I have struggled with shortness of breath for several years now. I just thought I was experiencing normal aging and had put on a bit of weight, but a friend recently told me about COPD. Could I have COPD and not know it?

Chronic obstructive pulmonary disease (COPD) is a progressive lung disease that affects an estimated 30 million Americans, but about half of them may not know they have it.

Many people mistake shortness of breath as a normal part of aging or a result of being out of shape, but that is not necessarily the case. COPD, a term used to describe a variety of lung diseases including emphysema and chronic bronchitis, develops slowly so symptoms may not be obvious until damage has occurred.

Symptoms can include an ongoing cough, a cough that produces a lot of mucus, lack of energy, shortness of breath, blue lips or fingernails, swelling in your feet, ankles or legs, wheezing or chest tightness.

Those most at risk are smokers, former smokers over age 40 and people who have had long-term exposure to other lung irritants such as secondhand smoke, air pollution, chemical fumes or dust. There is also a rare genetic condition known as alpha-1-antitrypsin (AAT) deficiency that can increase the risks.

If you are experiencing any symptoms, you should consult with your doctor about getting tested. A simple breathing test called spirometry can tell if you have COPD, and if so, how severe it is. Early screening can also identify COPD before major loss of lung function occurs. If you do have COPD, there are things you can do to help manage symptoms and protect your lungs from further damage.

Quit smoking: If you smoke, the best thing you can do to prevent more damage to your lungs is to quit. Ask your doctor about prescription anti-smoking drugs that can help reduce your nicotine craving. You can also find free resources from the National Cancer Institute offers a number of smoking cessation resources at SmokeFree.gov or call 1-800-QUIT-NOW.

Avoid air pollutants: Stay away from things that could irritate your lungs like dust, allergens and strong fumes. To help improve the air quality at your home, remove dust-collecting clutter and keep carpets clean; run the exhaust fan when using cleaning products, bug sprays or paint; ban smoking indoors; and keep windows closed when outdoor air pollution is high (see AirNow.gov for daily air-quality reports).

Get vaccinated: Respiratory illness such as, the flu, pneumonia and the coronavirus can cause serious problems for people who have COPD. You may want to talk with your physician about the recommended vaccinations for your medical circumstances.

Take prescribed medications: Bronchodilators (taken with an inhaler) are commonly used for COPD. They help relax the airway muscles to make breathing easier. Depending on the severity of your condition is, you may need a short-acting version only for when symptoms occur, or a long-acting prescription for daily use. Inhaled steroids may also help reduce inflammation and mucus and prevent flare-ups.

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.

Does Social Security offer any special help to beneficiaries who struggle managing their benefits? My aunt, who has no children, has dementia and struggles keeping up with her bills and other financial duties.

Social Security has a little-known program, known as the Representative Payee Program, that helps beneficiaries manage their Social Security benefit payments. Here is what you should know.

Representative Payee Program

Authorized by Congress in 1939, the Social Security Representative Payee Program provides money management assistance to beneficiaries who are in need of help managing their Social Security income. Beneficiaries in need of this help are often seniors suffering from dementia or minor children who are collecting Social Security survivors' benefits.

Currently more than 5 million Social Security beneficiaries have representative payees.

Representative payees also handle benefits for nearly 3 million recipients of Supplemental Security Income (SSI), a Social Security administered benefit program for low-income people who are over age 65, blind or disabled.

Who Are Payees?

A representative payee is typically a relative or close friend of the beneficiary needing assistance, but Social Security can also name an organization or institution for the role, such as a nursing home or social-service agency.

Some of the duties of a representative payee include:

• Using the beneficiary's Social Security or SSI payments to meet their essential needs, such as food, shelter, household bills and medical care. The money can also be used for personal needs like clothing and recreation.
• Keeping any remaining money from benefit payments in an interest-bearing bank account or savings bonds for the beneficiary's future needs.
• Keeping records of benefit payments received and how the money was spent or saved.
• Reporting to Social Security any changes or events that could affect the beneficiary's payments (for example, a move, marriage, divorce or death).
• Reporting any circumstances that affect the payee's ability to serve in the role.

