can be overcome. Grandparent Scam, of end of Tidbit. The ... · In Being Mortal: Medicine and What...
Transcript of can be overcome. Grandparent Scam, of end of Tidbit. The ... · In Being Mortal: Medicine and What...
Continuum The
Issue 2 Summer 2015
If someone you love is a nursing
home resident, you may have won-
dered what rights they have under
the law. Fortunately, residents are
protected under federal and state
laws that help ensure they get the
care and services they need. These
rights can vary by state.
The nursing home must provide the
resident with a written description of
his legal rights. It’s always a good
idea to keep the information your
loved one receives about rights,
admission and transfer policies, and
other topics in case you need to
access it later.
Medicare beneficiaries have certain
guaranteed rights and protections.
In addition, federal law specifies
that nursing home residents also
have the following rights:
Freedom from discrimination
Nursing homes don't have to accept
all applicants, but they must comply
with Civil Rights laws that don't
allow discrimination based on race,
color, national origin, disability, age,
or religion under certain conditions.
If you believe that your loved one
has been discriminated against,
contact the Department of Health
and Human Services, Office for
Civil Rights at (800) 368-1019.
Respect
Your loved one has the right to be
treated with dignity and respect. As
long as it fits your love one’s care
plan, he has the right to make deci-
sions about his daily schedule,
including when to go to bed, get up
in the morning, and eat meals. Your
loved one also has the right to
choose the activities he wants to
participate in.
Freedom from abuse & neglect
Your loved one has the right to be
free from verbal, sexual, physical,
and mental abuse, involuntary
seclusion, and misappropriation of
property. This includes, but isn't lim-
ited to, staff, other residents, con-
sultants, volunteers, staff from other
agencies, family members or legal
guardians, friends, or other individu-
als. If you believe that your loved
one’s needs haven’t been met or
that he has been abused or neglect-
ed, report this to the facility, your
family, your local Long-Term Care
Ombudsman, or your State Survey
Agency. It may be appropriate to
report the incident of abuse to local
law enforcement or the Medicaid
Fraud Control Unit (their phone num-
ber should be posted in the nursing
home).
Freedom from restraints
Physical restraints are any manual
method or physical or mechanical
device, material, or equipment
attached to or near a resident’s body
so that he or she can't remove the
restraint easily. Physical restraints
prevent freedom of movement or
normal access to one's own body.
A chemical restraint is a drug that's
used for discipline or convenience
and isn't needed to treat medical
symptoms.
It's against the law for a nursing
home to use physical or chemical
restraints, unless it's necessary to
treat medical symptoms. Restraints
may not be used to punish or for the
convenience of the staff. Your loved
>> TURN TO PAGE TWO
Know Your Loved One’s Rights
Elder Law Practice of Timothy L. Takacs 201 Walton Ferry Road, Hendersonville, TN
Federal and State Laws Protect Residents of Nursing Homes
P3 / Read a review of
Being Mortal, a best-
seller about the state
of end-of-life care in
the U.S.
P5/ Caregiver guilt
can be overcome.
These simple tips
can make all the
difference.
P6 / Don’t fall for the
Grandparent Scam,
the latest in a long
line of financial fraud
targeting seniors.
P4 / Toffee Bars are
an Elder Law Prac-
tice staff favorite and
the ultimate Takacs
Tidbit.
The Continuum / Page 2
Know Your Loved One’s Rights >> FROM PAGE ONE
one has the right to refuse restraint
use except if he is at risk of harming
himself or others.
Information on services & fees
You and your loved one must be
informed in writing about services
and fees before your loved one
moves into the nursing home. The
nursing home can't require a mini-
mum entrance fee as a condition of
residence.
Money
Your loved one has the right to
manage his own money or to
choose a trusted person to manage
these affairs. If your loved one
wants the nursing home to manage
personal funds, he must sign a writ-
ten statement that allows the nurs-
ing home to do so. However, the
nursing home must allow your loved
one to access bank accounts, cash,
and other financial records. Your
loved one’s money (over $50) must
be placed by the nursing home in an
account that will provide interest.
They must provide quarterly state-
ments. The nursing home must pro-
tect funds from any loss by buying a
bond or providing other similar pro-
tections.
Privacy, property, & living
arrangements
Your loved one has the right to pri-
vacy, and to keep and use personal
belongings and property as long as
they don't interfere with the rights,
health, or safety of others. Nursing
home staff should never open your
loved one’s mail unless he allows it.
