Probate laws in Tennessee play an important role in the orderly distribution of a person’s assets after they die and help to settle their affairs. The probate process typically begins when you hire an attorney who will file a petition on your behalf in the appropriate probate court, initiating the legal proceedings.
The court then appoints a Personal Representative (aka the executor) to oversee the estate, and their primary responsibility is to manage the assets and debts of the deceased loved one. Notification of heirs and beneficiaries is a critical step to ensure all interested parties are aware of the probate proceedings.
If you are nominated or appointed as a Personal Representative, there are several things you’ll want to keep in mind to ensure a seamless probate process.
Probate Court Jurisdiction and Venue
In Tennessee, your attorney will file for probate in the county where your loved one lived at the time of their death. This is wherever they consider to be their permanent home.
Across Tennessee, your probate case may be heard in a different type of court than a friend’s in another county. For example, in Davidson County the Circuit Court hears probate cases while in Rutherford County they are handled in General Sessions Court. Many counties process probate petitions through their Chancery Court. An experienced probate attorney will be able to tell you the procedure in the county where you live.
Tennessee Intestacy Laws
Intestacy laws in Tennessee come into play when there is no valid will. These laws dictate the distribution of assets when a person passes away without explicit instructions, outlining the order of inheritance among surviving family members.
Myth-busting: Many people are concerned that if they do not have a will, the government will take their belongings instead of their family. While there are certain exceptions where the government can claim funds that are owed to them, your closest family members will inherit if you do not have a will.
Validity and Execution of Wills
Tennessee recognizes several types of wills, from handwritten wills to the ones you think of that are typed up and signed in a lawyer’s office in front of a notary. Each type of will has different requirements in order to be “admitted to probate.” This just means that the court needs to make sure that the will is authentic before it is acted on.
The law is specific about how that authentication can happen. Probate laws delineate the requirements for a valid will and the various types of wills recognized in the state. Ensuring compliance with these stipulations is imperative for a seamless probate process.
Probate Inventory and Appraisal
Part of the probate process involves creating an inventory of the deceased’s assets and how much those assets are worth. This allows the heirs and beneficiaries to know what to expect in terms of inheritance and for the court to require insurance to protect those funds if needed.
Many people are concerned about their privacy if the inventory is made a part of the public record, but informal inventories are often used instead of filing as part of the public record. This can be written into your will or agreed to by your family after your death.
Creditor Claims and Debts
To handle creditor claims and debts, personal representatives must notify creditors and prioritize the settlement of outstanding debts so ensure that the distribution of assets is fair and equitable.
One primary responsibility of the personal representative is to pay any valid claims of the estate. Your attorney will assist you in notifying creditors, both by mail and in the newspaper, so that they can come forward and file claims if there is money owed. Your attorney will guide you through the process of evaluating whether those claims are valid and paying them (if appropriate).
Estate Administration and Accounting
Once all assets have been gathered and all creditors have been paid, it’s time to distribute the funds. An accounting, whether formal or informal, will assist the personal representative in getting the numbers right. Depending on family dynamics and the requirements of the will, the accounting may or may not need to be filed with the Court’s Clerk.
While the term “accounting” sounds scary, all it means is that you are keeping track of what funds come into and out of the estate. Your attorney will assist you in preparing the accounting if one is required by the court.
Will Contests and Disputes
Probate laws in Tennessee address the possibility of will contests and disputes, outlining the grounds for contesting a will and the specific procedures involved in resolving such disputes.
Probate taxation is an overview of estate taxes, potential tax liabilities, and exemptions are governed by Tennessee probate laws. Understanding and following the laws around taxation ensures proper estate planning and compliance.
Although Tennessee no longer has an inheritance or estate tax, taxes are still an important process of probate and estate planning. As part of the probate process, the personal representative will be responsible for filing the deceased person’s final income tax return, as well as any federal estate taxes. There may also be state tax returns due based on what types of assets the decedent had.
Your attorney and accountant will assist you with maintaining the deadlines and knowing what these requirements are.
Closing the Probate Estate
In the final phase of the probate process, assets are distributed to heirs and beneficiaries, and the personal representative or administrator is officially dismissed of their duties. Take some time to celebrate – you’ve made it!
