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.
Aging in place is the ability to live in your own home and community independently, regardless of age or ability. It allows you to remain in familiar surroundings while maintaining a sense of autonomy. Planning ahead for aging in place is crucial to ensure a smooth transition and a comfortable future.
By getting informed about aging in place, you can make good decisions that will positively impact your quality of life as you grow older.
Benefits of Moving Early
One of the main benefits of moving early is increased housing options. By planning ahead, you can explore different housing choices that cater to your needs and preferences.
Enhanced quality of life is another advantage. If you start early, you can create a supportive and comfortable living environment that promotes your overall well-being while reducing stress. When you plan and prepare, you can avoid the rush and uncertainty of emergency moves.
Improved safety is important, too. Adapting the living space to accommodate changing needs can prevent accidents and injuries, meaning you’ll be healthier and happier.
Assessing Your Needs
When planning to age in place, it is important to assess and address specific needs. Here are some things you can do:
Make simple home modifications like grab bars and clear plenty of space to walk or move with mobility aids.
Invest in medical equipment or technology like stairlifts, home monitoring systems, etc., for added peace of mind.
Check into community support services, like meal delivery programs and in-home care providers, to stay socially engaged.
Secure accessible transportation so you can get where you need to go, even if your situation changes.
Our area has awesome resources for those who want to stay independent without personal vehicles. Check out WeGo, Senior Ride Nashville, or Wilson County Rides in addition to rideshare programs. If you need transportation to a medical appointment and have a Medicare Advantage plan, you may have transportation benefits!
Exploring Housing Options
Independent living communities provide a range of housing options that cater to those who want an active and social lifestyle. These communities usually offer amenities and services designed to enhance well-being and promote socialization.
Assisted living facilities are suitable for individuals who require some assistance with daily activities. Trained professionals are available to provide support while still allowing residents to maintain their independence.
Nursing homes provide comprehensive 24/7 care for individuals with complex medical needs. These facilities offer skilled nursing services and rehabilitation programs.
Our personal favorites, though, are continuing-care retirement communities. They provide a continuum of care, helping people transition seamlessly between independent living, assisted living, and nursing care as their needs change. While you may never need anything more than independent living, it’s comforting to know that you won’t have to plan another big move or relocate further from friends and family.
Financial Planning
Most people ages 65 and up are eligible for Social Security retirement benefits. Additional government assistance programs, such as Supplemental Security Income (SSI) and Veterans Affairs (VA) benefits, may be available to eligible older adults. Exploring these options can provide extra financial support.
Consistently saving for retirement ensures you’ll have the necessary funds to support your desired lifestyle. Retirement savings, such as 401(k)s and IRAs, can help you live comfortably in retirement. If you are fortunate enough to have a pension, it will be a great resource to help your quality of life in your golden years.
For these types of accounts, you’ll want to make sure that you name a beneficiary with your financial institution. If you have a pension, you will need to designate whether you want your spouse to continue receiving income in the event that you predecease them.
Medicare and Medicaid are government programs that provide healthcare coverage for seniors. Understanding the eligibility criteria, available benefits, and how (or whether) they can be combined with other plans is essential for effective financial planning.
Your Medicare coverage may assist with certain improvements to your home and home health care under limited conditions. Medicaid (also called TennCare) is frequently used by individuals in nursing homes to supplement their income to pay for care.
Long-term care insurance can help cover the costs of assisted living, nursing homes, and in-home care. It provides financial security and peace of mind for individuals planning their futures and provides more robust and flexible solutions than relying on Medicare or Medicaid alone.
Long-term care insurance can be expensive, but there are newer options to make it a better value overall, such as hybrid policies that provide a death benefit and deduct the amount spent on long-term care needs. Your insurance agent is a great resource to talk through these options.
Building a Support Network
Family and friends play a vital role in supporting those who wish to age in place. Reliable support systems can provide emotional support and practical assistance, ensuring that loneliness is never an issue.
Community organizations like FiftyForward and other local non-profits offer various activities and services to help seniors stay connected. Support groups for older adults can offer a space to share experiences, find understanding, and receive advice from others facing similar challenges. These groups foster a sense of community and provide emotional support.
Professional caregivers can provide specialized assistance and care for individuals who require additional support. Hiring trained professionals can ensure individuals receive the help they need while remaining in their own homes.
Maintaining Independence
Physical exercise and wellness are essential for maintaining independence and overall well-being. Engaging in regular exercise like walking or fitness classes can improve strength, balance, and flexibility.
Mental stimulation and cognitive health are also important. Doing puzzles, reading, and socializing can help keep your mind sharp and promote cognitive function. A little daily Wordle competition is a favorite in April’s house.
