As we approach Halloween and Día de los Muertos, it seemed appropriate to get a little more matter-of-fact about deathcare resources. One end-of-life resource that we want to highlight is the option of engaging a “death doula” for those who are facing the end of their lives.
Our guest blogger this week is Ellen Abbott. We met Ellen in her role as Care Manager for Visionary Care Consultants but soon learned that we shared an interest in helping people through some of the most difficult transitions of life. Ellen completed her certification as a death doula in 2019, so we asked her to tell us more about what a death doula is and how they serve those at the end of their lives.
You may have heard recently about a “death doula” or an “end of life doula” and wondered who they are and what do they do? As a death doula myself, I’m happy to tell you!
What is a death doula?. We use midwives to educate and assist families to help bring babies into the world, why not have the same for those who are towards the end of their journey here?
There is a growing movement among end-of-life professionals in the United States to bring back the role of a non-medical person who stands in the gap between doctors, hospice, and the family of a dying loved one. This person guides the family and the client around the maze of the healthcare system, educates on hospice, offers practical information about death and provides emotional support around the entire process.
Who do death doulas serve?
A death doula serves the dying person as well as their loved ones. The goal of a death doula is to make sure that their client’s final wishes and needs are carried out before, during and after their death. This creates a healing and easier transition for the client and family.
When should a death doula be called?
You don’t have to have a terminal diagnosis to hire a death doula. There are some doulas who focus on helping their clients plan so that they know what they want at the end of life, and instructions on what the family needs to know to carry out those wishes. This is extremely helpful to the family and client since the topic of death and final wishes are not popular conversations in today’s world.
How do death doulas charge for their services?
Every death doula is different. Most offer free consultations and then an hourly rate of anywhere from $30-$100 an hour. Some offer packages for legacy planning along with being present for the client at the time of death. In middle Tennessee there is a Death Doula alliance, made up of local doulas that have been trained specifically for this role. They come from all backgrounds but usually from nursing, social work, counseling or clergy.
Over the last century, death has been viewed as a medical failure even though we all know one day we will die. A death doula helps to normalize these conversations and talk about these topics that no one wants to bring up. The death doula starts with the end in mind, to ease client’s fears, knowing they have a plan and someone at their side when the time comes.
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.
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.
There are many ways that seniors are preyed upon by scammers. Some ways are more common than others. In each instance, a scammer seeks to gain control of the elderly person’s finances or property for their own benefit. However, in order to stop fraud, it’s important to know the specifics. The following post will discuss how to help your aging parents avoid scams and fraud.
Educate Seniors About Suspicious Phone Calls
Swindlers often cold-call seniors to get personal information. Here are a few common phone scams you can look out for:
Sweepstakes scams
Inform your elder to be suspicious of phone calls stating that they have “won” a sweepstakes. These scams will try to get the senior to provide bank account information for direct deposit. They may also try to convince the senior to send a check to pay for the taxes on their “winnings”.
Grandchild scams
In this scam, an elder will receive a call from someone stating that they are a grandchild who is in trouble and in need of help. When the senior answers the phone they will hear something like this: “Grandma, it’s me… please don’t tell my parents.” The caller will then claim they are out of town and need to be wired money to make bail or to pay for travel expenses. Have a discussion with your loved ones about what to do if they receive a phone call like this. Many families create a “code word” for everyone to use. If the scammer doesn’t know the code word, then they are not who they say they are. A code word is a quick and effective way to vet emergency phone calls.
Voter registration scams
The voter registration scam is when someone calls about registering the elder to vote, asking for their address, birthday, Social Security Number, or a password or PIN code.
Healthcare scams
An elder may get a call offering discounts on health insurance or a call from someone claiming they work for the government and need a Medicare number or Social Security Number to issue a new card.
How to Help Seniors Avoid Being Scammed on the Telephone
We cannot stress how important it is to encourage seniors to never give out their personal information to strangersover the phone. Even if the people on the phone are claiming to be friends or loved ones!This is one of the best ways you can help your seniors avoid getting scammed. If your loved one is getting an exorbitant amount of phone calls from people they don’t know, consider asking them if you can change the settings on their phone to only allow notifications from numbers already found in their contacts.
If you suspect your aging parent has already been a victim of a fraud crime, report it to the National Elder Fraud Hotline 833–FRAUD–11. This hotline is a free resource created by the U.S. Department of Justice (DOJ), Office for Victims of Crime for people to report fraud against anyone age 60 or older.
Help Aging Parents Avoid Scams by Talking Openly About Finances
Ask your aging parents if they would consider allowing you to join them on their next visit to financial advisors, accountants, attorneys, and other important service providers. If you are welcome to join them, you will have a unique opportunity to prove to the providers your relationship and good intentions towards the senior. If the service provider believes that you have the senior’s best interest at heart, they may contact you when and if they believe something suspicious is going on with your loved one’s accounts.
We must warn you that becoming too involved in a loved one’s financial life may create the appearance of undue influence. It is important to help keep loved ones from being exploited, but you also don’t want to find yourself the subject of a lawsuit claiming that you are the one committing financial exploitation. Please be careful in how you approach discussing finances with the seniors in your life.