As a representative payee, you cannot combine the beneficiary's Social Security payments with your own money or use the payments for your own needs. The bank account into which benefits are deposited should be fully owned by the beneficiary, with the payee listed as the financial agent.

Some payees, generally those who do not live with the beneficiary, are required to submit annual reports to Social Security accounting for how benefits are used. For more information on the responsibilities and restrictions that come with the role, see the Social Security publication "A Guide for Representative Payees" at SSA.gov/pubs/EN-05-10076.pdf.

How to Get Help

If you believe a beneficiary may need a representative payee, call Social Security at 800-772-1213 and make an appointment to discuss the matter at a local office. Applying to serve as a payee usually requires a face-to-face interview.

Social Security may consider other evidence in deciding if a beneficiary needs a payee and selecting the person to fill the role, including doctors' assessments and statements from relatives, friends and others in a position to give an informed opinion about the beneficiary's situation.

You should also know that if you become a representative payee you cannot collect a fee for doing it. However, some organizations that serve in the role do receive fees, paid out of the beneficiary's Social Security or SSI payments.

For more information on the program visit SSA.gov/payee.

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.

My husband and I are moving to a different area of the country to be near our daughter. Will this affect our Medicare benefits? Will we need to adjust our coverage or re-enroll in a new plan?

Moving can affect your Medicare benefits. It will depend on the type of coverage you have and where you move.

If you and your husband are enrolled in "original Medicare" Part A and Part B, you will be happy to know that you will not need to change your plans when you move because they are the same throughout the United States. However, you will need to notify the Social Security Administration of your change of address. You can do this at SSA.gov/myaccount/ or by calling 800-772-1213.

If you are enrolled in a Medicare Part D prescription drug plan or a Medicare Part C Advantage plan and you move out of your plan's service area, you will need to choose a plan that serves your new area. Depending on the type of coverage you have, you may need to take additional steps when you move.

Medicare Part D Plan: If you are enrolled in original Medicare and have a stand-alone Medicare Part D prescription drug plan, you will need to contact your plan administrator to find out if you have coverage in the area where you are moving. If you do not, you will need to enroll in a new plan that provides coverage in your new location.

Typically, you can make this switch the month before you move and up to two months after the move. Otherwise, you will need to wait until the next open enrollment held during the fall. You could be penalized for not having acceptable prescription drug coverage. To shop for new Part D prescription drug plans in your new location, see Medicare.gov/plan-compare.

Medicare Advantage Plan: If you are enrolled in a Medicare Advantage plan, contact your plan to find out if it will serve your new area. If it does not, you will need to enroll in a new plan that does.

You can switch Advantage plans the month before you move and up to two months after you move. Be aware that if you relocate out of your Medicare Advantage plan's service area and fail to enroll in a new plan in your new area, you will automatically be switched to original Medicare. This will happen when your old Medicare Advantage plan is forced to disenroll you because you do not live within its service area anymore. To shop for new Advantage plans in your new location, see Medicare.gov/plan-compare.

Medigap Policy: If you are enrolled in original Medicare and have a supplemental Medigap policy, you will need to notify your provider that you are moving, but you should not need to change insurance companies or plans. There also are Medicare Select plans, which are Medigap plans that are network-based and are available in a few states. These plans may require you to change.

Medigap plans are standardized across the country. For example, Medigap Plan F offers the same coverage in one state as it does in another state. Take note that Massachusetts, Minnesota and Wisconsin have waivers from the federal government allowing them to standardize Medigap plans differently, so plan designs are different in those three states.

You should be aware that Medigap costs vary by location, so your monthly Medigap policy premium may be higher or lower depending on the cost of medical care in your new area. Call your plan provider and tell them your new ZIP code and they will let you know the new cost.

Sometimes you will be pleasantly surprised that the cost is lower. If it is not, you could look for a cheaper policy. However, you may have to undergo medical underwriting. Medigap policies come with their own rules for enrolling, and some states have different enrollment standards than others.

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.

