I Can No Longer Get Mom In The Shower. How Do I Keep Her Clean?

Fear of taking a shower is common among people with dementia.

Here are some suggestions:

• Make sure the bathroom lighting is adequate. An inability to see will only increase her anxiety.
• Let the shower run first for a few minutes, to warm up the bathroom. No one likes getting into a cold shower.
• Purchase a shower chair at a medical supply company or a pharmacy, so she can sit when she feels unsteady.
• Install a hand-held shower head. This is often less threatening than water pouring down from above.
• Play soft, calming music.
• Use a soap she used to love, and from which she might recall the fragrance.
• She wants as much privacy as possible. Let her try and bathe herself, with some sideline coaching.
• Try having her soak in the bathtub, instead of a shower. This is more relaxing.
• Consider having a home health agency look over your bathroom, and make suggestions about how it could be better-adapted to your Mom's needs.
• Consider sponge baths as an occasional option.
• Consider bathing your mom in bed, using a dry shampoo, which many hospitals are doing.

Try and stick with the bathing routine your mother always had. Morning or night? Shower or bath? She'll feel more at ease if her routine is similar.

Lastly, consider hiring a bath aide, on your own or through an agency. Your mom may be embarassed to be bathed by her daughter, and might respond better to someone outside the family.

When you're a caregiver to someone with dementia or Alzheimer's, questions never stop popping into your mind. But we can help... because we're Elder Law attorneys.

At The Law Offices of Alice Reiter Feld & Associates, we've been walking South Florida families through the Dementia Journey for the past 33 years. And we've prepared them in advance for that possbility, as well, with comprehensive estate planning, wills, trusts, powers of attorney, long-term care planning, asset-protection plans, and assistance with Medicaid or the VA.

We know every step of the Dementia Journey. And we're just a phone call away.

The Seven Big Risk Factors For Alzheimer's

Thirty-five million people around the world suffer from Alzheimer's. And this number's going to skyrocket as the Baby Boom generation ages.

However, researchers are finding that how we live can have a major effect on our changes of getting it. And that seven conditions, in particular, may actually account for half of those 35,000,000 cases.

The implications are startling. This means that you can start to fight Alzheimer's no matter how old - or young - you are!

Here's the list of "The Dirty Seven"...

RISK 1 - LACK OF EXERCISE: The No. 1 preventable factor with regard to Alzheimer's is exercise... or, more precisely, lack thereof. So get your rump off the couch!

RISK 2 - DEPRESSION: About 15% of Alzheimer's cases - or one in every seven - may stem from chronic depression. So if you're suffering from long-term depression, you're at much higher risk.

RISK 3 - SMOKING: If the possibility of lung cancer hasn't yet scared you off, maybe this will - 11% of Alzheimer's patients were smokers!

RISK 4 - HIGH BLOOD PRESSURE: If your numbers are high, so is your chance of getting Alzheimer's. Some 8% of Alzheimer's patients had high blood pressure.

RISK 5 - OBESITY: America's carrying around way too much weight. And some 7% of Alzheimer's patients were overweight in mid-life.

RISK 6 - LOW LEVEL OF EDUCATION: If you have a lower level of education, you have a higher chance of Alzheimer's (7% of Alzheimer's patients). But it's never too late to start doing some mental gymnastics!

RISK 7 - DIABETES: Researchers say that 3% of U.S. Alzheimer's patients have diabetes. So problems with blood sugar are a potential marker.

If you have a family member dealing with Alzheimer's or dementia, we can help. At The Law Offices of Alice Reiter Feld & Associates, we're Elder Law attorneys. And we have one of the largest Alzheimer's/Dementia Resource Centers in South Florida.

Over the past 33 years, we've walked thousands of families through the Alzheimer's/Dementia Journey. And we've helped them prepare in advance for the possibility of it, as well... with comprehensive estate planning, wills, trusts, powers of attorney, long-term care planning, asset-protection plans, and assistance with Medicaid or the VA.

We know every step of the Alzheimer's/Dementia Journey. And we're just a phone call away.

The Ultimate Cruel Irony: Alzheimer's Researcher Has Alzheimer's

What happens when a seeker of a cure for a dreaded disease becomes a victim of that disease?