Your loved one has the right to use
a phone and talk privately. The
nursing home must protect your
loved one’s property from theft.
This may include a safe in the
facility or cabinets with locked
doors in resident rooms. If your
loved one and his spouse live in the
same nursing home, they are enti-
tled to share a room (if they both
agree to do so).
Medical care
Your loved one has the right to be
informed about his medical condi-
tion, medications, and to see his or
own doctor. Your loved one also
has the right to refuse medications
and treatments and to take part in
the development of his care plan.
Your loved one has the right to
view his medical records and
reports.
Visitors
Your loved one has the right to
spend private time with visitors at
any reasonable hour. The nursing
home must permit family to visit at
any time, as long as your loved one
wants to see them. Your loved one
doesn't have to see any visitor he
doesn't want to see. Any person
who helps your loved one with
health or legal services may see
him at any reasonable time. This
includes doctors, representatives
from the health department, and a
Long-Term Care Ombudsman,
among others.
Social services
The nursing home must provide
your loved one with any needed
medically-related social services,
including counseling, help solving
problems with other residents, help
in contacting legal and financial pro-
fessionals, and discharge planning.
Complaints
Your loved one has the right to make
a complaint to the staff of the nurs-
ing home, or any other person, with-
out fear of punishment. The nursing
home must resolve the issue
promptly.
Protection against unfair transfer
or discharge
Your loved one can't be sent to
another nursing home or made to
leave the nursing home unless it's
necessary for his own welfare,
health, or safety, or that of others,
his health has declined to the point
that the nursing home can't meet the
care needs, his health has improved
to the point that nursing home care
is no longer necessary, services
haven’t been paid for, or the nursing
home closes. A nursing home can't
make your loved one leave if he or
she is waiting to get Medicaid. The
nursing home should work with other
state agencies to get payment if a
family member or other individual is
holding your loved one’s money.
Your family & friends
Family members and legal guardi-
ans may meet with the families of
other residents and may participate
in family councils. If you are your
loved one’s legal guardian, you have
the right to look at all medical rec-
ords about your loved one. You have
the right to make important decisions
on his or her behalf. You can play a
major role in making sure your loved
one gets good quality care.~
The Continuum / Page 3
In Being Mortal: Medicine and What
Matters in the End, author Atul
Gawande looks at the problems of
the aging population and inevitability
of death. He points out that many
physicians are so hell-bent on pre-
serving life that they cause horrible
and unnecessary suffering.
Gawande goes on to say that some-
times in striving to give a patient
health and survival, their well-being
is neglected. He looks at the "Dying
Role" as the end approaches de-
scribing it as the patient's ability to
"share memories, pass on wisdom
Book Review: Being Mortal and keepsakes, settle relationships,
establish legacies and
make peace with their
God. They want to end
their stories on their own
terms." He feels that if
people are denied their
role, out of obtuseness
and neglect, it is cause for
everlasting shame.
Gawande provides the
reader with an understand-
ing that though end of life care is
inevitable, there are ways to
humanize the process. The
patients, their families and medical
professionals are coming
to terms with how to better
face the decision making
processes that will be, in
many cases, the last deci-
sion. The subject matter is
complex and sensitive but
the moral of the book is
that "The End Matters."~
Excerpted from a book
review by Barbara Geach
posted on Amazon.com, September
26, 2014. Reprinted by permission.
Free Starter Kit Simplifies End-of-Life Talks Too many people are dying in a way
they wouldn’t choose, and too many
of their loved ones are left feeling
bereaved, guilty, and uncertain.
The Conversation Project seeks to
change that by providing tools, tips
and resources that make it easier for
people to talk about their wishes for
end-of-life care. The goal is to make
sure that our own wishes and those
of our loved ones are expressed
and respected.
Launched in 2010 by syndicated
columnist Ellen Goodman and oth-
ers, the Conversation Project aims
to transform our culture so we shift
from not talking about dying to talk-
ing about it. The founders believe
it’s time to share the way we want
to live at the end of our lives. And
Life’s all about having a plan B
Advance Directives and how to use them
it’s time to communicate about the
kind of care we want and don’t want
for ourselves. The place for this to
begin is at the kitchen table—not in
the intensive care unit—with the
people we love, before it’s too late.
