Last week we defined TennCare and how it applies to our clients. This week I want to go more in-depth with how TennCare serves Tennesseans with long-term care.
Many people believe that Medicare benefits will cover nursing home care once an individual is 65 or older, but this simply isn’t true. While Medicare covers the first 100 days, it doesn’t cover long-term assisted living. Read more about Medicare here.
“ Choices” is Tennessee’s Medicaid program for long-term care services and support
Back to TennCare/Medicaid…
My Mom doesn’t have long-term healthcare insurance. What are my options?
Payout of pocket until you run out of cash – This is an unrealistic option for most families. Nursing home care is expensive. Not a lot of people have an extra $7,000-$11,000 a month in their bank accounts.
Do a reverse mortgage on her home.
Qualify for the TennCare / Medicaid program called “CHOICES”.
As you can see, options 1 and 2 are very unpleasant and leave nothing left for a loved one’s legacy. However, option 3, CHOICES, is definitely something worth looking into.
What is CHOICES?
CHOICES is the category of TennCare that provides Long-Term Services and Supports (LTSS) such as nursing home care.
What is the process for getting qualified for CHOICES?
In order to be eligible to receive benefits from TennCare/Medicaid your loved one must first qualify within these three categories:
Medical eligibility
Income threshold
Asset threshold
Being medically and financially eligible is necessary for TennCare approval
How does someone become medically eligible for TennCare CHOICES?
The state of Tennessee will determine who is medically eligible to receive TennCare Long-Term Services and Support (LTSS) by using a pre-admission evaluation (PAE). This PAE is used to determine if the applicant can do basic life skills on their own without help. The PAE will also determine if the applicant is safe in their current environment.
The PAE is a strict evaluation and it is performed on a case-by-case basis. An applicant must receive a score of 9 or higher on a 26 point scale in order to be considered medically eligible for TennCare Long-Term Support Services.
For example, a caregiver or healthcare provider may be asked about a patient’s level of ability to do things and how much assistance is needed.
The following Activities of Daily Living (ADLs) are covered in the PAE evaluation:
Transfering
Mobility
Communication
Medication
Orientation
Eating
Behavior
If you or your loved one is unlikely to get to a nine or higher on the PAE, it is always appropriate to ask for a “safety determination” evaluation as an alternative route of becoming medically eligible for Choices.
How can someone become financially eligible to receive CHOICES?
You must be able to prove that the applicant has a low income and little assets. As of January 2022, an individual applying for TennCare CHOICES cannot have an income exceeding $2,523.00 per month. Additionally, the applicant cannot have more than $2,000 in assets. This includes any money in the bank and investment accounts but also requires consideration of retirement accounts, life insurance policies, real estate, artwork, jewelry, and any other valuables. When we talk about the assets for a couple of things get a little more complex. The most important thing is that both the applicant and their family are taken care of, both medically and financially.
My Mom is over the limits for income and assets? What do we do?
If the applicant is in excess of the amounts we can plan for that! We have a tool to help people who have excess income and assets yet need to qualify for TennCare/Medicaid called the “Care and Savings Assessment”. With this Care and Savings Assessment, we work to determine the best way to structure you or your loved one’s finances, either now or in the future. We plan so that our clients have the peace of mind knowing they can qualify for TennCare if and when they need it!
In conclusion
It is often helpful to have an attorney assess your financial situation and offer recommendations on how those finances may be restructured to qualify for TennCare Long-Term Services and Support (LTSS). As an experienced TennCare planning attorney, I can help you evaluate your risk and create a plan that takes care of everyone in the family.
Are you ready for help with TennCare planning? Contact us and we can discuss your plan. Next week we will go over some examples of how we restructure an individual’s finances to meet their needs for long-term care.
As far as we know, we only live once – and we never know when it’s going to end. It’s important to plan so you can prepare.
You can start 2024 off strong by getting your affairs in order.
1. Create an Estate Plan
First, decide whether you want a will, a trust, or both. Some people opt for a will and a living trust, but it’s up to you what you choose. If you want an attorney to talk over your options, we’d be happy to do that!