Stay Up to Date on Changes Made to Their Estate Plan
Check to see if a non-relative has been included as a representative or beneficiary, or if any relatives have been cut out of the estate plan since the last time you reviewed it. There may be perfectly reasonable explanations for these changes. However, they could also indicate that someone is trying to manipulate your loved one.
Ask Your Senior About Caretakers or Sudden “Best Friends“
Has a non-relative, long-time friend, or neighbor started spending a lot of time with your loved one? Do they suddenly have a new “best friend” or someone who takes care of them at home?
These developments could be a sign that someone is trying to work their way into an elder’s life in order to exploit them, financially or otherwise. It might seem innocent enough (and even generous!) for a new friend to “hang out” with an elder and take care of their medical and financial needs. But because of the potential for abuse, we recommend hiring caregivers through a reputable agency. Obtain reviews and make sure they have the proper licensure and training.
Making new friends and meeting people is fine, and even encouraged to minimize the isolation that many older adults face. However, it’s important to communicate with your loved ones to make sure they are not giving un-vetted people undue control over their life.
Investigate Sudden Missing Items or Extravagant New Purchases
It is important to talk with your elderly loved ones about finances so that, if they consent, you can regularly review their statements and stay up to date on other financial developments. One easy way to do this is to have the senior grant you view-only access to their bank accounts. You may also consider a paid subscription monitoring app such as EverSafe or LifeLock. These companies provide constant monitoring for any unusual activity on the accounts. This makes preventing suspicious transactions much easier.
Make sure to ask questions about weird financial transactions. Have there been any large cash transfers? Vehicles suddenly missing or new ones showing up unexpectedly? Heirloom household items that have disappeared? Fancy or expensive new gadgets showing up that are out of character for your loved one to buy? This can indicate that someone has convinced the elder to give them assets or that they have duped the elder into buying something they don’t need.
Recruit Friends, Family, Social Groups, and Neighbors to Keep a Watchful Eye on Your Senior
Keep an open dialogue with neighbors, friends, and advisors who are connected with your aging loved ones. The more people you have looking out, the less likely it is that someone can take advantage of them without your knowledge. Elder abuse is less likely when a senior has a variety of people checking in on them.
A Strong Estate Plan Can Help Aging Parents Avoid Scams
Finally, encourage your aging parents to meet privately with an experienced Elder Law Attorney to determine what they can do to protect themselves from bad actors. Having a legal document in place naming a trusted advisor, or agent, to help handle finances can protect them. An experienced Elder Law Attorney also knows what questions to ask and the warning signs to look for in suspected elder exploitation.
Other Ways You Can Help Aging Parents Avoid Scams
The main point you should take away is that it’s important to have an open dialogue with your aging parents about the variety of scam tactics out there. Send your loved ones this article about how to protect themselves. It has a lot of great tips that can be implemented right away.
Do you want help creating a Financial Power of Attorney or other legal support? Give us a call. You can schedule your free 15-minute Initial Call online. It’s easy! We are here to help.
Elder fraud and financial exploitation have become an epidemic. As a Nashville elder law attorney, I am seeing more than ever before, con artists and family members alike taking advantage of their elderly relatives, friends, or neighbors. The numbers have only gotten worse with the Covid-19 pandemic and a larger aging population.
The best defense against elder fraud is having caring friends or family with the senior’s best interests at heart. But those friends and family can only prevent elder fraud if they know how to spot it.
What is Elder Fraud?
Broadly defined, elder fraud is when someone improperly (or illegally) uses or steals a vulnerable senior’s assets. Every state has a different definition of “elder fraud” or “financial exploitation” of an elderly person. In Tennessee, financial exploitation of elders or other vulnerable adults can be prosecuted under criminal and civil laws. Edler fraud is a form of Elder Abuse.
The 3 Common Financial Scams that Victimize Seniors
A recent survey identified the three most common scenarios of financial exploitation:
Theft or diversion of funds or property by family members.
Diversion of funds or property by caregivers.
Financial scams perpetrated by strangers.
In the two most common scenarios of financial exploitation, the fraud is committed by someone who knows the elderly person. Most people think of fraud as emails from Nigerian princes or telephone scams. In reality, however, financial exploitation is commonly perpetrated by family and friends.
Another common misconception is that adults are only susceptible to elder fraud if they have a condition that can affect memory and reasoning skills. According to the Alzheimer’s Association, 15-20% of elders 65 and older have some type of mild cognitive impairment. But it is important to recognize that any senior can fall victim to elder fraud, and many do.
How Can I Help a Senior Avoid Being Scammed?
There are a number of things you can do to help prevent your loved one from being taken advantage of. Start by educating them on the tell-tale signs of elder fraud and how to protect themselves.
Most importantly, if you are concerned that a loved one is being targeted by a financial predator or a loved one with bad intentions, you should seek help as soon as possible. That may mean calling the police, your loved one’s attorney, and in some cases, even the FBI.
As an Elder Law Attorney in Nashville, I am here to guide you through any of the issues that you may be facing. To schedule an appointment, simply call schedule a free 15-minute Initial Call and we’ll see if we can provide you with some guidance on what to do to help you avoid common scams that victimize seniors.
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.
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
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.
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.
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.
