Social Security

Linda asked, "When should I take my Social Security? I will turn 57 this year and have a strong earnings history, having paid into Social Security for nearly 35 years. Given the year I was born, my 'regular' retirement age for purposes of Social Security will be age 67 but I can take 'early' benefits starting at age 62 or even wait until age 70. Which is better for me?"

Social Security Benefits

The average American retires and receives Social Security to cover part of his or her retirement expenses. A typical Social Security payment replaces approximately 40% of your pre-retirement income. To qualify for Social Security, you need to have contributed to the fund for 40 quarters or 10 years. Your Social Security payout will be dependent on your highest earning years.

Full Payments at Age 67

In the 1980s, Congress decided to slowly increase the age for full Social Security benefits from 65 to 67. For anyone born after 1960, the full Social Security retirement benefit is available at age 67.

Based on the tables, at age 67 Linda would qualify for $3,345 per month (in current dollars). If she waits until that age to start payouts, she receives a larger amount than if she selects an early payout at age 62 and it will be adjusted for inflation.

The favorable news for Linda is that she would receive this larger amount plus cost-of-living increases for her lifetime. In addition, if she works after age 67, there's no reduction in her Social Security payment. She can continue to receive the full income of her work and the Social Security benefit. Of course, because both she and her employer are contributing to the Social Security system while she is working, her actual Social Security benefit is significantly reduced. Her Social Security payout will be taxed and her net after-tax benefit will be reduced.

Because Linda is still working, she is contributing about $600 per month of after-tax income to Social Security. Her employer is also contributing a similar sum. The net Social Security benefit to her, after payment of income taxes on her contribution and the contribution by her employer from her salary, is now approximately $300 to $600 of added after-tax monthly income.

Early Payout at Age 62

Linda could join many Americans and start taking payments when she is age 62. In the case of early retirement, a benefit is reduced 5/9 of one percent for each month before normal retirement age, up to 36 months. If the number of months exceeds 36, then the benefit is further reduced 5/12 of one percent per month. If the number of reduction months is 60 due to retirement at age 62 when normal retirement age is 67, then the benefit is reduced by 30 percent.

This amount will be adjusted every year based on the Social Security cost-of-living increase. While her benefit is adjusted for inflation, the actual value or purchasing power of this amount will not change. Linda's mother is still living and her grandmother lived to be 96, so she may be wise to plan for a fairly long retirement.

There is one other challenge for Linda. If she continues to work, and many individuals do work until their late 60s, she will lose part of her Social Security payment. For every $3 in income (over an indexed limit) she earns between age 62 and her full retirement age, she loses $1 in Social Security benefits. By taking her payment at age 62, she receives both a lower payout for her lifetime and reduced payments for the years until her full retirement age.

Delaying Payments to Age 70

If Linda continues with her present employment and does not need her Social Security income, she can receive an increased benefit by delaying the start of payments to age 70. The benefit starting at age 70 for Linda is currently 24% higher than what she would receive at age 67. With inflation adjustments, Linda's benefit could be even higher by the time she reaches age 70.

This represents a significant increase over her normal retirement amount. The amount increases by about 8% per year because the government has held her funds longer and she has a shorter period of time before beginning to receive her payments.

If Linda lives to her mid-80s, then she will have received a greater total Social Security benefit. If she joins her long-lived relatives who have survived to their mid-90s, her net economic benefit from Social Security by delaying the first payouts to age 70 is dramatically greater than her total payouts starting at age 62 or 67.

Tax-free Social Security Payouts

Individuals with lower incomes do not pay any federal tax on Social Security. Generally, single people with incomes under $25,000 per year do not pay tax.

50% of Social Security Taxable

For many Social Security recipients, their income is in the middle range and 50% is taxable. For example, a single person with taxable income of approximately $25,000 to $34,000 would pay tax on half of his or her Social Security. The taxable income is called the modified adjusted gross income and includes adjustments for some types of tax-free income.

Because Linda has a substantial IRA, she expects to have a higher level of income.

85% of Social Security Taxable

With other pension income and IRA income, Linda anticipates a modified adjusted gross income of over $36,000 per year. As a result, 85% of her Social Security is taxable.

Linda is not very pleased with this plan. Because she already paid tax on her half of the Social Security, she feels that this is a very substantial tax. However, with the increasing need to fund Social Security in the future, the high probability is that Linda will pay tax on 85% of her Social Security during her lifetime.

Social Security for Spouses

A spouse may have different options for receiving Social Security. First, if he or she qualifies based on employment, then the best choice may be to take his or her normal benefit at the selected retirement age.

However, a surviving spouse can receive a reduced spousal benefit starting at age 60. At a later date they may transition to a full benefit under their own qualification.