You can also decide whether you want a durable power of attorney for finances (in case you’re not able to make financial decisions).
2. Plan for Your Healthcare
You can also consider whether you want to create an advance directive for your care. Most advance directives have a living will and durable power of attorney for healthcare.
The living will tells doctors what kind of care you wish to accept or reject when it comes to emergency treatment, and durable power of attorney lists the person you trust for your care should you become unable to communicate.
3. Organize Your Important Documents
Once you’ve prepared all of your important papers, organize them and put them all in one place.
Here are some examples of papers that you should keep together.
Personal Information
Personal info is needed for identification purposes and is best kept together so your family can be prepared when they need it.
Social security number
Date and place of birth
Names and addresses of spouse and children
Location of important legal certificates (birth/death, marriage/divorce, citizenship, adoption)
Employers and dates of employment
Education and military records
Names and phone numbers of religious contacts
Group memberships, awards
Names and numbers of close friends, relatives, doctors, lawyers, advisors
Health Information
Emergencies happen – and when you’re not prepared, your family has to scramble to find what your medications are, etc. Keep them all in the same place and be sure that your loved ones know where to look.
List of any ongoing conditions and treating doctors’ names
Current prescriptions (keep this list up-to-date)
Durable power of attorney for healthcare
Advance directive
Health insurance info, policy and phone number
Financial Information
Your finances will help family members better understand what financial resources they can draw from to help you with your care, should you need it.
Sources of income/assets
Social security benefits information
Insurance info (car, home, life, long-term care) with policies and phone numbers
Bank and account information
Investment income
Copy of the most recent income tax return
Location of most up-to-date will with original signatures
Liabilities, including what’s owned and when payment is due
Mortgages/debts, how and when they’re paid
Original deed of trust for home
Car title and registration
Credit and debit card numbers and names
Safe deposit box and key number
If you’re looking for a place to keep all of these, let us know. We’re happy to offer LawSafe memberships for a reasonable rate to help keep track of all the not-so-little things that your loved ones may need if there is an emergency or end-of-life event.
4. Talk with Your Loved Ones
Once you have everything in one place, tell your loved one where to find your information. Be sure to also tell your loved ones about your plans – you don’t want your family to find out after the fact that you’ve selected someone they don’t know as your Personal Representative!
You can also let your doctor know about advance care plans, and, if applicable, give your doctor permission to discuss your care with your family.
5. Review Plans Regularly and Update
Once you’ve done all the hard work (it takes time getting all that paperwork together), be sure to review your plans annually. If you’ve had a major change happen, you should consider revisiting your plans as well, to make any necessary updates.
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It takes time to get your affairs in order, but it is such a relief to your loved ones when they don’t have to worry about what your wishes are. In fact, this could be your masterpiece! If you’d like to get updates like this one on a regular basis, sign up for our newsletter!
Is a care community the right place for your loved ones? There are a lot of terms out there for what living situations can look like as you age, and it’s easy to get them mixed up. Luckily, it’s not as confusing as it sounds.
Today we will discuss assisted living facilities: what they are, what they can do for your loved ones, and potential drawbacks.
Getting informed about your options is the first step in making the best choice for your family’s needs. It also means that you can be the expert the next time someone throws up their hands and asks, “What is the difference between a nursing home and assisted living?”
What is an Assisted Living Facility?
An assisted living facility (ALF) is a residential option for individuals who require assistance with daily activities but do not need the level of care provided in a nursing home. These facilities offer a combination of housing, support services, and personalized care to promote independence and well-being. Think of assisted living as an apartment complex with friendly neighbors that happens to have trained caregivers on staff.
On the flip side, a skilled nursing facility, AKA nursing home, is a residential care facility designed for the long-term care of adults with serious health conditions. People living in an assisted living facility can still manage their independence and well-being, while nursing homes are for those who need more help.
Benefits of Assisted Living Facilities
Here are the pros of ALFs:
Professional Care and Assistance: Trained caregivers assist with tasks such as bathing, dressing, medication management, and mobility. This professional care ensures that residents receive the support they need to maintain their health and well-being.
