Can you give me some tips on how to pick a good nursing home in the COVID era? My mother had a stroke a while back and needs some extra care now. I have been taking care of her at home, but her health has declined to the point that I am unable to do it any longer.

COVID-19 has hit nursing homes hard over the past year, making it extremely difficult for people attempting to choose a nursing home during this time.

Many eldercare experts suggest avoiding nursing homes during the pandemic if possible. However, some families, like yours, are finding themselves in the difficult situation of needing long-term or rehabilitative care for their elder loved one.

To help you find a good nursing home in the COVID era, here are some steps to follow.

Make a list: There are several sources you can turn to for referrals to top nursing homes in your area. These include your mom's doctor, a nearby hospital discharge planner and friends or neighbors who have a loved one in a nursing home. The Medicare website also has a helpful nursing home compare tool at Medicare.gov/care-compare. In addition to helping you locate nursing homes in your area, it also provides a 5-star rating system on recent health inspections, staffing, quality of care and the facility overall.

Keep in mind that it may be desirable to choose a nursing home that is close to family members and friends who are able to check in. Friends and family who are familiar with the resident are sometimes best equipped to notice concerning changes that warrant further intervention.

Do some research: To research the nursing homes on your list, call your long-term care ombudsman. This is a government official who investigates nursing home complaints and advocates for residents and their families. The ombudsman can tell you which nursing homes have had complaints or problems in the past. To find your local ombudsman, call your area aging agency (800-677-1116) or visit LTCombudsman.org.

You should also visit the Centers for Medicare and Medicaid Services website (data.cms.gov), which provides updated data on U.S. nursing home reported COVID-19 cases and deaths.

Contact the nursing homes: Once you have identified a few good nursing homes, call them to see if they have any vacancies, what they charge and if they accept Medicaid.

Also, find out their staff-to-patient ratio and staff turnover rate, their COVID infection-control procedures, the percentage of residents and staff that have been vaccinated for COVID and their facility visitation policy.

If visitor restrictions are in place, see if they offer smartphone, tablet or laptop technology assistance so you can have video calls with your mom.

Tour your top choices: The best way to evaluate a nursing home is to visit it in person, but because of COVID, some facilities may offer limited or virtual tours only. To help you evaluate and rate a facility, Medicare offers a checklist of questions at Medicare.gov/NursingHomeCompare/Checklist.pdf.

Paying for care

The national average for a semi-private room is $255 per day and nearly $290 for a private room, so paying for care is another area of concern. Medicare only helps pay up to 100 days of rehabilitative nursing home care, which must occur after a qualifying hospital stay of at least three days.

Most nursing home residents pay for care from their personal savings, a long-term care insurance policy or through Medicaid once their savings are depleted.

The National Clearinghouse for Long-Term Care Information website (Acl.gov/ltc) is a good resource that can help you understand and research your financial options. You can also get help from your State Health Insurance Assistance Program (SHIP), which provides free counseling on all Medicare and Medicaid issues. To find a local SHIP counselor visit ShiptaCenter.org or call 877-839-2675.

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.

Where can I turn to find a good Medicare covered hospice provider? My husband's mother has a terminal condition and wants to pass away at home, if possible, so I am helping out where I can.

Hospice is a wonderful option in the last months of life because it offers a variety of services, not only to those who are dying, but also to those left behind. Here is what you should know about hospice care, along with some tips to help you choose one.

Understanding Hospice

Hospice care is a unique service that provides medical care, pain management and emotional and spiritual support to people who are in the last stages of a terminal illness – it does not speed up or slow down the process. The goal of hospice care is to simply keep the patient as comfortable and pain-free as possible, with loved ones nearby.

The various services provided by a hospice program come from a team of professionals that works together to accommodate the patient's end-of-life needs.

The team typically includes hospice doctors who work with the primary physician and family members to create a care plan; nurses who dispense medication for pain control; home care aids that attend to personal needs like eating and bathing; social workers who help the patient and the family prepare for end of life; clergy members who provide spiritual counseling, if desired; and volunteers who fill a variety of niches, from sitting with the patient to helping clean and maintain their property.

Some hospices offer massage or music therapy. Many provide bereavement services for relatives and short-term inpatient respite care to give family caregivers a break.

Most hospice patients receive care in their own homes. However, hospice will go wherever the patient is – hospital, nursing home or assisted living residence. Some hospice providers even have their own facility to use as an option.