Common Issues and Pitfalls
The probate process takes a lot of time and effort (and maybe three hundred takeout coffees). The costs include court filing fees, attorney fees and possibly personal representative fees, which adds up. It’s important to have an attorney who knows the laws and the best way to complete the process efficiently so as much money goes to the people that your loved one wanted to have it.
Most people want to know how long the process will take or have heard horror stories out of other states (looking at you, Florida!).
In Tennessee, it can take as little as six months, depending on when your person died, how fast the court moves, the assets involved, family dynamics, and other variables. In most cases, it takes at least a year, and often more. If everyone gets along, it’s not such a bad process, and the attorney will handle much of it for you.
We also encourage the use of an after-loss professional like Sunny Care Services who can take some of the most frustrating tasks off your plate.
If you’ve become the Personal Representative for your loved one’s estate and want to prevent a lengthy probate process, it’s a good idea to start planning now. Talk with an attorney who has experience with probate and estate planning. (Psst – that’s us!)
Recent Developments in Tennessee Probate Laws
Probate laws are subject to change, and recent developments, including legislative updates and notable court decisions, can impact the probate landscape. Staying informed about these changes will help you navigate the probate process instead of asking, “Is it over now?” when you’re only halfway through.
Fortunately, Graceful Aging Legal Services can help you stay informed on such topics with our newsletter. Sign up today!
Aging often comes with increased healthcare costs and healthcare costs impact everyone—regardless of income level. Miller Trusts are a legal tool that helps individuals with high income qualify for Medicaid long-term care benefits. With a Miller Trust in Tennesee, you can become eligible for TennCare even if you are over the “income cap” set by the state.
What is a Miller Trust?
The Medicaid program (called TennCare here in Tennessee) typically requires limited income to qualify. A Miller Trust is a legal arrangement designed to help those with high income qualify for Medicaid long-term care benefits. By establishing a Miller Trust, also known as a Qualified Income Trust, you can redirect your income into the trust, your income then becomes exempt from Medicaid income calculations.
Why are Miller Trusts Used in Tennessee?
Tennessee is an “income cap” state for Medicaid. That means that those who have income above the cap will not qualify for TennCare. Miller Trusts are used primarily as a tool to create eligibility for Medicaid/TennCare even when you might have too much income. There are times when assets may fall within Medicaid eligibility requirements while income exceeds eligibility limits. In this case, a Miller Trust can help.
Without a Miller Trust even when assets meet eligibility requirements, income may exceed the limits for Medicaid eligibility. By redirecting income into a Miller Trust, you can effectively reduce your income for Medicaid eligibility purposes, ensuring you can receive necessary long-term care benefits.
The Benefits of Miller Trusts
There are several key benefits associated with establishing a Miller Trust.
Qualifying for Medicaid
The primary benefit of a Miller Trust is that it allows individuals with middle to high income to qualify for Medicaid long-term care benefits. A Miller Trust provides a way to legally redirect income into the trust effectively lowering income for Medicaid eligibility purposes.
Preserving Income
Miller Trusts also provide a means to preserve income. Instead of having to find a way to reduce your income to meet Medicaid’s income requirements, you can redirect your income into the trust. This ensures you can continue to receive your income while still qualifying for Medicaid long-term care benefits. It provides a way to maintain some financial flexibility while accessing the necessary healthcare coverage.
The Process of Setting Up a Miller Trust
The process of setting up a Miller Trust involves several key steps.
Gathering Financial Information
The first step in setting up a Miller Trust is gathering all relevant financial information. Financial information must be thorough including all income sources and other financial details to create a comprehensive financial report. An effective Miller Trust helps you meet income qualifications for Medicaid. In order for a Miller Trust to work for you it is critical to have an accurate understanding of your current financial situation.
Selecting a Trustee
The next step, in setting up a Miller Trust is to select a trustee. It is important to choose someone who possesses good organizational skills, excellent financial management, and will always prioritize your best interests. Opting for a trustee (typically a family member) who works with a lawyer who has a focus on Medicaid planning to set up the trust ensures they can adeptly navigate the intricacies involved in establishing a Miller Trust. Once the trust is established, it’s usually not too difficult to care for the account.
