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April Harris Jackson

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Who should I name in my healthcare power of attorney?

Who should I name in my healthcare power of attorney?

Your medical power of attorney, also known as your healthcare power of attorney (HPOA),  should name somebody who is accessible in an emergency. This is someone who will naturally be right by your side or someone who will be available by cell phone. This person is known as your “agent” for healthcare decisions.

Who is the best person for the job?  

The ideal candidate for a healthcare agent is someone who can meet these basic qualifications: 

You trust their judgment

It’s good to have somebody who is already in a position of making decisions with you and for you. Someone who you would trust to help you in carrying out the decisions that you have made. They also need to be able to take the information you have provided them and apply it to a different situation. 

They can handle stress in an emergency

All medical emergencies are stressful. Pick an agent who has a history of making logical decisions at difficult times. 

The agent will honor your values regarding medical decisions or end-of-life care

The agent you choose should be someone who knows you very well. You have discussed your values, goals, and preferences. Make sure your agent is someone who will act as your spokesperson and advocate.

You feel comfortable speaking to them about your death, dying, or care during incapacitation

In order to have a good healthcare agent, make sure that you are both comfortable discussing your values around death and dying. This is a serious topic that deserves a well-thought-out conversation. Be prepared to discuss what quality of life you want to have and what types of treatments you would want to have to maintain it. The more you speak together about your feelings towards death, dying, and treatments if incapacitated, the better your agent will be. 

They will be available at any time

A good healthcare agent is someone who is going to be available when you need them. There’s no way for you to know when you will need your healthcare power of attorney. You need a reliable person who will answer the phone or make a return call as soon as they get the message that they are needed to make healthcare decisions for you. 

Someone who lives nearby

Oftentimes it’s a good idea to choose an agent who lives close by. While not completely necessary, it is better to have an agent who will naturally come to the hospital to be with you during an emergency. 

Someone who is younger than you

While not necessary, it is often very useful to have an agent who will likely outlive you. 

close up of a person wearing leather shoes and blue jeans. They are standing on asphalt in front of arrows that point in several directions. The largest arrow says "Medical Decisions"
Choose someone who can be your proxy for medical decisions.

In conclusion

Again, your healthcare agent should be someone who is easily accessible. Someone that you feel comfortable discussing your wishes with, even though they may be uncomfortable topics, and someone who respects your choices and would help you carry them out. Most people pick their spouse or adult child to be their healthcare agent. However, if you have a medical professional in your family, that person may be a good choice depending on their relationship with you. Ultimately it is up to you to choose someone you are comfortable with making these types of medical decisions. 

Why do you need a healthcare power of attorney?

While not all healthcare power of attorneys ever go into effect, it is important to have one in the case of an emergency. You never know when you will be unable to make decisions or communicate your decisions for yourself. If you need help with creating a healthcare power of attorney, medical directive, or other documents that formulate a well-thought-out estate plan, consider scheduling an initial call with us.  

Who should I name as my financial power of attorney?

Who should I name as my financial power of attorney?

This month we will discuss the subject of powers of attorney. In week one, we will discuss how to name a financial power of attorney. This is also known as a durable power of attorney.

There are many things to consider when appointing a financial power of attorney (aka an attorney-in-fact). This is an important position. Whoever you appoint would have the ability to make decisions regarding how you manage your finances. While it may seem obvious, it’s important to focus on choosing someone who is organized, trustworthy, and financially responsible.

What powers does an agent have when they have a financial power of attorney?

As stated earlier, the agent with a financial power of attorney can handle your finances just as you can. An agent will have the ability to go to your bank and handle banking transactions. They can contact your investment account broker and manage those funds. They can handle your insurance and sell your house. Of course, you want your agent to only make financial transactions in your best interest while you are incapacitated.

Can things go horribly wrong? Yes! Your agent has the power to clean out all of your bank accounts and sell your home. Heck, if they wanted to, they could take your assets, move to Fiji, and set up a little beach bar! I want to reiterate: It’s important that you choose someone who would never even think of doing something like that. You need to choose someone who will only have your best interest at heart.

