Should End-of-Life-Care Be Provided to Every American?

If Dr. Ezekiel Emanuel’s last name sounds familiar, it should; he’s the brother of Rahm Emanuel, former White House Chief of Staff and now Mayor of Chicago. He’s also a well-known oncologist, and chair of the Department of Bioethics at the National Institutes of Health.

Dr. Emanuel is a longtime proponent of end-of-life care. And he’s a forceful spokesperson on the need to change the way we look at – and treat – the process.

My clients know me as a strong believer in the right of terminal patients to have a say in how they’re going to die…whether they want extraordinary measures to extend their lives a bit, or whether they’d like to die naturally, using only pain medication.

Dr. Emanuel believes that all doctors should be formally trained in end-of-life care and discussions. Walking into a room with a patient to discuss a terminal diagnosis or prognosis can be overwhelming – even for experienced doctors. For doctors, there’s never been formal training in how to discuss terminal illness with patients and families, or how to discuss palliative options.

In Dr. Emanuel’s opinion – and mine – our doctors should know how to tell us, and what types of options to offer.

Dr. Emanuel says that more than 40% of American hospitals don’t offer access to palliative (pain-control) care. And he believes this should be a requirement.

He also disagrees with the current standard that a patient must have a life-expectancy of less than six months to be admitted to hospice. But pain has no time-line…and admittance to hospice should be based on need, not projected life.

Emanuel’s quick to add that he’s not talking about "death panels"…but simply the right of people to make their own choices.

It’s an issue that invariably leads to other issues…and a lot of questions. But we can help.

At The Law Offices of Alice Reiter Feld & Associates, we’ve been answering tough questions like these for 34 years…for thousands of South Florida families. And we’ve answered their questions, as well, on comprehensive estate planning, wills, trusts, powers of Attorney, long-term care planning, asset-protection plans, and assistance with Medicaid or the VA.

We can answer your questions on the tough issues. And we’re just a phone call away.

If You Live In Florida, Choosing The Best Adult Day Care Facility Just Got Easier

If you’ve got a loved one with Alzheimer’s, you know that choosing the right day care facility can keep you up at night. But if you live in Florida, you may finally be able to sleep a little better.

On July 1, a new law went into effect, requiring stricter licensing regulations for day care centers claiming to specialize in Alzheimer’s. The new regulations will make it easier to distinguish between centers that claim to specialize in Alzheimer’s patients, and those that actually do.

Until now, any center could claim to specialize in these patients. Now, however, the licensing requirements for such centers will be stricter.

Among the new requirements:

• A registered or licensed practical nurse must be on-site at least 75% of the time.
• No less than one staffer for every five clients.
• Staffers must receive extra training in Alzheimer’s care.
• Alarms on every outside door, to prevent wandering.
• Staff will monitor all medications.
• Clients will not be allowed to drive themselves to or from the center.
• There will be more Alzheimer’s/dementia-appropriate activities.

Florida’s new law may actually be among the strictest in the country. And, if you’re an Alzheimer’s caregiver, that should certainly help you sleep better at night.

Caring for a loved one with Alzheimer’s may be the most difficult thing you’ve ever had to do. It’s a long and very-winding road…with a lot of detours, and a lot of potholes.

But you don’t have to navigate it alone. We can help.

At the Law Offices of Alice Reiter Feld & Associates, we practice Elder Law – and only Elder Law. And we have one of the largest Alzheimer’s/Dementia Resource Libraries in South Florida.

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 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 and the VA.

We know the way through the Alzheimer’s/Dementia Journey. And we’ll get you through it. We’ll be there for you every step of the way, with the experience of 33 years, and a soft shoulder when necessary.

And we’re just a phone call away.

The Fiscal Cliff May Be Just Starting For Some Of Us

If you thought the “Fiscal Cliff” drama ended on Jan. 1, you could be in for a rude awakening. In fact, you could be in for a “Perfect Storm” – a combination of the 2010 Affordable Care Act and new tax changes coming this year.

As part of the Affordable Care Act (ACA), several changes in the income-tax structure are now taking effect.

The new “fiscal cliff” tax structure extended the previous tax cuts to most married couples who bring in less than $450,000 taxable income. However, there’s a cloud to this particular silver lining - a new Medicare surtax that will affect couples making more than $250,000. This new tax is 3.8% on whichever is less…net investment income or adjusted gross income.

Net investment income generally means income-streams such as rent, dividends, interest and income from passive business activities (after expenses). If you’re a married couple and your earned income (salary or self-employment) is over $250,000, you’ll be hit by another tax - a new .9% Medicare tax. If you’re an employee, your company’s now required to withhold this .9% once you’ve passed the $200,000 mark.

Pretty much every American has questions about the new tax structure, and the Affordable Care Act. But if you’re a Boomer or senior, you probably have even more questions….because the ACA may come into play for you before it does for the rest of the population. I get phone calls – and visits – virtually every day from clients confused about the financial impact of the ACA and the new tax changes, as well as what the ACA provides and what it doesn’t.

You need an Elder Law attorney to sort things out. And that’s exactly who we are.

At The Law Offices of Alice Reiter Feld & Associates, we’ve been answering questions like these for the past 33 years. We’ve helped thousands of South Florida families find answers. And we’ve helped them prepare for these changes – and future ones, 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.

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

Medicare Claim Rejected? Fight Back!

Believe it or not, the odds are not stacked against you. Many families appeal – and win.

In my experience, I’ve seen far too many people taking a defeatist attitude when a claim is rejected…and paying thousands of dollars out of their own pockets. And my advice to my clients is always the same: You’re not licked yet!

You can appeal a rejection. And – quite often – you can win. In fact, in certain categories – such as rejections of payments for doctor visits and services covered under Part B – 53% of those who appeal actually won.

Knowing how to appeal, of course, is the key…because appeal procedures vary widely, among original fee-for-service Medicare, a Medicare Advantage plan from a private insurance company, and a Part D prescription-drug plan.

Federally-subsidized Advantage plans are similar to health-maintenance or preferred-provider organizations. If you’re planning to appeal a rejection by one of these, or by a Medicare Part D prescription drug plan, the Centers for Medicare & Medicaid Services has a helpful brochure called “Medicare Appeals.”

If you need help appealing a hospital discharge, or appealing claims under original Medicare, Medicare Advantage, a good resource is www.medicareinteractive.org.

If you have original Medicare, and you want to appeal an end-of-care decision by a home health agency, skilled-nursing facility, hospice agency, or outpatient rehabilitation facility, try the Center for Medicare Advocacy, which publishes booklets on the appeals process.

And if at first you don’t succeed…try, try again. In most cases, appeals can be heard up to five times!

You also may want to consider using an attorney or advocate, along with going to organizations like the Medicare Rights Center, the State Health Insurance Assistance Program, and the National Association of Healthcare Advocacy Consultants (nahac.com).

Let’s face it…trying to find answers to Medicare questions usually leads only to more questions. But we can help.

At The Law Offices of Alice Reiter Feld & Associates, we’ve been practicing Elder Law in South Florida for 33 years. We’ve answered Medicare questions for thousands of families. And we’ve helped them, 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 answer your Medicare questions. And we’re just a phone call away.