How to Improve Your Balance

After taking a fall last month, my doctor suggested I start doing balance exercises. Do you have any tips for balance?

Most people do not think about practicing their balance, but it is a good idea to start doing so. The same way that you walk to strengthen your heart, lungs and overall health, you should practice maintaining your balance.

As we age, our ability to maintain balance declines, which can increase your risk of falling. More than one in three individuals aged 65 or older falls each year and the risk only increases with age. A simple fall can cause a serious fracture of the hip, pelvis, spine, arm, hand or ankle, which can lead to hospitalization, disability, loss of independence and potential fatalities.

How Balance Works

Balance is the physical ability to distribute your weight in a way that enables you to hold a steady position or move at will without falling. Balance is controlled by a complex combination of muscle strength, visual inputs, inner ear workings and specialized receptors in the nerves of your joints, muscles, ligaments and tendons which help with orientation. These factors are sorted out in the sensory cortex of your brain, which takes this information and gives you balance. Over time, these neurological pathways dull and causes individuals to gradually lose their balance.

Poor balance can lead to a vicious cycle of inactivity. Individuals who feel unsteady end up curtailing certain activities, which can lead to inactivity. If they are continuously inactive, they no longer challenge their balance systems or their muscles. As a result, both balance and strength decline and simple acts like strolling through a grocery store or getting up from a chair become trickier for these individuals. This can shake their confidence and cause them to become even less active.

Balance Exercises

If you have a balance problem that is not tied to illness, medication or some other cause, simple exercises may help preserve and improve your balance. Some basic exercises you can do include:

• One-legged stands: Stand on one foot for 30 seconds or longer, then switch to the other foot. You can do this while brushing your teeth or even while waiting in line somewhere. In the beginning, you might want to have a wall or chair to hold on to in case you lose your balance.
• Heel rises: While standing, rise up on your toes, lifting your heel as high as you can. Drop back to the starting position and repeat the process 10 to 20 times. You can make this more difficult by holding light hand weights.
• Heel-toe walk: Take 20 steps and with every step, touch your heel to your toe on your opposite foot. Keep your focus straight ahead instead of looking down at your feet.
• Sit-to-stand: Without using your hands, get up from a straight-backed chair and sit back down 10 to 20 times. This improves balance and leg strength.

For additional balance exercises visit, a resource created by the National Institute on Aging that offers free booklets that provide illustrated examples of many appropriate exercises. You can order your free copy online or by calling 800-222-2225.

Savvy Living is written by Jim Miller, a regular contributor to the NBC Today Show and author of "The Savvy Living" book. Any links in this article are offered as a service and there is no endorsement of any product. These articles are offered as a helpful and informative service to our friends and may not always reflect this organization's official position on some topics. Jim invites you to send your senior questions to: Savvy Living, P.O. Box 5443, Norman, OK 73070.


Published September 30, 2022

Flu Vaccines for Older Adults

I just turned 65 and would like to learn more about the stronger flu shots I see advertised for older adults. What can you tell me about them and how are they covered by Medicare?

There are three different types of flu shots that the CDC recommends for people aged 65 and older. These FDA-approved annual vaccines are designed to offer more protection than the standard flu shot, which may be important for older adults who have weaker immune defenses and those who may be at a greater risk of developing dangerous flu complications.

Fluzone High-Dose Quadrivalent: Approved in 2009 for use in the United States, the Fluzone High-Dose is a high-potency vaccine that contains four times the number of antigens as a regular flu shot, which creates a stronger immune response and results in better protection. According to a study published in the New England Journal of Medicine, the Fluzone High-Dose proved to be 24% more effective at preventing the flu in seniors than the regular dose.

Fluad Quadrivalent: Available in the United States as of 2016, this vaccine contains an added ingredient called adjuvant MF59, which helps create a stronger immune response. In a 2013 observational study, Fluad was 51% more effective in preventing flu-related hospitalizations for older patients than a standard flu shot.

Please note that both the Fluzone High-Dose and Fluad vaccines can cause more mild side effects than the standard-dose flu shot, including pain or tenderness at the injection site, muscle aches, headache or fatigue. Neither vaccine is recommended for seniors who are allergic to chicken eggs, or who have had severe reactions to a flu vaccine in the past.

The CDC does not recommend one vaccination over the other. Please talk to your healthcare professional to determine which vaccine is best for you.

FluBlok Quadrivalent: An alternative vaccine for individuals with egg allergies is FluBlok Quadrivalent, a vaccine that does not use chicken eggs in their manufacturing process. This vaccine was 30% more effective than a standard-dose influenza vaccine in preventing flu in people aged 50 and older in a clinic study.

All the above-mentioned vaccines are generally covered by Medicare Part B, but subject to Medicare payment limitations.

