Are Hallucinations And Delusions Part Of Dementia?

To answer this question, we first need to understand the difference between a hallucination and a delusion.

Hallucinations are sensory experiences, which can only be verified by the person experiencing them. Delusions are beliefs that, despite all evidence to the contrary, remain fixed in the person's mind.

Yes...dementia can cause either one. So, however, can drug side-effects.

If your loved one seems to be experiencing hallucinations or delusions, it's relatively easy to find out if they're being caused by drug interactions. You can research it on the Web, of course...or you can just call the doctor. If you believe that drugs are the culprit, you'll need to speak with the doctor about discontinuing use, or switching drugs. She'll most likely tell you to taper off slowly.

If the hallucinations or delusions are related to your loved one's dementia, that, of course, is a different story. Some patients experience both. Some experience one or the other. And others experience neither. If the hallucinations don't upset your loved one, then most doctors will tell you that valuation can be an important tactic. For example, if your loved one thinks he sees or hears someone who isn't really there, ask what his friends' names are.

The situation becomes more complex if these events are causing distress in the patient, for example, if the patient believes that someone is trying to break into the house, or to kill them. In cases like this, you may have to tell what doctors call a "therapeutic fib" - you can say you called the police and they took the intruder away. This approach won't work forever, though. If the disturbing hallucinations continue, it's time for medical intervention.

If you've got questions about dealing with a loved one's dementia, we've got answers. At The Law Offices of Alice Reiter Feld & Associates, we have one of the largest dementia resource libraries in South Florida.

We practice Elder Law - and only Elder Law. And, over the past 33 years, we've walked thousands of South Florida families through the Dementia Maze. In addition, we've helped them draw up comprehensive estate plans, wills, trusts, powers of attorney, long-term care plans, asset protection plans, and with issues relating to the VA or Medicaid.

We can walk your family through the Dementia Maze. And we're only a phone call away.

How Can I Better Understand What My Loved One With Alzheimer's Is Going Through?

Of course, you'll never totally understand it, and you'll never totally be able to feel it...in large part because your loved one will never totally understand it, let alone be able to express her feelings about it.

There may be lonelier and sadder jobs in the world than being a caregiver to an Alzheimer's patient...but not many of them. And, unfortunately, the journey toward better understanding what they're going through, and what they're feeling, must be grounded in the realization that you'll never fully know.

The good thing about Alzheimer's, though - if there is a good thing - is that resources are available to find out some of these answers. People are writing about it, people are talking about it, and people are studying it more than ever before.

You can learn a bit about what your loved one is feeling if you join a caregiver support group. (And you'll also benefit from the realization that there are many other people in the same predicament that you are...you're not alone!) Other good sources are your local Alzheimer's Association (alz.org), and your local Area Agency on Aging. One of the best sources of information is National Institute on Aging, an arm of The National Institutes of Health (alzheimer's.org).

If we listed all the good websites with information on Alzheimer's, we'd need a book, not a blog. And speaking of books, there are - literally - hundreds of good ones available. Ask your Alzheimer's Association for some good ones. Or just go on Amazon and explore titles about Alzheimer's. Believe me, there are enough to keep you busy for a long time!

And there's another good resource available, as well...a Board-Certified Elder Law attorney who can walk you through the Alzheimer's Journey.

At The Law Offices of Alice Reiter Feld & Associates, we are Elder Law attorneys. And, over the past 33 years, we've walked thousands of South Florida families through the Alzheimer's Journey... with professionalism, with compassion, and, when necessary, with a soft shoulder. In addition, we can also help you with comprehensive estate planning, wills, trusts, powers of attorney, long-term care planning, asset protection, and issues with Medicaid or the VA.

This is one journey you don't have to make alone. We're just a phone call away.

Should My Loved One Be Evaluated? And By Whom?

If you're starting to ask yourself this question, then the answer is simple: Yes.

When a loved one's forgetfulness or confusion becomes obvious, it's time for a complete examination by a physician. This is the best way to determine whether the symptoms are temporary - perhaps caused by depression, poor nutrition, drug intoxication or interaction, alcohol, or organ dysfunction - or if they're permanent, and caused by dementia or Alzheimer's.

We're talking about a complete work-up here - physical exam, medical history, neurological testing, lab tests, brain imaging, and function tests.

If your loved one has never been evaluated, it's best to see a neurologist or geriatrician. If, on the other hand, he's already been diagnosed with Alzheimer's, you should see a geriatric psychiatrist, who can look for signs of depression, agitation, or behavioral issues.