Can you offer any tips on choosing a good adult day care provider for an elderly parent? My 81-year-old father, who just moved in with me, has dementia and needs attention during the day while I am at work.

Adult day care services can be a great option for caregivers who work, or for those who just need a break during the day. Here is what you should know, along with some tips to help you find and choose one.

Adult Day Care

The business of adult day care services has grown rapidly in recent years. According to the National Adult Day Services Association, there are upwards of 4,600 adult day centers across the United States. This is a 35% increase since 2002. The centers provide services to more than 260,000 participants and family caregivers, which is a whopping 63% increase over the last two decades.

As the name implies, adult day care provides care for elderly seniors who cannot care for themselves at home. While services will vary from center to center, they typically provide personal care, meals and snacks, various activities and social interaction in a safe and supportive environment. Additionally, many centers provide health services such as medication management, therapies, exercise and transportation to and from the facility.

Adult day care centers generally operate programs during normal business hours five days a week. However, some centers may offer services in the evenings and on weekends.

Costs for care will vary, usually from $25 to more than $100 per day depending on where you live. The national average is $75 per day.

Unfortunately, in most cases, original Medicare does not pay for adult day care, but some Medicare Advantage plans and many long-term care insurance policies do. Many seniors or their families pay for care out-of-pocket.

If your dad is lower income and cannot afford this, state Medicaid programs provide financial assistance if he meets eligibility requirements. Some states have PACE programs that provide financial aid. Contact your state Medicaid office (see Medicaid.gov) for more information. The VA even provides adult day care to eligible veterans enrolled in their Medical Benefits Package. See VA.gov/geriatrics to learn more.

How to Choose

Your first step in shopping for an adult day center is to determine the kinds of services you and your dad need. After you do that, here are some tips to help you locate and choose a good provider.

Start by contacting your Area Agency on Aging (call 800-677-1116 to get your local number) to get referrals to adult day service programs in your area. You can also search on your favorite online search engine for accredited services and centers.

Once you have a list of a few centers, call them to find out their eligibility criteria, if they offer the types of services your dad needs, if they are accepting new clients, their hours of operation, if they are licensed and/or registered with a state agency (this is not required in all states) and what they charge.

After you identify a few good centers, go in for a visit. Find out about the staffing ratio (at least one staff member for every six participants is recommended) and what kind of training they have. While you are there, take note of the cleanliness of the facility. Is it homey and inviting? Does the staff seem friendly and knowledgeable? Be sure to taste the food and also consider making an unannounced visit. You may want to search online for a helpful checklist of questions to ask during your visit.

After your visit, be sure to check the center's references. Get names and phone numbers of at least two or three families who have used the center you are considering and call them.

I just found out I have stage 1 hypertension and my doctor recommended I get a home blood pressure monitor to keep an eye on it. Can you offer me any tips on choosing a good one?

Monitoring your blood pressure at home is a smart idea! Everyone with elevated or high blood pressure (stage 1 and higher) should consider getting a home blood pressure monitor. Home monitoring can help you keep tabs on your blood pressure in a comfortable setting. Plus, if you are taking medication, it will help ensure it is working and alert you to a health problem if one arises. Here are some tips to help you choose a good monitor.

Types of Monitors

The two most popular types of home blood pressure monitors are automatic arm monitors and automatic wrist monitors that are electric and/or battery powered.

With an automatic arm monitor, you simply wrap the cuff around your bicep and with the push of one button the cuff inflates and deflates automatically. The monitor gives you your blood pressure reading on the display window in a matter of seconds.

Wrist monitors work similarly, except they attach to the wrist. Wrist monitors are smaller in weight and size. This makes them more portable and more comfortable to use than the arm monitors, but they tend to be a little less accurate. To help choose the best monitor for you, here are several things to consider:

Make sure it fits: Be sure the cuff fits the circumference of your upper arm or wrist. Using a cuff that is the wrong size can result in an inaccurate reading. Most arm models have two sizes or an adjustable cuff that fits most people. Wrist models also fit most people.

Choose one that is easy to use: Be sure the display on the monitor is easy to read and the buttons are large. The directions for applying the cuff and operating the monitor should be clear.