Safe and Secure Environment: Assisted living facilities prioritize the safety of their residents. They have safety measures in place, such as emergency call systems, 24/7 staff availability, and secure premises. This creates a secure environment where residents can feel protected and have peace of mind.
Opportunities for Socialization: Your loved one can participate in a built-in community of peers, providing opportunities for socialization and companionship. Various social activities, events, and outings allow friendships to bloom and reduce feelings of loneliness and isolation.
Access to Amenities and Services: Assisted living facilities often provide a range of amenities, such as dining services, housekeeping, transportation, and recreational activities. These amenities enhance the quality of life for residents and make daily living more convenient and enjoyable.
Drawbacks of Assisted Living Facilities
Here are the cons of ALFs:
Lack of Independence: Moving into an assisted living facility may require some adjustment, as it can mean a loss of independence for adults used to living on their own. The level of independence can vary depending on the facility and the person’s needs.
Costs and Financial Considerations: Assisted living facilities can be expensive, and the cost is not covered by Medicare. It’s also not typically covered by Medicaid either, but it could be covered by long-term care insurance. It’s essential to consider the financial implications and assess if the cost is manageable for your family in the long term.
Adjustment Period and Potential Discomfort: Moving to a new environment can be challenging for some people, especially if they have lived independently for a long time. It may take time to adjust to the new surroundings and routines, which can cause initial discomfort.
Potential for Limited Personal Care Options: While assisted living facilities offer a certain level of care, it may not be as personalized as individualized home care. Some people may have specific care needs that cannot be fully met within the facility’s structure.
Downsizing to a Smaller Living Space: Going into a small apartment at an assisted living facility from a multi-bedroom home is a huge adjustment. Many people spend their entire lives collecting things that need to be sorted through and majorly downsized or moved into storage.
Factors to Consider When Choosing an Assisted Living Facility
Not sure what to think about? Here you go:
Location and Accessibility: Think about where their support system is located, as well as amenities and healthcare services. Accessible transportation options and a convenient location can make it easier for loved ones to visit and for residents to engage in community activities. If location is a dealbreaker, consider in-home care instead.
Quality of Care: Research the facility’s reputation and quality of care. Look for certifications, accreditations, and licensing information.
Staff-to-Resident Ratio: Ask about the staff-to-resident ratio to ensure that there are enough caregivers available to provide personalized attention and care. A low staff-to-resident ratio can indicate that residents may not receive adequate support.
Turnover Rate: Everything is a bit more complicated after COVID, but finding out how many of the nurses/CNAs have been there over a year can be a good indicator of how consistent the care is at that facility.
Available Services and Amenities: Review the services and amenities offered by the facility. Consider the specific needs and preferences of your loved one and ensure that the facility can meet those requirements. This may include dietary accommodations, transportation, housekeeping, and recreational activities.
Costs and Affordability: Evaluate the cost structure and understand what is included in the fees. Inquire about any additional charges or potential increases in the future. You’ll want to make sure that the facility’s costs align with your budget and financial capabilities.
Reviews and Recommendations: Seek out reviews and recommendations from residents and families with experience with the facility. Their firsthand insights can provide valuable information about the quality of care, staff, and overall resident satisfaction. You can also ask friends about where their family members who need care have lived.
Gut Instinct: Make sure you tour options before making a final decision. Sometimes you will get a feeling that something is off or not a good fit, and sometimes you will know that the care community is a great fit for you or your loved one.
Independence with a Little Help
If your mom’s joints are starting to slow her down, but she’s still independent enough to defend her position as the best bridge player in her weekly group, an assisted living facility might be the right choice for her.
There are also independent living facilities (like retirement facilities/retirement dorms) that accommodate those who need a little bit of help but don’t need as much control over where they go and what they do.
Assisted living facilities offer help when residents need it and space when they don’t, allowing your family members to retain their independence and helping you keep your peace of mind. Going through any major living change can be hard, and your loved ones may struggle with the idea of potentially losing their independence.