If you don't know where to look for a doctor, check a physicians' referral service. And if you participate in caregiver support meetings, ask the other participants.

A word of warning - Don't Settle! If you're not comfortable with a physician...find a new one! You'll be working closely with this person the rest of you loved one's life. And you need someone you trust...someone with whom you feel comfortable!

Once you have a diagnosis, make sure the primary physician is kept in the loop; after all, she's still the one you'll be seeing for general check-ups and regular health issues.

The best doctors in this field are the ones who realize that Alzheimer's is a family illness...and that the caregiver must be carefully monitored, as well, for signs of stress or depression.

This is a very stressful time for the entire family. And, for many families, a very confusing time. But you don't have to go through this process alone. Help is available.

At the Law Offices of Alice Reiter Feld & Associates, we're Elder Law attorneys. And, over the past 33 years, we've walked thousands of South Florida families through the Elder Care Maze, with comprehensive estate planning, wills, trusts, powers of attorney, asset-protection planning, long-term care planning, issues with Medicaid or the VA, and, of course, Alzheimer's/dementia questions. And we've done it with professionalism, compassion, and, when needed, a soft shoulder.

You don't have to make this journey alone. We're just a phone call away.

Me? On Medicaid?

Many people are under the impression that Medicare will provide long-term care benefits for them if they need an assisted living facility and/or nursing home. Boy, are they in for a surprise!

If you're one of these people, sorry to burst your bubble. But it's better if your bubble's burst now, while you can still do something about it.

Medicare does provide care for over-65's if they're blind or disabled. Medicare does not, however, provide chronic care services for most individuals with a long-term illness from which they probably will not recover. Put bluntly - Medicare doesn't give a hoot about your long-term health care problems!

As a result, many people are forced to pay for long-term care out of their own pockets. And if you're like most people, your pockets are not large enough! Medicaid can cover long-term care - but might require you to pay for your own care until you have only $2,000 left in assets.

However, there are ways to protect yourself - or a loved one - from being totally impoverished by the Medicaid rules. The best way? See an Elder Law attorney.

Most families, of course, can't afford nursing home costs (which can easily run more than $7,000 a month). While Medicare sometimes covers up to 100 days in a skilled nursing facility, it generally doesn't cover the long-term care required by Alzheimer's patients. Instead, its limited nursing home coverage is more meant for people who will eventually recover.

That's obviously not the case with Alzheimer's patients. They need custodial, rather than rehabilitative care. This means assistance with preparing meals, bathing, grooming, toileting, and other normal activities.

Alzheimer's disease is the third most-expensive illness in the United States, after heart disease and cancer. Health care costs for Alzheimer's average more than $200,000. So it's understandable that, sooner or later, most patients who need long-term nursing home care turn to Medicaid.

The three most common ways to pay for nursing home care are long-term care insurance, paying yourself, and Medicaid. If you can afford the $200-$300 a month (and if you have no major pre-existing conditions), long-term care insurance is the best option.

People who already have Alzheimer's aren't going to be able to get long-term insurance. But if their spouse is relatively healthy, and can afford it, it's much better than spending your assets down to the poverty level.

Sound confusing? Just wait until you're confronted with the qualifications requirements for Medicaid! If you haven't yet called an Elder Law attorney...you probably will then!

At The Law Offices of Alice Reiter Feld & Associates, we are Elder Law attorneys. We walk families through the Medicaid Maze every day. In fact, over the past 33 years, we've helped thousands of South Florida families navigate this maze. And we've helped them, as well, with comprehensive estate planning, wills, trusts, powers of attorney, long-term care planning (so you'll never have to pay $7,000 a month for nursing home care!), asset protection (ditto!), and issues with Medicaid or the VA.

This is what we do - every day. And we're just a phone call away.

Be Involved In Your Loved One's Nursing Home Care!

Once your loved one is admitted to a nursing home, the most important thing you can do is ensure they receive good care. And the best way to do that is to be involved...be a care advocate.

Your key roles are to participate - actively! - in planning your loved one's care, and to maintain frequent contact with nursing home staff.


Care Planning

This process begins with a baseline assessment, within two weeks after the new resident moves in. A team - possibly a doctor, nurse, social worker, dietitian, and physical, occupational, or recreational therapist - assesses information from both resident and family. This assessment then becomes the baseline against which progress is measured.

The team asks family members about the resident's medical, psychological, spiritual, and social needs. You can also tell them about their preferences and routines.

It's a good idea for the family to make their own list of needs, and to give it to the assessment team. For example, you may have noticed signs of depression, along with symptoms of Alzheimer's. And this is important information.