It's the cruelest irony imaginable. A quest that moves out of the scientific and into the personal. And a race against time.

That's the situation in which Rae Lyn Burke finds herself.

Rae Lyn Burke is a noted researcher. After helping to develop vaccines for HIV, herpes, and hepatitis B, she turned her attention, in the 1990's, to a newly-emerging disease that had started claiming seniors at an alarming rate - Alzheimer's.

She helped develop an experimental drug called bapineuzumab, which helps clear the plaque in the brain that scientists believe can precipitate Alzheimer's. And her early work with mice was encouraging enough, in her mind, to presage beneficial applications for Alzheimer's patients.

Rae Lyn Burke didn't only "work" at a desk. She was a 24/7 thinking-machine, the kind of person whose mind never stopped; for example, she loved to play with numbers in her head while commuting. And it was while playing those games that she began to realize something was wrong.

In 2008, she was diagnosed with Alzheimer's. Now - at the age of 64 - even the easiest math problems are impossible for her. And she struggles with simple household tasks.

Burke, however, is still searching for a cure for Alzheimer's... the only way she now can. Every three months she receives bapineuzumab... the drug she helped create.

She believes the drug is slowing the progress of her disease. But it's not curing it.

She still has enough mental activity to realize what she's lost... and what she's going to lose.

It's a fate that could happen to any of us... or a family member. But you don't have to face it alone.

At The Law Offices of Alice Reiter Feld & Associates, we practice Elder Law - and only Elder Law. Over the past 33 years, we've walked thousands of South Florida families through the Alzheimer's/Dementia Journey. And we've helped them prepare in advance for it, as well, with comprehensive estate planning, wills, trusts, powers of attorney, long-term care planning, asset-protection plans, and assistance with Medicaid and the VA.

The Alzheimer's/Dementia Journey isn't an easy one. But we know the way... And we're just a phone call away.

The Let's-Not-Talk-About-Death-Checklist

As I mentioned last week, my mother is dying. And I can’t get my Dad – who’s normally an outgoing person – to talk about it.

He ranges from knowing she’s dying to not wanting to know. But he never talks about it. And that’s made me think about why we, as a society, are so afraid to talk about death. Like many a person who has hallucinations, we often seem to have a hallucination, as well…that if we don’t talk about it, it won’t happen.

Well, folks, I’m here to tell you that Ben Franklin was right about death and taxes. We talk plenty about taxes. But mention “death” – which, after all, is part of life – and we turn into stone.

News flash! Avoiding the conversation doesn’t postpone death!

Even my Dad once said that we start the process of dying the day we’re born.

So, if you’re a member of the “If-I-Don’t-Talk-About-It, It-Won’t-Happen” Club, here’s a short checklist to make sure you maintain your membership in good standing…

·         Do you avoid thinking about death?

·         Do you believe that thinking about death makes it happen?

·         Are you superstitious about death?

If you checked “Yes” to all three questions…congratulations! You’re a charter member of the club!

This isn’t an easy topic to discuss. But if you know of even one person who’s been around longer because his family didn’t discuss it…I’d like to meet him!

I don’t know how I’ll react when my Mom passes. I don’t know how I’ll feel a year afterward. But I do know this: I’m thinking about it. And I’m letting myself come to terms with it.

If you need someone to talk with about death, we can help. At The Law Offices of Alice Reiter Feld & Associates, we practice Elder Law. For the past 33 years, we’ve walked thousands of South Florida families through this journey. And we’ve prepared them for it in advance, as well, with comprehensive estate planning, wills, trusts, powers of attorney, long-term care planning, asset protection plans, and assistance with Medicaid and the VA.

We can walk you through the journey, too. And we’re just a phone call away.

What Is "Palliative Care?"

Palliative care is basically the prevention and treatment of pain. It does not aim for a cure, per se; it aims, instead, for relief. And – although anyone suffering from any disease can receive palliative care - it’s most often associated with hospice.

Hospice, of course, is different than hospital. People go to hospitals, generally, in search of a cure. People go to hospice when there’s no hope of a cure, so they can die in a comfortable, homier atmosphere.