Consider what extra features you want: Many automatic monitors come with additional features such as irregular heartbeat detection that checks for arrhythmias and other abnormalities; a risk category indicator that tells you whether your blood pressure is in the high range; a data-averaging function that allows you to take multiple readings and get an overall average; multiple user memory that allows two or more users to save their readings; and downloadable memory that allows you to transmit your data to your computer or smartphone.

Where to Buy

You can find blood pressure monitors at pharmacies, medical supply stores or online. You do not need a prescription to buy one. Prices typically range between $40 and $100.

In most cases, original Medicare will not cover a home blood pressure monitor. If you have a Medicare Advantage plan or a private health insurance policy, it may provide coverage.

After you buy a monitor, it is a good idea to read the instruction manual before use. Take it to your doctor's office so they can check its accuracy and teach you the proper techniques of how and when to use it. You may also find helpful resources using your favorite 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.

If you have a chronic illness, your personal planning will need to involve careful consideration of your condition. Many Americans experience ALS disease, Alzheimer's, Huntington's disease, Parkinson's disease, multiple sclerosis (MS) or other types of chronic diseases.

If you or a loved one has one of these conditions, it is important to communicate with your attorney and other advisors about your condition. There are specific planning options both during life and for your testamentary plan that should be considered.

ALS (Lou Gehrig's disease) is a disease that progressively affects a person's ability to control muscle movement. Symptoms include muscle twitching and cramping. Most ALS victims will eventually need a ventilator for breathing, but often will be quite clear-headed during their lifetime.

Alzheimer's is a disease with a progressive reduction in mental capacity. Mild Alzheimer's may be identified by memory lapse and forgetfulness. As Alzheimer's progresses, the individual begins to lose speech facility, forgets to follow normal personal cleanliness habits and loses control. Often, the Alzheimer's sufferer eventually loses the ability to recognize family members and other loved ones.

Huntington's disease is an inherited disorder. The person with Huntington's disease may have great difficulty with coordination and eventually will suffer from dementia and require full-time care.

Parkinson's disease is a disorder of the nervous system. It can lead to progressive deterioration of both the physical body and mental capabilities. Because there is great variation with the disease, some individuals with treatment are able to live reasonably long lives.

Multiple sclerosis (MS) is also a disorder of the nervous system. There is progressive damage to nerve fibers that leads to physical and mental disability. MS may be fairly moderate at first but tends to lead to attacks that can cause progressive deterioration. MS may range from fairly mild to quite severe and very debilitating.

These five and other chronic diseases are all unique and different. Some afflict the body and others reduce the capabilities of the mind. For example, Alzheimer's has greater impact on mental ability, while ALS victims are often suffering in body but may be quite clear in mind.

Your attorney and other advisors need to understand the conditions sufficiently well so that your documents and plans reflect your particular circumstance.

The principal documents for any chronic illness are a durable power of attorney for healthcare, a living will and a HIPAA release. In many states, the durable power of attorney for healthcare and living will are combined into one document described as an advance directive.

Durable Power of Attorney for Healthcare

If you have a chronic illness, particularly one that leads to loss of mental capacity, it is very important to have a designated person who can make medical decisions for you. In the event that you are unable to reason or communicate, your designated advisor must discuss your medical care with doctors and hospital staff.

A durable power of attorney for healthcare allows you to designate a trusted person to speak to the doctors on your behalf. This power in some states is a separate document. In others, it is the first portion of an advance directive. Many states refer to the person holding the durable power of attorney as your "healthcare proxy."

Regardless of the form of the document or the name of your agent, this person is qualified to make your medical decisions if required.

Whom Should You Appoint?

For a person with a chronic illness, this can be a challenging decision. You would like to select someone who understands your medical condition and your preferences about care. This could be a family member or friend.

Adult children are often selected, but may experience great emotional trauma in making an end-of-life decision. A friend may be a good choice if you do not have a child who feels willing or emotionally capable of making those decisions.

Generally, you will select a healthcare proxy agent and a successor. It is usually best not to select two persons as your proxy agent—they might disagree at a critical time while you are in need of an immediate decision.

