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.
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.
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!
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!
I don’t know about you, but I don’t plan to retire at 65. I mean, that’s only 25 years away. And I like my job. Maybe that’s you.
Even still, don’t put off signing up for Medicare when you turn 65. Here’s Why.
Mistake #1: Waiting until after you retire to sign up for Part A.
Why it’s a mistake: Medicare is basically free money. You paid for it with your taxes for the past forty-some years…but still.
Ultimately here’s the deal–you CAN wait. But since it’s no skin off your back, wouldn’t you rather set it and forget it? Think about that time you set up automatic payments into your savings account or 401k. You may not have missed the money, but when you got your tax forms, you saw the benefit of making a small change. It’s the same here. Signing up for Part A is easy, and makes the process of signing up for Part B or a Medicare Advantage plan much easier.
Mistake #2: Staying on private health insurance coverage instead of signing up for Part B, without doing further research.
Why it’s a mistake: The plan you are currently on may not provide enough coverage.
If you plan to stay on your current coverage instead of signing up for Part B as soon as you turn 65, you want to make sure that your health plan provides appropriate coverage. We’re talking about a qualified group health plan (as defined by the IRS). If you’ve ever had to provide proof of “creditable coverage” for plan enrollment, this is similar. Otherwise, you will pay a penalty when you sign up for Part B coverage. This penalty is paid with each premium payment and never goes away. The longer you are eligible for Part B without signing up, the more the penalty costs. Do your future self a favor and get HR to confirm (in writing) that your current coverage meets the requirements.
Mistake #3: Assuming that your current insurance plan will continue to be available after you become eligible for Medicare
Why it’s a mistake: Believe it or not, some insurance plans and employers will not cover you (or your spouse) if there is other coverage available elsewhere. That includes Medicare. Medicare enrollment begins three months before you turn 65 and lasts three months after. Start looking at your options early to make sure you don’t get left without insurance unexpectedly.
Whatever you decide about retirement, make sure that you have the information you need to make good, informed decisions.
Next week we’ll be getting into the nitty-gritty of how to actually sign up for Medicare. Make sure to follow us on Facebook or Instagram to see when the blog gets posted!
Healthcare in America is…..complicated. Medicare ensures that most people 65 and older have access to basic care for hospitalization and doctor’s care.
But what else does it include? That’s a great question….because it all depends on what you sign up for. Some of it will depend on the specific plan you sign up for but all plans include core services. If we talk about Part A or Part B coverage, a Medicare Advantage plan (Part C) automatically includes these same services. If you didn’t catch our Medicare 101 post last week, go catch up here.
I had the good fortune to go through a training hosted by the State Health Insurance Program a few years ago that really opened my eyes to how Medicare coverage works. It was one of my first steps into the realm of elder law.
Since then, I’ve helped clients who are on Medicare and helped my parents navigate the process too when my Dad turned 65. I wanted to share some of my favorite free resources to find out information about Medicare. Depending on whether you like to keep things old school, or want things as paperless as possible- there’s an option for everyone!
By mail- When you sign up for Medicare, you will get a Medicare and You handbook that is useful for helping you figure out what is included in Parts A and B. It is easy to read and understand exactly what your coverage includes.
By phone- As I mentioned above, the State Health Insurance Program (SHIP) is an awesome program that helps Tennesseans find the right health care plans for them. You can reach them at 1-877-801-0044 or, in the before times, at local health fairs. Just remember that they are staffed by volunteers and might take some time to call you back. If you’d like to become a volunteer, they would love to have you!
Online: Yes, I know that government websites don’t have the best reputation for having easily accessible information. But trust me….Medicare.gov is different. Whether you just want to learn about Medicare, compare plan options, or look for a new doctor, this website makes it simple to find what you’re looking for.
In your pocket- The Medicare “What’s Covered” App is available for Apple and Android user. You can open your phone to find out if a service or treatment your doctor recommends is covered and how much it is likely to cost out of your pocket. I’m pretty jealous that my insurance company doesn’t offer this.
All of these options now have online availability (check out those lovely blue links). Regardless of how you prefer to absorb information, I hope you’ll find one resource that is your favorite. We will be polling our social media readers on Facebook and Instagram this month to see what their favorite Medicare resources are…..we hope we’ll see you there!