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.
“ 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?
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:
Medical eligibility
Income threshold
Asset threshold
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.
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.
Probate is the name for the legal process of distributing assets after someone passes away. These assets can include bank accounts, real estate, vehicles, retirement accounts, life insurance, and financial investments. Before the assets can be distributed, however, they must first be gathered and used to pay creditors.
After that, the heirs can finally receive their distribution of the estate. However, even then, there are several factors that can still delay the distribution process. In our practice, it is common for probate to last about nine months. In more complex cases, probate can easily last several more months or even years. These delays ultimately mean less money and more headache for the surviving family.
Let’s go through the factors that cause delays in probate, and discuss what steps can be taken to minimize the delay.
1. Passing away without an Estate Plan
If you pass away without an estate plan, your loved ones will have to go to probate court. The court will appoint someone among them to be the “Personal Representative.” The Personal Representative will be responsible for contacting all of the financial institutions about your death. They will also be responsible for using your funds to pay creditors and ultimately make distributions to your heirs.
When there is no estate plan, the process for appointing a Personal Representative can be seriously delayed. The family will have to come to a consensus on who the Personal Representative will be before they present their choice to the court. Moreover, whoever is selected as Personal Representative is often not prepared for the role, as they had not been told to expect it. The process of going through all of your finances and contacting all of your financial institutions might be overwhelming for them, especially if they did not know your finances very well. Moreover, they will be responsible for mediating tension between the family, which is made even more difficult if members of the family do not think you explicitly wanted them to serve as Personal Representative.
Having an estate plan would minimize all of these consequences and delays. By having an estate plan, your family will already know who you want to represent your estate, which will make the process for appointing a representative much smoother. The person you select to represent your estate will also be better prepared for the role, as they are aware that they will one day need to fulfill the role.
The best way to minimize delays in probate is thus to have a clear estate plan in place, and to let your family and loved ones know about your intentions.
2. Family Tension
Even with an estate plan, family dynamics can still play a major role in probate. For example, if the only major asset that you have at the time of your death is your house, and one of your heirs would like to live in it while the other heirs would rather sell it and keep the sale value, tension will ensue and attorneys may need to get involved. All of this will ultimately lead to a delay of the probate process, and may ultimately divide the family in an irreparable way.
Feuds such as the one described happen even in the most loving of families. To avoid these feuds, it is important to not only have an estate plan, but to have one drafted by an experienced estate planning attorney. An experienced estate planning attorney will be familiar with cases such as the one described and will be able to help you think through exactly what you would want to happen if these cases occur. Your estate plan will thus be better able to help your family navigate your precise wishes for your assets, ultimately easing tension and expediting the probate process.
Hiring an estate planning attorney to draft your estate plan is one of the most important steps you can take to minimize probate delays.
3. Financial Complications
If you keep your finances private, it will be difficult for your intended heirs to know what to expect after you pass away. They may not even know where you bank and what financial investments you have. The more difficult it is for them to know your finances, the more difficult it will be for them to notify your financial institutions of your death and gather accounts.
Furthermore, if you are in debt or are not paying your taxes, your Personal Representative will be responsible for using your assets to pay your creditors and the IRS. This can cause serious delays to the probate process, especially if the Personal Representative was unaware. Creditors will ensure they receive their payments by filing claims against the estate through probate court. These claims ultimately slow down the probate process as each claim requires a hearing before a judge.
To save your family time, headache, and grief after your death, it is important that you keep your finances in order. Pay off debt when you can, and keep a clear record of it. File your yearly taxes appropriately. Let your loved ones (especially your Personal Representative) know of your finances and how to contact each financial institution in case something happens.
Even in the best of cases, probate takes a while. To minimize delays, we recommend having an experienced estate planning attorney draft your estate plan, clearly telling your loved ones of your intentions, and keeping your finances in order as much as possible. Your loved ones will already be filled with grief after your death. The best gift you can give them is preparation.
Here at Graceful Aging Legal Services, we offer software that can help our clients keep their estate in order. Contact us at 615-846-6201 or hello@galsnashville.com if interested.
As a child, our parents are responsible for making sure we get our regular check ups and vaccinations, but as an adult- throw in figuring out health insurance- things get so much more complicated!
Scheduling doctor appointments is a necessary task that can come with a lot of headache and uncertainty. How often should we go? Where do you find a primary care physician????
Just like you get your car a check up before you go on a long trip, it’s important to regularly check in with appropriate medical professionals in order to prevent a bigger health crisis down the road. Which screenings do we need throughout our life and at what intervals? Let us help you relieve some of that stress by following these scheduling and screening tips!
