GRAY MATTERS
Notes, News & Musings on Elder Care
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Faith United Methodist Church will host “Caring for Your Parents” on Sunday, March 27 from 2-4 pm. Adult children with aging parents will especially benefit from this free program sponsored by the Office on Aging’s One Call Club, Covenant Health Senior Services, the Mercy Health Partners Geriatric Assessment Program, and the Elder Law Practice of Monica Franklin.
“Caring for Your Parents” is designed to educate, support and empower caregiver children. Our panel of experts consists of Diana Nelson, Geriatric Nurse Practitioner; Monica Franklin, Certified Elder Law Attorney; the Reverend Dr. Paul Humphrey, and Susie Stiles, Licensed Clinical Social Worker. Discussion will include information on the changing needs of older adults, the challenges of the caregiver child, the legal and financial issues at hand, and the role of faith and community in coping with caregiving.
Faith United Methodist Church is located on the corner of Dry Gap Pike and Rifle Range Road at 1120 Dry Gap Pike, Knoxville, TN. (865) 688-1000 www.faithseekers.org RSVP at 524-2786
The Patient Protection and Affordable Care Act (ACA), with its focus on prevention, ushers in many improvements to Medicare. For example, Medicare will now pay for an annual wellness visit during which the beneficiary may receive a comprehensive health risk assessment and develop a personalized prevention plan. There is also improved cost-sharing for a laundry list of Medicare preventive services including: bone mass measurement, breast cancer screening/mammograms, abdominal aortic aneurysm, flu shots, Hepatitis B shots, prostate cancer screening and smoking cessation counseling. To learn more, go here.
The seminal case on conservatorship in Tennessee is In Re Groves. Click on this link to read the case.
The Groves court discusses the factors for a trial court to consider when appointing a conservator. The court correctly points out that our conservatorship statute does not require a showing of “incompetence.” Rather, the statute requires that a petitioner show by “clear and convincing” evidence that the respondent is “disabled” and “incapacitated.” Of course, those terms mean something in the law that is much more complex, but the court explains what those words mean and how the meaning of those terms impacts the appointment of a conservator. Read the case to learn more!
There is a common urban myth that giving away assets as we age is a good idea. Folks often hear that it is “okay” to give $13,000 per year to a child or other close relative. The problem is that giving away assets may interfere with Medicaid qualification. Of course, everyone believes that they will not go to a nursing home and never need Medicaid. Unfortunately, life happens and many older adults often need Medicaid as a payor source for in-home, assisted living or nursing home care. If the Medicaid applicant has given away assets in the five years preceding her application, then she will be penalized.
Rather than giving away assets because the local banker, accountant or tax attorney advised that it is acceptable, check with a certified elder law attorney first. Find out ALL the implications of giving away assets.
Hope you are enjoying the Holiday Season thus far!
Monica
My favorite morning ritual is reading the business section of the Knoxville News Sentinel while sipping hot coffee. Sunday is my favorite day since the Wall Street Journal, www.wallstreetjournal.com, reporters write a two page spread. Recently, I learned that people who make $75,000 are happier than people who make less, and making more than $75,000 doesn’t equate to being happier. Hmmm….wonder if that is true?
Why is $75,000 the magic number? It really isn’t magic, and it’s not always $75k. The author tells us that in NYC, it is about $160k, in Chicago, $75k is really $84k. It boils down to what one can afford in a particular community for the equivalent of $75k. In Fort Smith, AR, the number sinks to $65k.
What about our beloved K’town? The average salary for Knoxville, Tennessee citizens is $30,143 (www.simplyhired.com). Only about 12% of Knoxvillians make $75,000 or above. I’m not exactly sure what this means for Knoxvillians, but I have noticed that there are a lot of grouchy workers at the fast food drive-by window and the grocery checkout (except for Earthfare, and they are all happy campers—literally!). I have always thought this is related to the economics of their work. It doesn’t pay enough and as a result of struggling financially, these folks are stressed.
Compare that to my Cracker Barrel experience this weekend. I noticed an elderly gentleman escorting families to their table. My breakfast buddy, Mark, explained that this gentleman is a retired school teacher and principal. Mr. Principal was happy. Did it have anything to do with money? Possibly.