Palliative care, in a very real way, helps ease the process of dying…which, of course, is a part of life. It doesn’t postpone death, by causing people to linger with untreatable illness. But it doesn’t hasten it, either.   

Palliative care in a hospice setting usually involves a team of specialists, ranging from doctors to clergy, to treat to treat pain and its symptoms, and to provide a psychological or emotional approach when warranted. And it works; most families who experience the death of a loved on in hospice say it’s better than passing away in a hospital.

Yet, many people don’t take advantage of hospice – even though it’s paid for by Medicare.

We often tend to think of a loved one’s death as the worst thing that could happen. But I would suggest that there’s one thing even worse – a loved one dying badly. What do we mean by “badly?”

According to Dr. Ira Byock, director of Palliative Medicine at Dartmouth-Hitchcock Medical Center in New Hampshire, dying badly is “Dying while suffering, dying connected to machines.” Dr. Byock believes that, if we deny an imminent death, we can become delusional, and can start acting in ways that can actually harm our loved one.

These are very difficult questions. But we can help.

At The Law Offices of Alice Reiter Feld & Associates, we practice Elder Law. Over the past 33 years, we’ve helped thousands of South Florida families answer these questions. And we’ve helped them prepare in advance for these questions, as well, with comprehensive estate planning, wills, trusts, powers of attorney, long-term care planning, asset protection plans, and assistance with Medicaid or the VA.

We can help you find your answers. And we’re just a phone call away.

End of Life vs. Prolonging Life

Unless you know something I don’t, we’re all going to die.

We’re not, however, all going to die the same way. Some of us will die naturally, in a comfortable environment – perhaps our own home – surrounded by family. Others of us will die in a cold, sterile hospital, surrounded by people in white coats whose job it is to keep us breathing as long as possible.

For better or worse – and, yes, it can often be for worse – modern medicine has become so adept at keeping us alive that “terminally”-ill people can now live for weeks, or even months. Of course, this is where the definition of “living” comes into play. And it’s where each of us must make a choice.

How do we want to “live?” And how do we want to die?

Many people spend their last days in hospitals, hooked up to machines that breathe for them and feed them, while being given drugs that can only prolong – not save – their lives. Almost half of terminal patients report significant pain…which can only be treated if they’re sedated. And if that’s the way you want to go, that’s OK. But you should be the one making the decision…not doctors!

Three-quarters of people say they want to die at home – but only one-quarter of us actually do. And here’s the reason: Only 25% of Americans have any type of advance directive.

What about you? Do you have an advance directive? Will your family know your wishes? And, if the answer’s “no”…are you really comfortable with that?

We can help you answer these questions for yourself…so that, when the time comes, the steps taken are the ones you’ve outlined in advance.

At The Law Offices of Alice Reiter Feld & Associates, we practice Elder Law – and only Elder Law. Over the past 33 years, we’ve helped thousands of South Florida seniors – and their families – to decide how they want to answer these questions. And we’ve helped them prepare in advance, as well…with comprehensive estate plans, wills, trusts, powers of attorney, long-term care planning, asset-protection plans, and assistance with Medicaid and the VA. And, yes…advance directives, too.  

The questions can be overwhelming. But the patient and the family – not doctors – should really be the ones answering them. We can help. And we’re only a phone call away. 

What Hospice Is. And What It Isn't.

When it comes to dying, we clearly don’t have a whole lot of choice in the matter.

However, we often do have a choice about where our loved ones pass away. We have a choice about whether they pass away in a hospital, poked and prodded until their last minutes on Earth, or if they die in hospice.

Unfortunately, too few of us actually take advantage of hospice, because too few of us really understand what it is…and what it isn’t.    

WHAT IT IS

“Hospice” is derived from the Latin word “hospitium” - guest-house. Of course, it’s not exactly a place you’d go to on vacation.

It is, however, a place in which to die with dignity. A place in which the patient is enveloped in a loving, warm atmosphere, in which the emphasis is on pain-relief, rather than cure.

Hospice is simply an approach to caring for patients at the end of their lives. It’s focused on improving remaining life, rather than prolonging it. And on the patient’s – and the family’s – emotional needs. 