Creating the Trust Agreement
Once a trustee has been selected the next step is to create the trust agreement outlining the terms and conditions of the trust, including how income will be deposited into the trust and how it will be used for qualified expenses. Consulting an attorney experienced in Medicaid planning is crucial to ensure that the trust agreement is drafted correctly and in compliance with all applicable regulations.
Funding the Trust
After the trust agreement has been created and signed, the next step is to fund the trust. This involves transferring income into the trust, which will then become exempt from Medicaid’s income calculations. This typically involves setting up your Social Security to be direct-deposited to the trust account. You can likely do this online if you have an online account with the Social Security Administration.
It is essential to follow all necessary procedures and guidelines when funding the trust to ensure that it is done correctly and in compliance with Medicaid regulations. Make sure you work with a banker who is familiar with Miller Trusts to be sure that all regulations are followed and ensure that all necessary documentation is provided. Your attorney should be able to provide recommendations for banks they have successfully worked with in the past.
Meeting Medicaid Requirements
Finally, meeting all Medicaid requirements is essential. Income limits, reporting, documentation and any other Medicaid requirements must be met for a Miller trust to be effective. Consulting with an attorney with experience in Medicaid planning can help ensure all requirements are met.
Managing a Miller Trust
Once a Miller Trust has been established, proper management is essential. Here are a few key considerations.
Using Trust Funds for Qualified Expenses
The funds in a Miller Trust should be used exclusively for qualified expenses. This includes medical and long-term care costs that are not covered by Medicaid/TennCare. For example, if Medicaid covers one set of dentures every two years but you lose yours before it’s time to get a new set, you can use it to cover another set of dentures. It is important to keep accurate records of all expenses paid from the trust to ensure compliance with Medicaid regulations.
A trust can also be used for professional expenses. For example, a Miller Trust can be used to pay for legal fees.
Keeping Accurate Records
Record keeping is a vital aspect of managing a Miller Trust. Accurate records of all income deposits, expenses paid and other trust related financial transactions are necessary for proper trust management. The records are required for ongoing compliance as well as the TennCare redetermination period when you will need to submit proof that you still financially qualify for TennCare/Medicaid.
Reporting to TennCare/Medicaid
As a Miller Trust beneficiary it is important to report any changes in income or financial circumstances to TennCare/Medicaid if there is a significant increase. This includes significant increases in income sources, the amount of income deposited into the trust, and any other relevant financial changes. By keeping Medicaid informed – and by getting in touch with an experienced Medicaid attorney – beneficiaries can maintain their eligibility and continue to receive the necessary healthcare coverage.
For example, if you get a Miller Trust and then get an inheritance, you may no longer be eligible for TennCare/Medicaid. However, at that point, it would be wise to talk to an experienced Medicaid attorney, because they may be able to help you if you notify them quickly and before the inheritance is received.
Potential Challenges and Considerations
While Miller Trusts can be a valuable tool for Medicaid planning, there are some challenges and considerations to keep in mind.
Legal and Financial Implications
When establishing a Miller Trust there are serious legal and financial considerations making it vital to consult with an attorney who has Medicaid planning experience. An experienced attorney will help ensure all legal requirements are met and help you fully understand the implications of a Miller Trust.
Estate Recovery
In all cases, Medicaid will seek to recover expenses paid on behalf of a Miller Trust beneficiary from the beneficiary’s estate after their passing. In other words, anything in the Miller Trust at the end of life will go to the TennCare/Medicaid office This is known as estate recovery. It is important to understand the potential implications of estate recovery and to plan accordingly when establishing a Miller Trust.
Monitoring Eligibility Requirements
Medicaid eligibility requirements can change over time and it is important to monitor these changes to ensure ongoing eligibility. It’s in your best interest to stay informed about updates and changes to Medicaid requirements.
Consult Graceful Aging Legal Services for Your Miller Trust
Miller Trusts provide an option for individuals who have significant income and want to qualify for Medicaid long term care benefits. If you or someone you love falls into this category, a Miller Trust is an option to divert your income.
In addition to the oftendifficult conversations surrounding estate planning, establishing and managing a Miller Trust can be quite complex and challenging. It is advisable to seek assistance from a lawyer who focuses on Medicaid planning to navigate the process of establishing and managing a Miller Trust.
