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April Harris Jackson

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Will TennCare Choices pay for my Mother’s nursing home?

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

TennCare Choices logo for Tennessee Medicaid Long-Term Services and Support
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? 

  1. 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.  
  2. Do a reverse mortgage on her home. 
  3. 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:  

  1. Medical eligibility 
  2. Income threshold
  3. Asset threshold
Wheelchair bound woman looking up at a nurse in white while at a nursing home for long-term care
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. 

Graceful Aging Legal Services, PLLC Logo for the Care and Savings Assessment - It is a graph with lines slowly going down.

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. 

Becoming the Primary Caregiver for Your Loved One

Becoming the Primary Caregiver for Your Loved One

When the chorus of life changes its tune and the caregiving role falls to your feet, you may be tempted to take a page from a pop anthem and think you can take care of your loved one on your own. 

Before you tell your loved one, “You belong with me,” you need to put your oxygen mask. Long-term care isn’t just about playing hero; it’s about strategic moves, open conversations, and sometimes tough choices to keep the rhythm going strong.

Organization: A Beautiful Arrangement

Without the arrangement, the symphony is just noise. Without organization as a caregiver, you run the risk of much more than musical chaos: you risk harming your loved one. 

Here are some ways to keep the composition arranged perfectly:

  • Make a calendar of appointments, etc. to add a lilt to your daily activities. 
  • Know who else is playing – create a contact list of those instrumental in care. 
  • Keep a list of medications in order to keep the mood right. 
  • Make a list of caregiving tasks and service providers in case you need backup.
  • Consider centralized communications so you don’t have to sing on repeat.

Strumming the Strings of Self-Care

The spotlight’s charm fades when your spirits are lower than the lowest note you can sing. Being the primary caregiver is a test of endurance, a commitment that needs more than just a peppy melody. 

Self-care is the unsung verse in this song, and nothing to scoff at:

  • Regular health check-ups will keep you humming at your best.
  • Little breaks (or respite time) are instrumental in keeping your pace steady.
  • Support groups hit the right chord and provide backup to your solo performance.

Remember, if you’re out of tune, the duet with the person you’re caring for suffers. For a symphony of support for caregivers, a visit to The Administration for Community Living would be helpful.

Chorus of Conversations in the Family Band

The band won’t play together well unless each member knows the score. Discussing care strategies for your loved one can induce discord, but it’s a necessity. Here’s how to keep from going off-key:

  1. Hold a family meeting to riff on everyone’s thoughts and responsibilities.
  2. Encourage open dialogue—you all belong in this family ensemble.
  3. Chart everyone’s care duties to avert a chorus of complaints later.

Is it time to orchestrate a family meeting? These AgeWell resources may help!

The Bridge to Assisted Living

You may be singing a sweet serenade, believing whole-heartedly that home is the only concert hall for your loved one. But sometimes, an encore in another venue—like an assisted living facility—might be the most logical option. 

Here’s what to consider:

  • Assess your loved one’s needs—can you help them meet their everyday needs?
  • What are you willing to give up to become a caregiver? Will you retire or quit?
  • Take time for personal reflection—are you feeling overwhelmed?
  • How will caregiving impact your own savings/retirement plan?
  • Are you married, and is your spouse/family supportive of your choice?
  • Explore alternatives that can offer better care than you might solo.

Another note: are there ways you can still provide care while maintaining your current lifestyle (paid caregivers, nonprofit or faith community volunteers, adult day services, etc.)?

When the melody gets complex, check out our article on the pros and cons of assisted living facilities or ask those you trust about the experiences they’ve had with assisted living facilities.

Finale: Legally Tuning Your Care Strategies

There’s an encore element that demands attention: legal preparedness. 

Having a plan in advance is like sheet music for the future, keeping everyone on the same page. Work with a legal service like Graceful Aging Legal Services, PLLC, that conducts these arrangements with expertise, so you can ensure the final movements of your caregiving symphony are in harmony with smart decisions for your future.

Securing the long-term care and future of a loved one is no solo act. It’s an orchestra of thoughtful planning, tied with legal strings that resonate within the court of life. So, tune your instruments, take a deep breath, and let the music play in confidence knowing you’re not in this alone. Contact us for help when you’re ready!

How to Be Proactive in Your Caregiving Journey

How to Be Proactive in Your Caregiving Journey

Caregiving is an important responsibility. It involves providing essential services to another person (often a senior), helping empower them to live their best life even as they age. 

Understanding the Caregiver Role

Caregivers must understand the tasks and responsibilities they may be taking on, and think carefully about what boundaries they’d like to set in advance. Doing this is a crucial part of performing the job well and ensuring each person receiving care gets the help they need.

Caregiving works best when it’s a community effort. There’s a lot of joy in caregiving (which is something not everyone expects when they go into it). You may think of caregiving as “This is how I’m helping someone else,” but you’re actually helping your future self as well. Caregiving provides an opportunity to think about your goals and be more proactive about aging than you would have been if you weren’t a caregiver. 

