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April Harris Jackson

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Is Assisted Living Right for Grandma After a Reindeer Attack?

Is Assisted Living Right for Grandma After a Reindeer Attack?

Is a care community the right place for your loved ones? There are a lot of terms out there for what living situations can look like as you age, and it’s easy to get them mixed up. Luckily, it’s not as confusing as it sounds.

Today we will discuss assisted living facilities: what they are, what they can do for your loved ones, and potential drawbacks.

Getting informed about your options is the first step in making the best choice for your family’s needs. It also means that you can be the expert the next time someone throws up their hands and asks, “What is the difference between a nursing home and assisted living?”

What is an Assisted Living Facility?  

An assisted living facility (ALF) is a residential option for individuals who require assistance with daily activities but do not need the level of care provided in a nursing home. These facilities offer a combination of housing, support services, and personalized care to promote independence and well-being. Think of assisted living as an apartment complex with friendly neighbors that happens to have trained caregivers on staff.

On the flip side, a skilled nursing facility, AKA nursing home, is a residential care facility designed for the long-term care of adults with serious health conditions. People living in an assisted living facility can still manage their independence and well-being, while nursing homes are for those who need more help.

Benefits of Assisted Living Facilities

Here are the pros of ALFs:

  • Professional Care and Assistance: Trained caregivers assist with tasks such as bathing, dressing, medication management, and mobility. This professional care ensures that residents receive the support they need to maintain their health and well-being.
  • Safe and Secure Environment: Assisted living facilities prioritize the safety of their residents. They have safety measures in place, such as emergency call systems, 24/7 staff availability, and secure premises. This creates a secure environment where residents can feel protected and have peace of mind.
  • Opportunities for Socialization: Your loved one can participate in a built-in community of peers, providing opportunities for socialization and companionship. Various social activities, events, and outings allow friendships to bloom and reduce feelings of loneliness and isolation.
  • Access to Amenities and Services: Assisted living facilities often provide a range of amenities, such as dining services, housekeeping, transportation, and recreational activities. These amenities enhance the quality of life for residents and make daily living more convenient and enjoyable.

Drawbacks of Assisted Living Facilities

Here are the cons of ALFs:

  • Lack of Independence: Moving into an assisted living facility may require some adjustment, as it can mean a loss of independence for adults used to living on their own. The level of independence can vary depending on the facility and the person’s needs.
  • Costs and Financial Considerations: Assisted living facilities can be expensive, and the cost is not covered by Medicare. It’s also not typically covered by Medicaid either, but it could be covered by long-term care insurance. It’s essential to consider the financial implications and assess if the cost is manageable for your family in the long term.
  • Adjustment Period and Potential Discomfort: Moving to a new environment can be challenging for some people, especially if they have lived independently for a long time. It may take time to adjust to the new surroundings and routines, which can cause initial discomfort.
  • Potential for Limited Personal Care Options: While assisted living facilities offer a certain level of care, it may not be as personalized as individualized home care. Some people may have specific care needs that cannot be fully met within the facility’s structure.
  • Downsizing to a Smaller Living Space: Going into a small apartment at an assisted living facility from a multi-bedroom home is a huge adjustment. Many people spend their entire lives collecting things that need to be sorted through and majorly downsized or moved into storage.

Factors to Consider When Choosing an Assisted Living Facility

Not sure what to think about? Here you go:

    • Location and Accessibility: Think about where their support system is located, as well as amenities and healthcare services. Accessible transportation options and a convenient location can make it easier for loved ones to visit and for residents to engage in community activities. If location is a dealbreaker, consider in-home care instead.
    • Quality of Care: Research the facility’s reputation and quality of care. Look for certifications, accreditations, and licensing information.
    • Staff-to-Resident Ratio: Ask about the staff-to-resident ratio to ensure that there are enough caregivers available to provide personalized attention and care. A low staff-to-resident ratio can indicate that residents may not receive adequate support.
    • Turnover Rate: Everything is a bit more complicated after COVID, but finding out how many of the nurses/CNAs have been there over a year can be a good indicator of how consistent the care is at that facility.
    • Available Services and Amenities: Review the services and amenities offered by the facility. Consider the specific needs and preferences of your loved one and ensure that the facility can meet those requirements. This may include dietary accommodations, transportation, housekeeping, and recreational activities.
    • Costs and Affordability: Evaluate the cost structure and understand what is included in the fees. Inquire about any additional charges or potential increases in the future. You’ll want to make sure that the facility’s costs align with your budget and financial capabilities.
    • Reviews and Recommendations: Seek out reviews and recommendations from residents and families with experience with the facility. Their firsthand insights can provide valuable information about the quality of care, staff, and overall resident satisfaction. You can also ask friends about where their family members who need care have lived.
    • Gut Instinct: Make sure you tour options before making a final decision. Sometimes you will get a feeling that something is off or not a good fit, and sometimes you will know that the care community is a great fit for you or your loved one.

Independence with a Little Help

If your mom’s joints are starting to slow her down, but she’s still independent enough to defend her position as the best bridge player in her weekly group, an assisted living facility might be the right choice for her. 

 

There are also independent living facilities (like retirement facilities/retirement dorms) that accommodate those who need a little bit of help but don’t need as much control over where they go and what they do. 

 

Assisted living facilities offer help when residents need it and space when they don’t, allowing your family members to retain their independence and helping you keep your peace of mind. Going through any major living change can be hard, and your loved ones may struggle with the idea of potentially losing their independence. 

 

It’s also wise to choose an assisted living facility attached to a retirement home, as it provides a quick transition for your loved one if their situation declines.

(No one wants to have to look for another facility or worry that the facility they’re at doesn’t provide the care their family member needs!)

These are called “step-up” or “step-down” facilities, enabling you to relax knowing that, no matter what happens to your loved one’s health, you’ve planned for their needs.

 

Your support and research into potential facilities is crucial. Weighing all the factors allows you to make an informed decision that best suits your loved ones’ needs. Sometimes what your loved ones need is a new community to be a part of (and to beat at cards).

 

Check out our blog for more advice about caring for your loved ones as they age.

Will TennCare Choices pay for my Mother’s nursing home?

Last week we defined TennCare and how it applies to our clients. This week I want to go more in-depth with how TennCare serves Tennesseans with long-term care. 

Many people believe that Medicare benefits will cover nursing home care once an individual is 65 or older, but this simply isn’t true. While Medicare covers the first 100 days, it doesn’t cover long-term assisted living. Read more about Medicare here

TennCare Choices logo for Tennessee Medicaid Long-Term Services and Support
Choices” is Tennessee’s Medicaid program for long-term care services and support

Back to TennCare/Medicaid…

My Mom doesn’t have long-term healthcare insurance. What are my options? 

  1. Payout of pocket until you run out of cash – This is an unrealistic option for most families. Nursing home care is expensive. Not a lot of people have an extra $7,000-$11,000 a month in their bank accounts.  
  2. Do a reverse mortgage on her home. 
  3. Qualify for the TennCare / Medicaid program called “CHOICES”

As you can see, options 1 and 2 are very unpleasant and leave nothing left for a loved one’s legacy. However, option 3, CHOICES, is definitely something worth looking into.

What is CHOICES?

CHOICES is the category of TennCare that provides Long-Term Services and Supports (LTSS) such as nursing home care.

What is the process for getting qualified for CHOICES?

In order to be eligible to receive benefits from TennCare/Medicaid your loved one must first qualify within these three categories:  

  1. Medical eligibility 
  2. Income threshold
  3. Asset threshold
Wheelchair bound woman looking up at a nurse in white while at a nursing home for long-term care
Being medically and financially eligible is necessary for TennCare approval

How does someone become medically eligible for TennCare CHOICES?

The state of Tennessee will determine who is medically eligible to receive TennCare Long-Term Services and Support (LTSS) by using a pre-admission evaluation (PAE). This PAE is used to determine if the applicant can do basic life skills on their own without help. The PAE will also determine if the applicant is safe in their current environment. 