Who should be your financial power of attorney?

When considering who should serve as a financial power of attorney, a lot of people are compelled to choose someone close to them. A lot of times this will be a relative, such as your children or possibly a sibling, but it doesn’t have to be. The agent could also be a close friend or even a professional if that is who fits that role in your life. In our practice, we like to make sure that our client acknowledges this very important point: the person you name as your agent in a financial power of attorney will have the ability to handle your finances pretty much the same as you will.

Choose an agent who can communicate effectively

Not only do you need to trust your agent, but we also recommend that you find someone that other people trust! While this element is not completely necessary, it may be important to you that your agent be relied upon to communicate important information effectively with the people in your life.

For example, if one of your relatives says to your agent: “Hey, my Aunty saved a lot of money and invested it well, how much does she have now and what has the spent money been used for?”. Ideally, you would have an agent that relatives intuitively trust to spend your funds in your interest. However, it would be really awesome if your agent took the time out of their day to respond thoroughly to your relative’s questions.

woman wearing a bright yellow sweater holding a smart phone and looking down. The caption says "3 ways online banking simplifies transactions" 1. allow direct debit from accounts 2. set up automatic payments 3. the ability to use instant transfer methods
Choose an agent that is comfortable with online banking

Your agent should be good at bookkeeping

In a perfect world, your agent with financial powers of attorney would be held accountable for the transactions coming out of your assets. A good agent can effectively answer questions about spending and back it up with good bookkeeping!

An agent with power of attorney does not have to live in your state

As we mentioned before, the era of digital banking is here and it allows us the option to choose from a larger pool of agents, regardless of their location. Now, many people think that their agent under a power of attorney cannot be someone who lives out of state. And that is simply not true. Sometimes it helps to have somebody who lives in the state, but that is not a requirement in Tennessee. We do so many things by email and telephone, texting, and online business transactions that your financial power of attorney person, your agent, will likely be handling any business transactions online. 

Choose an agent who will outlive you

While this is not a requirement, it is a good idea to think about someone who will outlive you. Generally, when you are using your power of attorney, it’s when you’re incapacitated. While there are times when a durable power of attorney is used on a temporary basis, such as during a medical event, it is more likely going to be during a period when we are at the end of our lives and are experiencing some type of ongoing health condition that is not likely to improve. We recommend that you look for an agent who can help on a continuing basis. A well-suited agent allows everyone to relax and enjoy the time you have left on this earth.

Who should NOT be your durable power of attorney

Again, while it may seem obvious, it is important to reiterate that anyone who is untrustworthy, unlikeable, terrible with money, incapable of balancing a checkbook, or unable to effectively use online banking might not be the best choice for becoming an agent of financial power of attorney. The goal is to find someone who can keep good accounting records and knows exactly where your money went, down to every last penny! A good agent is someone who is willing to communicate with everyone without hesitation. The main point is that no one in your circle should be concerned that your agent is taking advantage of you if you are incapacitated.

Now, if you are not incapacitated, your agent should only be acting if you are telling them to do so. Even if you have your power of attorney take effect immediately, your agent can and should only act under your direction. If you find that the agent acts otherwise, there are legal actions you can take against them in court. 

In conclusion

A power of attorney is a useful tool for organizing the “adulting” part of your life, especially in incapacitation. A financial power of attorney should be someone that you absolutely trust; someone who will not give pause to others in your life. Someone who is financially responsible and organized, and someone who is familiar with handling online transactions. It does not matter if your agent lives in your state. In short, find an agent you believe will always have your best interest at heart.

There are many types of powers of attorney. Many powers of attorney are used when creating a well-thought-out estate plan. Do you think you could use a durable power of attorney in Nashville? Schedule an initial call to see if we can help you with your situation.