Here's a quick list for you to consider...

1. Medical needs
2. Psychological needs
3. Spiritual needs
4. Social needs
5. Preferences and routines

The team then develops an individualized care plan, specifying the care required, and the strategies to address it. And you should know that family members - and the resident - can (and should!) participate in any planning meeting.

When you go to subsequent meetings, bring the list you gave them earlier. And if something's been overlooked, bring it up!

Federal law requires that nursing home care result in improvement (if possible). If improvement isn't possible, the care must maintain abilities or slow the loss of function. If your loved one has Alzheimer's - which is progressive - the purpose of care should be to maintain mental and physical abilities for as long as possible. For example, if your mother still has the ability to communicate clearly, the care plan should encourage her use of language.

IMPORTANT NOTE: The care plan may be part of the nursing home contract. According to federal law, generally nursing homes must review a plan every three months, or whenever the resident's condition changes. There must also be an annual reassessment. At these times additional meetings are held to update the plan.

It's your job to monitor your loved one's care, to ensure adherence to the plan. If you want your loved one to get the most personal attention possible - be a forceful advocate!

It's a stressful process, to be sure. But we can help.


At The Law Offices of Alice Reiter Feld & Associates, we're Elder Law attorneys. And we walk families through this process every day. In fact, over the past 33 years we've walked thousands of South Florida families through the Elder Care Journey...as well as with estate planning, wills, trusts, powers of attorney, long-term care planning, asset protection, and issues with Medicaid or the VA.

We have the answers to your questions. And we're just a phone call away.

Nursing Home Care For Dementia Patients

If you have a loved one with Alzheimer's, he/she may eventually need nursing home care. The challenge is in finding the right one - not only for your loved one, but also for the family.

Here's a checklist for you. Make copies, and compare different homes. Don't expect every one to score well on every question; simply consider which items are most important to you. but, don't rely only on a number. Ask to speak to family members of other residents. Also, contact the local or state ombudsman, and get a copy of the state inspection report.

Nursing Home Evaluation Form
Name of Nursing Home:                                                                              
Date Visited:                                                      

• First impression? 1 2 3 4 5
• Exterior paint, gutters and trim? 1 2 3 4 5
• Are the grounds pleasant and well-kept? 1 2 3 4 5
• Views from residents' rooms and other windows? 1 2 3 4 5
• Alzheimer's Special Care Unit? 1 2 3 4 5
• Secure outdoor area? 1 2 3 4 5
• Secure area with walking paths? 1 2 3 4 5
• Appropriate areas for physical and occupational therapy? 1 2 3 4 5
• Are barber or beauty salon services available? 1 2 3 4 5
• A well-ventilated room for smokers? 1 2 3 4 5
• General cleanliness? 1 2 3 4 5
• Clean smell? 1 2 3 4 5
• Enough space for residents? 1 2 3 4 5
• How noisy are hallways and common areas?
• Is the dining area clean and pleasant? 1 2 3 4 5
• Is there room at tables for both residents and aides, if necessary? 1 2 3 4 5
• Are common areas being used by residents? 1 2 3 4 5
• Can residents bring furniture and personal items for their rooms? 1 2 3 4 5
• Does the administrator know residents by name, and speak to them in a pleasant manner? 1 2 3 4 5
• Do staff speak to residents with cheerful, respectful attitudes? 1 2 3 4 5
• Do staff and administration work well together? 1 2 3 4 5
• What special training has the staff received for Alzheimer's residents? May I observe a training session? 1 2 3 4 5
• Do nursing assistants participate in the resident's care planning process? 1 2 3 4 5
• Employee retention? 1 2 3 4 5
• Does a state ombudsman visit regularly? 1 2 3 4 5
• How likely is an increase in private pay rates? 1 2 3 4 5
• Are there any additional charges not included in the daily or monthly rate? 1 2 3 4 5
• How are roommates selected? 1 2 3 4 5
• Describe a typical day? 1 2 3 4 5
• Can residents choose when to go to bed and wake up? 1 2 3 4 5
• Are meaningful activities available for Alzheimer's patients? 1 2 3 4 5
• If activities are in progress, what's the level of resident participation? 1 2 3 4 5
• Can Alzheimer's patients continue to participate in interests like gardening or contact with pets? 1 2 3 4 5
• Is there safe, well-lighted parking? 1 2 3 4 5
• Are hotels/motels nearby for out-of-town family members? 1 2 3 4 5
• Are area restaurants suitable for taking residents out with family members? 1 2 3 4 5
• How convenient will care planning conferences be for family members? 1 2 3 4 5
• Is an effective family council in place? 1 2 3 4 5
• Can meetings be scheduled to discuss any problems? 1 2 3 4 5

Putting your loved one in a nursing home can be a very traumatic process. But it doesn't have to be. We can help.