It’s also wise to choose an assisted living facility attached to a retirement home, as it provides a quick transition for your loved one if their situation declines.
(No one wants to have to look for another facility or worry that the facility they’re at doesn’t provide the care their family member needs!)
These are called “step-up” or “step-down” facilities, enabling you to relax knowing that, no matter what happens to your loved one’s health, you’ve planned for their needs.
Your support and research into potential facilities is crucial. Weighing all the factors allows you to make an informed decision that best suits your loved ones’ needs. Sometimes what your loved ones need is a new community to be a part of (and to beat at cards).
Check out our blog for more advice about caring for your loved ones as they age.
Being a parent to a special needs child is a journey filled with unique joys, challenges, and responsibilities. As you navigate the intricacies of caring for your child’s specific needs, it’s crucial to plan ahead to ensure their well-being and quality of life in the years to come. By taking proactive steps and establishing a comprehensive plan, you can provide a secure future and peace of mind for both you and your special needs child.
We will explore essential considerations and practical strategies to help you plan ahead for your special needs child. From financial planning to legal arrangements and support networks, we want to guide you through the process of creating a holistic plan that addresses your child’s specific needs.
Understand Your Child’s Needs: Start by gaining a thorough understanding of your child’s unique challenges and abilities. Consult with healthcare professionals, therapists, and educators who can provide valuable insights and assessments about how your child’s medical condition is likely to affect their development. It’s important to understand your child’s medical condition as it currently is, as well as how it will progress over the coming years. This knowledge will form the foundation of your planning process, helping you identify the areas where your child requires additional support and assistance.
Create a Financial Plan: Financial planning is crucial when it comes to securing your child’s future. Explore resources such as government assistance programs, insurance options, and special needs trusts. Consider working with a financial advisor experienced in special needs planning to develop a comprehensive financial strategy that accounts for long-term care, education, therapy, and other necessary expenses. One great option in Tennessee is an ABLE account – this savings/investment account is exclusively for disabled individuals and does not count against benefits that may have financial restrictions.
Establish a Legal Framework: Ensure you have the appropriate legal arrangements in place to protect your child’s interests. This includes creating a special needs trust, designating a guardian or caregiver, and documenting wishes for medical decisions. Consult with an attorney experienced in special needs law to ensure your legal documents align with your child’s specific requirements and comply with local regulations.
Build a Support Network: Seek out support networks and connect with other parents and families who have special needs children. They can provide valuable guidance, emotional support, and share resources and insights. Additionally, explore local organizations, advocacy groups, and community services that cater to the needs of special needs individuals. Additionally, you’ll want to make sure that you are taking care of yourself! Organizations like Tennessee Respite Coalition can work with you to create a plan to rest and recharge, which all parents need but becomes more important for you to be fully present when you are with your child. Building a strong support network will not only benefit your child but also provide you with a sense of community.
Plan for Transitioning into Adulthood: As your special needs child approaches adulthood, it is important to plan for their transition into independent living or alternative arrangements. Explore vocational training, employment opportunities, and housing options that are tailored to their needs. Investigate government programs that offer support and services for adults with special needs, ensuring a smooth transition into adulthood. When your child turns eighteen, you will want to discuss with your attorney whether a conservatorship is needed in order for you to continue having legal decision-making authority or if your child can engage in supported decision-making to ensure that you can continue to help them as your family continues to navigate benefits and resources that are available to them.
Regularly Review and Update Your Plan: As your family gets older each year, you will need to anticipate the financial, emotional, and social needs of your special needs child, yourself, and anyone else that you care for. Your child may have siblings who should begin to be included in a care plan as they become adults. Many adult siblings or other family members provide care and guidance when a special needs child loses their parents. Your child’s needs, circumstances, and available resources will change over time. Therefore, it’s essential to review and update your plan periodically. Stay informed about new laws and regulations that may impact your child’s benefits or financial planning. Regularly reassess your financial situation, adjust your goals, and ensure that your plan remains relevant and effective.