Living Will

A person with chronic illness needs both a healthcare proxy agent and a living will. Your healthcare proxy agent can make decisions regarding your care, even if you are not near death. The function of the living will is to describe your preferences for care if you are potentially in your last weeks or days of life.

The advance of medical science has enabled doctors to keep people alive for extended periods of time, even if there is virtually no possibility of recovery. If you are in this circumstance, your living will provides guidance to your doctors.

For example, the living will can discuss whether or not heroic measures will be taken to sustain your life. If you have an irreversible condition with no chance of recovery, the living will also specifies whether nutrition and hydration will be maintained.

If you suffer from one of the chronic illnesses that affects mental capacity, it may be important for you to sign your living will before your mental health deteriorates. Many Alzheimer's patients and other individuals with great mental deterioration are no longer capable of signing a living will.

Health Insurance Portability and Accountability Act (HIPAA)

In 1996, Congress passed the Health Insurance Portability and Accountability Act. HIPAA was designed to protect your rights to medical information. Your doctor and other medical providers will frequently acquire extensive background information and treatment information for your chronic illness. Under the HIPAA rules, there are safeguards to protect your personal medical information. A doctor, medical center or other provider may not disclose this information, particularly to someone who will use it for marketing or similar purposes.

However, you may wish to have your medical information released to your professional advisors so they can make appropriate decisions for you. In order to receive this information, your healthcare proxy must have a formal release from you.

The HIPAA release, which will be in writing, should describe the type of health information that may be released to the person. It may provide a general list of medical centers or providers or could have an open-ended release for any hospital or medical provider and may include a termination date. After you sign your HIPAA release, you can always revoke that release and sign a new one.

Many states have specific forms for advance directives, living wills or durable powers of attorney for healthcare. You will want to be certain that you have signed the correct form for your state.

Can you tell me what I need to do to replace a variety of important documents? Our house burned down a few months ago and we lost everything including our home property deed, car titles, old tax returns, Social Security, Medicare and vaccination records, birth certificates, marriage license and passports.

I am very sorry for your loss, but you will be relieved to know that replacing important documents that are destroyed, lost or stolen is pretty easy once you know where to turn. Here are the replacement resources for each document you mentioned.

Birth certificates: If you were born in the United States, contact the vital records office in the state where you were born. See CDC.gov/nchs/w2w/index.htm for contact information. This office will give you specific instructions on what you need to do to order a certified copy. Usually, the cost is between $10 and $30 for a certified copy.

Car titles: Most states offer replacements through a local department of motor vehicles office. You will need to complete a replacement title application form and pay the application fee, which varies by state. You will also need to show ID and proof that you own the car, such as your vehicle registration or your license plate number and vehicle identification number (VIN). Contact your state department of motor vehicles to get an application.

Property deed: To access your house deed, contact your county clerk's office, where deeds are usually recorded. You may be charged a small fee to get a copy.

Marriage certificate: Contact the vital records office of the state you were married in to order a copy (see CDC.gov/nchs/w2w/index.htm). You will need to provide full names for you and your spouse, the date of your wedding and the city or town where the wedding was performed. Fees range from $10 to $30, and you may be required to prove you are authorized to receive a certified copy.

Social Security cards: In most states (except in Alabama, Minnesota, Nevada, New Hampshire, Oklahoma and West Virginia), you can request a replacement Social Security card online for free at SSA.gov/myaccount.

If you live in a state where the online service is not available, you will need to fill out form SS-5 (visit SSA.gov/forms/ss-5.pdf to print a copy) and take it in or mail it to your nearby Social Security office along with any evidentiary documents that are listed on this form. For more information or to locate the Social Security office that serves your area, call 800-772-1213 or see SSA.gov/locator.

Medicare cards: If you are enrolled in original Medicare, you can replace a lost or damaged Medicare card by calling Medicare at 800-633-4227 or by logging into your MyMedicare.gov account. If you get Medicare health or drug benefits from a Medicare Advantage Plan, such as an HMO, PPO or PDP, you will need to call your plan to get your card replaced.

