Building It From Scratch
Elder law solo practitioner Claire E. Lewis on the Affordable Care Act, dealing with end-of-life issues, and her involvement in establishing the practice area in Indiana
Published in 2014 Indiana Super Lawyers magazine
By Ross Pfund on February 12, 2014
Q: What was it that first got you interested in the law?
A: There are a couple of factors. I was always interested in elder law, which really wasn’t even an identified field back when I was entering law school.
After my grandfather died, my grandmother came to live with my family. So I grew up with an older adult in the household and I loved dealing with my grandmother, talking to her and talking to her friends. She’d have a bridge club over. And I just loved listening to the stories.
As I got into my career path, I started thinking about the law and advocacy and how I could help that population.
I was very lucky, before I even went into law school, to find a job as a paralegal with Indiana Legal Services, a not-for-profit that provides free legal services to indigent people. My project was focused on older adults. They were just forming the senior law project, and there was really only one other staff person at the time.
So we were building it from scratch, which was a wonderful opportunity and the very thing that I wanted to do. It was almost a miracle job that came along. And I said, “OK, now I’m going to law school, so I can be lawyer doing this.”
Q: You were in the right place at the right time.
A: I was so in the right place at the right time. I don’t think these things happen too often in life, but I’ve been very lucky in that regard, to get involved in something that I love dearly. I will say, I owe so much to that project and to that not-for-profit. They do a remarkable job.
It was a wonderful, supportive environment, too, while I was in law school [at Indiana University in Indianapolis]. But I was learning about these things and then even got to see the development of a “law in aging” course at the law school while I was there.
Q: So you were really breaking new ground.
A: Yeah. It was just an area that had not taken off at the time. It took many years. It probably was another 15 years after I started working in the area that elder law really started developing as a separate field.
Q: What were some of the challenges involved in that?
A: The Indiana State Bar Association has a probate section, and elder law became a committee. I was active in that committee from the onset. We just kept growing and we started doing educational series and more people got interested.
We’d always have a really strong active committee meeting. Sometimes, I felt like we had more members than would show at a regular section meeting. So, there was a point at which a colleague of mine and I started talking about developing an elder law section of the state bar.
I thought it was a bit challenging just because of the mindset. I think probate had always seen us as one of their children, and letting us grow up and be on our own I think was a step that had not been considered.
But I have to say, everybody was very supportive. I went to the state board of governors for the State Bar Association requesting that we become a section of our own. I said, “We would like to spin off. We’ll still be good friends.” I think it was just, initially, maybe, the mindset that we were too small to stand up on our own. In fact, within the very first few weeks, we had 100 members of our section. It’s grown to a very large section of the state bar right now and one of the most active.
It’s a struggle that I think anybody goes through in their infancy to just sprout wings and fly.
Q: And as the population ages, there’s more demand for these kinds of services.
A: Absolutely. I think there will always be a demand from the planning standpoint. Really, at age 18, everyone should start thinking about doing basic planning and planning for that possibility that they could walk out the door and be in an accident and be incapacitated the next day. What then?
So, from that standpoint, I think there will always be a great need for the services of someone who has an eye toward that possibility. And I think that we’re going to be seeing a lot of challenges over the next several years as we struggle with health care issues in this country.
Every day, we hear something about the Affordable Care Act. It’s an uncomfortable period of time. We’re in our infancy with regard to that. A lot remains to be seen as to how this will impact older adults and the entire country.
Q: How do you think the ACA will affect your work?
A: Right now, I’m getting a lot of questions. There’s not a great impact right now on my work, per se, because most of my clients will not be affected by the ACA or they have already been affected, but in a very positive way. For example, my older adults who have Medicare Part D, the prescription drug plan, have been impacted very positively by the provisions of the ACA already. So it’s not really an issue for them.
But we have a rather uncertain future in Indiana. Indiana is choosing not to implement parts of the ACA. And as a result, we’re not quite sure where the state is going to go with Medicaid, in some of the Medicaid issues that can impact clients of all ages.
Q: When did you found your firm?
A: I went from [the not-for-profit world] directly into private practice and started my own firm. And I’m pretty committed to being here. I even built my own building. I think since I built my building, I’m definitely committed to staying exactly where I am.
Plus, I have a daughter who’s in law school. I’m hoping she’ll come this way eventually and keep me from being doomed to the life of a solo practitioner.
Q: It could be Lewis & Lewis. Is she interested in elder law?
