1 mile west of the Chicago Premium Outlet Mall (800) 810 3100
Our Law Elder Law motto is “Serving Seniors and Those Who Love Them.”  Jo Buscemi, niece of Raffaella Calabrese (more affectionately known as “Auntie Florence”), shared these words with me and asked me to share them with you: Dear Mr. Law, Around October 2008 my mother and I had our first meeting with Mr. Jonathan Johnson in regards to my Aunt Raffaella Calabrese (“Auntie Florence”).  My aunt had suffered for years with dementia and had various (six in all) live-in caregivers.  I was told by many to keep my aunt in familiar surroundings for as long as possible and I being her power of attorney, I did exactly that. I came to your Aurora office one day and had our initial meeting with Jonathan.  I was very apprehensive.  Norridge HealthCare Facility recommended that I talk with you folks.  Well, after our second meeting with Jonathan and many phone calls and questions, we returned in about November of 2008 and contracted with your firm for assistance.  I put off as long as I possibly could placing Auntie in a nursing home, and then only because our sixth caregiver was returning to Poland and Auntie had exhausted all her life’s savings in addition to what I paid for from my savings.  I have MS (Multiple Sclerosis) and it was difficult to care for my aunt and mom, so I had to quit my job two years ago.  But this letter is not about me—it is about my Auntie Florence. Auntie went to live at Norridge HealthCare Facility on June 18, 2009 and sadly, she passed away on February 9, 2010.  We were very satisfied with this facility and its staff.  During this time I was assigned to Gina Salamone as our attorney at Law Elder Law.  I know I drove Gina and Sean (and everyone who answered the phone) nuts with all my calls and my frantic questions and nervousness.  I do believe Gina and I have a bond, though, and I trusted her with my precious family member and for that I am very grateful to her. I have recommended people to your firm and I have even gone as far as handing out Jonathan’s and Gina’s phone numbers—and advised these people to get all their ducks in a row now rather than wait. I have attached a picture of Auntie Florence and I wish you to express my family’s sincere appreciation for all the thousand times I called, ranted, cried, and went nuts—but your staff never gave up, not once.  Gina even went to the DHS regional manager on our behalf. Mr. Law, I really appreciate everything your entire staff did for Auntie, and I promise you I will always recommend people who need this type of help to your firm.  God bless everyone at Law Elder Law in Aurora, Illinois.  Thank you all again on behalf of Auntie Florence and the Buscemi family—we truly thank you.   Please enjoy the catered lunch on Thursday that my family is having delivered to your office. Jo Buscemi
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Hogar De Ancianos San Buenaventura, Turrialba, Costa Rica, Central America

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My wife, Rose, and I recently visited the county nursing home in Turrialba, Costa Rica. We lived in Turrialba for a year in 2003-2004 to study Spanish and to learn a different culture, and our lives have been forever changed and broadened by that experience.  We now feel at home in this Spanish-speaking land.  We love being here surrounded by tropical birds, coffee plantations, and sugar cane fields.

This trip we wanted to learn about the local county nursing home, so we asked our friend and Spanish teacher, Olivia to ask permission to visit.  Yesterday we visited what is literally called “Home for the Ancient Ones”—Hogar de Ancianos.  We like it that Costa Ricans are not troubled by our North American political correctness filter.  They often call me “Gordo” which means chubby… oh well!  If someone has green eyes they are called “Gato” or “Gatica,” which means cat or kitten.  But back to my story. Olivia was our guide and we were accompanied by the assistant to the administrator, Benigne Solono Trejos, a living example of caring and compassion.  The facility is nestled into the volcanic mountainside of Turrialba and has a panoramic view of the now-active Turrialba Volcano and the widespread green of the valley below.  There were tropical flowers everywhere upon the grounds of the Hogar.  The windows and doors of the residents’ rooms were wide open to admit the warm sunshine and gentle breezes.  It can be cold here, but the average temperature year round is a lovely life-giving 75 degrees F.

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Costa Rica is the wealthiest country in Central America, but it is not rich by Western European or North American standards.  The facility may lack much of the equipment that is taken for granted in the USA, but the most important resources are present in abundance—loving and compassionate caregivers and administrators.  The facility smells of flowers and cleanliness!  I inspected every room and they were clean, clean, clean!

Our administrative hostess, Sr. Solono, has worked at the facility for 16 years and has sacrificed to stay at the Hogar and provide care for “the Old Ones.”  She considers every aged resident a part of her family.  At every room, it was obvious that the residents feel respected and valued. They live in a place of dignity. Most of the residents sat outside in the open air.  It was a beautiful day!  The buildings are designed with rooftops with large overhangs to create a front porch-terrace effect.  Those who were able could walk around, pet the dog, and volunteer to help in the laundry or do other small chores.  After all, everyone of every age wants to feel useful.

There are about 70 full-time residents at the home.  Surprisingly, there are far more men than women.  If you have visited a nursing home in the U.S. you know that there are very few men, since women typically outlive men by many years.  I asked how it could be that there were more men than women.  I was told that in Costa Rica, families try to keep the old ones at home and that women are able to provide more help with child care, cooking, and cleaning than men.  My wife said, “See I told you that you men are harder to take care of!”