Hospice can be provided in a local facility…or in the patient’s home. And there’s no cost; it’s provided under Medicare. 

WHAT IT ISN’T

Hospice is not a place to go a day before you die. And it’s not, unfortunately, a place recommended by enough physicians.

It’s simply a place in which you can leave this life with dignity and with peace.

Hospice also offers another big advantage. It’s a final opportunity (for both patient and family) to tie up any loose ends in their estate planning…and to make sure the patient’s wishes are honored. 

At The Law Offices of Alice Reiter Feld & Associates, we’re Elder Law attorneys. We’ve been helping South Florida families tie up loose ends – and honoring love ones’ wishes - for 33 years. And we’ve been helping them prepare for the inevitable (whenever it comes), with comprehensive estate planning, wills, trusts, powers of attorney, long-term care planning, asset-protection plans, and assistance with Medicaid or the VA.

If your loved one is nearing the end of life, consider hospice. And make sure their wishes will be honored. It’s the ultimate gift.  

We’re just a phone call away.

What Is Hospice? And How Can They Help My Mom?

“Hospice,” first of all, has nothing to do with “hospital.” A hospital strives to cure sick people…and, often, to keep them from dying. The mission of hospice, on the other hand, is to help terminally-ill patients die with dignity, on their own terms. Hospice is a place where the environment is warm and loving, and staff members have time – and compassion - not only for the patients, but also for their families.  

At hospice, there’s a holistic approach to pain management, which includes emotional and spiritual care. These facilities provide a warm, home-like atmosphere where patients can spend their final days without being poked, prodded, and MRI’ed when virtually no hope of a cure.

Hospice care doesn’t even have to be in a hospice facility and often is not. Staff can often come to the patient’s home or long-term care facility. (Some long-term care facilities even have their own hospice programs.)

Hospice may be called in by one’s doctor when he is determined to probably have no more than six months to live. This is when the goal of “cure” is replaced by “comfort,” and a team of a chaplain, certified nursing assistants, a doctor, registered nurse, and social worker is put together.  

Hospice is also concerned with the survivors. Grief counseling is available on both individual and group levels. And it’s helped many a person get back to living, again. 

This is a tough time. But you don’t have to go through it alone. At The Law Offices of Alice Reiter Feld & Associates, we can show you the way. Not only at the end of life, but also long before that, with estate planning, wills, trusts, powers of attorney, asset protection, long-term care planning, and assistance with Medicaid or the VA. Over the past 33 years, we’ve helped thousands of South Florida families. And we’ve done it with professionalism, compassion, and, when necessary, a soft shoulder.

We’re just a phone call away.

My Mom and Dad (Part Two)

Now that I’ve told you about my own Mom and Dad, and the end-of-life issues we’re facing, I feel like a burden’s been lifted from my shoulders.

I’ve spent the past 33 years, as an Elder Law attorney, encouraging people to discuss their feelings when a parent is dying. And now that my own mother is in hospice – and my 91-year-old father is facing life without her – I’ve become, in a way, my own client.

Death, to most of us, is the elephant in the room. We know it’s there. But we don’t want to acknowledge it. But if you know someone who isn’t going to die…I’d like to know about it!

Truly, it’s the one thing – maybe the only thing – that every one of us has in common.

I have no idea how I’ll react when my Mom dies. I have no idea how it will hit me a year down the road, or in years to come. But I’m allowing myself to think about it. And – as you can see! – I’m allowing myself to talk about it.

Now that I’m in the position of so many of my clients, I’m seeing some things in a new light…for example, what’s important, and what’s not.

I occasionally hear people fretting over buying a house. But now, when I hear that, I think, “Why aren’t you happy you have a chance to buy a house? Why aren’t you counting your blessings?”

Gratitude can be strong medicine for the soul. Yes, I’m mentally and physically exhausted from being a caregiver to my parents. But I’m also grateful that I have the opportunity to be here for them.

We’re living longer than ever, of course. Perhaps that makes it even harder to accept the fact that, one day, we’re going to die. Yet – no matter how long you live – it goes so fast! So why aren’t we taking more time to smell the roses…to enjoy the process of living?

My Dad once said that we start to die the moment we’re born. So why aren’t we discussing it more? Maybe we need to re-think the concept of death…and life.

