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
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.
What is a “spend-down”?
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
Buy some things for Bob that his Medicare did not cover, such as:
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.
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.
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.
Back to TennCare/Medicaid…
My Mom doesn’t have long-term healthcare insurance. What are my options?
Payout of pocket until you run out of cash – This is an unrealistic option for most families. Nursing home care is expensive. Not a lot of people have an extra $7,000-$11,000 a month in their bank accounts.
Do a reverse mortgage on her home.
Qualify for the TennCare / Medicaid program called “CHOICES”.
As you can see, options 1 and 2 are very unpleasant and leave nothing left for a loved one’s legacy. However, option 3, CHOICES, is definitely something worth looking into.
What is CHOICES?
CHOICES is the category of TennCare that provides Long-Term Services and Supports (LTSS) such as nursing home care.
What is the process for getting qualified for CHOICES?
In order to be eligible to receive benefits from TennCare/Medicaid your loved one must first qualify within these three categories:
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:
If you or your loved one is unlikely to get to a nine or higher on the PAE, it is always appropriate to ask for a “safety determination” evaluation as an alternative route of becoming medically eligible for Choices.
How can someone become financially eligible to receive CHOICES?
You must be able to prove that the applicant has a low income and little assets. As of January 2022, an individual applying for TennCare CHOICES cannot have an income exceeding $2,523.00 per month. Additionally, the applicant cannot have more than $2,000 in assets. This includes any money in the bank and investment accounts but also requires consideration of retirement accounts, life insurance policies, real estate, artwork, jewelry, and any other valuables. When we talk about the assets for a couple of things get a little more complex. The most important thing is that both the applicant and their family are taken care of, both medically and financially.
My Mom is over the limits for income and assets? What do we do?
If the applicant is in excess of the amounts we can plan for that! We have a tool to help people who have excess income and assets yet need to qualify for TennCare/Medicaid called the “Care and Savings Assessment”. With this Care and Savings Assessment, we work to determine the best way to structure you or your loved one’s finances, either now or in the future. We plan so that our clients have the peace of mind knowing they can qualify for TennCare if and when they need it!
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.
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.
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.
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.
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.
The first step in protecting yourself from scammers is to crawl under a rock… I’m just joking! But seriously, scammers are everywhere and target everyone. But the easier it is to find your information, the easier it is for them to contact you. Here are some things you can do today:
Opt out of “people” search engines. Here are the basic steps for opting out of people search engines: – First: Do an internet search on yourself. Where is your information listed? – Next: Find your listing on each website. Once you have the listing, write down the URL or ID number. – Finally: Use the IRL or ID for your listing and enter them into the opt out pages for each search engine.
Here are a few of the people search engine links to get you started:
While it may take a little time and effort, it is beneficial to your sanity to request your information be taken off of these websites!
Unsubscribe from email listings whenever possible. If you find you are suddenly getting emails for a business or organization you didn’t sign up for, simply label it “Junk” and move on. Your email provider will take care of the rest.
Do a privacy check up on your social media accounts. Set high limits on security and privacy on your social media accounts. Don’t let strangers message you. Unfriend anyone you don’t personally know.
The next step in fortifying your finances is to be overly cautious when talking to people you don’t know.
Don’t answer phone calls from numbers that are not programmed into your contacts. If it’s important, they will leave you a voicemail. If you accidentally answer the phone and you have no idea who is calling, don’t say anything other than normal pleasantries such as “hello” or “oh, that’s interesting”. Have a “refusal” script handy near the phone. It’s perfectly okay to say “I have to go now…” and simply hang up.
Create a “secret word” – The easiest way to protect yourself from a telemarketing or grandparent scam is to create a secret word. A secret word is a “code word” or phrase that only your loved ones will know. If the caller doesn’t know the secret word, then they don’t know you.
Follow the proper channels for communicating with government services. The IRS, Medicare, and Social Security will never call you! Nor will any correspondence be an emergency! There’s too much bureaucracy for urgency. For example, if the IRS wants to get in touch, they will send an official letter. That guy on the phone telling you that you owe past taxes and will go to jail is not from the IRS- he’s a scammer! And finally, never give your Medicare or Social Security information over the phone unless you initiated the phone call directly to the agency.