The PAE is a strict evaluation and it is performed on a case-by-case basis. An applicant must receive a score of 9 or higher on a 26 point scale in order to be considered medically eligible for TennCare Long-Term Support Services. 

For example, a caregiver or healthcare provider may be asked about a patient’s level of ability to do things and how much assistance is needed. 

The following Activities of Daily Living (ADLs) are covered in the PAE evaluation: 

  • Transfering
  • Mobility
  • Communication
  • Medication
  • Orientation
  • Eating
  • Behavior

If you or your loved one is unlikely to get to a nine or higher on the PAE, it is always appropriate to ask for a “safety determination” evaluation as an alternative route of becoming medically eligible for Choices. 

How can someone become financially eligible to receive CHOICES

You must be able to prove that the applicant has a low income and little assets. As of January 2022, an individual applying for TennCare CHOICES cannot have an income exceeding $2,523.00 per month. Additionally, the applicant cannot have more than $2,000 in assets. This includes any money in the bank and investment accounts but also requires consideration of retirement accounts, life insurance policies, real estate, artwork, jewelry, and any other valuables. When we talk about the assets for a couple of things get a little more complex. The most important thing is that both the applicant and their family are taken care of, both medically and financially. 

Graceful Aging Legal Services, PLLC Logo for the Care and Savings Assessment - It is a graph with lines slowly going down.

My Mom is over the limits for income and assets? What do we do? 

If the applicant is in excess of the amounts we can plan for that! We have a tool to help people who have excess income and assets yet need to qualify for TennCare/Medicaid called the “Care and Savings Assessment”. With this Care and Savings Assessment, we work to determine the best way to structure you or your loved one’s finances, either now or in the future. We plan so that our clients have the peace of mind knowing they can qualify for TennCare if and when they need it! 

In conclusion 

It is often helpful to have an attorney assess your financial situation and offer recommendations on how those finances may be restructured to qualify for TennCare Long-Term Services and Support (LTSS). As an experienced TennCare planning attorney, I can help you evaluate your risk and create a plan that takes care of everyone in the family.

Are you ready for help with TennCare planning? Contact us and we can discuss your plan. Next week we will go over some examples of how we restructure an individual’s finances to meet their needs for long-term care. 

How can I plan long-term care with TennCare?

TennCare is Medicaid

What is TennCare? (A brief overview of Medicaid)

Quite simply, TennCare is Tennessee’s Medicaid program. While the name “TennCare” has the word “care” in it, it is NOT Medicare. In order to further clarify the difference between the terms “Medicaid” and “Medicare,” you need to remember that we use “Medicare” to “care” for our elders and “Medicaid” to “aid” those, of any age, in need. Essentially TennCare is Tennessee’s brand of Medicaid. Hopefully, that little trick will help you remember the differences between each program. 

Who qualifies for TennCare?

Now that you are familiar with the difference between Medicare and Medicaid, let’s discuss who qualifies for TennCare (Medicaid). 

There are three qualification criteria that you must meet in order to obtain Medicaid/TennCare. 

1. Medical qualification There is a special medical test that applicants must pass in order to qualify.  Usually, a care facility will handle this piece of the Medicaid application. 

2. Asset qualification – A TennCare applicant who is single can only have $2,000.00 in assets before they are eligible for TennCare.  Vehicles and real estate are usually exempt from the count of assets. A “Care and Savings Assessment” is a good place to start if the applicant needs help with figuring out what they have in assets and what options are available to make excess assets “non-countable” for TennCare purposes. 

3. Income qualification – A TennCare applicant can only receive $2,382.00 per month (as of 2021) in order to receive TennCare. If an applicant has more than this amount in income, an attorney can resolve it through what is called a Miller Trust or a Qualified Income Trust.

Long-term care is very expensive

Why should I be concerned about long-term care services?

