"Our indigent patients often are uninsured or very under-insured, and are dealing with a lot of societal issues that affect their health," Johnson says. "The partnership makes great sense. If we can take some of the legal stresses off our patients they are going to be better patients who are more able to deal with their health issues if they aren't worrying about all of the other social barriers they face."
The Saint Luke's medical-legal partnership is based on the I-HELP model. I stands for income and insurance issues; H is for housing issues; E is for ensuring patient safety in domestic situations; L is for legal status; and P is for power of attorney and guardianship.
Cutler says she's done about 20-25 referrals a month since she started working as a contract vendor at Saint Luke's in January, and about half of the referrals have been housing-related.
She said the partnership takes a holistic view toward patients. "For example, we may agree to represent a disabled individual with an appeal for Social Security benefits," she said. "During the course of representation, we may also assist with an appeal for Medicaid health insurance. If we are successful, the patient gains an income source to secure stable housing and health insurance to obtain ongoing treatment improving his or her overall health. If we see a patient who's been referred to us by the social worker for one legal issue, we do a screening to see if there are other legal needs."
Johnson said having Legal Aid on site also has helped expedite guardianship and durable power of attorney procedures. "The financial impact is once you have a decision maker for the patient, we can act effectively and efficiently and provide timely care for the patient," she said.
"If they don't have a decision maker we don't know who to turn to so we make 500 phone calls. Maybe it's a family member that hasn't seen them in 20 years, and it takes longer to make decisions."
Once a decision-maker is appointed, Johnson said, a discharge plan can be built. "Nursing homes and long-term care facilities won't take a patient without a decision maker so they're here longer than they need to be while we are waiting for guardianship," she said.