Planning ahead for your special needs child requires careful consideration and proactive action. By understanding your child’s needs, creating a comprehensive financial plan, establishing legal arrangements, building a support network, and planning for their transition into adulthood, you can ensure a secure and fulfilling future for your child.
If you are ready to learn more about your legal options and requirements when it comes to caring for your special needs child, especially as they reach adulthood, click here to schedule an initial call with our office. Speaking with an experienced attorney can help provide peace of mind as you continue caring for your child and planning for their future.
Remember, you are not alone on this journey. Reach out to professionals, support groups, and organizations specializing in special needs care. Their expertise, guidance, and shared experiences can provide invaluable support as you navigate the path of planning for your special needs child’s future. Embrace the opportunities to advocate for your child, empower yourself with knowledge, and take the necessary steps to create a solid plan that supports their unique needs. By planning ahead, you can provide a stable and loving environment where your special needs child can thrive and reach their full potential.
Talking to your parents about aging, illness, and death is hard. It’s one of the hardest conversations you can have–but it’s also one of the most important. The feelings that might come up during the conversation, if uncomfortable, are better than the feelings that would otherwise come up when an emergency happens and there is no plan in place for taking care of them (or even a consensus among relatives on how to move forward). As we always say in our office: “it is better to have a plan and not need it than to need it and not have it.”
With that said, directly asking a loved one “hey, what would happen if you died today?” might not be the best way to start the conversation. So let’s consider some better alternatives to open the conversation about estate planning.
1. Tell your loved one what you’re doing for your own estate planning
Telling your loved one about your own estate plan, or your wishes to create your own estate plan, might make them consider making one themselves. Tell them what is in your Last Will and Testament, whether you have a Trust, and who you have chosen to act as your Power of Attorney. Hearing about your concerns for your own aging and death, and hearing how you’ve decided to navigate the future, will give them an idea of where to start, which is often the hardest part. Many people also struggle to decide on an estate planning attorney. It is important that the Nashville attorney they hire aligns with their needs. Hearing about your own process of hiring an attorney, and how you determined which one would be the right fit for you, can help them navigate the difficult world of hiring a Tennessee Wills and Estate Planning lawyer.
2. Talk about other situations that have happened that worried you or made you curious
Many of us know at least one person who has suffered the loss of a loved one and then had to endure the resulting feud among the family. These feuds happen so frequently that a significant number of fictional stories are based on them. Unfortunately, plenty of them could have been avoided if a clear plan had been put in place. And these feuds rarely start right after the death—many of them start much earlier, when the loved one’s health began to decline and someone had to step up to take care of them. Estate planning does not just mean deciding what happens after you die; it also means deciding what happens if your health begins to decline. If there is no plan in place for declining health, it will be up to the family to decide what happens. Even the closest of siblings can begin to resent one another if they feel that their parents’ care is not being handled properly.
Although it is fictional, the feud in This is Us between the siblings regarding their mother’s care is an accurate portrayal of what can happen in these situations. The siblings argued on what kind of medical treatment their mother should receive, and again on where she should live and who should look after her. Although all of the siblings had the best of intentions and loved each other and their mother, the feud nonetheless happened. The mother sensed the feud would escalate once her diagnosis advanced, and so she decided to name her daughter (her most level-headed child) as her healthcare power of attorney. Although the siblings still butted heads with one another, the daughter was able to carry out her mother’s wishes.
There are plenty of other examples in books and TV of families feuding over a loved one’s care or death. Talking about these hypothetical situations might make it easier to begin the conversation about aging and death.
3. Ask what would happen to their children, pets, and home if they were in a medical emergency
While discussions about aging and death might be intimidating, discussions about medical emergencies might be easier to handle. Medical emergencies can happen to anyone at any time. Our office even recommends that eighteen year olds get power of attorney documents in place, as it is important for them to have someone able to speak to medical professionals on their behalf in the event of an emergency. Since medical emergencies can happen to anyone, loved ones who do not like having their age pointed out might be more receptive to the conversation. If you know your loved one is anxious about having a stroke or falling down stairs, and tends to avoid or shut down conversation about either of those scenarios, it might be a good idea to use another medical emergency in your conversation (like a car accident, for example). While it is important for your loved one to confront their anxieties, it is not always our place to force them into a confrontation. Using a more neutral example (like the car accident) instead of one they constantly worry about might be a good way to ease them into the conversation.