To receive hospice care, the individual typically must get a referral from a physician stating that life expectancy is six months or less.

It is important to know that home-based hospice care does not mean that a hospice nurse or volunteer is in the home 24 hours a day. Services are based on the needs and requests of the patient and the family. Hospice care can also be stopped at any time if your mother-in-law's health improves or if she decides to re-enter cure-oriented treatments.

How to Choose

The best time to prepare for hospice and consider your options is before it is necessary. This helps minimize the number of important decisions that must be made during a stressful time. There are more than 4,300 hospice care agencies in the U.S., so depending on where you live, you may have several options from which to choose.

To locate a good hospice in your area, ask your mother-in-law's doctor or the discharge planner at your local hospital for a referral. You can also search online at Medicare.gov/care-compare, which provides lists and ratings of hospice providers in your area.

When choosing, look for an established hospice that has been operating for a few years and is certified by Medicare. To help you select one, the National Hospice and Palliative Care Organization offers a worksheet of questions to ask at CaringInfo.org.

Medicare Coverage

Medicare covers many aspects of hospice care and services for its beneficiaries. There is no deductible for hospice services although there may be a very small co-payment – such as $5 for each prescription drug for pain and symptom control, or a 5% share for inpatient respite care. Medicaid also covers hospice in most states, as do many private health insurance plans.

For more information, see the "Medicare Hospice Benefits" online booklet at Medicare.gov/pubs/pdf/02154-medicare-hospice-benefits.pdf.

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.

I will turn 65 in a few months and plan to keep working for several more years. I have good health insurance from my employer now. Do I have to sign up for Medicare when I reach 65?

If your health insurance is covered through your employer, the decision to enroll in Medicare at 65 will depend on the size of your employer and your plans to continue working. The same rules apply if your health insurance comes from your spouse's employer.

First, let us review the basics. Original Medicare has two parts. Part A provides hospital coverage and is free for most people. Part B covers doctor's bills, lab tests and outpatient care. Part B has a monthly premium, which is $148.50 for most beneficiaries in 2021, but higher for individuals earning above $88,000.

If you are already receiving Social Security, you will automatically be enrolled in parts A and B when you turn 65. You will receive your Medicare card in the mail. It will include instructions to return it if you have work coverage that qualifies you for late enrollment. If you are not yet receiving Social Security, you can apply online at SSA.gov/medicare.

If you plan to continue working past age 65 and have health insurance through your employer, your first step is to ask your benefits manager or human resources department how your employer insurance interacts with Medicare. In most cases, you should at least enroll in Medicare Part A because it is free. If you are funding a health savings account (HSA), you may not want Part A because you cannot make contributions after you enroll. The decision to obtain Part B coverage will depend on the size of your employer.

Small Employer

If your current employer has fewer than 20 employees, Medicare can be your primary insurer and you should enroll in Medicare Part B during your initial enrollment period. This is a seven-month period that includes the three months before, the month of, and the three months after your 65th birthday.

If you miss the seven-month sign-up window, you will have to wait until the next general enrollment period, which runs from January 1 to March 31 with benefits beginning the following July 1. You will also incur a 10% penalty for each year you wait beyond your initial enrollment period. The penalty will be added to your monthly Part B premium.

Large Employer

If your employer has 20 or more employees, your employer's group health plan can be your primary insurer while you are employed. In this case, you do not need to enroll in Part B when you turn 65 if you are satisfied with the coverage you receive through your employer. If you decide to enroll in Medicare, it will supplement your employer insurance by paying secondary on all your claims.

Once your employment or group health coverage ends, you will have eight months to sign up for Part B without a penalty. This is known as a Special Enrollment Period.

Check Drug Coverage

You should verify your prescription drug coverage. Call your benefits manager or insurance company to find out if your employer's prescription drug coverage is considered "creditable." If it is, you do not need to enroll in a Medicare Part D prescription drug plan. If it is not, you should purchase a plan during your initial enrollment period or you will incur a premium penalty of 1% of the average national premium for every month you do not have coverage. You can review plans at Medicare.gov/plan-compare.

If you need help or have more questions, contact your State Health Insurance Assistance Program, ShiptaCenter.org, which offers free Medicare counseling. You may also call the Medicare Rights Center helpline at 800-333-4114.

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.

