I need a hip replacement and want to find a good, safe hospital to have it done. What resources can you recommend for evaluating hospitals? I do not currently have a doctor.

Most people spend more time shopping for a kitchen appliance or flat-screen TV than choosing a hospital. However, selecting the right hospital can be as important as the doctor you choose. Here are some tips and resources to help you research hospitals in your area.

Hospital Shopping

While you may not always have the opportunity to choose your hospital, especially in the case of an emergency, having a planned procedure can offer you a variety of choices.

When shopping for a hospital, one of the most important criteria to consider is the strength of the department that will be treating your area of need. A facility that excels in coronary bypass surgery, for example, may not be the best choice for a hip replacement. Research shows that patients tend to have better results when they are treated in hospitals that have extensive experience with their specific condition.

In order to choose a hospital that is best for you, it is important to discuss your concerns and consider alternatives with the doctor who is treating you. Some doctors may be affiliated with several hospitals from which you can choose. If you have yet to select a doctor, finding a top hospital that has expertise with your condition can help you determine which physician to actually choose.

Another important reason to do some research is the all too frequent occurrence of hospital infections, which kill around 75,000 people in the U.S. each year. Checking the hospital’s infection rates and cleanliness procedures is also a smart move.

Free Researching Tools

There are a number of free online resources that can help you evaluate and compare hospitals in your area, including:

• Medicare’s Hospital Compare (Medicare.gov/HospitalCompare): Operated by the Centers for Medicare and Medicaid Services, this tool has data on more than 4,000 U.S. hospitals.
• Why Not The Best (WhyNotTheBest.org): This tool was created by the Commonwealth Fund, a private foundation that provides performance data on all U.S. hospitals.
• The Leapfrog Group (LeapfrogGroup.org): This national, not-for-profit organization grades more than 2,000 U.S. hospitals on quality and safety.

These websites use publicly available data to rate hospitals on various measures of performance, like death rates from serious conditions such as heart failure and pneumonia, frequency of hospital-acquired infections, patient satisfaction and more.

On these websites, you plug in your location to find hospitals in your area. You can then check to see how each hospital manages patients in various conditions.

Two other websites that can help you choose a good facility include U.S. News & World Report (USNews.com/best-hospitals) and Healthgrades (Healthgrades.com).

U.S News & World Report is an online publication that publishes a hospital ranking in 17 medical specialties like cancer, orthopedics and urology. It also provides ratings on common procedures and conditions, such as heart bypass surgery, hip and knee replacement and COPD. They also rank hospitals regionally within states and major metro areas.

Healthgrades, which is a private, for-profit organization, provides free hospital ratings on patient safety and medical procedures and scores hospitals using a 5-star scale. They also provide comprehensive information on most U.S. doctors including their education and training, hospital affiliations, board certification, awards and recognitions, professional misconduct, disciplinary action and malpractice records, office locations and insurance plans.

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.

The SECURE Act was passed by Congress and signed by the President in late December. It reduces future taxes for IRA owners by increasing the age for required minimum distributions from 70½ to 72. However, to pay for the cost of this tax reduction, the taxes paid by future IRA beneficiaries (typically children) will increase.

After the owner's death, IRAs, 401(k)s and other retirement accounts are generally transferred to designated beneficiaries. Custodians of IRAs and other retirement accounts offer a form, either printed or online, to select primary and secondary beneficiaries.

Most married IRA owners select their spouse as the primary beneficiary and children as the secondary beneficiary. When the first spouse passes away, the surviving spouse usually rolls over the IRA into his or her own IRA account. Under the SECURE Act, this is permitted and the surviving spouse must start required minimum distributions (RMDs) after reaching age 72.

When a surviving spouse passes away, children are typically the IRA designated beneficiaries. For individuals without children, the designated beneficiaries are often nephews and nieces. If the IRA owner designates children, nephews, nieces or other family as beneficiaries and also allocates part of the account to a charitable beneficiary, the portion for the nonprofit is normally distributed in a lump sum. However, distributions to children, nephews, nieces and other family members must now be made within 10 years.

For IRA owners who passed away in 2019, a child was able to "stretch" the IRA payout over his or her life expectancy. Assume mother Mary owned a traditional IRA and passed away in 2019. She designated daughter Susan (age 50) as her IRA beneficiary. While the IRA payouts are taxable income, Susan could reduce taxes by taking RMDs over her life expectancy. For a child age 50, the potential distribution period was approximately 34 years. By "stretching" the traditional IRA payout over 34 years, Susan reduced her income tax and benefitted from tax-free growth within the IRA.

If Mary passes away in 2020, the SECURE Act makes Susan take all distributions within ten years. She can wait and take the full payout in the tenth year, but that will greatly increase the tax rate paid on the IRA. Most children will choose to take partial payouts each year for the ten years. With a ten-year payout, the income taxes paid by Susan will be substantially higher than the prior "stretch" plan.