We're the Law Offices of Alice Reiter Feld & Associates. We practice Elder Law...and only Elder Law. And, over the past 33 years, we've helped thousands of South Florida families with decisions like this...as well as with estate planning, wills, trusts, powers of attorney, long-term care planning, asset protection, and issues with Medicaid or the VA.

We can help. And we're just a phone call away.

Assisted Living For Dementia Patients

An assisted living facility might be an option for Alzheimer's/dementia patients who don't yet require skilled nursing. And it might be an option, as well, for the spouse who can no longer do all the care-giving.

Applicants must meet certain guidelines, such as a specific score on a mental status exam. In addition, an applicant may also have to undergo an assessment procedure, to determine if the level of care is adequate, or appropriate. This enables doctors to assess whether any other factors are contributing to the patient's dementia - including whether medications and dosages are correct.

If an applicant is accepted, a written care plan is developed. It's not set in stone, though...it should be reviewed once the first month, and every three months afterward. And it's important to review it again if there's a change in the resident's condition.

If you're considering an assisted living facility, visit several!

Here's a checklist for you...

• Is the facility licensed, if required by your state? There's little state or federal oversight of these facilities. So always make sure there are safety requirements in place.
• What's the environment like? Many people with Alzheimer's experience agitation, and need a safe place to wander around. So look for common space areas, and at least one enclosed outdoor area.
• What kind of activity program is in place? Ask to see the activity calendar. Look for a wide variety of activities, providing social interaction, mental stimulation...and fun.
• What's the staffing ratio? A good rule of thumb is two certified nurse's aides (CNAs) for every ten residents during daytime, with one CNA per ten residents at night. 
• What training do staff members get? Does it include interactions with an instructor, group discussion, and role-playing? Or is it simply watching videos?
• Does the facility have a special Alzheimer's unit? Dementia patients generally do better in a unit (or facility) specifically for them. The best choice is a special care unit, where staff has received additional, specialized training.

WARNING! Don't be fooled by words...especially the words "special care unit." While some facilities do provide additional staff training, others simply add a locked door.

BUYER BEWARE! Contracts are similar to those for apartment leases. Some facilities offer month-to-month agreements, while others ask for a year-long commitment (which lets you lock in the monthly fee.) However, because the progress of dementia varies so much from person to person, a year-long agreement may cause an expensive problem if the patient unexpectedly needs nursing home care. If you sign a year-long agreement, be sure the contract has an escape clause, allowing someone to move out with reasonable notice if he/she needs a higher level of care.

Many facilities cost as much as nursing homes. But neither Medicare nor Medicaid covers it. Long-term care insurance may pay all or part. But, without it, assisted living residents generally pay themselves.

Does the whole process seem frightening? It doesn't have to be.

At The Law Offices of Alice Reiter Feld & Associates, we're Elder Law attorneys...and we help families with decisions like this every day. In fact, over the past 33 years, we've helped thousands of South Florida families deal with this issue...as well as comprehensive estate planning, wills, trusts, powers of attorney, long-term care planning, asset preservation, and issues with Medicaid or the VA.

If there's a way to save you money, we'll find it. And we're just a phone call away.

All About Hospice

What, exactly, is hospice?

It's a gift to terminal patients and their families. And it makes the last days of life easier for both.

Hospice is a team-approach to caring for people in the end stage of terminal illness, allowing them to die with dignity. There's an emphasis on compassion for the patient, and support for the family.

Hospice teams typically include medical directors, nurses, social workers, chaplains, counselors, and trained volunteers who can provide services such as hairdressing or running errands. (In one case I know of, however, a team included a music therapist who played the patient's favorite songs.)

Your loved one will have to qualify...you'll need a doctor's statement saying that the patient is not expected to live more than six months. At that point, the focus of medical treatment changes from cure to comfort, pain relief, and the dying process.

Hospice care focuses on "dying well." Team members help patients and families plan the end of life, deal with emotions like fear and grief, and reach closure on issues important to the patient. And they also help ensure compliance with the patient's advance directives.

If you're a caregiver for a dementia patient, the time to explore hospice is now - before the need arises. And before you  may have to deal with availability (of beds) issues. Discuss hospice criteria with your loved one's doctor to determine his/her willingness to certify a patient for a program. And if you sense hesitation, don't be afraid to think about finding another doctor.