It takes a village to be a caregiver – so don’t forget to lean on the support of others during this time. (More about that later!)

Some typical roles of a caregiver include tasks such as:

  • Assisting with activities of daily living
  • Coordinating medical appointments
  • Providing emotional support
  • Managing medications
  • Handling bill payments
  • Meal planning and preparation
  • Resolving insurance benefits issues
  • Providing assistance with technical issues
  • Planning or providing transportation for loved ones

As a caregiver, it’s important to remember that the role can sometimes present physical and emotional challenges. Working to meet this head-on and find solutions is an important part of advocating for the individual you care for and yourself. Don’t forget to laugh where you can – it’s a great way to cope with the emotional and physical strain, build rapport, and enjoy this season!

Planning to Help Them Age in Place

Aging in place refers to the ability of an individual to live in their home and community safely and independently. Caregiving can help facilitate this process, enabling seniors to keep their homes rather than move into an assisted living facility.

(Aging in place isn’t the only option, however; some older individuals prefer to downscale or move into an assisted living facility for more companionship. Make the choice that works best for you and your family.)

Proactive caregiving should always provide a supportive environment for daily living activities. Evaluate the home for potential hazards and make necessary modifications and adaptations.

Some helpful and simple changes that can significantly increase safety include:

  • Everything they need, on one level. Although most people opt for single-story homes, it is possible to have a multi-story home and still embrace this principle. For example, April has everything she needs on the ground floor of her home except her washer and dryer. But she plans to hire someone to do her laundry once she can’t make it up and down the stairs safely!
  • Installing grab bars and ramps. All of us lose our balance sometimes, but as we age, it can become more common. Having something to provide stability within the home is important.
  • Using non-slip flooring and removing throw rugs. What is the point of throw rugs, anyway? Over time, they all curl up and cause a major tripping hazard. 
  • Use cord covers. Unless you want to go entirely off the grid as you age, cords will be a part of your life. They can be a tripping hazard, but cord covers can help!
  • Exploring accessible technology resources. Another aspect of aging can be limited vision and hearing. It can be helpful to find ways around these impairments.
  • Using medication management apps. Reminders are especially important to those who need to take their medicine at the same time daily. 

Building a Support Network

Anyone who has worked in caregiving knows that it is overwhelming. Having a strong support network for both caregivers and the senior individual is of the utmost importance.

Caregivers should seek to involve family and friends in the caregiving journey as much as possible. These people can provide much-needed assistance and emotional support as the situation is navigated. It’s also wise to utilize professional support, such as home healthcare aides or respite care services. Remember, you can’t pour into someone else’s life if you are empty, so respite care can be vital for your well-being!

There are also many community organizations and support groups that connect caregivers with others who understand their experiences.

Remember – a support network doesn’t have to just include those providing care to the person who needs care. A good support network should also provide care to the caregiver. As April says, “Don’t think you need to be a first-line caregiver to be important in the caregiver support system.” 

Self-Care for Caregivers

Taking good care of yourself provides a strong foundation to care for others. Burnout is a common issue for caregivers but must be dealt with for the overall well-being of both the caregiver and the person who is receiving care. 

So how should caregivers manage their mental health and levels of burnout? 

Here are some ideas:

  • Practice mindfulness to stay emotionally healthy
  • Engage in hobbies to keep your creativity alive
  • Move your body and exercise

If you’re still feeling burned out despite your best efforts to manage your stress, it can be a wise idea to seek respite care services. These services can help provide you with a break from your caregiving responsibilities and allow you to rest. You can also consider joining a support group designed especially for caregivers!

But what if you’re a friend or family member of a caregiver and want to know how to support them?

Here are some specific examples you can use:

  • A daily or weekly phone call to check in
  • Giving your friend a break every now and then
  • A monthly hike with a friend (boom – friendship and exercise!)
  • Send a thoughtful card or letter their way to encourage them
  • Bring them homemade meals or gift cards

Communication and Decision-Making

Trust is one of the most essential components of caregiving and aging in place. Good communication helps facilitate this trust, allowing caregivers and those receiving care to speak honestly about future goals and preferences.

Legal preparations, such as establishing power of attorney or creating a living will, can help ensure the senior’s wishes are respected and get all involved parties on the same age about end-of-life planning. Ensure all decision-making processes are clearly outlined to avoid any conflicts or misunderstandings.

Supported decision-making involves everyone – not just the person who is approaching end of life, but those who are involved with their care and part of the overall support system. The most important thing a person of any age can do is to talk to their support system in advance. 

First, talk to your family about your wishes, then write them down. Make sure everyone’s on the same page. If you can only do one of the two things, talk to your family.