If you have more questions about Miller Trusts and would like to know if it’s a good option for you or your family, click here to schedule an initial call with our office. We’d love to work with you!
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!
As a child, our parents are responsible for making sure we get our regular check ups and vaccinations, but as an adult- throw in figuring out health insurance- things get so much more complicated!
Scheduling doctor appointments is a necessary task that can come with a lot of headache and uncertainty. How often should we go? Where do you find a primary care physician????
Just like you get your car a check up before you go on a long trip, it’s important to regularly check in with appropriate medical professionals in order to prevent a bigger health crisis down the road. Which screenings do we need throughout our life and at what intervals? Let us help you relieve some of that stress by following these scheduling and screening tips!
Read on for a list of appointments you should make this year, and remember to ask if your insurance is in-network when you schedule! We’ve got a handy tool at the end of this article to help you keep track of your appointments.
Appointments for All Adults 18+
Primary care physician (PCP)
When: Annually
Who: Everyone. Seeing a PCP on a regular basis is the best way to monitor your wellness. Your PCP will be able to help you make an informed decision on what appointments you should add to your annual list.
Dentist
When: Every 6 months
Who: Everyone
Gynecologist
When: Annually or if pregnant/trying to conceive
Who: People with female reproductive systems. It is recommended that you begin annual gynecologist visits as a teenager or after you become sexually active. Regardless of sexual activity, it is recommended that your first visit be by age 21 at the latest. If you have a new sexual partner, an STI test is recommended. If you regularly have more than one sexual partner, it might be wise to have a STI and Pap test every 6 months.
Eye doctor
When: If you have healthy vision, schedule a visit once in your 20s, twice in your 30s, and once at age 40. Those with existing vision needs should follow their eye doctor’s recommendations on frequency of visits. If you develop any vision difficulty or eye problems, a check up is recommended.
Who: Everyone
Dermatologist
When: Annually
Who: Everyone, especially if you spend a lot of time in the sun, are fair-skinned, or have family history of skin cancer.
Vaccinations
When: As recommended. Your PCP should be able to help you decide when to get vaccinations or boosters. Vaccine recommendations frequently include:
Annual flu vaccine comes out around September
HPV vaccine and meningitis for young adults
Shingles
Covid 19 vaccine and appropriate boosters
Who: Everyone
It’s important to get regular appointments with your doctors so they will have a baseline for your health conditions in case things change.
Appointments for Adults ages 40 +
Gynecologist – Mammogram
When: Annually
Who: People with breasts
PCP – Rectal Exam/PSA blood test
When: Annually
Who: People with prostates
Gastroenterologist – Colonoscopy
When: Regular screenings are recommended for those between the ages of 45 and 75. If your colonoscopy shows no signs of cancer, you can typically wait 10 years before scheduling another one.
Who: Everyone
If you’re 50+, add this l screening to your list:
Lung Screening
When: Annually
Who: Adults who have smoked 1 pack of cigarettes per day for 20 years or 2 packs per day for 10 years and currently smoke, or adults who have quit smoking within the last 15 years.
If you’re 60+, add this screening to your list:
Osteoporosis Screening
When: Age 65 and up
Who: Cisgender women and People assigned female at birth
If you have a family history or risk factors of any particular diseases, talk with your PCP to decide if you need earlier, more regular, or other specific screenings. Remember, prevention is better (and cheaper) than the cure!
Extra tips:
Need a New Year’s Resolution? Schedule all of your doctor appointments before the end of January so that you can cross that task off your to-do list and feel good about prioritizing your wellness
The ACA covers 100% of preventative health care. Visit Healthcare.gov for more information.
Add travel time to your appointments in your calendar
Remember to wear short sleeves to doctors appointments so they can easily take your blood pressure
We know keeping up with all of these appointments and screenings can be overwhelming. If you’re a visual organizer like us, please use our fillable guide to make sure all of your appointments are scheduled. Hang the guide on your fridge or in your office so that you’ll never miss an appointment!
Cheers to taking care of ourselves and advocating for our health in 2023!