HOW TO PAY


Medicare covers hospice for qualified patients. In fact, most programs are designed to meet Medicare and National Hospice Association guidelines.

Medicare guidelines include incontinence, and/or the inability to communicate verbally, walk without assistance, or bathe or dress without help. In addition, a patient must have experienced one or more other problems on their list.

If your loved one is exhibiting signs of end-stage Alzheimer's, call the doctor about hospice. (Surprisingly, some dementia patients actually improve in hospice...enough to return home!)


WHEN TO CALL


Some families contact hospice programs too late to realize the full benefits. Hospice team members often hear "I wish we'd contacted you sooner." That's why good communication with doctors - or an Elder Law attorney - is important.

At The Law Offices of Alice Reiter Feld & Associates, we can help you with decisions like this. We're Elder Law attorneys. And over the past 33 years, we've helped thousands of South Florida families deal with questions such as these...as well as estate planning, wills, trusts, powers of attorney, long-term care planning, asset protection, and issues with Medicaid or the VA.

We'll walk you through the Elder Care Journey with professionalism, with compassion, and, if you need it, with a soft shoulder.

And we're just a phone call away.

How To Evaluate Adult Day Care Centers

No one needs a break more than a full-time caregiver for a senior with dementia or Alzheimer's. An adult day care center with a program for Alzheimer's patients might be the solution. And it's an option, as well, for working people who can't be care-givers in the daytime.

These programs offer socialization and therapeutic activities that may - possibly - help to slow the progress of the dementia. And they often offer flexibility in terms of usage, ranging a half-day per week (with or without lunch) to full-time day care five days a week.

Your state office on aging, your local chapter of the Alzheimer's Association, a hospital social worker, or a nearby nursing home would have the names of good centers. Then visit the center in advance, to see if the program is right for your loved one and your situation. It's not unusual for the program director to request a meeting with your loved one, to ensure the center can provide appropriate care.

Here are some things to consider...

• Is the center licensed by the state? State regulations may include requirements for staff training, health inspections and fire inspections. Incidentally, the National Adult Day Services Association is now developing accreditation standards.
• Is the atmosphere friendly? Watch the staff go about their business, and watch them interact with the seniors. Do you feel a comfort level? If not, go somewhere else!
• Is the environment homey and comfortable? Or is it drab and institutional-looking?
• What type of medical care is available? (Centers can vary widely.) The best programs include a nurse who can provide assessment, dispense medication, and perform screenings.
• Do the activities seem to have a goal, such as socialization, or mental stimulation, or just plain fun? Or are they just taking up time?
• Find out the staffing ratio!!! For Alzheimer's patients, a ratio of one staff member to every four adults is considered good.
• Is the program exclusively for people with dementia? This is important! In a mixed environment, people with Alzheimer's don't do as well as in programs deigned specifically for them.
• Is a contract necessary? Alzheimer's progresses at unpredictable rates - so you shouldn't sign a contract for more than a month at a time.

The Elder Care Journey can be a very intimidating process for families. But it doesn't have to be.

At The Law Offices of Alice Reiter Feld & Associates, we've been helping South Florida families find Elder Law solutions for 33 years. We've walked thousands of them through the process, in addition to providing them with services such as estate planning, wills, trusts, powers of attorney, long-term care planning, asset protection, and assistance with Medicaid or the VA.

We can help. And we're just a phone call away.

Caring For A Dementia Patient At Home

Caring for a person with Alzheimer's disease is the definition of "a labor of love." And it's the definition, too, of "constant change."

At first, you may just have to help out in small ways. Later you may face more-practical issues, like changing door locks so your loved one can't wander away, turning down the water heater to avoid burns, and making sure stove burners are turned off after cooking. Eventually, you'll reach the point where you don't feel comfortable leaving your loved one at home.

It's inevitable that your relationship will change as you cope with the challenges. And it's perfectly normal to experience anger, resentment, and grief as the person you love slips away.

In the United States, 70 percent of people with Alzheimer's remain in their own homes, with the help of a spouse or other family member. Fortunately, if you're the spouse or family member, there are services available to help you, such as support groups, respite care, home health support, adult day care, and hospice services.

Don't wait to explore your options. Your local Alzheimer's Association (www.alz.org) chapter will help you find a support group, with others in the same boat.

Respite Care

Respite care programs provide temporary relief, utilizing substitute caregivers. These services may be offered by paid home-health aides or local volunteers. And they can give you a few precious hours out of the house.

