She then became an Assistant State’s Attorney in Lake County in Illinois and spent two years prosecuting criminals in DUI and misdemeanor cases and advocating for domestic violence victims, using child and expert witnesses, evidence and racking up court trial experience. For the next seven years, she worked in high-end divorce, family law, marriage dissolution and parentage cases.

However, her caregiving and family obligations began to affect her career.

“[My] mom did not live long,” Curler said. “I had to move to be [closer to my parents]. My parents [were] getting sick. I could not [balance caregiving with my career]. I lost my job, dealing with their illnesses.”

As a result, she performed several legal volunteer roles, especially working as a pro bono legal guardian as a social services attorney with the Chicago Volunteer Legal Services since 2010.

This was the same year that she opened up her own law office to practice estate planning, elder law, probate, disability planning, Medicaid planning, veterans’ aid and attendance benefits, guardianship, caregiving coaching and problem solving and nursing home placement contracts.

Curler said her new legal practice improved her own problem solving and decision making habits in caregiving and arranging home health care or long-term care for her parents.

“I found out [what was possible and not possible] with probate, elder law and estate planning,” she said. “ [I] looked at rehabilitation and elder care. [I] quickly made changes [to my mother’s and father’s mode of care]. I [provided some volunteer care] in nursing homes. I talked [about] alternatives [to] nursing home. I [would] go to families and [arranged for them to conduct facility] tours. I made sure clients got [the] care [they needed].”

With her own legal work and real-life caregiving credentials, Curler decided to connect the work of agents who assist families in deciding between home health, short-term and long-term care with her law practice.

“Agents [representing the families help them] make decisions [about care for their loved ones],” she said. “I got creative and flexible.”

“You go to hospitals and the rehabilitation centers and [you must follow] a set of procedures. I have a hard time believing [that most of the seniors there wanted to actually be in those homes]. They don’t want to be in a nursing home.”

In researching and advocating in her new legal practice and caregiving for her mother, Curler found that Medicare only pays a certain percentage of the bill and does not cover rehabilitation. Much of the billing is private pay, she said.

Specifically, the Centers for Medicare and Medicaid (CMS) regulations state that patients cannot pay more in out-of-pocket costs and deductibles under Medicare Part C or Medicare Advantage than they would under traditional Medicare parts A and B for three specific services like chemotherapy, kidney dialysis and skilled nursing facility care.

Patients, particularly, seniors will not be charged for skilled nursing facility care or rehabilitation care for the first 20 days. After the first 21 to 100 days in skilled nursing care, a patient may pay upwards of $100 to $200 per day.

Part A of Medicare covers inpatient hospital, hospice care, inpatient care in a skilled nursing facility and home health care services. Part B covers medical care and services provided by doctors and other medical practitioners, home health care, durable medical equipment and some outpatient care.

Eligibility for Part A begins the first day of the first month that a person receiving Social Security benefits turns age 65. Those with end-stage kidney disease are eligible the first day of the third month of kidney dialysis treatments. Curler used Social Security disability care to cover her parent’s treatment and therapy, particularly for her mother.

Medicare will cover kidney disease not related to terminal illness and those that clearly are, including inpatient respite care for family caregivers in need, in a hospice center, hospital or nursing home.

Continued: Part Three

This article was originally published March 3, 2014 on the website of, one of seven websites that comprise The Pharm Psych Network, a medical communications and education company.