Medicare, Medicaid, and Aging Parents in Northeast Texas with Nikki Vineyard — Full Episode Transcript

Always want to have a plan before there's a crisis, because when you get into crisis mode, you only have the options that you can get.

When caregiving feels overwhelming and the system feels impossible to navigate, this is your guide. Here, you'll learn ways to navigate long-term care planning, find real support for caregiving, and prepare you for the road ahead. I'm your host, Lindsay Friedman, and now you're not in this alone. Let's get started.

Hello, welcome back to another episode of LTCareNav's Care Compass. I'm your host, Lindsay Friedman, and today we are here with Nikki Vineyard of Golden Years Advisor and of CarePatrol of Northeast Texas. Welcome, Nikki.

I'm so glad you were able to make this. We are going to start the same way I start with everyone. Who are you? What do you do? And most importantly, why do you do it?

Thank you so much for inviting me to be here. It's a pleasure. So I'm Nikki Vineyard and I grew up as an only child and I took care of my mom when she had cancer in 2019, and my grandmother passed away in 2022. They were really my rocks. Going through those experiences of losing both of them gave me this foundation for seniors.

When CarePatrol, which I initially started with, came in and showed me how to help seniors navigate this industry, I fell in love with the company. So that started first. I got my certification as a senior advisor, helping families.

And then I wanted to learn about Medicare because in the industry you hear about traditional Medicare versus Advantage plans. And I wanted to know why. What is the difference? Why choose either? How can I help the ones that can't do traditional, because it does get expensive? Going through that experience, I'm able to put real-life experience into helping others.

And being in a rural area, I have to kind of be all things. I have to know a little bit about a lot. I've really learned a lot over the past three years. I'm able to help these families navigate even when they don't need senior care, like housing — they may need something in their home, or how to get their affairs set in place, and just what are the things their loved ones are going through and how can they help better educate themselves. So that's my story.

That's great. You touched on something we're going to go to first — Medicare, and how you got into it because you didn't understand it. And there's so much to understand. What do you think is the biggest misconception about Medicare?

That people can figure it out on their own. I'm a very big advocate for using a Medicare broker who understands the ins and outs of Medicare. But you have to make sure that you get a quality broker who will actually explain the fine print and the nuts and bolts of your situation.

That's why I learned about it — because I wanted to help people where they are and figure out what the next steps are. Because just because you have one plan doesn't mean you have to stick with that plan, and what are the reasons to change? It's a misconception that you can just go to Medicare.gov and figure it out. That's not going to get you all of your answers, especially with the complicated situations.

It is so complicated. And seeing that your other hat is senior care — why do you think so many families assume that Medicare is going to pay for long-term care? And how do you approach that with a family when they have that moment and they realize it's not?

The misconception I see across the board is people think that just because Medicare will pay for short-term care — like if you have a hip replacement or some sort of surgery, or you have to be in the hospital for three days to go into a rehab — they will pay for that. However, they think that is long-term care because skilled nursing facilities have the short-term rehab stay.

So they take that as, okay, that's going to pay for my long-term care too. They don't understand that it's got to be Medicaid that's actually paying for it, and not Medicare. So we walk through that process to help them understand that.

How many families come to you and actually understand the difference versus not?

There's actually a lot of people — once they get to the level where I help them — that do understand that it's Medicaid versus Medicare. It's the younger generation, the kids taking care of their parents, that don't understand it.

Once you sit down with the adult child and explain this, what is usually the reaction? And how many families are actually prepared for what long-term care looks like?

Only about 30% are prepared for what long-term care looks like. The kids are usually pretty shocked that Medicare doesn't pay for their care.

The whole healthcare system is really kind of challenging, right? Do you find it harder to navigate the Medicare piece of this or the long-term care piece of it? Where do you think families are struggling more?

Probably the long-term care. They don't ever see themselves as needing long-term care because their parents didn't — they stayed at home. They had kids that could take care of them.

We are seeing dementia especially just overtaking so many families, and they don't know how to navigate it and they don't know how to help their family member. They try to take care of them at home, but as the stages progress, it gets harder and harder. So that's where they find themselves — we're really not prepared for that.

Is that where you usually find families coming to you — almost at the moment where it's a little too late, fewer options?

Yes. But if I can get to them a couple of months before they make that decision, we can talk about how to get with an elder law attorney to prepare — because there's a misconception that you have to have nothing to be on Medicaid, when actually that's not the case. It's easier to qualify for Medicaid when you're married than when you're single.

But if you get to an elder law attorney to help protect your assets and your income, you can qualify for Medicaid easier. There are ways to do it.

When would you tell a family — when is the ideal time to come and meet with you for the CarePatrol piece of it?

Probably when they start seeing a decline in their loved one. Just to kind of prepare before a crisis — that's the most important aspect of anything. You always want to have a plan before there's a crisis, because when you get into crisis mode, you only have the options that you can get.