Paying for Home Health Care

Medicare doesn't pay for home health aides who provide custodial care - such as bathing, dressing, light housekeeping, grocery shopping, or even staying overnight when a caregiver needs a break. Unfortunately, though, this is the kind of home service a person with Alzheimer's usually needs.

Many states have a Medicaid waiver program that will cover certain custodial services. To qualify, you'll have to meet a Medicaid asset test.

To apply for a Medicaid home-based waiver, contact your state office on aging. They'll do a medical assessment of your loved one, to determine the services required to keep her at home.

Developing a Care Plan

If 24-hour care is now required, home services probably wouldn't be appropriate. However, if only limited services are required, the agency may approve a "care plan." But you'll have to meet income limits set by the state.

If you think this all sounds confusing...you're right! But it doesn't have to be. We can be your guide through the entire process, and through all the big decisions.

We're The Law Offices of Alice Reiter Feld & Associates. We're Elder Law Attorneys. And we've been guiding South Florida families through these processes for 33 years. In fact, we've guided thousands of families through the Elder Care Maze, from estate planning, wills, trusts, and powers of attorney to long-term care planning, asset preservation, and assistance with the VA or Medicaid.

We'll be there for you...at every fork in the road. And we're just a phone call away.

What Is A Do-Not-Resuscitate Order?

It's an advance directive (sometimes called a DNR) stating that you don't want your heart or breathing re-started under certain circumstances. It takes effect only if you can no longer communicate your wishes. But this document is not done by an attorney; it's a physician's directive, used primarily for terminally-ill patients.

DNRs are not honored if cardiac arrest occurs during surgery or certain other procedures meant to improve the quality of life, or lead to significant recovery.

You may wish to be kept alive as long as possible, no matter your condition. Or, you may prefer to decline all life support. You may want some type of care - pain management, for instance - but not others. Which is why it's important to choose an agent who'll honor your wishes.

Doctors, who've taken an oath to do everything in their power to maintain life, are still only human. They may have professional or religious reasons for not wanting to comply with a patient's wish to deny or discontinue life support. And they may also fear liability issues from distraught family members.

Legally, though, doctors are obligated to honor your advance directive. If for any reason they can't, they're required to transfer you to another doctor who will. And, if your doctor refuses, you're entitled to appeal to the ethics board, or request a court order that the wishes be honored.

An advance directive is especially important when it comes to family member who may not know - or agree with - your wishes. If you talk with your loved ones when you sign the directive, you'll relieve them of the burden of having to make these decisions themselves. And you'll eliminate any ambiguity about your wishes.

Some people confuse "living will" and "living trust." A living trust, however, deals with property - not medical decisions.

Your directive may be included in a durable power of attorney for health care decisions, but it's generally a separate document.

Legally, an advance directive should be signed, dated, and witnessed. Some states require that it be notarized at the time of signing.

Sound confusing? It's not...if you have a guide who knows the ropes.

At the Law Offices of Alice Reiter Feld & Associates, we practice Elder Law - and only Elder Law. And, over the past 33 years, we've guided thousands of South Florida families through the Elder Care Journey, with estate planning, wills, trusts, power of attorney, long-term care planning, asset protection, and issues with the VA or Medicaid.

We'll guide you through...from beginning to end. And we're just a phone call away.

Using Life-Support, And The Living Will

Michelle has a dilemma.

Her father, Paul, has Alzheimer's disease. He can't swallow. He can't walk, bathe, or dress by himself. He's lost 45 pounds. And - most important - he can no longer speak. These symptoms usually indicate the end stage of the disease.

Paul's doctor wants to insert a feeding tube to keep him alive. But Michelle isn't sure. While Paul was in the early stages of dementia, he executed a power of attorney for health-care decisions, naming Michelle as his agent. The two of them, however, never discussed what should be done if Paul could only be kept alive by machines. As a result, Michelle doesn't know what to do.


End-of-life decisions are always traumatic. But if Paul had discussed his last wishes with Michelle, and had executed an advance directive, she would know the right decision.

And that's why we all need a living will...so our family doesn't have to guess what we'd want.

A living will allows you to specify your wishes about life-support in case of a terminal illness. And it takes effect only if you become terminally-ill, and can't communicate your own wishes.

No one likes thinking about these things, of course.

However, by making these decisions now, you're sparing your family an agonizing decision that may still haunt them long after you're gone.

You can also include your guidelines for what would constitute a minimally-acceptable quality of life. The specific circumstances in which you'd want - and not want - life support. Whether you'd want food/water through artificial means. How your pain should be addressed. Your wishes about organ or tissue donation. And you can also leave final messages for your dear ones.