The question of paying for long term care was my next enquiry.  Sr. Solono told us that the central and local governments provide only a bit of support.  In fact, just like in the U.S., government may give with one hand but take with the other.  In Costa Rica, the government keeps raising the standards of care but provides no money to accomplish those goals.  Amazingly, one of the biggest sources of funding for the Hogar is a lottery which is conducted on an as-needed basis.  (The Hogar must receive a governmental permit to sell lottery tickets within the county that they serve.)  In addition, they own a fairgrounds where they conduct an annual fair as a fundraiser.  Fundraising is a constant concern and activity of the administration and many volunteers. As we visited many residents, we were cheerfully greeted by those who were able.  I fell in love with Eva, an octogenarian who happily spoke excellent English.  Her career was as an assistant in the international center of agriculture called Catie.  She shares a room with her sister, who is confined to a wheelchair and sat quietly until she spied my bare legs sticking out below my walking shorts.  She is the first woman in my life to become excited upon seeing my legs!  She chortled and in Spanish she told me that I had chubby legs.  Olivia, our Spanish teacher, said that she was flirting with me.  My wife stated flatly, “You should be so lucky!” I want to thank Sr. Solono Trejos and the entire team at the Hogar de Ancianos San Buenaventura.  You are doing a great job as you serve seniors and those who love them! home-of-ancient-ones-rose-sr-olivia-avendano-sr-solono-trejos-for-bottom-of-blog
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Many of our elder law clients live at Countryside Care Center in Aurora, Illinois. We hear from our clients and their families that great care is provided for both private pay and Medicaid clients. When we are asked by families to recommend a skilled care facility, we often say, “Choose the care, not the curtains!”  In other words, investigate what it’s like to live in a facility—don’t just judge the place by the décor and the architecture. Recently, I had the pleasure of taking a tour of Countryside Care Center to get to know the staff better.  Jean Bennett, Marketing Manager, greeted me and introduced me to Anthony Clark, R.N., Clinical Nurse Manager and Physician Liaison (pictured on the left in the photo above).  After telling me some of his favorite lawyer jokes, he showed me a whole new way to think about long-term care nursing. Q:    Anthony, why do you serve here at Countryside? A:    I had wanted to get an operating room position, but due to circumstances, I decided to apply here.  Actually, an operating room job can be easier, because you never get attached to the patients—and most of the time… you win!—the patient gets well.  But in a nursing home facility, you experience just the opposite.  You spend long periods of time building relationships with people, and then you face the reality of their inevitable death.  You have to learn how to deal with your grief. That’s one of the real challenges of being a part of a long term care setting.  Ultimately, you will lose someone you care about.  I try to focus on providing our residents with comfort, care, and friendship.  I have a lot of friends who live here. Q:    How do you and your staff find job satisfaction working in the nursing home at Countryside? A:    One of the greatest things we have here at Countryside is our Reminiscence Boulevard; that’s our memory enrichment wing.  Our staff go out of their way to love and care for our residents.  They smile, joke, sing, and dance together.  The staff on the Boulevard take pride in what they do.  They do their work well, and the residents and the residents’ families come to trust each one of them. Q:    What is one of the big reasons that you chose to work at Countryside? A:    Formerly, I did work in a fancy and totally remodeled short-term rehabilitation center.  Before the new construction, it had been an older, smaller facility.  The nursing team had been able to provide the highest quality of care.  But, after the reconstruction, we had a state-of-the-art building in which it was physically impossible for us to safely serve our residents.  Here, we can see all of the rooms from either end of the hallway. Q:    What is a special point of pride for you? A:    The staff must be emotionally up each time they come through the door, or it will show to our residents.  I am proud that every day, this care team shows up emotionally ready for the day. Many of us under-appreciate those who serve our frail, elderly and disabled, with both compassion and true friendship.  Thank you, Anthony, Jean, and the nursing teams like those at Countryside.
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They say that when you meet a person, you know neither who they really are nor the path they have walked.  I am grateful to introduce you to a very inspiring young leader, Jeremy Amster, a wedding singer and nursing home administrator. Recently I conducted my own personal investigation of Tower Hill Healthcare Center in South Elgin, Illinois.  I wanted to find out how they earned the coveted 5-Star Medicare Nursing Home Quality Rating.  Skilled nursing home care is provided to both private-pay and also quite a few Medicaid-qualified senior residents.  (There are two certainties about State of Illinois Medicaid nursing home reimbursement: it is too little and always too late.) When I arrived in the lobby, I saw an award to 33-year-old Jeremy Amster called “The Friend of Seniors Award.”  The award states that Jeremy’s leadership demonstrates “quality, creativity, enthusiasm, and care built into every life he touches.”    Jeremy is the proud husband and the father of Avery, Naftali, and Adir.  His office is an art gallery of the boys’ artwork.  One of his sons told a friend, “My dad helps old people and does payroll.”  The boys are frequent visitors who love to meet and greet the senior residents.  One such visit coincided with the arrival one Sunday morning of some nursing home inspectors.  The inspection team leader suspected that someone had “tipped off” Jeremy, and he was furious!  Jeremy countered by saying, “Do you think I would be here with my 5-year-old son if I knew you were coming?” Jeremy is very involved in Chicago area Jewish community events.  He tutors kids for their Bar Mitzvah lessons.  He works long hours at Tower Hill—but on Fridays he leaves on time to celebrate the Shabbat.  He quietly stated, “I believe that Orthodox Jews have the luxury of rest.  From sundown Friday night until sundown on Saturday, my wife and sons know that I will be there for them.  My kids know that no matter how busy I am, on Friday evening… Daddy is coming home.” Regarding the 5-Star Rating, Jeremy credited that award to the ownership and the staff.  He humbly stated, “The secret to keeping great staff is to give people a place to serve and to be proud of.  We have low turnover, strong loyalty, and our team believes in this place.” Later I asked Pam Hilderbrand, marketing director, and Jorie Gustafson, admissions director, what was the secret to the 5-Star Rating.  They credited Jeremy and the ownership of Tower Hill.  They all agreed when Jeremy said, “Most facilities have a box that all residents must fit in—but we shape our box to fit what our residents actually need.”  Then they really got to my heart when they told me their “Christmas story.”  “We don’t hold back when we give our Christmas dinner.  Many of our residents will never again go home for the holidays.  So we go all out!  We lavish upon them.  They are encouraged to invite two family members to join them for a sumptuous dinner complete with carving stations.” As I finished my investigation, it was obvious to me that Tower Hill’s success is due to acting in accord with the Golden Rule: “…you shall love your neighbor as yourself.” (Leviticus 19:18) **For more information contact: Tower Hill Healthcare Center 759 Kane St. South Elgin, IL 60177 Phone: 847-697-3310 www.towerhillhealthcare.com
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stalker This blog is not about strangers lurking in an alley.  Nonetheless, nursing homes are routinely “invaded” in the wee hours and weekends, because they are subject to unannounced night and weekend visits by trained teams of Medicare inspectors. These snoopy night stalkers show up and  “camp out” in the facility for days.  These teams have full authority to review and audit over 180 different items covering all major aspects of care in a skilled nursing facility.  They inspect the buildings, the medical records, the residents, the cleanliness, the staffing hours per resident, and much, much more.  These investigators are there to find deficiencies, note them, and  report them to the Center of Medicare and Medicaid Services (CMS).  The report is used to provide a rating which is available to the public at the Nursing Home Compare website.  The website lists each nursing home and assigns a quality rating between 1 and 5 stars.  A 5-star nursing home is heavenly! Unfortunately, a 1-star nursing home is a probably a living hell. CMS has created this rating system to help seniors and their loved ones see behind the scenes and beyond the nice décor to find a safe and nurturing care facility for a frail senior.   The most coveted score is a 5-star Medicare quality rating.  That score is received by only 10% of all skilled nursing home facilities.  There are very few facilities who receive such an award even when they are in the luxury market.  It is even more impressive when a facility which accepts Medicaid residents qualifies as a 5-star-rated Medicare facility.  Recently Tower Hill Healthcare of South Elgin, Illinois announced in their newsletter that they had received a 5-star award.  I was impressed!  Tower Hill is a 206-bed Medicaid-certified skilled care facility with a 31-bed Alzheimer’s wing. In my next blog, you will be introduced to a 33-year-old orthodox Jewish synagogue cantor and  wedding singer, Jeremy Amster, whose leadership skills have earned the 5-star rating.
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Celebrating New Year’s Day after a kayak run on the Fox River, I was just about knocked to the floor when I overheard someone say, “I’ve seen some wonderful deaths.” When I recovered from hearing this statement and recognized the sparkling eyes of the nurse who said it, I asked if I could meet with her at another time to learn about “wonderful deaths.”