Say your loved one needed a long-term care facility and they needed Medicaid. Well, you need about a month, a few weeks, to really prepare for that, to get your assets and finances in order. But when you're in crisis mode, you don't have that time. They're usually going into a long-term care facility in just a few days.

That has to be a really hard transition. How do you help families with both the adjustment of what's to come, but also emotionally?

I give them resources to be able to help them. Especially with my dementia clientele, there are videos that I can send them. There are some specialists in the industry that I can send them to their website. There are support groups — things of that nature that I can help with.

The other ones I just kind of take it step by step and tell them I'm always available, just to try and give options. And there are other people in the industry, like in-home care, that I can refer to them.

The ones that have planned for assisted living type environments are usually better off, because if you get help sooner, then you can avoid the long-term care Medicaid situation in a nursing home. If you can pay for it because you planned, then usually that situation is a little bit better — it will keep your loved one healthier and independent longer, because it is an apartment style. They have their own independence still, and they are still capable of making their own decisions.

Usually I find when your loved one isn't able to make their own decisions anymore, that's when they start to decline faster — because they give up. They feel like they can't do it anymore.

When you get a situation like that and emotions are running really high, how do you help the adult children or your client navigate these things? How do you talk them through what this is really going to look like?

I sit down and do a care evaluation. What help do they need? What does their financial situation look like? Are they a veteran? Do they have a long-term care policy? We go over all of that and try to figure out — do they own their own home? Can they sell it to help pay for care? Do they not need to sell it and put it in a Lady Bird deed to qualify for long-term care?

We just sit down and have a really good conversation about everything and take it one step at a time and help them navigate that. And sometimes I have to get elder law attorneys in there to help. Or sometimes, whenever it's a difficult situation, we do call on Adult Protective Services. They can help with some of that.

The goal for Adult Protective Services is not to get people in a nursing home and to take your rights away. It's to help that person have a better situation. And a lot of times it will help the family kick in and do the right thing.

You're the first person I've talked to who has really mentioned Adult Protective Services. Is that more specific to Texas, or is that kind of a national thing? What does that process actually look like? When should they be called, and who calls them?

It varies. I work with them here. I'm in a rural area, not in a large city, and so they really are beneficial in my area because they also provide other services. They do wellness checks.

I work with several of the APS investigators. They'll call me when they have a client that needs some help — to go in and do all of the things that I do. And then I report back to them and let them know, yes, they're doing this. And I can help walk the family through getting their powers of attorney, making sure they have the will, when's the right time to do it, what are your options if you don't have all that in place — just different things. So I think they work more predominantly and better with me in the rural aspect versus the city.

That's really interesting. Obviously where you live is really going to determine what your long-term care looks like — what it's going to cost. So living where you do, how do you think that impacts people who are searching for long-term care in your community?

A lot of people in my community, of course, get online — and I call it white noise, because they get a lot of ads and they don't realize what they're clicking on. And it comes from larger organizations that really don't support our area.

So a lot of my connections are organic. They're from other people in the industry — home health, hospice, elder law attorneys, financial advisors, APS. I work with the behavioral clinics here. So many different avenues that we work together to help the demographic here.

Because this is a retirement area — East Texas, Tyler specifically, is a high retirement area. They think, I can retire and live out my days, but they don't plan for long-term care. Just because we're rural doesn't mean it's not expensive — we are still just as expensive as some of the places in Dallas and Houston.

But we don't have personal care homes like they do. We have some group homes, but not assisted living personal care homes, which are licensed. And so that's one of the downsides of this area. They're starting to come — just not that many. The larger cities have more options than we do.

How do you navigate when there are fewer options? What does that look like for a family?

Well, they have to decide — can we take care of mom or dad or grandma and grandpa at home? Can we get help from other family members? Do they need to move to be around other people? Do we help them move into an assisted living? Usually that's budget. So we look at the budget for the different places and just see.

But I will say, in East Texas, Northeast Texas, the more rural areas, people want to stay home. They're not used to having neighbors right up next to them. They don't want to be in apartments. I come from Houston, so I'm used to being around people, going to festivals, living in apartments. It's not as big of a stretch for me as someone who wants to sit on their back patio and drink their coffee and watch the sun come up. A lot of seniors move here to do that, to get away from the hustle and bustle. And then having to get in that type of environment is a sell. It's a hard sell.

It's interesting because we hear a lot about wanting to age in place, but we also hear a lot about how loneliness is like an epidemic and it can kill elders. Do you find that your population is a little bit better with being alone?

Being alone does not necessarily mean loneliness. They think so. But I have seen people who are isolated, and then they start to — I don't want to say lose their mind, but they get confused and then they don't understand it.

I saw it happen to my grandmother. She worked till she was ninety, and then they made her retire. And she was gone in two years because it was COVID and she isolated, and I saw the confusion set in. She was a bookkeeper. She did her own taxes by hand, on paper. She was very intelligent, and she would get her facts turned around and I'd have to go, no, remember this and this. And hers wasn't a dementia or an Alzheimer's. It was because she was isolated and confused — just because she wasn't talking to anybody. She only had the TV.