You might also include the powers of your agent, among them...

• Choosing medical care/services
• Interpreting your written (or verbal) instructions.
• Arranging admission to a hospital, hospice, or nursing home.
• Taking any legal action needed to carry out your wishes.
• Applying for Medicare, Medicaid, Veterans benefits or other programs or insurance benefits for you.

At the Law Offices of Alice Reiter Feld & Associates, we're Elder Care Attorneys. And we've been creating customized Living Wills for South Floridians for the last 33 years...along with comprehensive estate plans, wills, trusts, powers of attorney, long-term care plans, asset preservation plans, and assistance with Medicaid and the VA. And we've guided thousands of families through the Elder Care Journey.

We can be your guide. And we're just a phone call away.

The Start Of The Alzheimer's Journey

This is about a woman named Shirley, who's been recently told she might have Alzheimer's. But it could be about - and will be about - many of us.

Her son Mike visited.

"Mom, I've been thinking we might need to talk," Mike said. "Ever since Dad died, I've been helping you with the financial stuff." Shirley nodded. "Now, don't get me wrong, Mom. We know you're still doing pretty well on your own right now."

Shirley knew what was coming.

"I understand you don't want to think about it," he finally said. "But the doctor said that one day you might now be able to tell me what you want, or you wouldn't remember things. And I wouldn't know what you'd want me to do."

"You'd know what I'd want."

"Well, Mom. I'm not sure I really would. I don't know where your papers are. I don't know who your financial advisor is. Why don't we at least write it all down together, and take it to a lawyer to see if we need to do anything else."

Shirley might retain her mental faculties for a long time...even years. During this time, she may experience only short episodes of impaired mental function. Which is exactly why she should be organizing these plans now!

Eventually, she may no longer meet her state's legal test for "capacity," a requirement for executing valid legal documents. If that happens, Shirley will no longer be able to execute enforceable legal documents at the very time she - and her family - need them the most. Someone else will have to make decisions and execute documents for her. And that's why she should act now.

If she draws up a Power of Attorney now, she can decide who she'd like to execute her wishes if she can't.

If she waits too long, though, a court will decide for her. That can be a very long, tortuous, divisive (among the family) process. And one that Shirley - and, no doubt, you - would rather spare her family.

We can help.

At The Law Offices of Alice Reiter Feld & Associates, we're Elder Law attorneys. Over the past 33 years, we've executed Powers of Attorney for thousands of South Florida families...as well as comprehensive estate planning, wills, trusts, long-term care planning, asset protection plans, and assistance with the VA or Medicaid. And we've done it with professionalism, compassion, and, when necessary, a soft shoulder.

You don't have to make the Alzheimer's Journey alone. We're just a phone call away.

My Dad Served In World War II. Does That Matter?

It sure does!

The Veteran's Aid & Attendance Benefit has often been called "the VA's best-kept secret."

This non-service-connected pension benefit is specifically meant to help wartime veterans with unreimbursed medical expenses...and even your spouse is eligible (if qualified). And the great thing about this benefit is that you don't have to spend yourself (or give gifts) into poverty to receive it.

Eligibility for this benefit is determined by any one of three factors:

1. You're over 65.
2. Your permanently disabled and unable to work.
3. You're home-bound and in need of regular attention. You don't have to be in your own home, however. It doesn't matter where you are...home, assisted/supportive living, or nursing home. The program is based on financial need, so there are income and asset limitations.

The program allows for the following benefit amounts (2012 figures):

• Married wartime veteran - Up to $2,019 per month tax-free
• Single wartime veteran - Up to $1,703 per month tax-free
• Widowed spouse of a wartime veteran - Up to $1,094 per month tax free

To get this benefit, though, you've got to understand how the VA views income. They use a system called Income for VA Purposes (IVAP). The formula used to calculate this figure is gross income minus unreimbursed medical expenses (UMEs)...including doctor's fees, dentist's fees, Medicare premiums and copayments, health insurance premiums, transportation costs to physician's offices, and assisted living facilities or in-home aides.

Sound confusing? It gets worse.

To the VA, gifts that you make to family carry very short periods of ineligibility. If you're applying for Medicaid, however, that's not the case. Gifting today is a very complex process that can lead to severe penalties with Medicaid. And you shouldn't undertake it without professional guidance. Done improperly, it can create huge gaps in care. And it can cost you just about every cent you've got.