Read on for a list of appointments you should make this year, and remember to ask if your insurance is in-network when you schedule! We’ve got a handy tool at the end of this article to help you keep track of your appointments.
Appointments for All Adults 18+
Primary care physician (PCP)
When: Annually
Who: Everyone. Seeing a PCP on a regular basis is the best way to monitor your wellness. Your PCP will be able to help you make an informed decision on what appointments you should add to your annual list.
Dentist
When: Every 6 months
Who: Everyone
Gynecologist
When: Annually or if pregnant/trying to conceive
Who: People with female reproductive systems. It is recommended that you begin annual gynecologist visits as a teenager or after you become sexually active. Regardless of sexual activity, it is recommended that your first visit be by age 21 at the latest. If you have a new sexual partner, an STI test is recommended. If you regularly have more than one sexual partner, it might be wise to have a STI and Pap test every 6 months.
Eye doctor
When: If you have healthy vision, schedule a visit once in your 20s, twice in your 30s, and once at age 40. Those with existing vision needs should follow their eye doctor’s recommendations on frequency of visits. If you develop any vision difficulty or eye problems, a check up is recommended.
Who: Everyone
Dermatologist
When: Annually
Who: Everyone, especially if you spend a lot of time in the sun, are fair-skinned, or have family history of skin cancer.
Vaccinations
When: As recommended. Your PCP should be able to help you decide when to get vaccinations or boosters. Vaccine recommendations frequently include:
Annual flu vaccine comes out around September
HPV vaccine and meningitis for young adults
Shingles
Covid 19 vaccine and appropriate boosters
Who: Everyone
It’s important to get regular appointments with your doctors so they will have a baseline for your health conditions in case things change.
Appointments for Adults ages 40 +
Gynecologist – Mammogram
When: Annually
Who: People with breasts
PCP – Rectal Exam/PSA blood test
When: Annually
Who: People with prostates
Gastroenterologist – Colonoscopy
When: Regular screenings are recommended for those between the ages of 45 and 75. If your colonoscopy shows no signs of cancer, you can typically wait 10 years before scheduling another one.
Who: Everyone
If you’re 50+, add this l screening to your list:
Lung Screening
When: Annually
Who: Adults who have smoked 1 pack of cigarettes per day for 20 years or 2 packs per day for 10 years and currently smoke, or adults who have quit smoking within the last 15 years.
If you’re 60+, add this screening to your list:
Osteoporosis Screening
When: Age 65 and up
Who: Cisgender women and People assigned female at birth
If you have a family history or risk factors of any particular diseases, talk with your PCP to decide if you need earlier, more regular, or other specific screenings. Remember, prevention is better (and cheaper) than the cure!
Extra tips:
Need a New Year’s Resolution? Schedule all of your doctor appointments before the end of January so that you can cross that task off your to-do list and feel good about prioritizing your wellness
The ACA covers 100% of preventative health care. Visit Healthcare.gov for more information.
Add travel time to your appointments in your calendar
Remember to wear short sleeves to doctors appointments so they can easily take your blood pressure
We know keeping up with all of these appointments and screenings can be overwhelming. If you’re a visual organizer like us, please use our fillable guide to make sure all of your appointments are scheduled. Hang the guide on your fridge or in your office so that you’ll never miss an appointment!
Cheers to taking care of ourselves and advocating for our health in 2023!
As we enter into the holiday season, I’ve invited my dear friend, Gabby Daikon, to share her experience with grief after losing her mother as a young adult. I met Gabby about a year ago through her grief journals and later joined her for virtual Yoga Nidra and “bad bitch” meditations. In a year that has been unpredictable, these practices have brought me comfort, and I hope her words will be a comfort to you.
Grief is all-consuming and yet different for every individual.
For me it felt like a fog, a fog that I knew was there but I couldn’t get to the other side of it. I hear that is what Seattle is like, I guess grief is like Seattle. I have never been but I hear it is beautiful but always cloudy. I think grief is similar in that it feels constantly dreary but also has a weird comfort and connection to the true essence of life. I am sorry if you live in Seattle and that offended you. I truthfully have no idea what Seattle is like.
Grief is a journey
My grief journey has been a bumpy ride, to say the least. I have struggled tremendously, found support, struggled again, learned to surrender and the ride keeps on going. I found that my biggest mistake was pretending to be OK. I held all of the burdens of my losses inside of myself and made myself sick. Truly sick.
Ride the waves
We run and hide from any negative emotions, but the more we tense and grip, the harder they hit. Instead, float on the tides. Let your emotions move you around without crashing over you; brutally. Wade into the fears, float with them, don’t judge yourself, and usually, you can come out without drowning.