To access the Starter Kit, visit http://
theconversationproject.org/starter-
kit/intro/.~
Looking for an interesting presentation for your civic
club or community group? Elder Law Practice staff
members are equipped to speak on a variety of topics
related to elder law, elder care, public benefits and
much more. In one of our newest presentations, Life’s
all about having a plan B, Associate Attorney Barbara
Boone McGinnis offers straight talk about Advance
Directives, what they are and how to develop them.
Contact the Elder Law Practice office at(615) 824-2571
to schedule your presentation.~
Speaker ’s Bureau Offers Free Presentations
The Continuum / Page 4
TennCare CHOICES is a program
for adults (age 21 and older) with a
physical disability and seniors (age
65 and older) that offers access to
home and community-based ser-
vices (HCBS). There are three
CHOICES groups:
Group 1 is for people of all ages
who receive nursing home care.
Group 2 is for adults with a physical
disability and seniors who qualify to
receive nursing home care, but
choose to receive HCBS instead.
Group 3 is for adults with a disabil-
ity and seniors who don’t qualify for
nursing home care, but need a
more moderate package of HCBS
to delay or prevent the need for
nursing home care.
CHOICES: A Brief Review
Toffee Squares
Oven: 325 F
Ingredients
1 cup butter 1 cup light brown sugar 1 egg yolk 1 teaspoon vanilla extract 2 cups all-purpose flour 1/2 teaspoon salt 1 large bar Hershey’s chocolate 1 cup pecans
Directions
Cream butter and sugar thoroughly.
Add egg yolk and vanilla. Add flour and salt. Mix well.
Spread batter evenly in ungreased 10 x 15 inch pan.
Bake for 20 minutes. Remove from oven and put chocolate bar on at once. As it melts, spread and sprin-kle with nuts. Cut into bars while slightly warm.
TAKACS TIDBIT
Many Elder Law Practice staff mem-
bers are accomplished cooks who
enjoy sharing their creations with
others. One favorite recipe, Toffee
Squares, comes from Helen Powley,
Tim Takacs’ maternal grandmother.
Though no one knows where Grand-
ma Powley got the recipe, everyone
knows that Toffee Squares are
really, really, really good.
To qualify for and remain in
CHOICES, a person must need the
level of care provided in a nursing
home; OR be "at risk" of needing the
level of care provided in a nursing
home; AND qualify for Medicaid long
-term services and supports.
To qualify for Medicaid long-term
services and supports: (1) The indi-
vidual’s income can't be more than
$2,199 per month (if it is, a Qualify-
ing Income Trust may be estab-
lished); (2) The total value of things
the person owns can't be more than
$2,000 (excluding the current resi-
dence) AND (3) The person can not
have given away or sold anything for
less than what it's worth in the last
five (5) years.~
Caring for a person with Alzhei-
mer’s disease at home is a difficult
task and can become overwhelm-
ing at times. Each day brings new
challenges as the caregiver copes
with changing levels of ability and
new patterns of behavior. Research
has shown that caregivers them-
selves often are at increased risk
for depression and illness, espe-
cially if they do not receive ade-
quate support from family, friends,
and the community.
The Alzheimer’s Caregiver Guide
published by the National Institute
on Aging offers valuable guidance
for family members caring for loved
ones with the disease. Download a
free copy of the guide at http://
www.nia.nih.gov/sites/default/files/
alzheimers_caregiver_guide.pdf.~
Alzheimer’s Guide Offers Helpful Tips
THIS ISSUE: Tim Takacs introduces a new series of
videos about Trusts. To watch the first video in the
series, scan the QR code on the right or go to
https://youtu.be/sCv6TlpcVyc.
Check out the Elder Law Practice YouTube Channel Did You Know?
The Continuum is now offered elec-
tronically. The email version contains
additional links and resources. To
receive future issues of the newslet-
ter via email, call (615) 824-2571 or
email [email protected].~
The Continuum / Page 5
Q What is TennCare (Medicaid)
estate recovery?
A Estate recovery is the pro-
gram required by the State of
Tennessee that seeks to recover
certain funds paid by TennCare
(Medicaid) after the person is
deceased. States must pursue
recovery of costs for medical assis-
tance consisting of nursing home
or other long-term institutional ser-
vices; home and community-based
services, including home health
and private duty nursing; hospital
and prescription drug services pro-
vided while the person was receiv-
ing nursing home or home and
community-based services; and
other items covered by the Medi-
caid State Plan.
