The Fiscal Cliff Has Been Avoided - For Now - Part 2

More meat-and-potatoes about the bill that avoided the Fiscal Cliff…

CLASS ACT REPEAL: The American Taxpayer Relief Act of 2012 repeals the CLASS Act, and provides for the establishment of a Commission on Long-Term Care. According to some reports, President Obama agreed to repeal CLASS if Republicans agreed to raise taxes on the wealthy. Most experts believe that CLASS won’t be implemented until a Democratic majority in both houses makes changes in its structure and funding.

COMMISSION ON LONG-TERM CARE: The bill stipulates that the Commission on Long-Term Care will “develop a plan for the establishment, implementation, and financing of a comprehensive, coordinated, and high-quality system that ensures the availability of long-term services and supports.” The President, Senate Majority Leader, Senate Minority Leader, Speaker of the House, and House Minority Leader will each appoint three members, for a total of 15. These members will represent the interests of consumers, seniors, family caregivers, health care workers, private long-term care insurers, state insurance departments, and state Medicaid agencies.

ADDITIONAL ITEMS: The new bill will also include various tax extensions, among them the deduction of state and local general sales taxes, and the credit for energy-efficient appliances. Federal unemployment benefits would be extended for a year. The bill also extends Medicare programs important to seniors, including payment for outpatient therapy services and Advantage plans for people with special needs.

CHALLENGES AHEAD: This bill still doesn’t provide solutions to the sequester or the debt-limit debate. We reached the legal borrowing limit on December 31. The debt issuance suspension will last only through February 28. So Congress doesn’t have much of a honeymoon before the debate starts again. And when it’s finished with the debt-ceiling debate, Congress will have to find an answer for sequestration…and a means of financing government after the Continuing Resolution expires on March 27.

The 113^th Congress will be dealing with issues such as tax reform, non-retirement accounts, exemptions, “loopholes,” and charitable deductions – along with hot-button entitlement programs such as Medicaid and Medicare.

You have to be a lawyer to understand it all. But we can help. Because we’re Elder Law attorneys.

At The Law Offices of Alice Reiter Feld & Associates, we’ve been helping South Florida families figure out the answers for 33 years. And we’ve helped them protect themselves from “complications,” 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 help you un-complicate things, too. And we’re just a phone call away.

The Fiscal Cliff Has Been Avoided - For Now - Part 1

It’s complicated. But, complicated or not, it’s going to affect everyone – especially Boomers and Seniors.

The American Taxpayer Relief Act of 2012 was actually passed by the Senate in 2013…at 2 a.m. on New Year’s Day. After speculation on New Year’s Day on whether Speaker Boehner would bring the bill to a vote - or if the House would add amendments likely be rejected by the Senate - the House eventually passed the bill at 10:45 p.m. And President Obama signed it the next day.

The bill addresses the Bush-era tax rates, estate and gift tax rates, Medicare reimbursement, and the sequester, among numerous other issues.

TAX RATES: The bill permanently extends current tax rates for individuals earning less than $400,000 and couples earning less than $450,000. Those earning more will see an increase from 35% to 39.6%. Wealthy folks will see an increase from 15% to 20% on capital gains and dividends. Individuals earning above $250,000, and married couples earning more than $300,000, will see a phase-out of the personal exemption.    

ESTATE TAX: The estate tax exemption will remain $5.12 million per person, but will be adjusted for inflation. The top rate will grow from 35% to 40%. Portability’s extended, as well, and the gift tax exemption will remain at $5 million.

PAYROLL TAX: This tax, which funds Social Security, has been at 4.2% since 2011, but will now revert back to the previous of 6.2%.

“DOC FIX”: This provision prevents the scheduled 27% reimbursement cuts to Medicare physicians this year.

OLDER AMERICAN FUNDING: Funding has been increased for the Older Americans Act and similar programs. This year only, Area Agencies on Aging will receive an additional $7.5 million, and Aging and Disability Resource Centers an additional $5 million.

The National Center for Benefits and Outreach Enrollment will receive an additional $5 million, and Medicare State Health Insurance Programs will receive an additional $7.5 million.

As I said…it’s complicated. But we can help.

At the Law offices of Alice Reiter Feld & Associates, we’ve been advising South Florida families on financial issues for 33 years. We’ve helped thousands of them, with proactive measures to see them through any legislative changes. And we help secure their futures, 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 help protect you and your family. We’re just a phone call away.

How Can I Start a Family Council at my Husband's Nursing Home?