Mr. Principal is probably drawing Social Security as well as a pension. His house is most likely mortgage-free. His Cracker Barrel earnings are gravy. Not only does a part time job give him extra moo-lah, it also provides him with structure, socialization, stimulation, and a reason to get up each morning. He knows he’s making a contribution by helping others who need a strong arm to lean on as they make their way to a table. He knows he makes a difference by smiling and helping young parents corral wandering toddlers. He has figured out how to age well. That’s really what matters.
After the Medicare benefit period ends, then the nursing home patient must pay for care from income, savings, or long-term care insurance. If the Medicaid patient does not have enough income, savings or long-term care insurance, then she should apply for Medicaid through the local Medicaid agency. In Tennessee, the Medicaid agency is called the Department of Human Services (DHS). Often, a nursing home business office staff member will submit an application for the patient without speaking with the family. Why? Because the nursing home needs payment as soon as Medicare ends. While submitting a Medicaid application may ultimately create eligibility problems for the patient, nursing home staff is merely trying to make sure the patient’s medical bills will be paid.
How does a nursing home patient qualify for Medicaid? When an unmarried patient-homeowner applies for Medicaid, she must show that she meets three simple eligibility criteria:
- She must have less than $2,000 in countable assets.
- Her gross monthly income must be under $2,022 (2010) if she lives in an income cap state such as Tennessee. If her gross income exceeds $2,022/month, then she must have a Qualified Income Trust (QIT).
- She must be medically qualified and pass a Patient Admission Evaluation (PAE).
For an unmarried patient, the elder law attorney may recommend setting aside funds in a special “exception” trust that will be used to improve the patient’s quality of life in the nursing home. There are simple spend down ideas that benefit the patient such as purchasing an irrevocable prepaid funeral/burial plan or purchasing any good or service that benefits the patient. The elder law attorney may also suggest ways to set aside funds for the family without jeopardizing the patient’s medical care.
For a married patient, the elder law attorney may use those techniques and others. The Medicaid rules for a married couple are different because the law provides protection from impoverishment for the community spouse. The elder law attorney uses techniques to maximize the income and assets that the community spouse retains so that he/she will not be impoverished by the high cost of the disabled spouse’s nursing home care.
So, the patient is in a skilled care facility, what’s next? Most nursing home stays begin with at least a three day hospitalization. Then the patient is discharged to a skilled care facility for some sort of skilled care such as physical, occupational, or speech therapy. This therapy is covered by the patient’s health insurance (Medicare) for a short period of time up to 100 days per benefit period. A great resource for understanding Medicare is the “Medicare and You” handbook published annually and mailed to all Medicare enrollees. A free copy in .pdf format is available here: www.Medicare.gov/Publications.
Medicare is health insurance. Everyone who has paid into the system and who qualifies (e.g., is over the age of 65, or who has been blind or disabled for at least 24 months) is entitled to Medicare. Medicare covers hospitalization, doctors’ visits, medical equipment and the like. Medicare deductibles and co-pays are often covered by a supplemental policy known as a Medigap policy.
After Medicare coverage ends, the patient must pay from income, long-term care insurance, savings, Medicaid, or some combination of these resources. Folks often confuse Medicare and Medicaid. Medicare, like any health insurance policy, does not have an income or asset limit. Medicaid pays for healthcare if a person meets certain financial and medical requirements.
In our community the average cost of non-skilled nursing home care is about $5500 per month. This does not include medicines. Some patients improve or “rehab” so that they may return home or to an assisted living facility. The skilled care may continue through home healthcare. Home healthcare is covered by Medicare as long as the person is “homebound,” needs the care to maintain or improve his level of functioning and the doctor continues to order the care. This is a wonderful benefit to help support a patient’s continued rehabilitation and functionality. In my next blog, I will address how patients who must stay in the nursing home pay for continuing care.
Families may hear: “We are discharging your Mom tomorrow. You will have to pick her up by 10 a.m.” This is IMPROPER! Families are not required to pick up a patient that they cannot care for safely and effectively.
Welcome to our blog! We created this blog to share our collective experience in the field of elder care ~ in a relaxed, conversational environment. We’ll be offering helpful information about products, services and developments in the field of elder care as they happen … along with a little humor. We made career choices to help the elderly and those caring for them because its our passion. It’s an honor and pleasure to serve “our greatest generation.” We’re looking forward to having a conversation with you!
~ Monica Franklin, Susie Stiles & Friends
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