How to Hire a Home Healthcare Provider in Middle Tennessee

How to Hire a Home Healthcare Provider in Middle Tennessee

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.

Helpful resources

How to qualify for TennCare (Tennessee’s Medicaid)

How to use TennCare Choices to pay for long-term care.

Will TennCare take my house?

Free Medicare resources.

3 Common Mistakes people make when waiting to sign up for Medicare.

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.

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. 

How to Prevent Abusive Caregiver Situations

How to Prevent Abusive Caregiver Situations

Last week we looked at red flags you should pay attention to with regards to caregivers and professionals in your network. This week we’ll look at how to prevent abusive caregiver situations and how to deal with abuse once it has occurred. Below are some actions you can take to guard against people in your network taking advantage of you. 

Things you can do now: 

Take advantage of your free yearly credit report.

You can get a free credit report from each of the three credit reporting agencies (Experian, TransUnion and Equifax). Hot tip! Space them out! Sign up to get one every four months. This will make it easier to discover any irregular activity fairly quickly.  

Ask your banker if they have completed the “BankSafe” program from AARP. 

BankSafe is a training platform designed to help financial professionals identify and stop suspected exploitations from caregivers. Ask your bank if they have participated in this training. If your bank has not had this training, encourage them to do so! Or consider moving funds to a bank or credit union that has already participated.  

Budget for paid assistance.

Remember that as much as family and friends may want to help, sometimes they can’t.  It’s important to make sure that you are able to afford assistance for things like traveling to appointments, grocery shopping, laundry, nutritious meals, cleaning, and other personal help you may need if you were injured or developed a medical condition. Endeavor to have enough of your retirement savings to ensure you can afford a positive work environment for your future caregivers. 

Power of Attorney documents on a table with a pen and manilla folder
Create a Durable Power of Attorney

Create a Durable Power of Attorney.

This Power of Attorney allows someone you trust to monitor and manage your finances, if needed. This could be a family member or close friend.  With access to bank accounts and credit card statements, they should be able to notice quickly if your spending habits change or if there is fraudulent activity on your account and they’ll be able to file a claim to protect your money! 

Things to keep in mind for later: 

Listen to your loved ones.

If you have a caregiver that is not in your family, do yourself a favor and trust a loved one’s opinion if they sense unsettling behavior from that caregiver. Sometimes others are able to see things that we are too close to observe. 

Don’t become too reliant on one person. 

You can have a housekeeper come every other week to clean the surfaces, a home health nurse to check on your health, and a food delivery service to prepare your meals or deliver groceries. Surround yourself with people who like their jobs.

Let family and friends know you welcome their visits and calls. 

Tell them what has been going on in your life and find out what is going on with them.  Maybe a few favorite snacks in the cupboard will even bring the grandkids by.  

Mother and daughter laying on bed, relaxing, visiting and smiling. Let family visit and call you to prevent abusive caregiver situations
Let family and friends know you welcome their visits

Don’t give up your routines.

Self-care is so important, we all know that! If you feel yourself falling into a slump, get outdoors, go to the store, call a friend or ask someone for help. You deserve to be loved and to love yourself. No matter what anyone says, you are the conductor of your life. 

“Stranger danger” isn’t just for children. 

As adults we get comfortable interacting with all kinds of people, but remember that not everyone has your best interest in mind. Beware of helpful people who appear out of nowhere! Trust your instincts and listen to your inner-voice. 

Don’t keep secrets.

If anyone tells you to keep a secret from your friends or family, something is very wrong. Red alert! 

Report anyone who threatens to physically harm you.

Call the police and tell your trusted loved ones. There are no second chances when it comes to your personal safety.  

smart looking older adult female wearing fashionable clothing and a red hat holding a smart phone. Practice being assertive to prevent abusive caregiver situations
Practice being assertive with others

Remember that “no” is a complete sentence.

If you are a people pleaser, practice different ways of saying “no” so you’ll be more comfortable in situations where you need to say it.