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April Harris Jackson

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Finding the right doctor for you and your needs

Right doctors for your primary care needs

So you’ve been to your primary care provider and they’ve told you it’s time to see a specialist. Or maybe they’re changing practices or retiring! Or maybe you’re looking at our list of recommended doctors appointments and realizing you need to make some new appointments as you get older. Whatever the case, now you’re tasked with finding a new doctor – and it might feel daunting.  We’ve got some tried and true recommendations to make this task just a little easier for you. 

Don’t be afraid to ask for a recommendation!  

Start with the doctor you trust – who do they recommend you visit? Maybe that’s a specialist within a greater healthcare system (Vanderbilt, St. Thomas, etc.) or maybe it’s someone who has expertise in your specific diagnosis. But don’t stop there! Next, if you’re comfortable, reach out to your family and friends to see if they have a provider whom they really like. Why do they like their doctor? If you trust their opinions, this might be a good resource for you. 

If you’re able, consider the possibility of driving to get a good doctor. Sure, they’re on the other side of town, but if they come highly recommended and you’re only going 1-2 times a year, it might be worth the traffic! 

Lastly, be sure to consider any deal breakers. This looks different for everyone, but it could include transportation factors, a specific focus in their practice, or you’re looking for a doctor of a specific gender (like a female OB/GYN). Take my example – my husband and I are child-free, so I was very pleased to find a gynecologist who doesn’t also help with childbirth. It means she is able to focus on what matters to me and isn’t away delivering a baby when my appointment time comes around. 

Check out their internet presence. 

Most offices these days have a website, listing their hours, providers, and even patient ratings of the physicians.  Do you like what you read there? Or is there something that makes you think twice? If there are comments, take the time to read those, as they may give you a deeper understanding of the provider’s demeanor and care (rather than just a 5 star rating). 

Additionally, use this website to confirm the doctor’s licensure. You can also view any disciplinary matters on your particular doctor in their Practitioner Profile on this website. 

Contact the provider’s office.

The last thing you want is to show up and find they only accept a certain type of insurance coverage! Call the office and ask if they take your insurance; you can find your information on your insurance card. Keep in mind that the staff may need to look up the information, but “I don’t know” is not an acceptable answer here. If the person who answers isn’t sure, ask to speak to someone in the billing department to verify your coverage. 

Don’t forget to also ask if you will need a referral to their office from your primary care provider. Some specialists will accept self-referrals, but your insurance company might think otherwise! 

What about a copay? 

Oftentimes, your insurance card will list a copay amount for various types of providers. If not, be sure to log in to your insurance company’s website and verify the copay, or call the number on your card to speak with a representative. Specialist visits typically have a higher copay amount than a regular PCP appointment; you will want to be prepared. 

Remember: just because you see a doctor once doesn’t mean you have to continue seeing them.  Just like any professional, you should find someone that you are comfortable with – which isn’t a reflection on the doctor or their skills, sometimes it’s something that you just have a gut feeling about and want to find a better fit.  Feel free to tell the doctor this. If you can articulate what you want, tell them and ask if they have a recommendation. They probably know other doctors in their area! 

You and your provider are a team, and by working together, you should be able to ensure you are taken care of for years to come! You have the ability to direct your healthcare and make decisions for your future; hooray for being proactive! 

Different Types of In-Home Care Services

Different Types of In-Home Care Services

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.

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.

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. 

4 Ways Scammers Try To Take Your Money!

4 Ways Scammers Try To Take Your Money!

Last week I defined elder abuse and described who is at risk. This week I want to delve deeper into the topic of financial abuse on older adults.

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

Grandparent scam

Charity scam

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.

Government impersonation

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.

Romance scams

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.

Financial advisors

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.

Home repair

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!

Funeral extortion

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.

funky lady laughing while on the phone. she is wearing a yellow sweater and bright orange sunglasses

In Conclusion

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:

  1. What steps are you taking to prevent yourself from becoming a victim of financial fraud?
  2. Do you have a financial inventory? Are you aware of what you could lose?
  3. 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!

You’re almost 65. Congrats on your Medicare Milestone!

We’ve been talking about Medicare for a few weeks now, but we haven’t gotten to the how-tos yet.  That’s about to change. Today we dig into how you actually enroll in Medicare. 

Your first Medicare enrollment period begins three months before you turn 65 and runs until three months after.  Even if you don’t sign up for any other coverage, we recommend that you sign up for Medicare Part A during this first enrollment period. 

To sign up for Part A, go to the Social Security Administration’s Medicare portal here.  It will be helpful to set up an account for when you come back to sign up for Part B or when you are ready to begin receiving retirement benefits. 

If you are signing up for Parts A and B, the process is the same. You’ll sign up through the Social Security Administration’s website. Remember that if you enroll for Part B, your premiums will either be deducted from your Social Security retirement payment or you will receive a bill. The 2021 Part B premium is $148.50 for most people.

If you are looking for a Medicare Advantage plan, Part D, or a Supplement (Medigap) plan, you will want to compare plan options using a plan comparison service.  There are insurance brokers like Kendall Chanley and Harry Perret here in town who can help you compare options and narrow things down. Once done, they will get you signed up. These services are free to you and it’s nice to have one agent who can help you each year. 

If you prefer to do things yourself or just want to do some exploring, Medicare.gov will allow you to find plans in your area and narrow them down based on what you are looking for and price ranges. I recommend filtering plans by the star ratings (four or above) and then whether you are looking for dental, vision, and prescription medicine access. 

Once you make it through your first enrollment period at age 65 (ideally), you’ll be eligible for open enrollment each year from October 15th through December 7th.  You may also have options to select coverage during a special enrollment period if you lose other coverage. 

Applying for Medicare isn’t nearly as scary as it sounds, but it does require advanced planning and research. You don’t want any deadlines sneaking up on you! Personally, I love using reminders on my calendar well in advance of any deadlines that I have. Maybe one to begin research, one to call an expert, one to compare plans, one to sign up….all before your birthday or November. 

What’s your plan for Medicare enrollment?  Head to our Facebook page to share your plans in the comments!