Unless you are a millionaire or multi-millionaire, TennCare eligibility and designation could have a major impact on your finances and your family. While you may not need TennCare now, you will want to plan as if you will need it in the future. As you may have heard us say before “we hope for the best, and plan for the worst.” Having a plan is an effective way to ensure that you will have long-term care coverage when you need it. This isn’t to say that you won’t find yourself needing TennCare much sooner than expected. When this happens we call it “TennCare Crisis Planning”. 

Knowing your options makes all the difference

I don’t know where to start!

The biggest obstacle to TennCare planning is determining what to do with your assets and income; especially if there is excess in any category. There are a lot of rules and potential pitfalls that you need to look out for. Fortunately, we have some great financial planning and legal resources that can help our clients. If you have an immediate need for TennCare or want to plan for TennCare we can supply the client with what we call a “Care and Savings Assessment”. It’s a wonderful tool that helps people effectively navigate through their options.

How do we help our estate planning clients with TennCare planning?

For our estate planning clients, we like to take into consideration the possibility that you may need TennCare in the future. 

For example, it is our priority to set up our client estate plans to make sure that TennCare is accessible if it is ever needed.  As with many government organizations, Medicaid has lots of rules to follow and many people find that they did not know what rules they were supposed to be following until it was too late!   Fortunately for our clients, we know the rules and can help you plan in advance of ever needing to apply for TennCare to cover medical care.  Additionally, we create documents that make sure that someone can apply for Tenncare on your behalf. This is useful if you become incapacitated in the future. 

How do we help our Conservatorship clients with TennCare? 

Many of our conservatorship clients are caregivers for a loved one who requires skilled nursing to keep them safe. The average cost for this type of care is about $7,000.00 per month or more.  There is usually a large gap between monthly income and fees.  Our firm can navigate the TennCare application process and assure that the appropriate language is in the conservatorship order paperwork with the court so that the client may obtain the appropriate benefits for their loved one.  

How do we help clients with TennCare Crisis planning? 

For those who have never considered the cost of long-term care until they or a loved one need to enter a nursing facility, the cost of care is likely to come as a shock- and an unaffordable, but necessary, expense.  This is when we can step in with what we call “crisis planning,” meaning that you need a plan and you need a plan now

In these cases, we are able to look at the household financial situation of the person needing skilled care, as well as the family situation overall, and come up with a plan for how to best use existing resources and get them qualified for TennCare benefits to pay for the nursing home bills. This process called our “Care and Savings Assessment”,  is one of the most rewarding things that we do!  It allows us to help people get the care that they need while still providing a quality of life for themselves and their families. 

If you are concerned about accessing TennCare benefits for long-term care, contact our office for a complimentary initial call using our online calendar here

Read our article about Medicare planning.

Have you thought about qualifying for TennCare in the future?
Will the Government Take Your Assets if You Do Not Have a Will in Place?

Will the Government Take Your Assets if You Do Not Have a Will in Place?

One concern I frequently hear is a worry that the government will take assets from a loved one or take assets from an estate instead of family members inheriting it. These are valid concerns because there are specific instances where this can happen, but as a general rule, the government DOES NOT take assets unless they have a legal reason for doing so.

The State of Tennessee will not take your assets

There are a few instances where the government will take your assets if you die without a will. For example, if someone received Medicaid (TennCare) to pay for long-term care, if they owed back taxes, or if no family members can be located. But, as a general rule, the State of Tennessee is not going to take your assets.

Tennessee will find your closest heirs

The State of Tennessee has a statute that lays out how your assets will pass if you die without a will. Your assets will pass to what we call your heirs at law. Those are really the people that you probably think of as your closest relatives: your spouse, your children, your grandchildren, your parents, your siblings, your nieces and nephews, your cousins, and farther out. But it’s the close relatives that the state will seek out.

Generally, the government is going to look for anyone related to you before they get any money. I hope that sharing this information with you has given you a sense of relief if you were told inaccurate information elsewhere.

If you have other questions about your estate or that of a loved one, click here to schedule a call with us.