Nutrition will help you maintain good health. A balanced diet of fruits, vegetables, and whole grains can support overall well-being and energy levels.
Keep appointments with doctors and specialists to manage existing health conditions and address new concerns. Regular check-ups, screenings, and preventive care can help individuals stay healthy and catch any potential issues early.
Want More Info on Aging Gracefully?
Taking these steps will help increase your chances of having a comfortable and fulfilling future.
Remember, it’s never too early to start thinking and planning for your golden years.
By the way, there’s a FiftyForward event coming up on 1/16 to discuss housing. We’ll be there – will you?
Navigating TennCare/Medicaid: What You Need to Know
What is TennCare? What’s the difference between that and Medicaid? How do you know if you’re eligible for it, and what can you do about it if you aren’t?
Fear not, dear reader, we’ll answer all of those questions and more as we dive into what you need to know about TennCare/Medicaid!
What is TennCare/Medicaid?
Simply put, each state has a name for its own Medicaid program. TennCare is the state of Tennessee’s Medicaid program. It’s a way of saying “Tennessee Medicaid” in fewer syllables.
In terms of what TennCare actually does, it’s a healthcare program that provides medical assistance to low-income individuals, pregnant women, children, and individuals with disabilities. It is funded by both the Tennessee and federal governments, and the primary goal is to ensure that everyone has access to essential healthcare services.
Who is eligible for TennCare?
To be eligible for TennCare, you have to meet specific income requirements and fall into a certain category. If you’re a low-income adult, a child, a pregnant woman, an elderly individual, or an individual with a disability, you’re in an eligible category. However, you still need to qualify based on your specific circumstances and resources available within the program.
Why is it important to understand TennCare?
Understanding TennCare (Medicaid) is crucial because it can provide you and your family with affordable access to healthcare services.
Most seniors are on a fixed income. The median retirement income for Tennesseans is just under $2,000.00-but the cost of a nursing home averages around $7,500 a month. Even if your loved one has savings that can be allocated toward their care, those savings can be depleted quickly. Knowing the eligibility criteria, application process, and coverage options can help ensure that those in need can receive the necessary medical care.
At Graceful Aging Legal Services, we have experience with TennCare applications. We’d be happy to discuss how you can protect your savings and your spouse while still qualifying for TennCare. Another good resource is Tennesse Justice Center, if you’ve got any questions.
What’s Covered?
The purpose of TennCare is to make sure that you have access to essential healthcare services that help you to maintain your well-being. With that in mind, there are a wide range of medical services covered under TennCare. However, some services, like nursing home care, require further application.
Services include:
Doctor visits, hospital stays, preventative care, and emergency services
Prescription drugs for managing health conditions
Counseling, therapy, and other treatments for mental health conditions
Dental and vision care
Applying for TennCare/Medicaid
Find out about the application process and what documents and identification information you’ll need to apply – and what not to do, so you can avoid delays.
Application Process
Applications are no one’s idea of a good time, but they are unfortunately necessary for TennCare. Luckily, the process isn’t as grueling as it used to be. You can do it online, by mail, over the phone, or in person, so pick whatever is easiest for you. If you have questions about the process or want someone to help you through it, that’s what we do for some of our clients!
To make the process easier, prepare all of the documents and information that will be needed for your application ahead of time. That will make filling out the actual paperwork go by much faster!
Required documents and information
Documents to prepare:
Identification documents
Medical history
Proof of income
Health insurance information
Information to have on hand:
Social security numbers of everyone applying
Dates of birth for everyone applying
Current income
Current address
Contact information
Citizenship and immigration status
Car and property value
Bank and financial statements (3 months)
Vehicle title (Kelley Blue book value)
Life insurance policy information
Common mistakes to avoid
Mistakes mean delays or denials of coverage, so here are major mistakes to avoid:
Providing incorrect or incomplete information
Failing to include required documents
Not reporting changes in income or household size
Transferring property or making large gifts
Sharing bank accounts and funds with someone other than a spouse
Renewing and Managing TennCare/Medicaid
Here are the key steps to renew and manage your TennCare plan.
Renewal process
TennCare coverage is not permanent and needs to be renewed periodically. TennCare will try to renew your coverage using the information they already have on file, but they may need further information. Keep an eye out for a renewal packet, and fill out the required information as soon as possible.
Reporting changes in income or household
It is essential to report any changes in income or household size to TennCare. These changes can impact eligibility and may require you to update your information or submit additional documents. Failing to report changes promptly can lead to complications in coverage.
