• Member of the Florida Bar;
• LLM in Estate Planning, Elder Law or Tax plus 2 years’ experience in the practice of law; OR at least 5 years’ experience in the practice of law in Florida (without LLM);
• Experience drafting estate planning documents;
• Ability to work independently and still be a team player;
• Entrepreneurial: anxious to learn entire business side of practice, including acquiring and retaining clients;
• Outgoing personality with exceptional communication skills; upbeat and positive high-energy person
• Highly-organized self-starter with an excellent work ethic;
• Comfortable doing public speaking; experience a plus;
• Bilingual (Spanish) is a plus.

The firm is an active office where multi-tasking is the ordinary course of every day. The successful candidate will receive mentoring and guidance but will be expected to bring a level of experience to the position to allow independent functionality in a short period of time.

For information about the firm, please visit www.florida-elderlaw.com.

To apply, please send your resume to mdiamond@florida-elderlaw.com with a cover letter explaining why you should be the applicant we hire. Compensation will be based on salary and incentive.

One of the best things you can do is to register your loved one – as soon as he/she is diagnosed! – in the Alzheimer’s Association’s “Safe Return” program. You can find information about this program at the website (alz.org), or at your local Alzheimer’s Association. When you enroll your loved one, you’ll choose a piece of jewelry for her to wear (most folks choose a bracelet), with the association’s logo on one side and an identification number on the other.

It’s wise to remember that your loved one may become suspicious at your request to wear this new piece of jewelry… which is why many caregivers also order one for themselves.

There are ways to guard against wandering, both high-tech and common sense. For example, you can visit electronics stores and see what might be appropriate. You can shop online at the Alzheimer’s Store (alzstore.com), which has some good safety products. You can hire agencies to asses your home for dangers to seniors with dementia. And, of course, you can visit Alzheimer’s support groups, to learn what others in your situation might be doing.

If your loved one does begin to wander, take immediate action. Put a baby monitor in his room so you can hear when he gets up. Install recommended safety devices. Tell your neighbors to be on the lookout. And ask your physician if there’s anything that can be done medically.

Also, get a copy of “The 36-Hour Day,” by Nancy Mace and Peter Rabins. It’s a good guide to what to expect on the Alzheimer’s Journey.

The Law Offices of Alice Reiter Feld & Associates is an Elder Law firm. Over the past 33 years, we’ve walked thousands of South Florida families through the Alzheimer’s Journey, with professionalism, with compassion, and, if needed, with a soft shoulder. And we’ve helped them prepare long before Alzheimer’s – or any other problem with an aging loved one – hits, with comprehensive estate planning, wills, trusts, powers of attorney, long-term care planning, asset protection, and assistance with Medicaid or VA issues.

We can walk you through the Alzheimer’s Journey. And we’re just a phone call away.

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 talk 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.

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.

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? 1 2 3 4 5
• 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 administrators 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 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.

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 interaction 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.

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.

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 no 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 designed 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.

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 alone.

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.

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 types 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 members 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.