Many nursing homes have them. But some don’t. I tell my clients who have a loved one in a nursing home: If the home doesn’t have one…start it yourself!

If set up and managed properly, family councils can be very beneficial – for the home as well as the families, because administrators can learn a lot. The goal is to discuss issues of importance to the families, while avoiding a blame-first atmosphere.

It’s not a place to hold complaint sessions; that’s a private matter between you and the administration. It’s not a place to degrade the facility or the staff; that’ll only make things worse. It is a place, however, to share ideas and concerns…and, hopefully, solutions. And it can become, if pursued in this spirit, a place where you can bond with the people who care for your loved one.

Your first step should be to speak with the administrator about creating a family council. You probably won’t face much resistance, as these are now fairly common. Ask for her help in setting things up. Find out which rooms might be available, what day and time would be good, who should facilitate the meetings, and how to get the word out about the meetings. Then, at the first meeting, discuss the schedule with the other families.

Some councils have “formal” meetings, with minutes, etc. Don’t get hung up on formal structures; the important thing is to arrive at solutions in an open, participatory manner.

In addition to problem-solving, a key function of a council is to arrange activities involving residents and families, such as picnics on the grounds. These special occasions can help foster a feeling of unity among residents, families, and staff.

If you’ve got a loved one in a nursing home, you’ve got questions. At the Law Offices of Alice Reiter Feld & Associates, we’ve got answers.

We’re Elder Law attorneys. And we’ve been answering South Florida families’ questions for 33 years, and helping them prepare for the future 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 answer your questions, too. And we’re just a phone call away. 

Beware: Scammers are Targeting Seniors

Small wonder that seniors are the biggest targets of frauds and scams.

They were born and grew up in a different world. Because of that - and because, by nature, seniors tend to be more trusting – every senior today has a red target on his/her back.

South Florida, of course, has the highest proportion of seniors in America. That’s why we lead the nation in identity theft and Medicare theft.

Many South Florida seniors receive e-mails stating they’ve won a prize, often in a contest they haven’t even entered. Others receive notice of free goods or services. To these types of e-mails, the experts all say the same thing. DON’T CLICK ON THE LINK!! If you didn’t enter the contest, you didn’t win anything. And if it sounds too good to be true – it is!

Another frequent tactic is to “notify” seniors that they’re eligible for free Medicare services. The only thing “free” about this is the opportunity for scammers to get their hands on your personal information, so they can bill the government for services they never provided.

Unfortunately, many seniors are embarrassed to report they’ve been the victim of a scam. And they don’t call the toll-free Medicare number, 866-357-6677 to report it.

One of my clients was recently targeted by one of the newly-popular schemes. She received a call from her “grandson,” saying he was stranded in England and needed her to wire money. However, this client had paid attention to what I had told her about scammers. And when she asked for her “grandson’s” last name…he hung up quickly.

At restaurants, pay with cash whenever possible. Giving credit cards to a server is never a good idea. And you should never use a debit card at a restaurant, either, because an unscrupulous employee can end up emptying your bank account.

When a senior is victimized by a scammer, it makes my blood boil. After all, at The Law Offices of Alice Reiter Feld & Associates, we’ve spent the past 33 years helping South Florida seniors keep what they’ve earned…with comprehensive estate planning, wills, trusts, powers of attorney, long-term care planning, asset-protection plans, and assistance with Medicaid and the VA.

We’ve helped thousands of people just like you. And if you’ve got questions about how to protect what you’ve earned…we’re just a phone call away.

Mom's Ongoing Spiritual Journey - Part 2

Rose was not angry, impatient, or irate. She was grateful. Her family came to visit from a distance more than once. Each time she would rally for a period of time to see them, kiss them, smile, tell them all “to sit down” and tell them how good they looked and how happy she was to see them. She never spoke about what was happening to her. She knew. So why talk about it?

She wanted to know how we were. How was Danny doing in Law School? How was Jennifer’s career going? How was Riley, her great-grandson? Her focus was always outward. Her spirit was filled with faith, and complete acceptance of the fact that she was in God’s hands. And for Rose, that was a good place to be.

Those closest to Rose, her husband and children, had their own intimate view and perception of her as a wife, mother, woman, grandmother, and aunt. What they could not fathom was how deeply her spirit and soul had touched the lives of so many people.

At her funeral, we heard from some of these people. And as we listened, we realized that this woman whom we had all seen as a simple, kind person, had in fact had a dramatic impact on the lives of others.