Pneumonia Vaccines

Other important vaccinations recommended to older adults by the CDC, especially this time of year, are the pneumococcal vaccines for pneumonia. Around 1.5 million Americans visit medical emergency departments each year because of pneumonia, and about 50,000 people pass away from contracting pneumonia.

The CDC recently updated their recommendations for the pneumococcal vaccine and recommends that that individuals ages 65 and older who have not previously received any pneumococcal vaccine should get PCV20 (Prevnar 20) or PCV15 (Vaxneuvance). If PCV15 is used, it should be followed by dose of PPSV23 (Pneumovax23) at least one year later.

Alternatively, if you have already received a PPSV23 shot, you should get one dose of PCV15 or PCV20 at least one year later.

Medicare Part B also covers the two pneumococcal shots – the first shot at any time and a different, second shot if it is administered at least one year after the first shot.

COVID Booster

If you have not already done so, you may also be a candidate to receive a COVID-19 booster shot this fall. Both Moderna and Pfizer have developed new bivalent booster vaccines that adds an Omicron BA 4/5 component to the old formula, providing better protection.

Savvy Living is written by Jim Miller, a regular contributor to the NBC Today Show and author of "The Savvy Living" book. Any links in this article are offered as a service and there is no endorsement of any product. These articles are offered as a helpful and informative service to our friends and may not always reflect this organization's official position on some topics. Jim invites you to send your senior questions to: Savvy Living, P.O. Box 5443, Norman, OK 73070.


Published September 23, 2022

Will the Inflation Reduction Act Lower Your Drug Costs?

What kind of changes can Medicare beneficiaries expect to see from the Inflation Reduction Act that was recently signed into law? How will this reduce out-of-pocket spending for Medicare beneficiaries?

The climate, tax and health care bill known as the Inflation Reduction Act was signed into law last month. The bill includes significant changes to the Medicare program that will kick-in over the next few years.

These changes will lower prescription drug prices for millions of individuals with Medicare. The government will be allowed to negotiate drug prices and cap out-of-pocket drug costs at $2,000 annually. Other changes include free vaccinations, lower insulin costs and expanded subsidies for low-income beneficiaries.

The Inflation Reduction Act also extends subsidies for health insurance premiums under the Affordable Care Act for three years. The subsidies have helped millions of Americans pay for health insurance before they are eligible for Medicare. Here is a breakdown of the changes and when they will commence.

2023: All vaccines covered under Medicare Part D, including the shingles vaccine, will be free to beneficiaries. The cost of insulin will be capped at $35 per month for participants. This will be a significant savings for more than 3 million Medicare enrollees who currently use insulin to control their diabetes. Also, drug makers will be penalized in the form of "rebates" that would be assessed and paid to the government if a drug's price increase exceeds general inflation.

2024: Cost sharing for catastrophic coverage in Part D will be eliminated. Currently, once your out-of-pocket costs reach $7,050, you enter catastrophic coverage. Participants are still responsible for 5% of your prescription drug costs, with no limit.

In 2024, people with Part D coverage will no longer be responsible for any out-of-pocket drug costs once they enter catastrophic coverage. This is significant for those who use expensive medications for conditions like cancer or multiple sclerosis. Also starting in 2024 through 2029, Part D premiums can not be increase more than 6% per year.

For lower income Medicare beneficiaries, eligibility for the Part D Low Income Subsidy (also known as Extra Help) will be expanded to 150% of the federal poverty level, from today's limit of 135%. This change will allow about 500,000 additional people with Medicare will qualify for financial assistance to help pay some or all their prescription drug premiums and deductibles.

2025: One of the biggest cost reduction measures for Medicare beneficiaries will begin in 2025 when out-of-pocket spending on Part D prescription drugs will be capped at $2,000 per year. This will be a major savings for the more than 1.5 million beneficiaries who spend more than $2,000 out-of-pocket each year.

2026: When Medicare's Part D program was enacted in 2003, negotiating lower drug prices was forbidden. Starting in 2026 Medicare will be allowed to negotiate prices with drug companies for 10 of the most expensive drugs covered under Part D. In 2027 and 2028, 15 drugs will be eligible for negotiations. After 2029, another 20 drugs will be added each year.

Savvy Living is written by Jim Miller, a regular contributor to the NBC Today Show and author of "The Savvy Living" book. Any links in this article are offered as a service and there is no endorsement of any product. These articles are offered as a helpful and informative service to our friends and may not always reflect this organization's official position on some topics. Jim invites you to send your senior questions to: Savvy Living, P.O. Box 5443, Norman, OK 73070.


