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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 is likely to need assistance in one 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 do 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 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

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

Many seniors prefer home healthcare rather than 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 care level is frequently a service provider such as a home healthcare aide. The aides usually 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 their certification and also their reputation. It is 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 enjoy meals and community 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 may 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 provides 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 who 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 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 and Memory 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.

I plan on retiring in a few months and need health insurance until I can enroll in Medicare. What are my options?

There are several places early retirees can find health insurance coverage before Medicare kicks in, but your options will depend on your income level, your health care needs and the length of time you need coverage.

Affordable Care Act: For most early retirees who are not yet eligible for Medicare, the Affordable Care Act (ACA) health insurance marketplace, also known as Obamacare, is the best option for getting comprehensive health coverage. Coverage will not be denied or cost more for preexisting health conditions.

If your income falls between 400% to 100% of the poverty level (or to 138% in states with expanded Medicaid coverage) after you retire, you will also be eligible for a subsidy that will reduce your monthly premiums. In 2024, 400% of poverty level is $60,240 for one individual or $81,760 for a married couple. Those with incomes below 100% of poverty level (or 138% in Medicaid expansion states), will qualify for Medicaid. For those with household incomes above 400% of poverty level, the ACA also provides subsidies to ensure premiums do not exceed more than 8.5% of their income for a benchmark policy.

To see how much subsidy you are eligible for, use the subsidy calculator at https://www.healthcare.gov/lower-costs/. To shop for ACA plans in your state, visit HealthCare.gov or call 800-318-2596. For extra help, contact a certified agent or broker at HealthCare.gov/find-assistance.

COBRA: Another temporary health insurance option you may be eligible for is the Consolidated Omnibus Budget Reconciliation Act (COBRA). Under this federal law, if you work for a company that has 20 or more employees, you can remain on your employer’s group health plan for at least 18 months – but could last up to 36 months. It is important to note that with COBRA, you will pay the full monthly premium yourself, plus a 2% administrative fee.

For more information, talk to your employer’s benefits administrator or contact the Employee Benefits Security Administration at Askebsa.dol.gov or call them at 866-444-3272.

If the company you work for has fewer than 20 employees, you may still be able to get continued coverage through your company if your state has “mini-COBRA.” Contact your state insurance department to see if this is available where you live.

Short-Term Health Insurance: If you cannot find an affordable ACA plan and COBRA is too expensive, another possible option is short-term health insurance. These plans, which are not available in every state, are more affordable, basic health plans that provide coverage for up to three months with a one-month extension available. Please note that short-term plans do not need to comply with the ACA so they can deny coverage, exclude preexisting conditions and may not cover prescription drugs.

Healthcare sharing ministries: If the previously listed options do not work for you, another temporary solution could be healthcare sharing ministries (HCSM). These are cost-sharing health plans in which members – who typically share a religious belief – make monthly payments to cover expenses of other members, including themselves.

HCSMs are less expensive than paying full out-of-pocket costs for traditional health insurance but be aware that HCSMs are not health insurance. They do not have to comply with the consumer protections of the ACA, and they can also reject or limit coverage for having pre-existing health issues and limit how much you will be reimbursed for your medical costs. Preventive care is also typically not covered either.

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 13, 2024

September is designated as National Preparedness Month. All individuals should use this time, before the natural disaster season, to protect important tax and financial information. The IRS offers several helpful tips to protect personal, financial and tax information. Additional information is also available on IRS.gov or FEMA.gov.

Protect Important Documents —Original documents may include tax returns, Social Security cards, marriage certificates, birth certificates and deeds to property. These should be secured in a waterproof container in a safe location. You should also make copies of important documents and keep them in a safe deposit box or send them to a trusted person in a different location.
Record of Valuables — With the ease of taking pictures on your cellphone, you should maintain photos of your high-value items. These photos or videos will be important if you lose the items in a natural disaster. These photos can help support your claims for tax benefits or insurance claims. The IRS also offers Publication 584, Casualty, Disaster, and Theft Loss Workbook. This will be very helpful to you if you have a loss due to a natural disaster.
Rebuild Your Records — After any natural disaster, you may have a challenge in reconstructing or rebuilding your records. These records could be essential for receiving a federal grant or an insurance company payment. If you can accurately estimate your loss through records, the insurance adjuster will be able to justify the payments. The IRS has a Reconstructing Records webpage on IRS.gov that may be helpful.
Employer Fiduciary Bond — If you are an employer, you may have difficulties if your payroll service provider experiences a natural disaster. Your payroll service provider is obligated to make timely federal tax payments. There should be a fiduciary bond that protects you as an employer if your payroll service provider is in a natural disaster and defaults.
IRS Tax Relief — If FEMA declares your area a federal disaster zone, the IRS frequently postpones tax filing and payment deadlines. If you are within the disaster area, you will not need to contact the IRS. The IRS automatically identifies taxpayers with a business or personal address in the covered disaster area. If you reside outside the covered disaster area but have been impacted by the disaster, you may call 866-562-5227 to determine whether you qualify for relief.

Can you give me some tips on choosing an appropriate walker for my parent? My parent has some balance issues as well as arthritis and could use a little more help than what a cane provides.

When it comes to choosing a walker, there are several styles and options to consider, but finding the best fit for your parent will depend on their abilities and where they will be using it. Here are some tips that can help you choose.

Types of Walkers

There are three basic types of walkers on the market today. To help your parent choose, consider how much support they will need. You should also visit a medical equipment store or pharmacy that sells walkers to test the different types. To locate a nearby equipment supplier, search Medicare’s directory available at Medicare.gov/medical-equipment-suppliers.

Here are the different types of walkers to choose from:

Standard walker: Considered the most basic style, this walker has four legs with rubber-based feet (no wheels), is very lightweight, about 5 to 6 pounds, and typically costs between $30 and $100. This type of walker must be picked up and moved forward as you walk, so it is best suited for individuals who need significant weight-bearing support or who are walking very short distances.

Two-wheel walker: This type has the same four-leg style as the standard walker except it has wheels on the two front legs that allow you to easily push the walker forward without lifting, while the back legs glide across the floor providing support while you step forward. These are ideal for people with balance issues and are priced between $50 to $250.

Rollator: A rolling walker has wheels on all (three or four) legs. Four-wheel rollators typically come with a built-in seat, basket and hand-breaks. This style is best suited for people who need assistance with balance or endurance inside or outside the home. Some rollators even come with pushdown brakes that engage with downward pressure and lock if you sit on the seat. If your parent needs to navigate tight spaces at home, three-wheel rollators provide good maneuverability, but without a seat. Rollators typically run between $55 and $650.

Other Tips

After deciding on the type of walker, there are additional factors to consider to ensure that the walker meets your parent’s needs. The walker’s height must be adjusted appropriately. To find the correct height, your parent should stand with their arms relaxed at their sides and adjust the walker so that the handgrips line up with the crease on the inside of their wrist.

You should also verify that the walker’s weight capacity will support your parent, and if they choose a four-wheel rollator, that their body fits comfortably between the handgrips when sitting. Heavy duty (bariatric) rollators with higher weight capacities, bigger wheels and wider seats are also an option.

Your parent should also test the handgrips to make sure they are comfortable and that the walker folds up for easier storage and transport. Depending on where your parent plans to use the walker, there are accessories that can be added for convenience such as food tray attachments, tote bags for carrying personal items, oxygen tank holders and tennis ball walker glides that go over the feet of a standard walker to help it slide more easily across the floor.

Lastly, if a walker is medically necessary, consult with your parent’s doctor or a physical therapist. If a walker is prescribed, Medicare will cover 80% of the rental or purchase price.