If you don't exercise, you don't get up and move around, it hurts your cognitive abilities. Same with eating healthy and drinking enough water and fluids — all that plays a part in our health as we age. We should never stop doing something. I always say retirement is a myth. You can retire from your job, but you need to have something else to do to make sure that your brain stays healthy, because it's a muscle just like your other muscles, and you've got to work those muscles.

That is so true. And being alone can be really challenging, because I'm picturing you in a place with large distances — you're not going to flick the light on at night to show the neighbors. As much as they're probably used to it, it's probably even harder to stay home and be cared for and to age in place.

I can give you a couple of examples. I have a lady that moved into a community — it was independent living because she was still somewhat independent, but she was on a walker, and her family was saying, she's just declining so much, she's at home alone, and we're going to put her here. Maybe she'll at least have her meals and things like that.

Within two months, she was helping her neighbors. She was walking without the walker. She was cleaning up common areas. She found purpose. She's talking to other people. And a lot of times that's just the key to healthy living — to keep your cognitive abilities engaged.

I really do look at assisted living — there's so much negative connotation about it. And I think it's because we are not picturing what it actually is. It's a community you get to live in, you get to thrive in, and if you need a little bit of care, we can get the little bit of care.

And you have people looking out for you. So if you fall, you're not going to be on the ground for three days, because you have other people checking on you — the staff, they're going to notice you're not down at breakfast or lunch. They're going to know your routine. So they check on you and they help you. I'm a huge fan. I'm a huge proponent of that kind of living and lifestyle, especially for people who are older.

Now let's go back and touch on the Medicare piece of it. Where can you offer Medicare?

I'm licensed in Texas, so I can offer it anywhere in Texas. But I do focus — because it's by county — I do focus in this county, because I like to sit down with someone. I might eventually get to where I'll do virtuals, on the phone or on a call like this. But right now I just focus in this area, unless they need me.

I can do a funeral trust, which is part of the licensing, which is a Medicaid financial planning tool. It's irrevocable, so you can put money in there and it doesn't have that Medicaid five-year look-back.

Can you talk a little bit about that as well? Because I think that's really helpful for people who are now seeing that Medicare is not going to cover it and they're going to need to think about protecting assets. Can you give a little more detail about what a funeral trust looks like?

An irrevocable funeral trust is kind of like an irrevocable trust that elder law attorneys use to protect assets and money when you're doing estate planning. This is going to be for someone who has a little bit of money — they need to go into long-term care, but they're going to have to private pay because they have this cash on hand.

So you can put up to fifteen thousand dollars in a funeral trust if you haven't planned for your funeral — or even if you have, you can use it additionally. And it bypasses that Medicaid look-back, so they're not going to look at it. And in Texas, you can do it for yourself, your spouse, and your children. So if you have sixty thousand dollars — you've got four different funeral trusts, if you've got four people in your family that you can actually use it for. And then you can immediately go into long-term care under Medicaid.

It's huge, because whether we like to talk about it or not, the one thing that's going to happen to each and every one of us is we're going to need a funeral one day.

That's great, because I did not know you could do it for your whole family. And what a lovely gift in one way that you can give your children, so they don't even have to worry about that.

And the funeral trust is easy. There's no cost to it and it works seamlessly with the funeral home. If you end up having to move to be closer to your children and you've already paid for your funeral in your old town — if you have a funeral trust, you can go anywhere. If you pay for your funeral already, everybody has to travel back to that hometown to have the funeral. So it's the beauty of being able to take it wherever you go.

And again, there's no fees to it. The funeral trust works with the funeral home to help pay for everything. It's funded within 24 to 48 hours, so you don't have to wait on it like life insurance. So it's a nice little additional way to save some of your money if you do have to go into long-term care and you haven't planned.

I love that, because you're kind of now such a one-stop shop. You're covering so many hard things. And just to know that you could have somebody who is as kind and wonderful as you — because I do know her and she is amazing — to be able to do that is really great.

So why don't you leave listeners with where you are and how they contact you?

I'm in Northeast Texas and you can contact me — I'll just shout out my cell phone, it's 903-704-8715. You can go to carepatrol.com and look up Northeast Texas — that's where I am. And I'm on Facebook and Instagram, and you can look me up under my Google profile.

Sometimes people go, you really need to get paid for your knowledge. And I'm like, but that's the beauty of helping people. God told me he wanted me to do this and I'm following his plan, and so he takes care of me. I'm very blessed in that way.

And I love that. People — yes, she is free to contact through CarePatrol, and we will throw links below. Nikki, thank you so much for coming and chatting with us today. I really appreciate it. And thank you to everyone listening.

All right, that's a wrap for today. Until next time, remember, you're not alone. Take things one step at a time, stay centered, and trust your compass. See you next time on LTCareNav's Care Compass.