Published September 9, 2022

Prepare For Natural Disasters

With the substantial risk of hurricanes in the southeastern region and the possibility of tornadoes, fires, earthquakes and other natural disasters throughout the nation, it is important for all Americans to take reasonable steps to be prepared. These steps could include securing and duplicating essential documents, creating lists of collections and other valuable property and understanding how to find assistance. By planning ahead, taxpayers will be better able to recover financially from a natural disaster.

1. Secure Documents – Taxpayers should keep important documents in waterproof containers and in a secure location. The important items include tax returns, birth certificates, deeds to homes and other property, insurance policies and similar documents. Some individuals choose to have a copy of these documents held by a relative or friend in a different state.

2. Copies of Documents – Some documents are available only on paper but should be converted to a digital file format. Once items are digitized, using commercial cloud–based storage systems can be helpful and will provide additional security.

3. Inventory of Valuables – Taxpayers should have a detailed inventory of valuable property. Take photos or videos of collections, art, jewelry or other valuable items. It is also helpful to have a general description of property, which may include the make and model numbers of some items. Keeping detailed documentation of possessions may be helpful when filing claims for insurance purposes or tax benefits.

4. How to Get Help – If a natural disaster strikes, it is important to understand how to obtain assistance. Contact insurance agents to report any losses. Some financial institutions are able to provide statements and electronic documents that may assist in rebuilding financial affairs. The site has a helpful page with the title "Reconstructing Records."

5. IRS Assistance – After every federal disaster declaration, the IRS provides assistance. The IRS Tax Relief in Disaster Situations webpage on may be helpful. In many cases, the IRS allows a delayed filing or tax payment date. The date will be specific by geographic area, which can be found on There also is an IRS disaster hotline at (866) 562-5227.

6. Disaster Loss Deduction – If a substantial loss occurs, taxpayers may qualify for a disaster loss deduction. The uninsured or unreimbursed disaster loss may be deductible under the rules set forth in IRS Publication 547, Casualties, Disasters and Thefts.

Check-In Services For Individuals Living Alone

Can you recommend any services that check-in on individuals who live alone? I live about 200 miles from my 82-year-old parent and worry about them falling or getting ill and not being able to call for help.

There are several different types of check-in services, along with some simple technology devices that can help keep your parent safe at home while providing you some peace of mind. Here are some options to look into.

Check-in app: If your parent uses a smartphone, a great solution to help ensure their safety would be to download a free app from your favorite app store that creates a daily check-in to confirm the user's wellbeing. These apps are used by thousands of individuals who live alone and want to ensure that if something happens to them, their loved ones will be notified quickly so they can receive immediate help.

Most of the apps require selection of what time(s) throughout the day the user would like for the app to check-in. The app will send a push notification at those times asking the user to check-in. If the user does not check-in within a certain time frame or respond after multiple pings, the app will notify the designated emergency contacts and share the last known location so that the user can receive fast help.

Some apps also offer additional services for a fee. These services can include in-person wellness check-ins who can visit your parent as well as provide assistance if needed.

Check-in calls: If your parent does not use a smartphone, another option to help ensure their safety is a daily check-in call service program. These are telephone reassurance programs usually run by police or sheriff's departments in hundreds of counties across the country and are generally free of charge.

Here is how they work. A computer automated phone system would call your parent at a designated time each day to check-in. If the call is answered, the system will assume everything is fine. But if the call goes to voicemail after repeated tries, the designated emergency contact would get a notification call. If the first emergency contact is not reachable, calls are then made to backup individuals who have also agreed to check on the individual if necessary.

The fallback is if no one can be reached, the police or other emergency services personnel will be dispatched to their home.

To find out if this service is available in your parent's community, call their local police department's nonemergency number.

If, however, the community does not have a call check-in program, there are third-party businesses that offer similar services for relatively low prices. You can find the businesses in your area by using your favorite online search engine.

Technology devices: You may also want to invest in some simple technology aids to keep your parent safe. One of the most commonly used devices for this is a medical alert system that cost about $1 per day. These systems come with a wearable "help button" that would allow the wearer to call for help 24/7.

Another option that is becoming increasingly popular is virtual assistant smart devices. These devices typically are smart speakers but may also include video capabilities and would allow your parent to call multiple emergency contacts with a simple verbal command. Wi-Fi is typically required to use these devices.

Savvy Living is written by Jim Miller, a regular contributor to the NBC Today Show and author of "The Savvy Living" book. Any links in this article are offered as a service and there is no endorsement of any product. These articles are offered as a helpful and informative service to our friends and may not always reflect this organization's official position on some topics. Jim invites you to send your senior questions to: Savvy Living, P.O. Box 5443, Norman, OK 73070.


Published September 2, 2022

What is an Annual Notice of Change?

Last year I received a "notice of change" letter from my Medicare provider. Should I expect another one this year?

