remains unseen.

In a history compiled by the Center for Law and Social Policy (CLASP), authors Alan Houseman and Linda Perle note that in the early 1900s “no legal aid program had adequate resources,” and that “legal aid reached less than 1 percent of those in need.” Civil legal aid programs began receiving federal funding in the 1960s as part of the War on Poverty and now also receive funding from IOLTA programs in every state, along with state and local support. (IOLTA stands for Interest on Lawyers Trust Accounts and is the money earned from interest-bearing accounts with funds pooled from lawyers handling nominal or short-term client funds.) Unfortunately, demand for services continues to outstrip supply by an alarming margin; nationally, more than 50 percent of those who seek civil legal aid are turned away due to lack of resources. Here in Massachusetts, the number is even higher, with nearly two-thirds of eligible people seeking legal assistance being turned away.

Funding woes stem in large part from a lack of public knowledge about civil legal aid, despite broad support for the ideals of fairness and justice. The average person simply does not know what civil legal aid is and how its benefits often extend beyond the individuals who receive it to the larger society by bringing about systemic reform, assisting people in remaining independent rather than reliant on government services, and helping our judicial system to run more efficiently. Civil legal aid is not a cause that lends itself easily to catchy slogans, buzz-worthy viral marketing campaigns, or celebrity endorsements.

So what should we do? Sean Gibbons, executive director of The Communications Network, offered some advice in the Stanford Social Innovation Review last February: “At their core, foundations and nonprofits are in the business of developing and advancing big, bold ideas. If you want your ideas to take hold and win, you need to communicate and communicate well. It’s not an option anymore—it’s a necessity.”

Recognizing this new reality, in 2013, national civil legal aid advocates and leaders formed Voices for Civil Justice, an organization dedicated to increasing the visibility of civil legal aid in the national media, increasing the capacity for media advocacy in civil legal aid organizations, and strengthening the notion of civil legal aid as an indispensable societal resource. Taking a strategic approach to educating the public about civil legal aid, the organization has funded messaging research and developed tools and other resources to help civil legal aid advocates speak more effectively about their work and do a better job of engaging the media in covering that work. This strategy is paying dividends, judging by Voices for Civil Justice’s press clips page, which is packed with stories that bring much-needed attention to the various barriers to justice  and the organizations and individuals that are working to overcome them.

For civil legal aid to fulfill its mission of ensuring access to justice for all, we must become better known and appreciated by the public. Accomplishing that requires broadcasting the stories of the people we serve―and the life-changing, live-saving work we do on their behalf and for the good of society. To do that, organizations must invest in strategic communications.

As Voices’ executive director Martha Bergmark told me, “At Voices for Civil Justice, we provide opinion research, messages, training and other resources to help the people who do know about the vital role of civil legal aid to be more effective and more frequent messengers―whether they’re communicating with a policy maker, a reporter, a donor, or their in-laws.”

There is a strong body of research and case studies that offer successful models for effectively sharing our stories of impact. In fact, the piece by Sean Gibbons quoted above was penned as part of a collaboration between The Communications Network and the Stanford Social Innovation Review on series of articles by nonprofit and foundation leaders showcasing successful social change communications campaigns. The Communications Network has created the portal com-matters.org to disseminate its model for effective social change communications based on a large research project it completed in 2014.

These are just a few of the resources available to us as we look to create platforms from which to spread the word about the critical but overlooked role that civil legal aid plays in our society. If you work in the field and aren’t yet a member of the JusticeVoices Network, consider signing up! While those of us doing this work are surely not in it for the glory, the time for toiling in obscurity is over.

Lonnie Powers is executive director of the Massachusetts Legal Assistance Corporation.

 

When Legal Assistance Can Improve Health

By Lonnie Powers

In April, The National Center for Medical-Legal Partnership (NCMLP), an organization dedicated to “leading health, public health, and legal sectors in an integrated, upstream approach to combating health-harming social conditions,” played host to more than 400 legal and health care professionals at its 11th annual Medical-Legal Partnership Summit in Indianapolis. The annual confab seeks to help organizations leverage the various ways in which civil legal aid—free legal assistance and representation for low-income people facing non-criminal legal issues—can protect individual and public health.