I am interested in getting my mom, who lives alone, a medical alert system. I would like to learn more about wearable options that will let her call for help if she falls or has a medical emergency. What can you tell me to help me choose one?

A good medical alert system is an effective and affordable tool that can help keep your mom safe and living in her own home longer. With all the different products and features available, choosing one can be challenging. Here are some tips that can help.

Three Key Questions

Medical alert systems, which have been around since the 1980s, provide a wearable help button – usually in the form of a neck pendant or wristband – that would put your mom in touch with a dispatcher who could summon emergency help or contact a friend or family member as needed.

To help you narrow down your options and choose a system that best fits your mom's needs, here are three key questions to consider.

1. Does your mom want a home-based or mobile system?

Medical alert systems were originally designed to work inside the home with a landline telephone, which is still an option. But since fewer and fewer households have landlines these days, most companies today also offer home-based systems that work over a cellular network. With these systems, pressing the wearable help button allows you to speak to a dispatcher through a base unit located in your home.

In addition, many companies offer mobile medical alert options. You can use these systems at home, but they will also allow you to call for help while the wearer is out and about.

Mobile alerts operate over cellular networks and incorporate GPS technology. These systems allow you to talk and listen to the operator directly through the pendant button. The GPS allows your location to be known in order for help to be sent.

If your mom does not leave the house very often, she may not need a mobile system. If she is still active, she may want added protection outside the home.

2. Should her system be monitored or not?

The best medical alert systems are monitored, meaning that the help button connects you with a trained operator at a 24/7 dispatching center.

You also have the option to choose a system that is not monitored. With these, when you press the help button, the device automatically dials a friend or family member on your programmed emergency call list.

These products can often be set up to call multiple people and to contact emergency services if you do not get an answer from someone on your list.

3. Should you add a fall-detection feature?

Most medical alert companies offer the option of an automatic fall detection pendant for an additional fee of $10 to $15 per month. These pendants automatically contact the dispatch center in the event of a fall, just as they would if the wearer had pressed the call button.

Be aware that this technology is not fool-proof. In some cases, this feature may register something as a fall that is not. The alarm might go off if you drop it or momentarily lose your balance but do not actually land on the ground.

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.

What are the IRS income tax filing requirements for tax year 2020 for retirees? My income dropped substantially when I was forced into retirement last March due to COVID, so I am wondering if I need to file a tax return this year.

Whether you are required to file a federal income tax return for the 2020 tax year depends on many factors, including how much you earned in 2020, the source of that income, your age and your filing status.

Here is a quick rundown of this tax season's IRS tax filing requirement thresholds. If your 2020 gross income was below the threshold for your filing status and age, you may not have to file. Generally, gross income includes all taxable income, except your Social Security benefits.

• Single: $12,400 ($14,050 if you are 65 or older by Jan. 1, 2021).
• Married filing jointly: $24,800 ($26,100 if you or your spouse is 65 or older; or $27,400 if you are both over 65).
• Married filing separately: $5, regardless of age.
• Head of household: $18,650 ($20,300 if age 65 or older).
• Qualifying widow(er) with dependent child: $24,800 ($26,100 if age 65 or older).

To get a detailed breakdown on federal filing requirements, along with information on taxable and nontaxable income, call the IRS at 800-829-3676 and ask them to mail you a free copy of the "1040 and 1040-SR Instructions for Tax Year 2020." You can also get it online at IRS.gov.

Other Filing Factors

There are, however, some other financial situations that may require you to file a tax return, even if your gross income falls below the IRS filing requirements. For example, you would need to file if you earned more than $400 from self-employment in 2020, owe any special taxes like the alternative minimum tax or get premium tax credits because you, your spouse or a dependent is enrolled in a Health Insurance Marketplace plan.

You will also need to file if you are receiving Social Security benefits, and one-half of your benefits plus your other gross income and any tax-exempt interest exceeds $25,000, or $32,000 if you are married and filing jointly.

To figure all this out, the IRS offers an interactive tax assistant tool on their website that asks a series of questions to help you determine if you are required to file, or if you should file because you are due a refund. It takes less than 15 minutes to complete.

You can access this tool at IRS.gov/Help/ITA. Click on "Do I Need to File a Tax Return?" You can receive assistance over the phone by calling the IRS helpline at 800-829-1040.