Rose had a quiet spirit with a big wallop. She left indelible imprints etched in the lives, souls, and spirits of others.

How deep were these imprints? Well, listen to some of the words said by various family members at the funeral…

• “She had a pure soul and a generous spirit. The way she made me feel as a child, the way she showered all of us with love, the way she was everybody’s aunt, no matter how large the family became, her pleasant demeanor and her reassuring smile are gifts she left, for all of us to hold onto. I hope that each of us, in our way, can try to live up to her legacy.”

•  “My fondest teenage memories involve my loneliness in Florida and how she insisted I stay with them on Bachelder Street. It was a small apartment…but it felt like a mansion because of her love and warmth.”

•  “I have learned a lot from my Aunt Rose, who had a great sense of humor and such a truly kind and sensitive love of life.”

• “She had the most musical laugh.”

When we stop and consider the spiritual nature of this journey for those making it, we’d do well to watch their acceptance of themselves during those declining days, and to look to the people who knew them the longest and loved them the most. We look to them because that’s where we find the consistency of who the person was - and will always be - for us.

As a Rabbi who is blessed with the opportunity to meet families with their own Roses, I leave you with the following notion to consider:

Funerals, really, are for the survivors. The person we are mourning has left us physically. But they’ll be “dead” only if there’s no one to remember them. Rose Meister will remain alive for generations to come…because her “spirit” and “spirituality” will live within each of us for the balance of our days.

Rabbi Mitch Feld, MSW, is the spiritual leader of Congregation Yom Chadash. Rabbi Mitch is available for speaking engagements, spiritual counseling and memorable life cycle events. You may find him at www.rabbimitch.com, mitch@rabbimitch.com or 954-755-3764. You will be glad you did.

Mom's Ongoing Spiritual Journey - Part 1

We are all born with a soul, and with a spirit. And I have learned, over time that we are not human beings having a spiritual experience, but, rather, spiritual beings having a human experience.

Rose Meister, my Mother-in-Law, had the ultimate spiritual and human experience, when she transitioned from this world to the next world that she now comprehends and we still cannot. To many of us, even the idea of another world is unfathomable. To others, it’s exactly the place to which they want to go when the time comes.

What is it that makes Rose’s - or anyone’s - journey so spiritual? That’s a good question - and there are no easy answers. My experience as a Rabbi is that people with strong and abiding faith - in whatever it is they believe - do not fear this transition.

Please don’t misunderstand me. I’ve yet to meet someone in good health that prays to leave and make this journey immediately. I am referring to those of advanced age who have an inkling that they are changing; becoming less alert, less mobile, sleeping more, losing interest, less focused, questioning their purpose, more forgetful, or losing their appetite. These are people who are not sick, and are generally in stable health. They fall into the category of older people who are now classified by a relatively new term: “Failure to thrive.”

This was Rose. There was no dramatic shift in her capacity, but rather, a slow erosion of the person we had known and loved for so long. She was now 90, and her caring and kindness toward others was intact. Her memory, attention span, mobility, interest, and focus, however, were all declining.

By now, you’re probably asking yourself – again – “What’s so spiritual about this?”

In Rose’s case, her spirituality was reflected in her attitude of acceptance of where she was and how she was…and her lack of needing to know answers to all the questions her husband, children and family had. Rose was okay without knowing. There was a part of her, of course, that knew without knowing, without being told, and without telling us that she knew. Rose lived in her faith and spirit. She didn’t need to ask questions to which she already knew the answers.

Next Time: Part 2

Rabbi Mitch Feld, MSW, is the spiritual leader of Congregation Yom Chadash. Rabbi Mitch is available for speaking engagements, spiritual counseling and memorable life cycle events. You may find him at www.rabbimitch.com, mitch@rabbimitch.com or 954-755-3764. You will be glad you did.

My Dad's In a Nursing Home...And Constantly Losing His Glasses, Wallet, And Dentures. What Can We Do?

Well, the first thing I tell clients in this situation is to remember why he’s there in the first place – he may have memory problems.

Then, I advise them to speak with the director of his unit, and find out why this keeps happening. Then you have to determine whether the item is worth replacing. Obviously, glasses and dentures need to be replaced. But other items may not need to be.

Wallets, for example, may be more of a comfort/reassurance item to him than anything else. And, if that’s the case, you don’t have to replace each one with a fancy wallet; an inexpensive one may do. In fact, it may pay to keep a few on hand.