The idea that legal assistance could impact public health was proved in 1975, when California Rural Legal Assistance won a groundbreaking victory in Carmona v. Division of Industrial Safety, which banned the use of short-handled hoes by farm workers because they forced workers to stay bent over for long periods of time, causing them crippling back injuries. Field managers had required the use of short-handled hoes because if they saw workers standing up, they knew they were not doing their work. After the hoes were banned, back injuries among the farm workers dropped more than 30 percent.

More recently in Massachusetts, Greater Boston Legal Services (GBLS) won two victories that enhance the health, safety, and independence of disabled people. First, GBLS settled a federal class action lawsuit against the Massachusetts Department of Transitional Assistance (DTA) for disability discrimination, based on claims that DTA didn’t have adequate systems to provide disabled clients with reasonable accommodations and that it routinely screened out disabled people from food stamp and cash assistance programs in violation of federal law. In a second class action lawsuit, GBLS took on the MBTA, Boston’s regional public transportation system, reaching a settlement requiring the MBTA to improve accessibility to bus and subway services. As a result, the MBTA has made nearly all of its stations fully accessible and has trained staff to respond to the needs of differently abled people using public transportation.

The formal medical-legal partnership model was created at Boston Medical Center (BMC) in the 1990s, when Dr. Barry Zuckerman, then the chief of pediatrics, became frustrated by the lack of clinical progress of his young patients as a result of substandard housing, poor nutrition, and other life circumstances―what are known as “social determinants of health.” Zuckerman hired a part-time attorney from Greater Boston Legal Services for the Pediatrics Department to assist his patients in addressing these unmet needs. The success of the program ultimately led to the creation of NCMLP.

Today, there are nearly 300 medical-legal partnerships in health care facilities in 36 states, including a partnership launched last September between Community Legal Aid and UMass Memorial Health Care in Worcester. Medical-legal partnershipsinvolve embedding lawyers and paralegals in the medical setting to ensure that patients can meet basic needs for food, housing and utilities, education, employment, health care, and personal and family stability and safety―all of which are essential ingredients to maintaining good health. The concept is best encapsulated by the description of a September 2015 segment of PBS NewsHourthat examined a medical-legal partnership in Nebraska: “What happens when a little boy gets a lifesaving bone marrow transplant for his leukemia, but can’t return home because the house he lives in has cockroaches that threaten his recovery? His doctor calls a lawyer.”

The partnerships go far beyond direct advocacy to encompass training for health care workers to identify health-harming social conditions, reforming clinical practice and institutional policies to better respond to patients experiencing health-harming conditions, and preventing such conditions by detecting the broader societal patterns that create them and advocating for policy and regulatory remedies.

Medical-legal partnerships are taking off as health care providers increasingly acknowledge their positive effects on patient health, the ability of health care workers to better understand and screen patients for social determinants of health, and in reining in health care costs. A study of a medical-legal partnership in California, for example, found that two-thirds of the families who participated in the program reported improved child health and well-being. Another study, which focused on a collaboration in Georgia, found increased physician satisfaction, a bump in Medicaid reimbursements to the partnering hospitals for their services, and a savings of $10,000 in annual continuing education costs.

From migrant farmworkers in California in the 1970s to disabled people in Massachusetts three decades later, civil legal aid organizations have long demonstrated expertise in identifying and rectifying the environmental factors that adversely impact the health and safety of vulnerable and underserved communities. Institutionalizing that expertise on the health care continuum through medical-legal partnerships is a logical step that enables our health care system to treat our most complex and vulnerable patients more effectively, efficiently, and cheaply. And that benefits all of us.

Lonnie Powers is executive director of the Massachusetts Legal Assistance Corporation.

Civil Legal Assistance is a Potent Anti-poverty Tool

By Lonnie Powers

Sargent Shriver, President Johnson’s personal choice to lead the War on Poverty, was once asked which of the anti-poverty programs he thought was the most important. “My favorite is Head Start because it was my idea,” he answered. “But I am proudest of Legal Services because I recognized that it had the greatest potential for changing the system under which people’s lives were being exploited.”

Legal services, also known as civil legal aid, has indeed been a potent anti-poverty tool in two ways. First, through individual case work that enables poor people to gain access to the rights and benefits from state and federal service agencies, health care providers and schools to which they are entitled. Second, through large, class-action lawsuits and advocacy efforts that change laws and governmental policies that adversely — and overwhelmingly — affect poor people.

