Taking extra care of vulnerable clients’ finances

By Rosemary McCracken | May 22 2012 06:01PM

With an aging population, health-care inflation will be higher in the coming years than any other kind of inflation. This means advisors need to make sure their clients’ assets will last as long as they do, says Dr. Raymond Rupert, founder and president of Rupert Case Management Inc. (RCM).This Toronto-based company has a network of more than 1,500 medical experts and provides care assessments, second medical opinions and advocacy services. The firm works with advisors and other consultants to help save their ailing clients time, money and perhaps even their lives.

RCM recently provided an 81-year-old Toronto man who had been diagnosed with dementia with a comprehensive and cost-effective care plan. Two elderly friends, who held power of attorney for him, had hired teams of two care providers to work around the clock at the man’s home, and the bills for this care were running to more than $20,000 a month. Concerned that his client’s assets would soon be depleted, the man’s lawyer asked RCM to assess the situation.

“It was clear that we had to audit the entire care plan,” Dr. Rupert said in an interview. “We needed to look at quality and consistency of care, and the care objectives. We hired a new team of care providers and got the man on the appropriate medications, which eliminated the need for a second worker at the home. That cut back 50% of the case costs.”

Costs were subsequently reduced even further – to about $6,000 a month – when the client was admitted to a private nursing home.

RCM’s bill was $950. That included a comprehensive care assessment, budget analysis, interviews with doctors, recommendations and a report.

Clients who want RCM to remain involved on an ongoing basis can enrol in the company’s Seniors’ Care Plan for a monthly fee of $60, $90 or $150, depending on the number of services they want. RCM will maintain all the client’s online records and be on call 24 hours a day.

“One of our client families, a couple in their late 70s, has a home in Florida, a home in Caledon north of Toronto and another home in Toronto,” Dr. Rupert said. “And they have different doctors in all these places. Our job is to co-ordinate all these doctors and be the repository for all their medical records. One of our nurse case managers has been assigned to this case.”

For clients or their family members who need specialized care, RCM will also assess long-term-care facilities, nursing homes and group homes across Canada, and assist in applying for admission to these facilities. The company has a national network of social workers who can access information on local care and housing providers.

Before forming RCM in 1993, Dr. Rupert spent more than a decade running a Toronto family practice. During those years, a friend of his wife woke up one morning with a hand seizure. The woman went straight to the emergency department of a nearby hospital where she had an MRI (magnetic resonance imaging, used to see detailed internal structures). She was told that she had a malignant brain tumour, and surgery was scheduled for a few weeks down the road. Dr. Rupert sent her X-rays to a Gamma Knife centre in Cleveland, Ohio -at that time, Gamma Knife centres were not in Canada. “Don’t operate,” he was told. The woman had a cavernoma, a benign brain lesion, and surgery was not needed.

After obtaining a number of other crucial second opinions, Dr. Rupert decided to form his own case management and advocacy business to fill a need in the health-care system. Over the years, RCM has also worked with companies and organizations including Mercedes-Benz, Google Canada, Sunoco and the Royal Canadian Mounted Police on behalf of their employees.

RCM may be able to help your clients if their life or living benefits insurance applications or claims are denied, rated, modified or postponed. It would attempt to generate hard evidence of the client’s insurability and to communicate this to the medical underwriters. “A national retailer who had recruited a new senior manager came to us after a paramedical examiner took his EKG,” Dr. Rupert said. “The EKG [electrocardiography] was reported as abnormal, which indicated a heart attack. He was declined insurance coverage.”

RCM completed a medical review and recommended a cardiac MRI. “This test,” Dr. Rupert said, “proved conclusively that the man had never had a heart attack.”

RCM presented the client’s case to the insurer and the reinsurer. The insurer issued the policy on a standard basis.

RCM may also be able to assist clients who have complex medical histories and anticipate problems with medical underwriting, and clients whose claims have been postponed, declined or modified for lack of medical evidence or because a medical issue needs clarification.