When someone joins your family, the holidays can be more joyous than ever. Of course, the flip side of that is that when your family loses someone, the holiday season can become a painful reminder of their absence.
I am very fortunate to still have both of my parents around, and until recently, my husband did too. Doing the work that I do, I’m always cognizant that our loved ones won’t always be around. However, when my mother-in-law passed unexpectedly this year, it threw a lot of our plans into chaos.
We had holiday traditions that will be difficult to carry on, and so I’m thinking about how we can continue existing traditions while acknowledging our loss, or create new traditions that honor the time we enjoyed with her.
Here are a few options that I’ve come up with to explore this year, and as the years go on.
Go to their favorite places.
My mother-in-law, Lynn, had very eclectic tastes. She loved art museums, coffee shops, bookstores, and any place that had locally made crafts. She is the one who created my candle obsession through various gifts over the years. This year a couple of new places have opened in our neighborhood that I know she would have loved, as well as places that she and I went together that I will probably visit again.
Wear their favorite colors/styles.
My grandfather died while I was in law school. One of my favorite things that we did together was take walks. He took a walk every day and had a coat rack full of sweaters, coats, and flannel shirts for anyone who wanted to walk with him if the weather was cool. When he passed away, I was able to get a few of the cardigans from his hall tree. They no longer smell like him, but I can’t wear them without remembering all the walks we went on and the ways that those walks helped shape our family.
Make their favorite recipes or eat at their favorite restaurant.
My mother in law loved Chef’s Market in Goodlettsville. It’s where she chose for our rehearsal dinner, and where we got take out from almost every Christmas Eve. While we may skip Chef’s Market for the holidays this year, I’m going to suggest we start going there on her birthday each year.
Share stories about them. What was their favorite thing about the holidays?
Did they love going to the movies after opening presents? Were they a wonderful or horrible gift giver? The holidays are a wonderful opportunity to share memories that were made over the years.
Donate to their favorite nonprofit or help someone they loved.
Helping others is always a great way to think outside of yourself for a while. If your loved one was a teacher, maybe you make a donation to their school’s library in their memory.Kroger’s Community Rewards program makes it easy to donate to others without any added expense to you and takes only a few minutes to set up.
Maybe you use hands-free calling while running an errand to check in with someone they cared about. I’m a big fan of keeping notecards and stamps in my car so I can write out a card while someone else drives or when I have a few extra minutes before a meeting.
Visit their grave, memorial, or a place they love. Don’t be afraid to talk to them. Give them an update on what has happened through the year.
I know this may seem silly to some people. But in all likelhood there were some things you shared with your deceased loved one that might not be appreciated by anyone else. Maybe you heard a joke that you know would crack them up, or want to make sure they are caught up on the family goings-on. You can say things out loud, or just think them but having a way to continue the relationship that was so important while they were living is comforting.
Save a place for them at the table. Consider putting their picture at their place instead of a place setting.
Even if someone isn’t with us physically at the holidays, chances are that they had an impact on how you celebrate. Find physical space for your loved on in your holiday celebrations.
Read their favorite book out loud.
In Iceland there is a tradition of getting books as gifts on Christmas Eve. Then the family cozies up with their book and hot chocolate for an evening of reading. I think it’s a lovely tradition. Since Christmas Eve was the part of the holiday that we spent with my in-laws, I might suggest that we adjust this tradition to read her favorite book and drink tea instead.
Look through photos of them and favorite memories.
Many families now create photo slide shows for memorial services, and the holidays might be a good time to pull that back up on your computer, go through the photos one by one, and talk about the events happening when the picture was taken. I bet you’ll learn a few things about your loved one, and get to share some things too!
10. Make a toast to their influence on your life.
Whether your loved one preferred champagne, eggnog, or Coca-Cola, the holidays seem like the perfect time to raise a glass in their honor. Toast to the immaterial things they left you. Did your son inherit their sense of humor? Your granddaughter has their love of science? They are a piece of you, so now is a great time to honor them.
The people we love don’t leave us when they pass away, and there’s no better way to honor their memory than on the days we tend to dedicate towards family over the holidays.
Does your family have special traditions to honor loved ones? Share them with us at support@galsnashville.com.
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 info@rahnashville.net.
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.