Perhaps, by acknowledging our eventual death, we’ll be able to live a more productive and joyful life!

My Mom and Dad

My Mom is dying. And my Dad’s in rehab.

As an Elder Law attorney for 33 years, I’ve helped thousands of South Florida families deal with end-of-life issues. And I’d like to think that I’ve been a compassionate and caring friend to these people, as well as an attorney.

But now the shoe’s on the other foot. And I’m in the position that so many of my clients have faced over the years: How to accept, somehow, that my Mom is at the end of her life. And that my Dad – who can hardly walk these days – is facing the loss of his best friend and life-partner of 66 years.

Truthfully, I don’t know how to feel. And I’m so busy with my clients – which, I guess, is a good thing – that I’m not entirely sure when to feel it. There’s a deep screaming within my soul, like being trapped in a dark room. But, yet, I know that I still have to maintain balance in my life…with my husband, my son, my clients, and my family (and myself, too!). And, so, while I do allow myself some tears, I never allow myself to forget that people depend on me, and need me.  

My Mom is now in hospice. She’s confused, bed-ridden, and unable to express herself much verbally. There are occasional hallucinations, too. She’s showing what the doctors refer to as “pre-active” dying.

My Dad? Well, he’s 91 now, and he hasn’t been without my Mom – even for a day – since he was 25. He’s the talkative type, friendly, outgoing, and a real jokester. Yet, I haven’t been able to get him to open up about this situation. But I can see that he goes from knowing she’s dying one minute, to denying it the next.

And me? I have a pounding headache all the time. I’m having trouble sleeping (I was sending out e-mails at 4 a.m. the other night). My stomach is doing so many back-flips that it feels like it’s turned inside-out on me. I’m emotionally and physically drained.

Yet, somehow, I get up every morning and do what I have to do. And, perhaps, that’s a result of the work ethic with which my Mom and Dad gifted me.

In a sense, now that I’m in the position of so many of my clients…I’ve had to become my own client. And I know that – like my clients – I, too, will somehow get through this. 

End-of-life issues eventually affect all of us. Yet, we’ve kept them in the dark for far too long. And it’s time we discussed them.

Together, we’ll all get through.

One (Unpublicized) Bonus Of The New Healthcare Law

Many of us thought the recent Supreme Court ruling pretty much ended the debate over the new healthcare law. But we were wrong. Speaker John Boehner is planning a House vote this week to repeal the Affordable Care Act (ACA), aka “Obamacare.”

Some have called the ACA a tax increase. But I think this legislation will make a big difference in the lives of millions of Americans. And it’s already saving seniors, families, and small businesses a lot of money.

The bill’s detractors want to remove many sections that help protect consumers. That could mean taking away the $3.7 billion that seniors in the Medicare prescription-drug "donut hole" have already saved. It could mean ending coverage for 6.6 million people under 26 years old who are now on their parents' insurance plans. It could mean taking away health-insurance tax credits for small businesses. And it could mean, as well, allowing insurance companies to over-charge or deny coverage to people with pre-existing conditions.

I genuinely believe that ACA will stop insurance companies from denying us care. It can help lower skyrocketing health costs. And it could improve the quality of care. 

I’m not a political person. But I wish that opponents would accept the Supreme Court decision and move on. I’m all for honest disagreement. But I’m very much against playing politics with peoples’ lives.

Why am I so passionate about this law?

Well, for one thing, I’ve spent the past 33 years helping South Florida seniors get the rights and benefits to which they’re entitled. And for another, my mother’s in hospice now. And my father’s having trouble walking…let alone dealing with the imminent loss of his partner of 66 years.

At The Law Offices of Alice Reiter Feld & Associates, we’ll fight for your rights. And we’ll protect you and your family, with comprehensive estate planning, wills, trusts, powers of attorney, long-term care planning, asset-protection plans, and assistance with Medicaid or the VA.

We know every step of the way. And we’re just a phone call away.

Healthcare Act Still Leaves Some Hurdles For Seniors (Part Two)

It’s going to take a while – perhaps until the new Affordable Care Act (ACA) is implemented in 2014 – to really see how things shake out. And to really understand the costs. 