Q My mother was recently
awarded a VA Death Pension.
Will she be audited in the future?
A Pension recipients and/or
their Fiduciary Agents may be
asked to complete a periodic Eligi-
bility Verification Report (EVR) ver-
ifying any changes in income, net
worth and medical expenses. Fail-
ure to return a properly completed
EVR, if requested to do so by VA,
will result in termination of a pay-
ee's income-based benefits. To
view the EVR online, visit http://
www.vba.va.gov/pubs/forms/VBA-
21-0516-1-ARE.pdf.
Q My father will soon be moving
to Tennessee from another
state. Will the Advance Directive he
drafted in that state be honored in
Tennessee?
A Laws differ somewhat from
state to state, but in general, a
patient’s expressed wishes will be
honored.
Q My mother is on Medicare and
needs surgery. I would like for
her to get a second opinion. Does
Medicare Part B pay for second
opinions?
A Medicare Part B helps pay for
a second opinion before sur-
gery provided that the surgery is
medically necessary and meets
certain criteria. To find a doctor for
a second opinion, visit medi-
care.gov/physiciancompare, call
(800) 633-4227 or ask your doctor
for the name of another doctor to
see for a second opinion. Members
of Medicare Advantage Plans
should ask their specific plan or
refer to their Evidence of Coverage
booklet for instructions.~
For many caregivers, guilt is a con-
stant companion. Some worry that
they aren’t doing enough. Others
may experience guilt for feeling
trapped, tired, angry or irritable.
Caregivers may also experience
guilt when they take time to care for
themselves.
Painful feelings — such as guilt,
sadness and anger — are like any
other pain. It’s the body’s way of
saying, “Pay attention.” Just as the
pain of a burned finger pulls your
hand from the stove, so, too, guilt
can guide your actions. Though
caregiver guilt can be instructive, it
can also be destructive. Guilt can
slow the normal grief process as it
drains the energy needed to work
through the loss.
How can you manage caregiver
guilt?
Be compassionate with yourself.
Discuss concerns with family,
friends or support group.
Ask neighbors for help.
Reach out to community organi-
zations.
Look for the higher purpose in
caregiving
Take action to meet your needs.
Instead of berating yourself, you can
alleviate guilt by remembering that
your efforts have made a difference
in your loved one’s final days.~
OVERCOMING
Caregiver Guilt
The Continuum / Page 6 The Continuum / Page 6
The Grandparent Scam is so sim-
ple and so devious because it
preys upon one of older adults’
most reliable assets: their hearts.
Scammers will place a call to an
older person and when the mark
picks up, they will say something
along the lines of: “Hi Grandma, do
you know who this is?” When the
unsuspecting grandparent guesses
the name of the grandchild the
scammer most sounds like, the
scammer has established a fake
identity without having done a lick
of background research.
Once “in,” the fake grandchild will
usually ask for money to solve
some unexpected financial prob-
lem (overdue rent, payment for car
repairs, etc.), to be paid via West-
July 2: Coffee Connections for Elder Law Practice cli-ents. Educational gathering for spouses of clients who are living in long-term care facilities. 2:00 p.m.—3:00 p.m. 201 Walton Ferry Road, Hendersonville. RSVP requested. (615) 824-2571.
July 21: Quarterly Caregiver Children Meeting. Educational gathering for children whose parents are Elder Law Practice clients. 6 p.m. - 7 p.m. Loca-tion to be announced. RSVP requested. (615) 824-2571.
July 28: Surviving Spouse Group. Educational gathering for surviving spouses of Elder Law Practice clients. 12 p.m. - 1 p.m. 201 Walton Ferry Road, Hendersonville. RSVP requested. (615) 824-2571.
July 30: Game Changing Approaches to Dementia Care. Educational work-shop for family caregivers. 5:00 p.m.—7:00 p.m. Bluegrass Yacht and Country Club, Hendersonville. Register at www.dementiawise.com.
FREE Monthly Memory Screenings. First Friday of each month at 11:00 a.m. 1522 Wilson Pike, Brentwood. (615) 285-3455.
Alzheimer's Association Support Groups: Call (800) 272-3900 or (615) 315-5880 for dates, times and locations closest to you.
For more events, visit TN-ElderLaw.com or ElderLawEducation.com. ~
Beware the Grandparent Scam
On the Calendar
ern Union or MoneyGram, which
don’t always require identification to
collect.