Appealing decisions
If your TennCare application or renewal is denied, there is an appeals process in place. This allows you to challenge the decision and provide further information or evidence to support your eligibility. If you get to this point we recommend working with an advocate, such as a lawyer or non-profit agency like the Tennessee Justice Center.
Want to Know How We Can Help You Qualify for TennCare?
Graceful Aging Legal Services is here to help! Contact us today to set up an appointment to talk about TennCare and estate planning, or caring for someone who needs advanced care without the resources to pay for it.
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!
For the month of November, we want to focus on caregivers. While family caregiving can be rewarding, it also takes a toll. Most family caregivers hope to add a professional service to their loved one’s support system, but figuring out how to do that is just one more thing to add to your already-full plate.
What types of care are there? Who provides these services? How much do they cost? What limits are there? How do I pick the right service for my family?
You’ve got the right questions, and Google is overwhelming. So we called in an expert. Our friend Perry Brown, President of our local Right at Home care team, was kind enough to provide us information about the types of care options available and the most common questions you may have. If you’d like to know more about Right at Home, we encourage you to check out their website here and sign up for their newsletter. If you are ready to talk to someone about in-home care, Perry and his team would be happy to help. You can reach them by phone at (615) 360-0006 or by email at [email protected].
Let’s Look at Types of Care You May Want to Consider
When an older loved one or adult with a disability needs caring support at home, it can feel daunting to know which professional care services are best. Who can help with bathing and meals? Is a registered nurse needed for wound care? Can hospice care happen at home?
The Global Coalition on Aging and the Home Care Association of America state that almost 70% of Americans who turn age 65 will need assistance at some point to care for themselves. These senior care industry leaders also report that “already 40% of adults aged 65+ need assistance with daily living activities.” The fast-growing care needs of the country’s increasingly older population can leave care recipients and their families confused over in-home care options. The complexity of nonmedical and medical services available also may jeopardize a loved one from getting the timely and attentive care they need.
To help simplify the professional in-home care choices, Lorraine Grote Johnson, Director of Care Quality at Right at Home, a leading in-home care agency, notes that it is important to understand the differences between home care and home healthcare. Grote Johnson, a registered nurse for more than 35 years in both hospital and home settings, gives the following overview of common care services available in the home.
Home Care
In-home caregivers are the extra hand to provide personalized support to a loved one in their own familiar home surroundings. Home care can be part time, full time or live-in assistance ranging from light housekeeping and meal preparation to personal grooming and toileting. At-home caregivers can provide care services such as being a companion who helps write the grandchildren to driving the care client to medical appointments and to complete errands. Home care allows a loved one to stay safe and independent at home as long as possible. Grote Johnson points out that home care staff members are not legally allowed to take on skilled medical care such as dispensing medications and working with tube feedings. Most at-home caregiving services are covered through private pay.
Home Healthcare
Home healthcare is skilled nursing care that is prescribed and directed by a physician and supervised by a registered nurse. Home healthcare is suited for complex health issues that require a higher level of medical assistance, or when a loved one is recovering from an injury or recent illness. A professional skilled nursing team can accommodate a client’s numerous medical care situations such as monitoring vital signs, medication setup and management, dressing changes, and continence care.
“Generally, home healthcare is delivered by Medicare-certified companies and may include physical therapy, occupational therapy and speech therapy,” Grote Johnson said. “A registered nurse makes a care plan and supervises a home health aide who helps a client with activities of daily living such as bathing and dressing. The RN does supervisory visits in the home at least once every two weeks.”
Medicare and other health service providers that pay for home healthcare determine the number and length of nurse visits to the home. Private pay skilled nursing care has no limit on in-home service hours. Specialized palliative care and hospice care also fit within the realm of home healthcare.
Palliative Care
Palliative care is specialized support for people living with a serious illness or transitioning toward death. Palliative care focuses on pain relief, comfort and reduced stress for an ill loved one and balanced overall health for the patient and family members. Palliative care serves not only the dying but also those with chronic diseases such as cancer, congestive heart failure, kidney disease and Alzheimer’s. A specially trained palliative care team includes doctors, nurses, professional caregivers and other specialists who work together to improve the quality of life for the care client.
Hospice Care
Originating in Europe during the Middle Ages, hospice, which is derived from the Latin word for “hospitality,” is care that aids the critically ill and dying with medical, emotional and spiritual support. Hospice or end-of-life care is a type of palliative care, but the ailing person is no longer seeking curative treatment. The aim of hospice care is to extend comfort, peace and dignity to individuals in the dying process. Hospice programs also support a patient’s family with counseling and bereavement care. Hospice teams of doctors, nurses, social workers, chaplains and other caregivers provide care in patients’ homes or at a hospice center, hospital or in-patient care facility.