Grief-positivity
My true healing began when I learned how to surrender to the pain, the grief, and all of the parts that make this life. It is so sad that grief is such a large part of life and yet rarely spoken about. I believe that when we begin to speak about it we can all heal and find the beauty in our journey.
Yoga Nidra provides a moment of reprieve
I found Yoga Nidra at a time when I truly needed it. I felt this constant pain of anxiety because I had this undercurrent of grief that I just could not truly access. Yoga Nidra was the first time I felt at peace for 45 minutes. I am not saying it healed me completely but it gave me a moment of reprieve and sometimes when we are deep in the grief journey that is all we can ask for. A moment of reprieve.
Yoga Nidra is a guided meditation
Yoga Nidra gives us the opportunity to float with the currents. During Yoga Nidra there are no moving postures, simply lie wherever you feel comfortable and allow yourself to feel supported. It is a guided meditation – you are not left alone with your thoughts, you are supported by the meditation. During this time you may be having trouble feeling rested, Yoga Nidra is equivalent to 3 ½ hours of deep REM sleep to the body. It also helps move energy through the subconscious mind and welcome what the mind needs to welcome without the tension and anxiety attached to it.
Yoga Nidra makes you an observer of the mind, an observer of grief, being able to welcome it without having it drown you. I invite you to just take a few deep breaths, allow what comes to come, and know that you can handle it.
Grief is personal
There are scientific benefits that I can list but the truth is that grief is not some scientific formula, we just have to do what we can to get through and for me, that was writing to my Mom and other loved ones when I truly needed her and Yoga Nidra. With the loss of a key family member there is so much more loss that people don’t speak about- like; the family dynamics, your personality, a self-identity, and so much more. So if you are deep in your grief all I can offer is my truest empathy and compassion because there are no magic words, it is just hard, and sometimes we just need people to understand how hard it is.
Use the promo code GALS to get a discount on one of Gabby’s services
Looking to reduce stress and anxiety? Improve your mental clarity? If so, consider adding Yoga Nidra to your wellness routine. Use the promo code “GALS” and you can get a discount on Gabby’s services.
This week we will discuss when a power of attorney can expire. A power of attorney is a legal document that allows someone else to make decisions on your behalf. It is created for a specific purpose such as financial or health care decisions. If the power of attorney expires, it no longer gives that person the authority to make decisions on your behalf.
When you die
A durable power of attorney for finances automatically expires when you die. Once your attorney in fact gets the news of your passing, they no longer have the ability to carry out any actions on your behalf.
For a healthcare power of attorney, the same conditions apply. However, there is one caveat. The healthcare power of attorney will typically allow your healthcare agent to handle the disposition of your body, make the funeral and burial arrangements, or order an autopsy if warranted. Additionally, the agent can order medical records after your passing if needed for some legal reason. Other than that, the general rule is that all powers of attorney pass away when you do.
A power of attorney can expire if the original purpose no longer exists.
A power of attorney can expire if the original purpose no longer exists. For example, if you created a power of attorney to manage your finances, but you no longer need help with those decisions, the document may expire. Please note that you cannot revoke powers of attorney if you are incapacitated.
It is important to document the original purpose of the power of attorney and keep track of changes to your situation. You should update your powers of attorney when changes occur. This helps to ensure it’s still possible to use a power of attorney should the need arise.
If you revoke it
Unless you’re incapacitated, you can revoke a power of attorney. Revoking the power of attorney removes authority from the person you appointed. This is not something we’d necessarily recommend doing without good reason, but it’s possible. We strongly suggest that you name someone who is trustworthy so that you don’t have to revoke it.
However, if you want to revoke a power of attorney, do it in writing. Include the name of the person who is having their authority revoked. We recommend speaking with an attorney if you have to revoke a power of attorney.
Limited powers of attorney
A limited power of attorney is a document that allows someone to make decisions on behalf of another person. This happens when someone cannot be present to carry out decisions for themselves. A Limited Power of Attorney allows someone else to act as your proxy. For example, military families give powers of attorney that expire to a friend or spouse while they deploy.
How often should you renew a power of attorney?
Most powers of attorney are meant to last forever. However, you might need to create a new one to replace an old one. For example, a bank may be hesitant to honor a power of attorney that you signed 20 years ago. They may want you to have it updated. You may also want to update a power of attorney if you move to a new state.
If you have questions or need to get a power of attorney in Nashville, consider scheduling an initial call. This 15-minute call is free and allows us to see if we can help you with your situation.