Check Your State

Even if you are not required to file a federal tax return this year, do not assume that you are also excused from filing state income taxes. The rules for your state might be very different. Check with your state tax agency before concluding that you do not need to file. For links to state tax agencies, see Taxadmin.org/state-tax-agencies.

Tax Preparation Assistance

If you find that you need to file a tax return this year, you can file for free through the IRS at IRS.gov/FreeFile if your 2020 adjusted gross income was below $72,000.

If you need additional help, contact the Tax Counseling for the Elderly (TCE) program. Sponsored by the IRS, TCE provides free tax preparation and counseling to middle and low-income taxpayers, age 60 and older. Call 800-906-9887 or visit IRS.treasury.gov/freetaxprep to find out about services near you.

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.

Let's look at the "top five" reasons people give for not owning life insurance.

1. Too Expensive. "I just cannot afford life insurance right now."
2. Confusing. "We looked at proposals from three companies-page after page of numbers. What does it all mean? I haven't the slightest idea!"
3. Too Many Types. "I checked into term insurance, whole life insurance, universal life, variable life, single premium and survivorship insurance. But which one is right for me?"
4. No Trust. "Those big insurance companies claim to have billions of reserve funds. But one of the biggest insurance companies has been on the ropes for months. Who can you trust?"
5. Don't Plan to Die. "Someday when I plan to die, I will consider life insurance. But for now-don't worry, be happy!"

Five Reasons to Own Life Insurance

There are several reasons for you to purchase life insurance. If you were to pass away, the life insurance death benefits could provide resources that are quite important to your family. The various benefits include payment of your funeral and final expenses, paying off mortgages or other debts, living expenses or income for a surviving spouse, inheritance for children and payment of estate taxes.

1. Final Expenses and Funeral Costs. Usually there are medical expenses during the last weeks of life. These frequently will range from $5,000 to $10,000. Your memorial service preparation and costs can also easily exceed $10,000. Total final expenses can often be more than $20,000.
2. Pay Debts and Mortgages. The payment of debts or a mortgage is a one-time expense. Depending upon the amount of your mortgage, this could cost anywhere from a few thousand dollars to many hundreds of thousands of dollars.
3. Living Expenses for Spouse. The largest amount of insurance is typically purchased to provide both economic security and an investment that will add to the spouse's other annual income. A reasonable method is to estimate a 5% return on the investment. For example, if a spouse needed another $25,000 of income over and above the amount paid by retirement funds, Social Security and other earnings, then insurance equal to $500,000 invested at 5% would produce this amount.
4. Inheritance for Children. Permanent insurance is frequently used as a method of providing an inheritance for children. Many parents who make substantial gifts to charity plan to use life insurance as a means of providing additional inheritance for children or other family members.
5. Estate Taxes. If your estate is large, there may be a substantial payment of federal or state estate tax. If you own a family business or other assets that are intended to be transferred to family, then your estate could be subject to estate tax. Life insurance can be an excellent method to provide funds for payment of estate tax. Normally, for larger estates the life insurance is owned by an irrevocable life insurance trust so the insurance itself is not subject to estate tax.

Determining the Life Insurance Amount

A fairly simple way for you to determine the total amount of needed insurance is to add up your one-time expenses, then calculate the amount of insurance invested at 5% necessary to benefit a surviving spouse, children or other family members. For example, if your one-time expenses are $200,000 and your spouse desires additional income of $25,000, then the total insurance would be $700,000. This amount includes $200,000 for expenses and $500,000 invested at 5% to produce the annual income.

More sophisticated calculations are available online. Use your favorite search engine to look for "life insurance needs calculator," and select from the available free public calculators.

How Life Insurance Works

Life insurance started because individuals were concerned that they might pass away and not provide sufficient resources for family. Because young families typically need a substantial fund and lack the ability to save enough in a short period of time, the concept of life insurance was created.

If many thousands of individuals pay premiums and those funds are invested, then a pool of funds will be available to compensate individuals. The life insurance company hires actuaries who determine the probable number of individuals who will pass away in a given year. Especially for younger persons, out of a pool of 100,000 only a few will pass away in a given year. As a result, the insurance company is able to receive all the premiums and invest them in the insurance reserve fund. The earnings and a portion of the funds are distributed each year to pay claims for those who pass away.