“Hospice typically serves a terminally ill person with a life expectancy of six months or less,” Grote Johnson explains. “In some cases, a hospice patient’s health improves to the point where the individual no longer needs the specialized care. Also, if a person starts to feel better, they may want to negate hospice and start receiving curative medical treatment again. At any point, a hospice client can change their mind about their care.”
Tips for Choosing At-Home Care
Because of the quickly expanding number of at-home services on the market today, Perry Brown, President Right at Home Nashville advises those in need of care and their families to consider the following tips for choosing at-home care:
Select services only from a professional, licensed agency. Make sure you see actual proof of certification and licensing for the agency.
Be certain that the caregiver who works with your loved one is insured and bonded.
Get a detailed care plan or treatment plan upfront. Ask about goals of the suggested services.
Review the caregiver’s qualifications, experience and amount of supervision on the job.
Discuss all financial costs and evaluate options for saving money on home care, including long-term care insurance, a reverse mortgage, Veterans Aid and Attendance benefits, etc. Reference Right at Home’s information on how to pay for home care.
For securing skilled nursing care and home healthcare, Grote Johnson offers additional suggestions. “Choose a company that knows and maintains federal and state regulations,” Grote Johnson advises. “Make sure the company does criminal background checks on their nurses and caregivers and verifies their licenses. Ask whether the nursing staff has gone through a thorough orientation and if they know infection control practices and what to do in emergencies. Also, make sure skilled nursing staff members have critical thinking skills and completed competency testing, and that home health nurses have the proper qualifications, because they are taking your loved one’s life into their hands in what could be life-or-death situations.”
Availability of qualified at-home services varies by locales across the country, so Brown recommends reviewing at-home agencies online, then visiting with the agencies in person. “Be sure to check references of the in-home agency candidates and their specific caregivers,” Brown explained. “Talk to others in the community who are familiar with the agencies and their reputations. In getting the best care possible for your loved one, every question and concern matters.” For additional information about choosing home care, home healthcare, palliative care or hospice care in your area, talk with local medical professionals for referrals, or contact the National Association for Home Care & Hospice, or use the U.S. Administration on Aging’s Eldercare Locator.
Many of our Nashville elder law clients wish to remain in their own homes for as long as possible. With the advances in medications, treatments, and home healthcare options, more people are able to stay in their own homes. Whether you are looking for a home healthcare provider in Middle Tennessee for yourself or a loved one, here are some great guidelines to follow:
1. Determine what level of care is needed.
The level of care that you need is the most important determination when you want to hire a home healthcare provider. This factor will affect many other decisions. For example, are you or your loved one dealing with a specific ailment? If so, it may be preferable to choose a provider or agency with experience in that field. Additionally, do you need round-the-clock care, someone to come a few hours a day, or something else entirely? There are adult day programs that can provide an outlet for social activities and certain therapies. Adult day programs can be used on their own or in conjunction with a home healthcare provider. You may wish to ask your elder lawyer for a list of possible facilities in the greater Nashville area or you can access statewide resources on the Tennessee Department of Human Services website.
2. Understand the difference between Home Healthcare and In-Home Care.
Home healthcare is provided to those recovering from surgery or hospitalization, or those needing continuous medical care. These services include skilled nursing care, physical therapy, occupational therapy, speech therapy, and administration of medication. In-home care on the other hand provides ongoing non-medical assistance following illness or surgery or for chronic disease or disability.
3. Decide if you want to hire someone on your own or if you want to go through an agency.
There are advantages and disadvantages to both options. If you choose to do it on your own, you will likely have more say in who will be providing the direct care, as well as what services he or she will provide, but you will be responsible for handling payroll and taxes. On the other hand, an agency will be able to screen applicants thoroughly and can handle payroll and other paperwork for you.
4. Ascertain how you will pay for the home healthcare services.
An experienced elder attorney can point you toward various resources, depending on your needs. You or your loved one may have long-term care insurance set up for just this situation, or you may be looking to Medicare, Veterans Administration, and/or TennCare/Medicaid to assist with the costs. Medicare will only pay for home healthcare, but not in-home care.
One step at a time
Deciding to hire a home healthcare provider in Middle Tennessee is a big job. Break things down into manageable objectives and avoid becoming overwhelmed. At any point in the process, an experienced estate planning and elder law attorney in the Nashville area will be able to offer practical advice and suggestions. If you are unsure about what to do consider scheduling an hour-long Strategy Session and get legal advice from our attorney. We also have a planning tool called the “Care and Savings Assessment”. We use this tool to help our clients qualify for TennCare.