A: Absolutely. She does very well with the older adult population. She fits right in. She’s an old soul. I have a son as well. He’s currently serving in Afghanistan; he’s a lieutenant in the Army.
Q: How do you deal with the strong emotions your clients have in relation to getting older or planning for death or degenerative diseases?
A: Every day in my office, I will have people in tears. Sometimes tears of relief in learning that there are options for them. It is something that goes hand in hand with the practice of elder law. We keep plenty of Kleenex in our conference room.
Sometimes I want to cry right with the clients. I try not to. But there are so many issues that we confront on a daily basis. You have a couple who’s been married 65 years, and now they’re faced with one of the members of the couple going into a nursing home because his Alzheimer’s disease has advanced to the point that the frail 88-year-old wife can no longer take care of him in the home.
Often, the client will feel so guilty, as though they’re committing the greatest betrayal of their spouse. We talk about those issues. I’m not a counselor, but sometimes I share what other clients have gone through. I’m very private and respect confidentiality, of course, but I share the fact that many people will report to me those same feelings.
And they learn that once the spouse is in the nursing home, they take on a different role. They’re back to being a wife or a husband, not a caregiver. They’re there to be an advocate and a supporter and so, we talk through those things all the time. I’m also very grateful to have a lot of wonderful community resources here, especially in Indianapolis, where we have a strong Alzheimer’s Association.
Q: You probably know a little more about the disease than the average person. Is the incidence of Alzheimer’s increasing or is it being diagnosed more often?
A: I once had a geriatrician theorize with me on this because it seems like we see so much more of it today than we ever did before. But I think that it’s probably because health care is better and health, in general, is better. People are living much longer.
So about the time you thought grandma was getting a little senile—that’s what we called it way back then—grandma would pass away. We wouldn’t really see the full-blown symptoms of Alzheimer’s disease when dementia really becomes apparent and you see the judgment issues and the mood changes and all of the things that really signal dementia. So, I’m not sure that the incidence is greater. But the statistics are terribly frightening.
Almost half of the population over the age of 85 has Alzheimer’s disease. It’s a pretty scary statistic. And as we live much longer, I can’t quite imagine what will happen to us baby oomers, because we’re going to live for a long time.
Q: Are there particular challenges in those sorts of matters?
A: Caregiver stress is a huge issue for many clients. Trying to alleviate that stress is important in my job. I can often point people in the direction of getting assistance in the home. Initially, it might be a minor amount of assistance. But I think the challenge is just getting people on the right path—making sure that if it’s a spousal situation, not only does the healthy spouse have appropriate legal documents, but the spouse who has been diagnosed with Alzheimer’s has appropriate planning documents.
Q: Have you ever had to put your elder law knowledge into practice with a family member of your own?
A: Pretty much all of my family members. I hounded them all until they all ended up getting good legal documents.
My mom lived a remarkable, long life into her 90s. She lived in Florida and stayed in her own little condo until the day she died. But in the last year of her life, she fell into a pattern that, unfortunately, I see with a lot of older adults.
She went into what we often will call the “failure-to-thrive” mode. It’s maybe the natural dying process. We get older, we don’t eat very much and everything starts slowing down and we sleep more and we’re not as active as we once were. And it sometimes takes a long time to die that way.
Since I work with hospice providers all the time, I suggested to my mom that we would bring someone in from hospice to look in on her. Hospice, by its nature, is suggesting that maybe within six months, death is anticipated. But as I said, it’s hard to predict in failure-to-thrive instances.
So we worked with hospice with my mom and that was very eye-opening from a personal standpoint. I was just so very glad we had that. My mom was a very proud lady and her one fear was that she’d die in her condo and have all these ambulances roaring in and disturbing her neighbors and sirens.
She was so fearful that it would be a situation where something happened and nobody could get to her, and her door would be locked and someone would call 911 and would have to break down her door. So, we got her an emergency call button and said, “No, none of that has to happen.”
I think it just relieved her in the last year of her life to know there was an exit plan. She exited with a flourish. My sister, who was a hospice nurse at the time, actually, called to say she thought that my mom was going downhill. We were all able to gather around and celebrate New Year’s Eve with my mom.
Got up New Year’s Day and she said, “Well, I’m just going to go take a little nap.” And she did and that was how she went out. So, I went through that experience with my mom, and as painful as it is to lose somebody you love so much, it was also a good experience for me to then share with clients and to know what they’re going through with these end-of-life issues.
This interview has been condensed.
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