The letter you are asking about is referred to as the Annual Notice of Change (ANOC), which is from your Medicare Advantage or Medicare Part D prescription drug plan typically sent in late September. People with only a Medigap plan do not receive these because Medigap plans do not have benefit changes from year to year. If you received an ANOC last year, you should expect to receive another letter next month.

The ANOC gives a summary of any changes in your plan's costs and coverage that will take effect on January 1 of the next year. The ANOC is typically mailed with the plan's "evidence of coverage," which is a more comprehensive list of the plan's costs and benefits for the upcoming year.

You should review these notices to see if your plan will continue to meet your health care needs in 2023. If you are dissatisfied with any upcoming changes, you can make changes to your coverage during fall open enrollment, which runs from October 15 to December 7.

Here are three types of changes to look for:

Costs: If you have a Medicare Advantage plan, find out what you can expect to pay for services in 2023. Costs such as deductibles and copayments can change each year. For example, your plan may not have had a deductible in 2022, but it could have one in 2023. A deductible is the amount of money you owe out-of-pocket before your plan begins to cover your care. Another example is that your plan may increase the copayments you owe for visits to your primary care provider or specialists.

Coverage: If you have a Medicare Advantage plan with prescription drug coverage, check to see if your doctors, hospitals and other health care providers and pharmacies will still be in network for 2023. You will have the lowest out-of-pocket costs if you go to providers and pharmacies that are within your plan's network. If you see an out-of-network provider, your plan may not cover any of the cost of your care, leaving you to pay the cost out-of-pocket. You should also contact your providers directly to confirm that they will still be accepting your plan in the coming year.

Drugs: If you have prescription drug coverage, look through the plan's formulary, which is the list of drugs the plan covers. Formulary changes can happen from year to year, so make sure the medications you are taking will be covered next year, and that they are not moved to a higher tier which will affect your copay. If you see any changes that will increase your costs, you may want to select a different drug plan that covers all of your medications. If the formulary is incomplete, or you do not see your drug(s) on the list, contact the plan directly to learn more.

If you have not received an ANOC by the end of September, you should contact your Medicare Advantage Plan or Part D plan to request it. This notice can be very helpful in determining whether you should make any changes to your coverage during the fall open enrollment. Reading your ANOC can also prevent any surprises about your coverage in the new year.

Shopping, comparing and enrolling in a new Medicare Advantage or Part D plan during the open enrollment period can easily be done online at Medicare's Plan Finder Tool at

If you do not have a computer or Internet access, you can also call Medicare and they can help you out over the phone. Your State Health Insurance Assistance Program (SHIP) provides free Medicare counseling and is also a great resource to help you make any changes. To find a local SHIP counselor in your area, use your preferred online search engine.

Savvy Living is written by Jim Miller, a regular contributor to the NBC Today Show and author of "The Savvy Living" book. Any links in this article are offered as a service and there is no endorsement of any product. These articles are offered as a helpful and informative service to our friends and may not always reflect this organization's official position on some topics. Jim invites you to send your senior questions to: Savvy Living, P.O. Box 5443, Norman, OK 73070.


Published August 26, 2022

Planning for Senior Care


Planning for retirement and senior care is very important. The activities of daily living for a senior person include eating, dressing, bathing and walking or moving. At some point, every senior will likely need assistance in one or more of these areas.

An important consideration will be the cost of providing that care. By retirement, it is helpful for you to own your home, be debt free, and have retirement income and savings. Retirement income will frequently include Social Security, your IRA or 401(k), a pension plan and investment earnings.

Typically, there are four different levels of care utilized by seniors. The first level includes "in-home care" which includes moderate assistance with certain living functions, such as meal delivery. In-home care often eventually progresses to "home healthcare," defined as assistance with the activities of daily living by a home healthcare aide or nurse. The next level is a more formal assisted living or independent living facility. In an assisted living facility, there are more staff and a higher level of assistance. Finally, the fourth level is skilled nursing care. This is 24-hour nursing care in a facility that is designed to provide a higher level of medical assistance.

Independent Home Care

Independent home care is popular for several reasons. First, it is the least expensive of the four levels of care. Independent home care, or "home care" typically provides a senior with assistance for one or more life functions that does not include healthcare.

With home care, seniors are able to live independently in their home. Seniors with home care might, for example, benefit from a program that delivers a daily meal to their home. If they are not able to maintain their driver's license, they might also participate in a ride-sharing program once or twice per week so they can go to the store to buy certain essentials.

There are a number of local charities that provide services to assist with home care and outreach services. In addition, friends and family can create a schedule to provide assistance to their senior loved one.

Finally, home care very often includes a home monitoring system that allows seniors to contact the monitoring service if they are injured. This service might also require seniors to check in at the same time every morning when an alert sounds so that the monitoring service can contact a relative who lives nearby if the senior does not respond.