Take Medicaid, for example. The ACA had originally mandated that states wishing to participate in the new joint federal-state program must adopt expanded Medicaid eligibility and coverage standards. However, the Supreme Court ruled that Congress can’t penalize states choose not to expand Medicaid. As a result, states won’t lose their existing Medicaid funds if they don't comply with the new standards.

It does seem reasonable to assume, though, that expanded eligibility and coverage standards will help many seniors who are unable to work because of a disability…and who sometimes have to make the horrible choice between eating and paying for their medications.

Some provisions that could help include…

• Coverage of certain preventive services in all new health plans.

• Reduction of the Medicare prescription-drug donut hole at first…then elimination of it in 2020.

• Beginning next year, the federal government will provide financial incentives to states offering preventive-care coverage under Medicaid. And patients won’t have to pay anything for some things.

       

• Starting in 2014, individuals and small businesses (up to 100 employees) will be able to purchase coverage (including Medicaid and CHIP programs) through state exchanges.

• As of 2014, there will no longer be annual limits on coverage or guaranteed coverage. The phrase “pre-existing conditions” will be permanently erased from the elder-care dictionary. Applicants will be “rated” based only upon their age, geographic area, family history, and whether they’ve smoked – nothing else. And this will be true whether you’re purchasing insurance individually, from the state exchanges, or from your (small-business) employer.

Despite all this, however, it would be a (major!) mistake to assume that all Medicare beneficiaries and disabled seniors will benefit from ACA. For example, starting next year, the threshold for itemized deductions for unreimbursed medical expenses increases from 7.5 percent of adjusted gross income (AGI) to 10 percent (except if you’re over 65…at least until 2016).

Having said all this, keep in mind, if you’re a Floridian, that Gov. Scott may fight implementation of the bill. And if he succeeds, of course, all bets are off.

It’s all very confusing…even to many of the legislators who voted on it! In fact, you’ll probably find that the only person who can “translate” ACA for you – in language you’ll understand – is an Elder Law attorney.

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 “translated” for thousands of South Florida families, with comprehensive estate planning, wills, trusts, powers of attorney, long-term care planning, asset-protection plans, and assistance with Medicaid and the VA.

We’ll walk you through the Elder Law Journey. And we’re just a phone call away.

Healthcare Act Still Leaves Some Hurdles For Seniors (Part One)

The Supreme Court ruling upholding most of the Affordable Cart Act of 2010 (ACA) will offer some interesting benefits to seniors with disabilities, or on Medicare. But that doesn't mean, however, there won't be any more hurdles to jump.

There are still some things we don't know - especially regarding costs - before we can breathe easier.

With the current system so badly broken, it's hard to envision ACA as a panacea for every problem. But there's no doubt it can benefit Medicare recipients, who will now receive preventive care coverage and smaller donut holes.

But, again, until we know more about costs, it's hard to project an accurate picture. For example, we still don't know exactly how ACA will address the problem of pre-existing conditions.

What we do know is that every American will be required to have health coverage starting in 2014.

Insurers are already required to provide coverage to children with pre-existing conditions. Starting in two years, they'll have to cover everyone with a pre-existing condition. In addition, lifetime pay-out limits will be eliminated.

Seniors who receive SSDI benefits must now wait two years to become eligible for Medicare. Many end up losing their health insurance during this period, and are unable to obtain new insurance because of pre-existing conditions... or high costs.

PCIPs (Pre-Existing Condition Insurance Plans) currently provide insurance to people with pre-existing conditions who can't gt coverage elsewhere. However, participation has been lower than expected. And costs have been higher than expected. The average participant still has to lay out $29,000 this year - more than double what was expected.

However, the state exchanges mandated by the new law will afford more choices, and will also tell seniors whether they're eligible for Medicaid or other reduced-cost insurance programs.

ACA will actually penalize for people without coverage, starting at $95 per adult in 2014, and increasing for the next two years. After 2016, cost-of-living adjustments will be applied.

Sound confusing? You ain't seen nothin' yet! Wait until two years from now,when everybody's trying to figure out every provision of this new act. Actually, though, there's only one person who can really figure it out - an Elder Law attorney.