Replacing lost or broken items can be expensive. But there are still ways you can save. For example, you can compromise on the frame of his glasses. Or, if he just uses them for reading, perhaps an inexpensive pair of reading glasses – available at any drug store – would suffice.

Even with dentures – which are obviously a necessity – it may be possible to save some money. If they’re broken, consider fixing them rather than replacing them. And if they’re lost, chances are, they’ll be lost again. It’s conceivable that they just don’t fit right…and your loved one may be removing them. If that’s the case, a dentist may suggest alternative measures…including re-fitting the dentures to; make them more comfortable.

If your loved one’s in a nursing home, you probably have a million questions – every day. But we can help.

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

If you’ve got questions, we’ve got answers. And we’re just a phone call away.

My Mother's Medication is Having Negative Effects. How Can I Get The Nursing Home to Adjust It?

Negative reactions to medicines are common among my clients’ loved ones. And I always tell them to start by documenting what they’re seeing. How do these negative effects manifest themselves? How often? Under what conditions?

Then make an appointment with the Director of Nursing at the home to talk it over. If you’re not satisfied with your conversation, ask to see the Administrator. And you should also attend the next care planning meeting for your mother. (Also, I advise my clients to call the doctor who prescribed the medicine, to make sure your mother’s not simply experiencing the common side-effects of starting a new medication.)

If you’re still feeling frustrated, you can contact the long-term care ombudsman in your state. These are trained volunteers who advocate for nursing home residents and their families. They can hopefully work out a solution with the nursing home.

As a last resort – and if you are your mother’s power of attorney for health care – you can ask the doctor to change the medication. (Keep in mind, though, that he/she may respond that it’s best not to change it.)

If you’re still not satisfied, you may consider moving her to another home. However, this is a step that should not be taken lightly! Moving can be very hard on people with Alzheimer’s or dementia.

If you have a loved one in a nursing home, questions will pop into your mind a hundred times a day. It can seem overwhelming. But we can help.

At the Law Offices of Alice Reiter Feld & Associates, we’re Elder Law attorneys. And we’ve been answering these questions for South Florida families for 33 years. We've helped thousands of them…with comprehensive estate planning, wills, trusts, powers of attorney, long-term care planning, asset-protection plans, and assistance with Medicaid or the VA.

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

The Nursing Home May Evict My Father, Because of Aggression. What Do I Do?

Occasionally I get a frantic call from a client in this situation.

The first thing I tell them is that aggression is usually caused by agitation. And if you can control the agitation, you can control the aggression.

I believe it’s helpful to meet with the Director of Nursing and her team to discuss the situation. If you’re not satisfied with the results, you can contact the long-term care ombudsman program in your state. These are trained volunteers who advocate for nursing home residents, and help in working out solutions.

If you’re confident that staff have done all they can, your loved one should be assessed. Go to the Alzheimer’s Association (www.alzs.org) to find a nearby program. What is an assessment? It’s a 24/7 observation…which could possibly result in changes to your loved one’s medication. (It’s possible that the medication could be causing the aggression.)

If a patient’s aggressiveness is not caused by medication, it may be caused by a lack of chemistry between patient and staff.

During the assessment, you can meet with social workers at the facility to see where else your loved one might be placed. It’s possible that a simple change in environment may be beneficial…although it may result in confusion initially.

If my clients are looking for a new home for their loved one, I encourage them to consider one with an Alzheimer’s unit, which is specially built and staffed with this population in mind. Staff at such a facility will be trained to deal with aggressive or agitated patients.

If your loved one has dementia or Alzheimer’s, you’ll have a hundred new questions every day. We can help.

At The Law Offices of Alice Reiter Feld & Associates, we’re Elder Law attorneys…and we’ve spent the past 33 years answering these questions. We’ve helped thousands of South Florida families, with comprehensive estate planning, wills, trusts, powers of attorney, long-term care plans, asset-protection plans, and assistance with Medicaid or the VA.

If you’ve got questions, we’ve got answers. And we’re just a phone call away. 

Are Group Homes With Four or Five People Appropriate for Alzheimer's Patients?

First of all, it’s important to define exactly what we mean by “group homes.” Some states call them “boarding care homes,” instead. Some states require licenses. So, to start your search, call your state’s licensing department and ask if licensure is required; and, if so, get a list of the homes in your area.

If it were one of my parents, I’d consider only those homes experienced with dementia patients. These facilities will have very specific safety measures, and staffs with special training in working with this population.