Vaccination records: Your first step is to go back to your doctor's office or vaccination site and see if they have copies of the records you need. If you are visiting a site, bring an ID and try to recall any dates when you were vaccinated. If that is not feasible, contact your state health department immunization information system (visit CDC.gov/vaccines/programs/iis/contacts-locate-records.html) where you may be able to print out replacements.

Tax returns: To get copies of old tax returns, start with your tax preparer. Professionals usually keep copies of client returns on file for a few years. You can also get copies of federal returns directly from the Internal Revenue Service. You will need to fill out and mail in IRS form 4506. Call 800-829-3676 and ask them to mail you a copy or download the form at IRS.gov/pub/irs-pdf/f4506.pdf. The cost is $43 for each return requested. You may be able to request state tax returns, availability may vary.

Passports: You can apply for a replacement passport at a Passport Application Acceptance Facility. Many post offices, public libraries and local government offices serve as such facilities. You can search for the nearest authorized facility at Iafdb.travel.state.gov. The fee is $145.

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.

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.

How does Medicare cover in-home health care? My husband has a chronic health condition that makes it very difficult for him to leave the house, so I am wondering if he could qualify for Medicare home health care.

Medicare covers a wide variety of part-time or intermittent in-home health care services to beneficiaries in need, if they meet Medicare's criteria. Here is how it works:

In order for your husband to secure coverage for home health care, Medicare first requires that he be homebound. This means that it must be extremely difficult for him to leave home and that he needs help doing so either from another person or with the assistance of a medical device like a cane, wheelchair, walker or crutches.

He will need to have a face-to-face meeting with his doctor to get a home health certification confirming that he needs skilled-nursing care or skilled-therapy services from a physical or speech therapist on a part-time basis.

His doctor can also request the services of an occupational therapist and a personal care aide to assist with activities of daily living such as bathing, dressing and using the bathroom. His doctor must renew and certify his home health plan every 60 days.

Your husband will also need to use a home health agency that is certified by Medicare. If he meets all of the requirements, Medicare should pay for his in-home health care.

Be aware that Medicare will not pay for personal care aide services (for bathing, dressing, using the bathroom, etc.), if he does not need skilled-nursing or skilled-therapy services too. Homemaker services, such as shopping, meal preparation and cleaning are not covered either.

If your husband has original Medicare, you can locate a Medicare-certified home health agency by calling 800-633-4227 or by visiting Medicare.gov/care-compare. If he has a Medicare Advantage plan, you should contact his plan directly and ask which home health agencies work with the plan and are within the plan's network of providers.

For more detailed information on how Medicare covers in-home health, see the "Medicare and Home Health Care" online booklet at Medicare.gov/Pubs/pdf/10969-Medicare-and-Home-Health-Care.pdf.

Other Options

If your husband does not qualify for Medicare home health care coverage, there are other coverage options depending on your situation. Here are several that may apply to you:

Insurance: If you have long-term care insurance, check to see if it covers in-home care. If you have a life insurance policy, see if it covers pay for care.

Medicaid: If your income is low, your husband may qualify for Medicaid, which offers different home and community-based services that can pay for in-home care. To investigate this, contact your local Medicaid office.

Also see if Programs of All-Inclusive Care for the Elderly (PACE) is available in your area at Benefits.va.gov/benefits/offices.asp. PACE provides in-home care, including help with activities of daily living, such as meals. PACE also provides dental and medical care, among other benefits.

Veterans Benefits: If your husband is a veteran, the Department of Veterans Affairs (VA) offers some benefits that can help. Two programs to inquire about are "Aid and Attendance or Housebound Allowances" and the "Veteran-Directed Care" program. Both programs provide monthly financial benefits to eligible veterans that can help pay for in-home care. To learn more, contact your regional VA benefit office (see Benefits.va.gov/benefits/offices.asp or call 800–827–1000).

To search for additional programs in your area that can help pay for your husband's home care, use your favorite search engine. You may want to search phrases such as, "paying for senior care", "find financial assistance for in-home care" and "eldercare financial assistance locator."

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.