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 walked thousands of South Florida families through the Elder Law Journey, with comprehensive estate planning, wills, trusts, powers of attorney, long-term care plans, asset-protection plans, and assistance with Medicaid or the VA.

We know every step of the Elder Law Journey. And we're just a phone call away.

How The New Healthcare Reform Affects Seniors

Now that the Affordable Care Act, or ACA, has been upheld by the Supreme Court, seniors stand to gain a lot more healthcare options.

The aim of ACA is to expand healthcare options for all Americans - but if you're a senior, your options may be even more "expandable." For example, many of the guaranteed benefits under Medicare Parts A and B will be expanded... and none will be cut.

One provision that could bring immediate benefits is assistance with the Medicare Part D "donut hole," in the form of a $250 rebate. And if you qualify, you don't need to lift a finger to get your check; it'll come automatically. Once you reach your donut hole, you'll receive a 50% discount on brand-name prescription drugs, and a 7% discount on generic drugs. And if you're on Medicare, you'll be entitled to a free annual wellness exam.

Medicare Advantage plans will provide the same benefits provided under Medicare Parts A and B; they'll continue to lower your out-of-pocket expenses for certain expensive services, and if you require extensive care. ACA will eventually reduce payments to Medicare Advantage plans from the current 14% profit-over costs to 1% profit, with bonus payments to those with high ratings. So if you're considering a Medicare Advantage Plan, look for one that's been around for at least five years, with a high rating from Medicare.

If you'd rather receive medical care at home than in a nursing facility, ACA will provide financial incentives to states offering assistance.

You'll still have to pay more for Medicare Part B if you reach a certain income, as well as Part D. Additionally, you'll be paying a higher Medicare tax rate... which will now include unearned income such as investments.

The ACA isn't easy to understand. It's a combination of medical jargon and legalese. (And it certainly hasn't eliminated the need to plan ahead for long-term care.) The only person who can fully understand the ramifications of this law is an Elder Law attorney.

At The Law Offices of Alice Reiter Feld & Associates, we practice Elder Law - and only Elder Law.

Over the past 33 years, we've walked thousands of South Florida families through the Elder Law Journey, with comprehensive estate planning, wills, trusts, powers of attorney, long-term care planning, asset-protection plans, and assistance with Medicaid and the VA.

We can show you the way. And we're just a phone call away.

Can Someone With Early-Stage Alzheimer's Lose Their Speech?

It's hard to answer this question with a blanket statement, because the disease progresses differently in each patient. There are, of course, some pretty common symptoms, such as memory loss. But some patients experience a wide range of symptoms, while others experience only a few.

If loss of speech occurs at all, it's usually in the mid- to later stages of Alzheimer's. As the disease progresses, it shuts down certain functions of the body, one of which can be speech. The person may start out fumbling for words, or not completing sentences. Then it may move to speaking full sentences... with words that don't make sense. At its worst, the disease robs a person of any ability to speak.

One of the reasons for some loss of speech can be mini-strokes. Sometimes these strokes happen prior to dementia, and sometimes after; again, no real pattern. If a stroke is bad enough, of course, the person can lose speech altogether. However, it's good to know that therapists can help him/her regain some of it.

If your loved one with Alzheimer's loses his/her speech early, it's time to consult their physician... and it's also time to consult a specialist such as a neurologist. Mini-strokes can be too small to detect by machine. But a good doctor may be able to tell by the symptoms, and information from the family.

Keep in mind that losing speech early on is not typical for Alzheimer's patients. But visiting a specialist may be the only way to be sure. Just as visiting an Elder Law attorney may be the only way to be sure that your loved one - and your family - are protected.

At The Law Offices of Alice Reiter Feld & Associates, we're Elder Law attorneys. Over the past 33 years, we've walked thousands of South Florida families through the Alzheimer's Journey, with professionalism, compassion, and, when necessary, a soft shoulder. And we've helped prepare their loved ones for the aging process long before that... with comprehensive estate planning, wills, trusts, powers of attorney, long-term care planning, asset protection plans, and assistance with the VA or Medicaid.

Walking families through the Alzheimer's Journey is what we do - every day. And we're just a phone call away.