Also, when making this decision, consider whether your loved one can stay in the home the rest of her life. For example, if she runs out of money, will the home accept Medicaid? (And will she be eligible for it?) What if she eventually needs a wheelchair, or becomes bedridden, or incontinent. Will she be able to remain there?

In my opinion, smaller homes (with just four or five residents) are best for dementia patients. They’re more “homey.” There’s more contact between the staff and residents. And staff are generally more versatile, as they often have to do a wider variety of jobs.

I believe that residents of smaller homes are often happier. The smaller homes often make it a point to involve residents in daily activities such as cooking and cleaning, folding laundry, helping with the trash, watering plants, and setting the table. Activities such as these allow your loved one to feel a sense of responsibility, and self-worth. And they allow her, as well, to develop a sense of community with the other residents.

When you’re dealing with Alzheimer’s, it’s inevitable that more and more questions will come up in your mind. But we can help. At The Law Offices of Alice Reiter Feld & Associates, we have one of the largest Alzheimer’s Resource Centers in South Florida.

We’re Elder Law attorneys. And over the past 33 years, we've walked thousands of South Florida families through the Alzheimer’s Journey…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 Journey. And we’re just a phone call away.

How Can I Help My Mom Stay at Home - And Manage Her Medications - As Long As Possible?

As an Elder Law attorney, I get asked this question a lot. And I always try to answer it with compassion, concern, and candor. (And, since my own Mom passed away recently, it’s a question that touches me personally, as well.)

I tell people, first of all, that there’s no single right answer; every patient is different, and every situation is different. The bottom line, as far as medication is concerned, is that she needs to take it…on time and in the right dosage!

If she’s capable of taking her medicine, but just needs reminders, there are a number of “medication minders” at drugstores, medical supply stores, and discount stores. For example, weekly minders might work…but someone has to fill them out at the beginning of each week. And it’s important to remember that that there needs to be reminder for your Mom about what time to take her medicine, as well.

There are also medicine-reminders with alarms that go off. Some families rely on a family member to call the patient each time she needs to take her medicine. Modern life being as frantic as it is, though, this may not be the optimal method; and it may place an unfair burden on the person responsible for calling.

If your Mom goes to an adult day care center, make sure the staff knows to remind her. Just be sure you’ve provided them with the original prescription bottle with the original label.

If none of these systems works, you need to hire someone who can go to the house and administer her medicine. And if that becomes too unwieldy, you may have to face the fact that your Mom might be better off in a nursing home or assisted living facility.

At The Law Offices of Alice Reiter Feld & Associates, we get asked questions like this every day. And, over the past 33 years, we’ve helped thousands of South Florida families prepare for 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 know every step of the Elder Law Journey. And we’re just a phone call away.

 

How Beneficial is a Dementia Care Unit for Someone with Alzheimer's?

As an Elder Law attorney, I get asked this question a lot. And I tell my clients that it can be very beneficial…if the unit is designed and staffed appropriately.

The goal of such a unit, of course, is to provide specialized care. Personnel should have specialized training for dementia. The unit itself should have smaller spaces, so patients don’t feel overwhelmed. It should be a quieter environment, to prevent over-stimulation. It should be locked securely, as many Alzheimer’s patients move around or pace.

I tell my clients to pay attention to the design of the unit at which they’re looking. Good dementia units are designed to provide more specialized care and less stimulation. In fact, many no longer have intercoms or p.a. systems.

A dementia unit should also have its own Activities Director, who designs specialized programs. Staff are often trained in how to help the seniors participate and enjoy themselves more.

Your state’s Department on Aging might provide you with a list of facilities in your area, or else point you toward the proper agency.

Another thing I tell my clients: Visit at least three facilities! Take a friend who can be objective. Then…

• Meet the staff – and observe their interaction with the patients.
• Is the facility clean? Are the grounds well-tended? (And secure??)
• Ask to see their most recent state survey.
• If the survey indicates deficiencies, what were they?
• Were they addressed? How?

 After speaking with the friend who accompanied you, make a list of pros and cons. AND LISTEN TO YOUR GUT!!

If you have a loved one with dementia, you’ll be asking yourself new questions every day. At the Law Offices of Alice Reiter Feld & Associates, we've been answering these questions every day – for 33 years.

We’re Elder Law attorneys. And we've helped thousands of South Florida families with these questions…along with comprehensive estate planning, wills, trusts, powers of attorney, long-term care planning, asset-protection plans, and assistance with Medicaid or the VA.

If you've got questions, we've got answers. And we’re only a phone call away.