Home Healthcare

The next level of care, home healthcare, involves a greater degree of assistance to seniors and includes healthcare services that are provided in the senior's home. Home healthcare will vary significantly depending on the level of services provided. However, it frequently will cost from $10,000 to $30,000 per year.

Home healthcare is preferred to assisted living or nursing home care because the person receiving care will be able to maintain his or her independence. While the cost is generally reasonable, there are many organizations and providers who can give you good quality care. A key decision for home healthcare is the person who will be the caregiver. Family is often the first option. If you have a child or other relative who is willing to provide assistance, you may be able to live quite comfortably in a family home or perhaps in an attached apartment.

The next level will frequently be a service provider such as a home healthcare aide. The aides visit on a regular basis and provide assistance. Many individuals are able to manage well by themselves as long as they have a home healthcare aide who makes regular visits.

A third level of home healthcare may involve visits by a practical nurse or registered nurse. The nurse may assist you with various types of care and check to see that you are using your medications or other types of therapy in a beneficial manner.

There are safeguards that should be carefully considered for home healthcare. The organizations that provide home healthcare are generally licensed by each state. You can check into their certification and also their reputation. It's also helpful to have a family member who is in regular contact with the senior person who is receiving home healthcare.

As you age and become more senior, it may be appropriate for you to stop driving and to depend on others for transportation. In addition, the family protector can watch to see that you do not make inappropriate expenditures or become vulnerable to any type of abuse.

Independent or Assisted Living

The next level of care is independent or assisted living which typically has a cost of $40,000 to $65,000 per year.

Many facilities provide both independent and assisted living. Independent living permits the individual to live in a residential facility, but to have a reasonably high level of control of his or her life. With independent living, the person will live in his or her own apartment or small residence and frequently retains a vehicle and the ability to drive. Independent living often offers a meals plan so that the resident can choose to eat in a common dining area.

Assisted living occurs in a more structured residence with a higher level of staff services. The assisted living facility will involve staff who regularly assist residents with the activities of daily living.

Long-term Care

Long-term care includes several levels of care. The two most common levels are skilled nursing and intermediate care. Skilled nursing will provide around-the-clock care from a licensed practical nurse or registered nurse. The cost of skilled nursing care may be $90,000 to $110,000 per year.

Intermediate care facilities also are intended to care for residents that have chronic illnesses or impairments of health. These facilities offer 24-hour staff care. However, they will not always have a registered nurse and may use vocational or practical nurse staff.

It is extremely important with long-term care to examine the facility. Is the facility owned and managed by a for-profit or a nonprofit? What is the affiliation of the organization?

A person may be in a skilled nursing home for several years. Because the costs are very significant, the financial strength of the organization is quite important. If the organization at some point in the future has a financial shortfall, it may find it necessary to reduce services. This could have great impact on the care of a senior person.

Other areas to consider are the facility and the services. What is the location of the facility? You should review the cleanliness of the rooms and the public areas and try to determine the general feelings of current residents toward the facility. Many care facilities offer a number of different types of services. Some of these are social or recreational while others are therapeutic and health related.

Finally, how are the levels of staffing and the food service for the facility? A good facility will have a caring and adequate staff and food service team for the number of residents.

Alzheimer's Care

Alzheimer's is a challenging disease because it leads progressively to very high care requirements. Because of the staff and facility requirements, Alzheimer's care can cost $100,000 or more per year.

There are three general levels of Alzheimer's. Early-stage Alzheimer's involves some short-term memory loss, difficulties with routine tasks and mood swings. Middle-stage Alzheimer's patients may start to show confusion about time and place, loss of memory and wandering. With late-stage Alzheimer's, there is a loss of cognitive function and eventual physical deterioration.

Home care is possible for early-stage Alzheimer's. A family member can provide the level of care needed. It is important that the caregiver understands the risks and takes protective actions to minimize the potential for the senior person to wander off and become lost.

The next level of care is an organized senior residence with a measure of independence. This will provide available 24-hour care, but still enables an early or middle-stage Alzheimer's patient to have some level of control of his or her activities.

Finally, for advanced stages of Alzheimer's, the senior person will need 24-hour residential care. Family members should examine the rooms, consider the staffing levels and review the policies regarding medication for those Alzheimer's patients.

Ways to Pay for Long-Term Care

What types of financial resources are available to help seniors pay for long-term care? My 86-year-old parent will need an assisted living facility or nursing home care in the near future, but has savings that are minimal and does not hold a long-term care insurance policy.