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It is no secret that senior citizens are the wealthiest segment of the U.S. population. Much has been written and said about the trillions of dollars that will ‘change generational hands’ as the current seniors pass their wealth to their children/grandchildren. Unfortunately, seniors have to contend with a dirty little secret that was put in place by the current Republican administration when they passed the Deficit Reduction Act of 2005 (DRA). The DRA made changes in the way that the government will punish seniors for acts of both charity and giving. The Medicaid rules presume when a senior makes a charitable or family gift, that the gift was an attempt to get rid of excess assets in order to qualify for Medicaid nursing home expenses. That’s right—seniors are guilty until proven innocent. The burden of proof is on the seniors to show that when they gave money to their church or child, that they had some other reason than to qualify for Medicaid. This DRA rule creates a cruel penalty of ineligibility for Medicaid services if and when a senior who gave away money needs nursing home services at any time within 5 years after the gift. Our government has created a punishment for seniors who may suffer chronic long-term illness within 5 years after a gift. As long as this law is in place, seniors must remember that the IRS gift tax rule allowing gifting up to $13,000 tax-free is only a tax rule. Giving away $13,000 may cause a senior to suffer a loss in nursing home coverage of 2 to 3 months if they need such assistance within 60 months after giving that money away. Thanks to our government, giving may now be hazardous to your health…care!
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