And finally here are some other very smart ways to stop scams:
Never click on a link within an email. I know this is a hard and fast rule, but the extra time it takes to navigate to a website outside of your email is worth your financial safety.
Don’t rush into making major financial decisions. Shop around and do your research before altering your home mortgage, making major home repairs, or changing your investments. Review all contracts until you are comfortable that you understand what you are required to do, what the other party must do, and what happens if something goes wrong. And finally, don’t hesitate to have someone else review your important documents.
Subscribe to a fraud monitoring plan. If you don’t want to fuss around with monitoring your credit or data on the web use a credit monitoring subscription instead. Companies such as LifeLock and EverSafe offer paid subscriptions that monitor your information and alert you to suspicious activity.
Set up safeguards at the bank. If someone else assists you with making purchases, consider giving them a credit or debit card with pre-set limits. Additionally, make sure your caregiver is being paid a fair wage and has fair amounts of time off- this will reduce the financial pressure on them to steal.
Create a trust. Creating a trust is a great way to have control over what happens to your assets, especially if you become incapacitated. Trusts aren’t easy to change and provide rules and limitations over who has access to your assets.
If possible, hire a team. Life is much less complicated when you have a professional accountant, financial advisor, and attorney on your side. Leave the legal and financial details to the people who keep up to date on the current federal rules and regulations.
And most importantly: Do not become isolated. No one gets through life alone. We all need a village to help more or less at certain stages of life. Just like you would have a neighbor keep an eye on your house during vacation, having a support system keeping an eye out for you is always a good thing. And you can do the same for them!
I hope this list has motivated you to reassess your financial security measures. There are so many actions that you can do today! Which one are you going to do first?
If you’re looking for an attorney who focuses on Elder Law, please don’t hesitate to reach out. It costs nothing to schedule a 15 minute consultation with the team at GALS!
As we gracefully age, we become targets for some crafty criminals who will entice you to give them your personal information and money. Most of the time we don’t realize it’s happening until it’s too late! Here’s a detailed list of the top scams commonly used on older adults to take their money.
1. Telephone Scams on the Elderly
This is one of the most popular telephone scams on older adults. It is a sinister scam as it preys on your emotions. Basically, a con artist will call posing as a frantic family member who is in serious distress or trouble. They may also pretend to be a lawyer or police officer that is calling on the behalf of the troubled grandchild. The goal is to get you to wire money immediately or give a bunch of cash to a courier. If successful, the scammers will likely continue to call for money.
If you receive a phone call asking you to donate to a charity for a recent disaster, it is likely a scam. Do your research and only donate to charities you’ve fully vetted.
The IRS, Medicare, Social Security or other government offices will never call you! For example, if a fake IRS agent calls you with aggressive threats saying you owe money and must pay immediately, it is a scam! The government does not contact people this way and they don’t work this fast either (we all know this from personal experience). Typically, the government will contact you via USPS mail.
Unexpected prize and lottery scams
These scams bait you into thinking you must pay a “fee” to collect a prize you’ve won. This scam relies on you forgetting that you have entered the competition. These scams can come at you via telephone, email, mail, text message and social media.
Tech support scams
If you receive a phone call from someone claiming to be tech support, hang up! In this scam, someone will contact you via phone, pop-up, or email saying you have a security breach within your computer. They will ask you for your username and password or ask you for permission to remotely take over your computer. The goal of the scammer is to find your confidential information and use it to take your money!
2. Computer Scams on Older Adults
SMS or email phishing scams
Phishing scams come from well-known sources such as your bank or investment company. These messages look legit and prompt you to click on links that redirect to fake websites. Once you enter your username and password into the fake website, the hackers have your credentials and have control over your accounts.
Malware and ransomware
You will see this scam in emails and on social media. The goal of the scammer is to get you to click on a link in an email or an interesting article. Once you are on their website, they will ask you to download some software. Unfortunately the software contains a virus designed to steal your personal information. Sometimes the hacker will hold the information on your computer “hostage” until you pay a ransom. If you pay the ransom, there is no guarantee your computer will be unlocked.
There are a lot of scammers who pretend to be looking for love on social networking and dating apps. These scammers use a fake identity and manipulate you into giving them your money!