At the same time, the scam artist will
beg the grandparent “please don’t
tell my parents, they would kill me.”
While the sums from such a scam
are likely to be in the hundreds, the
very fact that no research is needed
makes this a scam that can be per-
petrated over and over at very little
cost to the scammer.
If you suspect you or someone you
love has been the victim, call the
local police, your bank (if money has
been taken from your accounts),
and Adult Protective Services via
the Eldercare Locator at (800) 677-
1116 or www.eldercare.gov.~ Sometimes asking for help is the most
meaningful example of self-reliance.
― Unknown
The Continuum / Page 7
Guest Column
There’s no place like home, espe-
cially when it comes to creating a
healing environment during an ill-
ness or after a surgery. Most people
recover faster and the cost is usually
much less than lengthy hospital
stays.
WHAT is homecare? Homecare is
defined as skilled care delivered on
an intermittent basis outside a hos-
pital setting. Examples include nurs-
ing services; home health aid assis-
tance; and medical social services.
In order to be eligible for Medicare
reimbursement, homecare must be
intermittent and the patient must
meet all “homebound” criteria. In
addition to Medicare reimbursed
services, homecare companies can
provide nurses or caregivers that
stay from 2 to 24 hours shifts under
private duty. Some agencies also
provide non-skilled care or custodial
care, which consists of housekeep-
ing, shopping, etc. This type of care
is not covered by Medicare.
WHERE is homecare performed?
It can be most anywhere you call
home—from a single family dwell-
ing, apartment or assisted living
facility to a homeless shelter as long
the patient is consistently there for
visits from providers.
HOW do you get homecare? It
starts with a call and possibly a visit
to your doctor. Let him or her know
that you want homecare service.
Your doctor will contact a homecare
agency with orders. Keep in mind
that you and your loved one have
the right to choose the homecare
provider. If you choose someone
other than the one you were
referred to, make your wishes
known to your physician. The
homecare provider will then visit
the patient and develop a pro-
posed care plan with input from
both the patient and caregiver. The
physician must be willing to over-
see treatment and sign off on the
plan of care, which may be
renewed if certain criteria are met.
WHO pays for homecare?
Homecare expenses can be paid
by state and federally funded pro-
grams like Medicaid and Medicare,
private insurance, HMOs and
PPOs, or long-term care insur-
ance. Some patients pay for their
own care.
WHEN might homecare be
helpful? Homecare may be appro-
priate after a hospitalization, to
manage pain, to teach caregivers
about disease, to address gait or
balance issues, for medication
management, and to manage
behaviors and dementia.
Homecare agencies differ widely in
their capabilities and skill.
Research all your options and
choose a homecare provider as
carefully as you would choose a
surgeon or a
hospital.
Carol Keopf,
R.N. is Nurse
Liaison for Van-
derbilt Home
Care Services
Inc. Contact
Carol at (615) 936-0336 or at
It’s not the load that breaks you down.
It’s the way you carry it.
― Lena Horne
The Who, What & Where of Home Care
Information contained herein may contain general explanations of
laws. It should not be considered as legal advice. Please seek counsel
from an attorney regarding legal planning.
Copyright 2015
The Continuum is a quarterly newsletter designed to
enhance the service Elder Law Practice of Timothy
L. Takacs provides to clients. Please direct feed-
back, questions and comments to continuum@tn-
elderlaw.com.
Phone: (615) 824-2571
Fax: (615) 824-8772
Toll-Free (866) 222-3127
Family Education Website:
www.tn-elderlaw.com
Professional Education Website:
www.elderlaweducation.com.
201 Walton Ferry Road
Hendersonville, TN 37075
*** NOTE: If you did not receive this issue by mail but would
like to be added to the mailing list for future issues, please
call (615) 824-2571. ***
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NASHVILLE, TN
PERMIT NO. 3731
Tim Takacs, CELA
Certified as an Elder Law Attorney by the
National Elder Law Foundation
Certified as an Elder Law Specialist in Tennessee
Barbara Boone McGinnis, JD Associate Attorney
Lisa Proctor, Office Manager
Emily McCord, LMFT, Elder Care Coordinator
Debra King, LMSW, Elder Care Coordinator
Bonnie Woodard, Medicare Specialist
Ann Elise Walston, Legal Assistant
Chelle Guidry, Legal Assistant
Bo Siler, Office Assistant