With the 50th anniversary of the War on Poverty in 2014, we have been treated to numerous assessments of the effectiveness of Johnson’s (and Shriver’s) program these past 12 months. It is indisputable both that tremendous progress has been made, but also that much work remains.

To continue progress, civil legal aid must be deployed more broadly in future efforts to combat poverty, and public resources for legal assistance must be increased greatly.

A look at how civil legal aid assists those struggling with homelessness and/or unstable housing, as well as those who are victims of intimate partner violence is instructive.

Numerous programs around the country demonstrate that civil legal services can help poor people keep their housing, or negotiate exits from housing that allow them to have more control over the process, and ensure a smooth transition to safe, affordable housing. A pilot program launched in 2009 by the Boston Bar Association showed conclusively that poor people in housing court in Quincy, Mass. to fight eviction notices fared much better when they were represented by attorneys. Two-thirds of those with full representation kept their housing; only one-third of those who went through housing court without an attorney were able to do the same. Similar results have been found in New York City, San Francisco and San Mateo County in California.

Meanwhile, a landmark 2003 study published in Contemporary Economic Policy showed that legal services is one of the most effective ways to help women living in poverty escape intimate partner violence. Amy Farmer and Jill Tiefenthaler, researchers at the Carnegie Mellon Census Research Data Center, were intrigued by a U.S. Department of Justice report noting that rates of domestic violence had significantly declined during the 1990s. They analyzed data from the National Crime Victimization Survey and the U.S. Census to tease out the reasons for the decline. Their conclusion? Access to civil legal services ensured delivery of protective orders; assistance with child custody and support; and divorce and property distribution that victims needed to begin rebuilding their lives. Civil legal assistance was also critical for resolution of domestic violence-related legal disputes around immigration, housing and public benefits.

While services provided by emergency shelters, counselors, and hotlines are vital in the short-term, Farmer and Tiefenthaler wrote, services provided by civil legal aid “appear to actually present women with real, long-term alternatives to their relationships.” (It is also interesting to note that between 1994 and 2000, the period during which incidents of domestic violence declined, the availability of civil legal services for victims of domestic violence increased 245 percent (from 336 such programs to 1,441).

Despite these clear successes, many people do not understand what civil legal aid is, and surveys regularly find that most Americans erroneously believe that poor people have a right to free counsel in civil cases. Meanwhile, state and federal funding for legal assistance is well below what it needs to be.

This fall, the Boston Bar Association’s Statewide Task Force to Expand Civil Legal Aid in Massachusetts released Investing in Justice, a report showing that over 60 percent of those eligible for civil legal aid in Massachusetts who seek services are turned away due to lack of resources. The Task Force proposed that the Commonwealth’s investment in civil legal aid be increased by $30 million over the next three years to begin to address the unmet need. Currently, the state invests $15 million annually in civil legal aid.

The irony, of course, is that the civil legal aid yields a measurable — and significant — return on investment. Looking at work solely related to housing, public benefits and domestic violence, three independent economic consulting firms which did analyses for the Task Force found that every dollar spent on civil legal aid in eviction and foreclosure cases saved the state $2.69 on state services associated with housing needs such as “emergency shelter, health care, foster care, and law enforcement.” Every dollar spent assisting qualified people to receive federal benefits brings in $5 to the state. Every dollar spent on civil legal aid related to domestic violence is offset by a dollar in medical costs averted due to fewer incidents of assault.

This summer, Philadelphia resident Tianna Gaines-Turner became the first person actually living in poverty to testify before Congressman Paul Ryan’s Congressional hearings on the War on Poverty. In a strong and moving testament to the need for increased state and federal funding to end poverty, Gaines-Turner said, “People living in poverty―those who were born into it, and those who are down on their luck — want to get out of poverty. We want to create our own safety nets, so we never have to depend on government assistance again.”

Civil legal aid is a powerful tool that helps people living in poverty build a foundation of stability from which they can create a better future for themselves, their families and our communities.

Lonnie A. Powers is the Executive Director of the Massachusetts Legal Assistance Corporation. He has more than 40 years of policy and legal experience at the state and national levels, having devoted the majority of his career to establishing, building, sustaining and revitalizing legal aid organizations. Lonnie began his legal career in his native Arkansas, first with the Attorney General’s Office and later with Legal Services of Arkansas, where he served as Executive Director.