Financial Considerations

Having finances in order is also crucial for aging in place. Understanding the insurance options and government assistance programs is important for caretakers to assist seniors with tasks like budgeting and managing support services. Resources that could prove helpful include FiftyForward and TCAD in Tennesee. 

Long-term care insurance, veteran’s benefits, Medicaid, and Medicare are some common options that can help with the financial aspects of caregiving and aging in place. It’s best to seek help from a trusted financial advisor or insurance agent to work through these options and determine the best way to combine them, if possible.

Resources and Recommendations

Consider checking out books from your local library about caregiving or finding helpful websites about caregiving. 

Here are some good places to get started:

You can also ask for recommendations from caregiving friends or family about programs that will support you!

Community programs like meal delivery programs and dial-a-ride services provide social engagement opportunities and promote overall well-being for seniors. Be sure to find out what services are available in your area, as they can be wonderful enrichment opportunities.

Proactive caregiving makes it possible for seniors to successfully age in place. As a proactive caregiver, you should make it a top priority to create a safe and comfortable living environment for the person you’re caring for. 

Understanding your role and what resources are available is critical in ensuring seniors maintain independence and dignity as they age, and having the right support can help you ensure you’re providing the best care possible so both you and the person you’re caring for have a positive quality of life.


At Graceful Aging Legal Services, we aim to help seniors age well. Part of this includes planning for their future and the future of their families. Want to learn more about aging in place? Contact us today, and we’ll help you prepare and organize so that major decisions aren’t looming over your head!

Proactive Steps to Provide a Secure Future for Your Special Needs Child

Secure Future for Your Special Needs Child

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.

  1. 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.
  2. 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. 
  3. 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. 
  4. 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.
  5. 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. 
  6. 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.

Finding the right doctor for you and your needs

Right doctors for your primary care needs

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!

How do I qualify for Medicaid?

Long-term care is expensive

Many people have sufficient income to maintain a regular lifestyle but are unable to afford the high cost of long-term care. With the average cost of long-term care around $7,000.00 a month, it is incredibly difficult for most families to afford it, even more so after retirement. That’s why it’s a good idea to plan for qualifying for TennCare, also known as Medicaid.

Evaluate and restructure your assets to qualify for TennCare

do you know how to qualify for tenncare? Image is of a man in a long-term care facility. He is taking a walk with a nurse and his partner.
It’s worthwhile to know how to qualify for TennCare

As we discussed in our blog last week, there are certain criteria you need to meet to be eligible for TennCare. As an elder law attorney, one of my jobs is to help families get their loved ones qualified for TennCare while maintaining resources available for the rest of the household.

One of the ways that we do this is by restructuring a family’s assets. We do this by turning resources that are countable for TennCare purposes into items that TennCare does not count as part of its eligibility assessment

This process is known in the elder law community as a spend-down. The goal of the spend-down is to make you or your loved one eligible for TennCare as far as your assets are concerned. If you are overqualified for income-based criteria, we can use a special type of trust called a Qualified Income Trust, or a Miller Trust, to reduce your income. The goal of a spend-down is to maintain the quality of life for all family members including those who need long-term care. 

Image of a scooter as a mobility device. Buying a scooter is a good way to spend down your assets to qualify for tenncare
Bob might benefit from purchasing a quality mobility device

What is a “spend-down”?

For example…

Bob needs to go into long-term care. Bob is eligible based on his income. He makes $2,000.00 a month of social security retirement income. Bob also has a house, a car, and $50,000.00 in the bank. Bob is widowed and his children are adults. 

We need to do something with at least $48,000.00 from Bob’s bank account in order to make him eligible for TennCare. His house and his car are not countable for TennCare purposes in most cases. What can we do? 

  • Make improvements to his home that would improve his quality of life and access to the things that he needed in the home. This might include: 
    • Grab bars in the shower or hallway.
    • A ramp into the main entrances.
    • Paving the driveway or expanding it closer to the door 
    • Widening doors 
  • Buy some things for Bob that his Medicare did not cover, such as:
    • Hearing aids
    • Dentures
    • Eyeglasses
    • Top of the line mobility devices 

There may be other things that would improve Bob’s quality of life. There are things we can spend money on or convert into income. I am also going to suggest to everyone that they use the money to make arrangements for end-of-life needs if they have not done so already. Since at some point Bob’s children will need to make arrangements for his burial or cremation, paying for it now from his excess funds is a great way to make those funds unavailable for TennCare purposes and meet a future need. 

image of a smiling older gentleman sitting with his daughter. Do you know how to qualify for medicaid?
Bob has peace of mind because he has plans in place for long-term care

Bob might want a Care and Savings Assessment

It’s not easy getting approved for TennCare / Medicaid, and we know it! That’s why we offer help in planning your steps to qualify. It doesn’t matter what your starting point is, we’re here to help you navigate the process with one goal: get our clients the quality of care that they need. Contact us if you would like to make plans for qualifying for TennCare.