4. Ask if they can show you where their estate planning documents are
After signing estate planning documents with our clients, we tell them to please let their family know their wishes and how to find the original documents. After all, the estate planning documents are only as good as the family’s ability to find them. In the event of a medical emergency or death, the signer of the documents will not be able to locate them. If no one else knows where they are or how to find them, the documents become effectively useless. It is therefore of the utmost importance that loved ones know where to locate the original documents. If you know or suspect that your loved one already has a plan in place, ask them where the documents are and how they plan to transfer the documents into the right hands in the event of an emergency or death.
For more information on how to talk to your loved ones about aging, illness, and death, we encourage you to check out The Conversation Project.
So you’ve been to your primary care provider and they’ve told you it’s time to see a specialist. Or maybe they’re changing practices or retiring! Or maybe you’re looking at our list of recommended doctors appointments and realizing you need to make some new appointments as you get older. Whatever the case, now you’re tasked with finding a new doctor – and it might feel daunting. We’ve got some tried and true recommendations to make this task just a little easier for you.
Don’t be afraid to ask for a recommendation!
Start with the doctor you trust – who do they recommend you visit? Maybe that’s a specialist within a greater healthcare system (Vanderbilt, St. Thomas, etc.) or maybe it’s someone who has expertise in your specific diagnosis. But don’t stop there! Next, if you’re comfortable, reach out to your family and friends to see if they have a provider whom they really like. Why do they like their doctor? If you trust their opinions, this might be a good resource for you.
If you’re able, consider the possibility of driving to get a good doctor. Sure, they’re on the other side of town, but if they come highly recommended and you’re only going 1-2 times a year, it might be worth the traffic!
Lastly, be sure to consider any deal breakers. This looks different for everyone, but it could include transportation factors, a specific focus in their practice, or you’re looking for a doctor of a specific gender (like a female OB/GYN). Take my example – my husband and I are child-free, so I was very pleased to find a gynecologist who doesn’t also help with childbirth. It means she is able to focus on what matters to me and isn’t away delivering a baby when my appointment time comes around.
Check out their internet presence.
Most offices these days have a website, listing their hours, providers, and even patient ratings of the physicians. Do you like what you read there? Or is there something that makes you think twice? If there are comments, take the time to read those, as they may give you a deeper understanding of the provider’s demeanor and care (rather than just a 5 star rating).
Additionally, use this website to confirm the doctor’s licensure. You can also view any disciplinary matters on your particular doctor in their Practitioner Profile on this website.
Contact the provider’s office.
The last thing you want is to show up and find they only accept a certain type of insurance coverage! Call the office and ask if they take your insurance; you can find your information on your insurance card. Keep in mind that the staff may need to look up the information, but “I don’t know” is not an acceptable answer here. If the person who answers isn’t sure, ask to speak to someone in the billing department to verify your coverage.
Don’t forget to also ask if you will need a referral to their office from your primary care provider. Some specialists will accept self-referrals, but your insurance company might think otherwise!
What about a copay?
Oftentimes, your insurance card will list a copay amount for various types of providers. If not, be sure to log in to your insurance company’s website and verify the copay, or call the number on your card to speak with a representative. Specialist visits typically have a higher copay amount than a regular PCP appointment; you will want to be prepared.
Remember: just because you see a doctor once doesn’t mean you have to continue seeing them. Just like any professional, you should find someone that you are comfortable with – which isn’t a reflection on the doctor or their skills, sometimes it’s something that you just have a gut feeling about and want to find a better fit. Feel free to tell the doctor this. If you can articulate what you want, tell them and ask if they have a recommendation. They probably know other doctors in their area!
You and your provider are a team, and by working together, you should be able to ensure you are taken care of for years to come! You have the ability to direct your healthcare and make decisions for your future; hooray for being proactive!