3. Fraudulent Business that Target Older Adults
Legitimate services with illegitimate businesses
As an older adult you will be heavily marketed for a reverse mortgage, credit repair, or refinancing. There are a lot of fake businesses that will offer you free homes, investment opportunities, and foreclosure or refinance assistance. If it’s too good to be true, it probably is!
Counterfeit prescription drugs
Not only does this scam hurt your wallet, it hurts your health. There are a lot of fake websites that are more than happy to sell you counterfeit prescriptions.
Fake Anti-aging products that scam older adults
Online shopping has made it easier for criminals to sell you anti-aging cosmetics. Unfortunately you might be buying a product that contains arsenic, beryllium, cadmium, aluminum, and biological contaminants. These products are unsafe and really gross!
4. Tricky People who “Help” Older Adults
Caregivers who scam the elderly
It’s natural to trust those who are close to you. This includes hired help and family members or friends who provide you with caregiving services. Unfortunately there are tricky people out there who will manipulate or outright steal your money and possessions.
While most financial advisors are trustworthy, there are a few rotten ones out there that like to scam older adults. These “advisors” might make trades that line their pocket yet empty yours. They might try to involve you in a Ponzi scheme, promise unrealistic returns, or simply walk off with your money because they aren’t who they say they are.
Beware the door-to-door salesman offering to repair your roof for cheap because they have leftover material from another job. Also beware the “repairman” who asks to inspect your home without you asking. These scammers want you to pay cash up front and are not bonded and insured. Never prepay for services you might not receive!
Another tricky person is the funeral director who tries to sell you something you don’t need such as a casket when your loved one is being cremated. These funeral directors are counting on you being confused because of your grief and loss.
While this list was fairly detailed, it is not exhaustive! New methods to scam older adults appear every day. Make it a habit to check the federal agency websites to stay up to date about current financial scams. I want you to be aware of what’s out there!
And finally, I want you to think:
What steps are you taking to prevent yourself from becoming a victim of financial fraud?
Do you have a financial inventory? Are you aware of what you could lose?
Do you have a plan for protecting your finances in the future?
In my next blog I will discuss several methods you can use to protect yourself and your money!
October is Fraud and Financial Awareness Month. For this reason, I think it is a great time to share with you some information about elder abuse and financial scams. As you know, our firm assists a lot of older or vulnerable adults and we enjoy being able to help protect individuals and families from harm. Over the next few weeks, I will introduce the topic of elder abuse and discuss who is at risk. I will also explain why older adults are often a target of abuse and the various types of scams used. Finally, I talk about what to watch for and some ideas on how you can protect those around you.
How common is elder abuse in America?
There are higher rates of elder abuse in the United States than in most countries. The National Council on Aging reported that about 10% of older Americans have experienced some form of elder abuse, with many of the victims exploited more than once. Unfortunately, a high percentage of these crimes go unreported. Therefore it is estimated that only 1 in 24 instances of abuse are actually reported. Understandably, these are alarming statistics!
[A] single or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person. This type of violence constitutes a violation of human rights and includes physical, sexual, psychological, and emotional abuse; financial and material abuse; abandonment; neglect; and serious loss of dignity and respect.
Who is at risk for elder abuse?
Many older adults experience medical conditions that can lead to a reliance on a larger network of people to assist with day-to-day activities. This leaves the elder exposed to more opportunities for elder abuse. Unfortunately, this is all too common. Many of us have heard stories about friends and family members being victims. Below is a list of those who are at higher risk for elder abuse:
Individuals who live with mental or physical disabilities.
An elder who lives with someone who is financially dependent on, emotionally disconnected with or resentful of the vulnerable adult.
Socially isolated individuals.
An elder who lacks familial connections or financial means.
Elders who live in institutions or long-term care facilities.
Do you know an aging person who has been exploited or neglected?
Can you think of an instance where an elderly person in your network has been taken advantage of? Is someone in your family receiving phone calls demanding them to pay back taxes? Has a relative suddenly started dating a prince overseas?
These situations are just a fraction of the examples of elder abuse. The rest of the posts this month will go over the most common ways elders are financially exploited, how to spot tricky behavior from others, and what to do if you or someone you care about is a victim.