The cost of assisted living and nursing home care in the U.S. is very expensive. According to the Genworth cost of care survey tool, the national median cost for an assisted living facility is over $4,600 per month, while nursing home care runs more than $8,100 per month for a semi-private room. Prices will vary depending on if your parent stays in a private or semi-private room. You can search for the costs of assisted living and nursing home care in your area on your favorite web browser.

Most people pay for long-term care (LTC), which encompasses assisted living, nursing home and in-home care, with personal funds, government programs or insurance. If someone is lacking in savings and has no LTC insurance to cover costs, here are the best options to look for funding.

Medicaid: Medicare is the government run health insurance program for individuals ages 65 and older and is available for individuals with disabilities. The first thing you need to know is that Medicare does not cover long-term care. It provides limited short-term coverage, up to 100 days for skilled nursing or rehabilitation services, but only after a three-day hospital stay.

Medicaid is the joint federal and state program that covers health care for individuals with limited finances. This program does cover nursing home and in-home care. To be eligible for coverage, the individual must have very low-income and not more than $2,000 in countable assets, including investments. (Note that most people who enter a nursing home do not qualify for Medicaid at first but pay for care out-of-pocket until they deplete their savings enough to qualify.)

There are also many states that now have Medicaid waiver programs that can help pay for assisted living. To get more information on Medicaid coverage and eligibility, call your state Medicaid office or visit the Medicaid website at

Veterans Benefits: If your parent is a U.S. veteran, or a spouse or surviving spouse of a veteran, there is a benefit called Aid and Attendance that can help pay for long-term care.

To be eligible, an individual must need assistance with daily living activities like bathing, dressing or going to the bathroom. Annual income must be under $15,816 as a surviving spouse, or $24,610 for a single veteran, after medical and long-term care expenses. Assets must also be less than $138,489, excluding a home and one car.

To learn more, see, or contact your regional VA office, or your local veterans service organization by calling (800) 827-1000 for contact information.

Life insurance: If your parent has a life insurance policy, find out if it offers an accelerated death benefit because that would allow a tax-free advance to help pay for care.

In the alternate, an individual may consider selling the policy to a life settlement company. These are companies that buy life insurance policies for cash, continue to pay the premiums and collect the death benefit. Most sellers generally get four to eight times more than the policy cash surrender value.

If your parent owns a policy with a face value of $100,000 or more and is interested in this option, get quotes from several brokers or life settlement providers. To locate some, use the Life Insurance Settlement Association member directory at

Savvy Living is written by Jim Miller, a regular contributor to the NBC Today Show and author of "The Savvy Living" book. Any links in this article are offered as a service and there is no endorsement of any product. These articles are offered as a helpful and informative service to our friends and may not always reflect this organization's official position on some topics. Jim invites you to send your senior questions to: Savvy Living, P.O. Box 5443, Norman, OK 73070.


Published August 19, 2022

Living Wills and Advance Directives


As you approach end-of-life decisions, there are several steps that should be taken to make sure you receive the right type and level of care. To assist you in these decisions, most states now permit either an advance directive or a living will. Some seriously-ill persons also have a doctor sign a Physician Order for Life-Sustaining Treatment (POLST). These documents are designed to assist your family and doctors in making the decisions according to your preferences.

Senior Medical Planning

There are three important background areas that you should learn about before entering into senior medical care. These are the medical oath and principles of your care providers, the rules created by Congress to ensure your medical information is protected and the decisions by your state on the specific document that you use to convey your wishes.

Doctors will frequently follow a set of principles that were originally called the Hippocratic Oath. The first oath was written by Hippocrates, a Greek doctor who is considered the father of modern medicine.

A modern version of the Hippocratic Oath typically states, "To practice and prescribe to the best of my ability for the good of my patients." Following this principle, your doctor will attempt to restore you to good health.

Because of modern improvements in medicine, it is possible to prolong your life through the use of ventilators, intravenous feeding and other devices. While you certainly want your doctors and nurses to provide very good care, you may also need to offer some guidance on how extensively your family and doctors should use modern technology to prolong your life.

A second major area for you to understand is called HIPAA. The Health Insurance Portability and Accountability Act (HIPAA) was passed by Congress in 1996. It is designed to provide protection for you and to keep your health information private.

Under the HIPAA rules, you have the right to see your health records, but you must give written permission before your records are released to other individuals. The information provided by doctors or nurses about your care, medications or other personal information is protected. However, you will want to be certain that your designated healthcare proxy (the person who will assist in making healthcare decisions) has the right to review these records. You should sign a HIPAA release form in order to enable your advisors to give proper recommendations to your doctors and nurses.

Finally, you must understand the specific documents of your state. Some states use an advance directive in which you choose a combination of a durable power of attorney for healthcare and a living will. Other states have separate documents. It is very important that you use the appropriate document tailored for the laws of your state.

