Estate planning has traditionally been framed around one central question: What happens to my assets after I die? While this is an important part of the conversation, it leaves a critical gap—what happens during life, particularly if illness, incapacity, or the need for long-term care arises?
The Elder Law College's 360° Approach to practice reframes estate planning by starting with lifetime needs first. Instead of treating incapacity, healthcare, and long-term care as side issues, the 360° model integrates them as the foundation of the plan. Only once lifetime security is in place does the planning process move to questions of inheritance and wealth transfer.
This "lifetime-first" perspective is more than a philosophical shift—it's a practical strategy that results in better outcomes for clients and families alike.
The Traditional Estate Planning Mindset
For decades, most estate planning attorneys have focused their work on what lawyers call "post-mortem" issues: wills, trusts, probate, and taxes.
While those issues matter, they overlook the reality that today's clients are living longer—often well into their 80s and 90s. With longevity comes a higher likelihood of cognitive decline, chronic illness, or disability.
Consider this:
- According to the Alzheimer's Association, one in three seniors dies with Alzheimer's or another form of dementia.
- The U.S. Department of Health and Human Services estimates that nearly 70% of adults over 65 will need long-term care at some point.
Without proactive planning, these realities can quickly exhaust family finances, trigger legal crises, and spark family conflict.
What Is the 360° Approach?
The 360° Approach, taught by the Elder Law College, flips estate planning on its head by addressing lifetime concerns before post-mortem matters.
Its core principles include:
Lifetime Needs First
- Address healthcare, incapacity, and long-term care planning early.
- Establish powers of attorney, advance healthcare directives, and care agreements.
- Secure eligibility for public benefits such as Medicaid and VA Aid & Attendance.
Estate Needs Second
- Once lifetime needs are secured, shift focus to wills, revocable trusts, charitable gifts, and asset distribution.
Integration and Balance
- By treating both lifetime and estate needs as interconnected, families avoid "piecemeal" planning that leaves dangerous gaps.
Why Lifetime-First Planning Matters
1. Rising Healthcare and Long-Term Care Costs
Nursing home care now averages over $100,000 per year in many states. Without Medicaid or VA planning, families can lose life savings in just a few years.
Case Example: In Matter of Shah, 95 N.Y.2d 148 (2000), the New York Court of Appeals considered Medicaid eligibility planning through trust structures. The case highlighted how strategic pre-planning, rather than last-minute crisis planning, protects both elders and their families.
2. Increased Incapacity Risk
As life expectancy increases, so do cases of dementia, stroke, and other impairments. Without advance directives and powers of attorney, families may face contested guardianships.
Case Example: In re Guardianship of Kowalski, 478 N.W.2d 790 (Minn. Ct. App. 1991), illustrates how incapacity and family disputes can collide. The court's recognition of Sharon Kowalski's partner as guardian highlighted both the importance of respecting personal wishes and the risks of leaving decisions unsettled.
3. Client-Centered Planning
Elders are often more concerned with quality of life than with how much money is left after death. The 360° model ensures their immediate needs—like housing, caregiving, and healthcare choices—are addressed.
Core Elements of the 360° Model
1. Incapacity Planning
At the heart of the 360° model is protecting clients in the event of incapacity.
- Durable Powers of Attorney: Appoint trusted agents for financial and healthcare decisions.
- Advance Healthcare Directives: Outline wishes for medical treatment, life support, and end-of-life care.
- Guardianship Avoidance: Clear documentation reduces the risk of contested court proceedings.
2. Long-Term Care & Medicaid Planning
Lifetime-first planning anticipates the potential need for care and creates structures to preserve assets.
- Medicaid Asset Protection Trusts: Shield certain assets while preserving Medicaid eligibility.
- Spend-Down Strategies: Ethical and legal techniques to qualify for benefits without impoverishing the family.
- VA Benefits: For qualifying veterans, Aid & Attendance can cover significant care costs.
3. Special Needs & Family Support
Many elder clients care for disabled spouses or children. The 360° model ensures these dependents are protected.
- Special Needs Trusts: Preserve eligibility for SSI and Medicaid while providing supplemental support.
- Caregiver Agreements: Compensate family members providing care, reducing future inheritance disputes.
4. Integration with Estate Planning
Once lifetime needs are secured, estate distribution can be addressed more confidently. Wills, trusts, and charitable bequests become meaningful because they rest on a foundation of security and dignity during life.
Benefits of the Lifetime-First Approach
- Prevents Crisis Planning: Too many families wait until a medical emergency forces rushed decision-making. Lifetime-first planning avoids this scramble.
- Preserves Family Wealth: Medicaid and VA planning reduce the risk of losing everything to long-term care.
- Reduces Family Conflict: Clear incapacity planning prevents sibling battles over guardianship or asset management.
- Improves Quality of Life: Clients can live out their years with greater dignity and less stress.
Best Practices for Clients and Attorneys
- Start Early: Don't wait until a health crisis strikes.
- Ask the Right Question: "How will I live?" before "What happens when I die?"
- Work with an Elder Law Attorney: Not all estate planners are trained in Medicaid, VA benefits, or incapacity planning.
- Review Regularly: Update documents as laws, health, and family circumstances change.
Conclusion
The 360° Approach is more than a new way of thinking—it's a necessary evolution in elder law practice. By prioritizing lifetime needs before estate distribution, clients and families achieve greater security, dignity, and peace of mind.
Cases like Matter of Shah and In re Guardianship of Kowalski remind us that real-life challenges often unfold long before a will is read. Estate planning without lifetime planning leaves families vulnerable.
At Elder & Estate, we embrace this holistic approach, ensuring our clients are protected in life and remembered in death.
If you're ready to safeguard your future and your legacy with lifetime-first planning, contact Elder & Estate today for a consultation.