At The Law Offices of Alice Reiter Feld & Associates, we're Elder Law attorneys. Over the past 33 years, we've helped thousands of South Floridians file for VA or Medicaid benefits. And we've helped them, as well, with comprehensive estate planning, wills, trusts, powers of attorney, asset protection, and long-term care planning.

We know the ropes...and we'll get you through. We're just a phone call away.

More On The Medicaid Jungle: Planning For A Disabled Spouse

What happens if your spouse needs care? You not only need to consider his/her costs, but also the income you'll need to live on. The law governing this situation is the Spousal Impoverishment provision of the Medicare Catastrophic Act of 1988. And it's just as complicated as it sounds!

Basically, the couple's assets are divided in half. The spouse at home is the "community spouse," and the one in care the "institutionalized spouse." A few states allow the community spouse to keep the maximum of (up to) $109,650. However, most state just divide the assets in two. The institutionalized spouse can keep $2,000, and the amount the community spouse can keep is the Community Spousal Resource Allowance (CSRA).

The community spouse is allowed a minimum income, called the Minimum Monthly Maintenance Needs Allowance (MMMNA), currently set by the federal government at $1,750 per month. So, if a female community spouse has $500 in Social Security income and her disabled husband has Social Security of $1,250, all his income would be diverted to his Community Spouse to get her income to the MMMNA of $1,750.

However, if the community spouse earns $2,000 a month between her Social Security and pension, the other spouse's $1,250 would go to the nursing home as a co-pay. Confused yet???

Planning alternatives do exist. But you won't find them without the assistance of an Elder Law attorney.

Your friends may tell you, "Just Give Away $13,000 Per Year to Each Child." Unless they're Elder Law experts, however, don't listen!

In Medicaid's eyes, even small gifts can be combined to establish a long period of ineligibility. And that's before the state even looks at your assets!

Medicaid considers a gift to be a transfer. And if these transfers were made during the previous five years, the state would expect the family to return the money to pay for care.

You may think you've dealt with frustrating bureaucracies before. But - trust me - until you deal with Medicaid, you ain't seen nothin' yet!

You don't have to deal with Medicaid alone, though. That's why we're here.

At the Law Offices of Alice Reiter Feld & Associates, we practice Elder Law - and only Elder Law. We've been practicing it for 33 years. And we've walked thousands of South Florida families through the Elder Law Journey...not only with Medicaid, but also with comprehensive estate planning, wills, trusts, powers of attorney, asset preservation, long-term care planning, and the VA.


We deal with Medicaid every day.

And we're just a phone call away.

Medicaid: Single Or Married?

Single applicants can become eligible for Medicaid by spending down.

This doesn't mean a single person can't protect his money. But gifting intra-family is now more difficult if there's a possibility of long-term care... especially since the new Deficit Reduction Act extended the "look-back period" (when the state is allowed to examine your finances) from three years to five.

Single people need to focus on income first, and then the asset base. For example, let's say George, a widowed veteran, has Social Security income of $1,300, a pension of $1,100, and a wartime veteran's pension of $1,703... bringing his monthly income of $4,103. Let's say that George has dementia, and needs 24-hour-a-day care.

The monthly nursing home cost would be $6,200, and his prescriptions average $300 per month, bringing the monthly bill to $6,500. There's a $2,515 shortfall between here. George has $400,000 in the bank. But how long will that last?

Of course, prices will go up... and this shortfall may grow. If we multiply the monthly shortfall times 60 months (the look-back period), George would need to access at least $150,900 of his $400,000. But - again - keep in mind that this is all guesswork. There are simply too many variables to predict an exact amount that George should gift, and an exact amount to leave "at risk."

Married Couples

Married couples applying to Medicaid funds face unique problems, partially because they often feel the rules shouldn't apply to them. For instance: "I'm fine. My wife's name isn't on most of our savings investments anyway."

Think again - you're wrong! The state views marital assets as a unit... and it couldn't care less whose name is on the account!

Then there's the "Just give it to your kids" argument. WRONG!! This is actually a huge violation of Medicaid rules - an "improper transfer." Medicaid has very strict gifting rules. You're navigating very treacherous waters here. Mistakes often are not forgiven. And they're sometimes impossible to fix.

If  you think you've seen bureaucracies before...just wait until you get involved with Medicaid!

At The Law Offices of Alice Reiter Feld & Associates, we practice Elder Law. For the past 33 years, we've helped thousands of South Florida families navigate these treacherous Medicaid waters. And we've helped them, as well, with estate planning, wills, trusts, powers of attorney, long-term care planning, asset protection, and the VA.


We deal with Medicaid every day. And we can navigate these waters for you.

Give us a call.