The Advance Directive

Your first key advisor is the person who will make your medical decisions if you are incapacitated. This individual is frequently called the healthcare proxy. He or she is your agent and holds your durable power of attorney for healthcare. Normally, you will select primary and secondary persons as your healthcare proxy agent.

You will want to list the persons, their addresses and phone numbers so they can be easily contacted. Your secondary healthcare proxy will assume the primary role if the first person is unable or unwilling to serve.

Part of your advance directive will also explain the level of authority that you have given. Your healthcare proxy usually does not have the authority to make decisions unless, in the view of your doctor, you are no longer able to make decisions yourself. However, many forms allow you to sign and empower that person immediately. The authority of your healthcare proxy may also extend after you pass away so that he or she can make appropriate decisions at that time.

Your healthcare proxy may be called upon to make significant decisions for your care. For example, it may be necessary to decide whether or not to use morphine or other types of pain medication. If the decision is to make use of morphine, then a second decision will be made on the use of a low dose or a high dose. With a lower dose of morphine or other types of pain medication, you may have greater clarity of mind but may be less comfortable. If you receive higher doses of medication, you may not be as clear-headed, even though you are at a higher comfort level. These decisions can only be made based on your condition at a given time, but they do directly impact the quality of your life in that circumstance.

A healthcare proxy may also be called upon to make very significant decisions about the hospital, nursing home or other care facility and the level of treatment. For example, some seniors have suffered broken hips or limbs at a time when their demise was near. A healthcare proxy will need to make decisions about the appropriate level of care or treatment under those circumstances.

A second section of an advance directive allows you to give counsel on the level of measures and technology that will be used to prolong your life. If you have an incurable or irreversible condition that will result in your death within a relatively short time, there are medical devices that can significantly prolong your life.

These are sometimes referred to as "heroic measures." If you desire all reasonable measures to be taken, you can generally request that care. If you do so, your life may be extended to the greatest extent possible under "generally accepted healthcare standards."

Your healthcare guidelines expressed in your advance directive will discuss your preferred level of nutrition and hydration. If you prefer to receive nutrition and hydration through intravenous methods, you may specifically request those options.

It is helpful for medical providers to have some level of direction for your pain management. If you prefer a higher level of pain management even though that gives you less clarity of thought, you may so indicate.

A third, fairly typical section of the advance directive covers donation of organs and designation of your primary doctor. If you would like to donate specific organs or designate specific purposes for the use of your body, you may identify the particular organs or discuss purposes. Common purposes include transplantation, therapy, research and education.

Advance directives and living wills may, under state law, be witnessed in a manner similar to the witnessing of your will. Some states require two witnesses or a notary to witness your advance directive. Check with your state law to make certain that you have complied with those requirements. A helpful website with state law requirements is It is maintained by the National Hospice and Palliative Care Organization and seeks to improve care at the end of life.

Physician Orders for Life-Sustaining Treatment (POLST)

A Physician Order for Life-Sustaining Treatment (POLST) is a medical order signed by your doctor or a medical staff person as authorized under your state law. While the name and provisions may be different in some states, the POLST option is generally available nationwide. If you have a serious illness or may pass away within one year, you may want to ask your doctor to sign this medical order.

The POLST typically covers cardiopulmonary resuscitation (CPR), medical interventions and nutrition. You may choose to have CPR or select "Do Not Resuscitate (DNR)." Your medical interventions may include full treatment to prolong your life, selective treatment that avoids burdensome procedures or comfort-focused treatment. Nutrition can be maintained long-term with feeding tubes, for a trial period or you may select no artificial means of nutrition.

All of these decisions should be made in consultation with your doctor. Both your doctor and you or your healthcare proxy must sign the POLST. Your POLST may reflect your values, religious beliefs and goals for care.

Even if you have a POLST signed by your healthcare provider, you still need an advance directive. The advance directive appoints your healthcare proxy (primary and secondary) and covers many medical circumstances not covered by the POLST. Everyone should sign an advance directive, while those who are seriously ill may benefit from a POLST.

Action Steps

After completing your living will or advance directive, you will sign and typically have witnesses for your original document. Prepare several copies of your advance directive. You will want to give a copy to your healthcare agent, your family, clergy, your doctors and other advisors who may be involved in assisting with your medical decisions.

At any time you may revoke the living will or advance directive. It generally is best to revoke the entire document and complete a new document. If you attempt to amend different parts of the advance directive, there is a risk that you may sign provisions that conflict or are inconsistent. If you are in need of urgent care or treatment, you do not want any conflicting provisions in your living will or advance directive.

Your living will or advance directive is a very important part of your personal planning. It is designed to help you receive the best possible care at the end of your life and still comply to the greatest extent with your personal healthcare preferences.

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