The insurance funds are primarily invested in bonds. The insurance company generally receives 1% to 1.2% to cover all of their overhead and costs. The balance is returned through insurance proceeds to beneficiaries.

Life Insurance Policy Categories

Insurance is generally divided into two categories-term insurance and permanent insurance.

Term Insurance

Term insurance is the least expensive type of insurance and is favored by younger people and many financial planners. The term insurance is available with an annual renewable term (ART) or with a fixed payment for five years, 10 years, 15 years or longer.

Because term insurance does not include any investment or cash value, it enables the largest potential policy to be purchased for the least cost. Due to intense competition within the insurance industry, prices on term policies and level-pay term policies have moved lower in recent years.

Some types of term policies also include the ability to convert to whole life or universal life at a future time. If the conversion is elected, then there will be a substantial increase in the premium.

Permanent Insurance

Permanent insurance includes several types. The traditional favorite is whole life insurance, but there are also universal life, variable life and survivorship life insurance.

Whole Life. The traditional whole life policy involves both insurance and a cash value. The premiums are substantially higher than term insurance because the policy will build a savings element or cash value. During the first year, much of the cash value may be used by the insurance company to cover the commission payment to the sales representative, but over time the cash value may increase. The owner of the policy has the right to borrow against the cash value at favorable rates.

Whole life is frequently fixed in terms of premiums paid and death benefit. The insurance company is determining the probable return of its reserve fund and, based on the age and health of the insured person, calculates and commits to a fixed benefit in exchange for a certain premium.

Universal Life. Universal life was created to provide an option for people who would consider purchasing term insurance and invest an additional amount in mutual funds. With universal life, the policy is invested and a cash reserve is built up. The insurance reserve growth covers the cost of the insurance policy. Universal life policies may include flexible options for increasing or decreasing premium payments. Of course, the cash value of the policy will change with a modification of the premium schedule.

Variable Universal Life. If the insured desires to own life insurance but also potentially gain from investments in stocks and bonds, a variable policy may be appropriate. With a variable policy the insured typically is permitted to invest in different mutual funds managed by the financial services company. If the mutual funds increase in value, the policy cash value will increase.

Survivorship Life. For a couple, an attractive option is to purchase a survivorship policy. This policy pays a death benefit after both husband and wife pass away. Because two persons are insured, it frequently is possible to obtain insurance even if one spouse is in poor health. Quite often, this insurance can be purchased at a more reasonable premium because two persons must pass away before the death benefit is paid. It is particularly useful for providing funds to pay for taxes if a business is to be transferred from parents to children after they both pass away.

Life Insurance Beneficiaries

In most estates, life insurance does not pass through the probate process. The insurance policy is a contract between the insured and the insurance company. The person who purchases the insurance has the right to name the beneficiaries. Normally, a primary and a secondary beneficiary are named. It's also possible to divide the insurance policy among several children or other beneficiaries.

A common beneficiary designation is for the spouse to be a primary beneficiary and the children to be the contingent beneficiaries with equal shares. If the spouse were to predecease the insured or they were to pass away in a common accident, then the children would receive the insurance proceeds.

Minor children should usually not be the beneficiaries of a policy. In many states, if a minor child receives a substantial inheritance, a conservator must be appointed to manage the assets. This is quite expensive and also has the disadvantage of transferring the assets to the minor child when he or she becomes an adult.

A much better arrangement is to transfer the policy to a living trust for the benefit of the minor children, or to create a trust and a will for the benefit of the minor children and transfer the policy to the estate to fund that trust.

Prudent Purchase of Insurance

Life insurance is an important decision, and it is helpful to learn about the different types of insurance. Most individuals will also visit with a chartered life underwriter (CLU) or other representative of a financial services company.

The representative can conduct an insurance needs analysis and suggest the appropriate type of insurance. It is helpful for you to do sufficient research to understand the reasons why many individuals choose term insurance or permanent insurance. In addition, the use of online calculators to determine insurance funding will also provide you with a better understanding of the appropriate amount of insurance. The amount of insurance recommended by online calculators can vary greatly, so understanding your probable needs is quite important.

Insurance Company Ratings

Insurance companies are rated by several sources. A.M. Best, Weiss, Moody's and other ratings services are available. You should be certain to ask for the ratings of any company if a representative suggests purchasing a policy from them. It is also easy to go online and do a search for "insurance company ratings" and obtain the actual ratings for most financial services companies.