Some surviving spouses have three, four or more children. If one of the children is a "creative spender," a parent may choose to set up a trust. Without the protection of a trust, this creative spender may take the full IRA payout, send a huge tax payment to the IRS and quickly exhaust the balance in creative and unexpected ways. To protect these children, many parents have created "conduit" trusts to restrict the payout to only the RMDs due to the child.

Unfortunately, the SECURE Act eliminates RMDs for most children (there are exceptions for a disabled or chronically ill child). Under the SECURE Act there is no RMD and thus, with a conduit trust, no payout to the child until the tenth year. At that time, the full payout is made and the child will face a huge income tax bill.

Jamie Hopkins is a financial expert with the Carson Group in Omaha, Nebraska. She explains the conduit IRA trust problem and notes, "That is a complete disaster from a planning perspective," Hopkins said. "We just subjected most of that IRA money to the highest tax margin possible and locked up access to it."

Many concerned IRA owners want to update their estate plans to attempt to replace the "stretch" IRA distrubutuion schedule. Could a plan combine the tax-saving benefits of a stretch IRA with a term-of-years or life payout to children or other heirs? Could this plan also have the tax-free growth benefit of a stretch IRA?

While it sounds too good to be true, an IRA to a testamentary unitrust plan includes all of these benefits. An IRA owner may create a testamentary unitrust to create a replacement stretch distribution. When the IRA owner passes away, the unitrust is funded with the traditional IRA. Because the unitrust is tax-exempt, there is a bypass of the income tax on the traditional IRA and any future growth within the trust.

In the unitrust, the full IRA proceeds are invested and earn taxable income for the unitrust recipients. After all payments are completed, the remaining unitrust principal is transferred to qualified charities. The children or other heirs benefit from substantial income (with no reduction in trust corpus earning power due to taxes). After all payments are completed, there is a generous gift to the donor's favorite charities.

I have read that people with heart problems need to be extra careful during the winter months because heart attacks are much more common. Why is this?

Everyone knows winter is cold and flu season, but many do not know that it is also the prime season for heart attacks too, especially if you already have heart disease or have suffered a previous heart attack. Here is what you should know, along with some tips to help you protect yourself.

In the U.S., the risk of having a heart attack during the winter months is twice as high as it is during the summertime. Why? There are a number of factors, and they are not all linked to cold weather. Even people who live in warm climates have an increased risk. Here are the areas you need to pay extra attention to this winter.

Cold temperatures: When a person gets cold, the body responds by constricting the blood vessels to help the body maintain heat. This causes blood pressure to go up and makes the heart work harder. Cold temperatures can also increase levels of certain proteins that can thicken the blood and increase the risk for blood clots. First and foremost, stay warm this winter. When you do have to go outside, make sure you bundle up in layers with gloves, a hat and place a scarf over your mouth and nose to warm up the air before you breathe it in.

Snow shoveling: Studies have shown that heart attack rates jump dramatically in the first few days after a major snowstorm, usually a result of snow shoveling. Shoveling snow is a very strenuous activity that raises blood pressure and stresses the heart. Combine those factors with the cold temperatures and the risks for heart attack surges. If your sidewalk or driveway needs shoveling this winter, hire a kid from the neighborhood to do it for you, or use a snow blower. If you must shovel, push–rather than lift–the snow as much as possible, stay warm, and take frequent breaks.

New Year's resolutions: Every Jan. 1, millions of people join gyms or start exercise programs as part of their New Year's resolution to get in shape, and many overexert themselves too soon. If you are starting a new exercise program this winter, take the time to talk to your doctor about what types and how much exercise may be appropriate for you.

Winter weight gain: People tend to eat and drink more, which results in more weight gain during the holiday season and winter months. These are all hard on the heart and risky for someone with heart disease. Keep a watchful eye on your diet this winter and avoid binging on fatty foods and alcohol.

Shorter days: Less daylight in the winter months can cause many people to develop "seasonal affective disorder" or SAD, a wintertime depression that can stress the heart. Studies have also looked at heart attack patients and found they usually have lower levels of vitamin D (which comes from sunlight) than people with healthy hearts. To boost your vitamin D this winter, consider taking a supplement that contains between 1,000 and 2,000 international units (IU) per day.

Flu season: Studies show that people who get flu shots have a lower heart attack risk. It is known that the inflammatory reaction set off by a flu infection can increase blood clotting which can lead to heart attacks in vulnerable people. If you have not already done so this year, get a flu shot for protection. And, if you have never been vaccinated for pneumococcal pneumonia, you should consider getting these two shots (given 12 months apart) too.

How do I go about a filing an appeal with Medicare when they will not pay for something that they covered in the past?

If you disagree with a coverage or payment decision made by Medicare, you can appeal. Approximately half of all Medicare appeals are successful, so it is definitely worth your time.

Before appealing, talk with your doctor, hospital and Medicare to see if you can spot the problem and resubmit the claim. Some denials are caused by simple billing code errors by the doctor's office or hospital. If that does not fix the problem, here is how you appeal.

Original Medicare Appeals

If you have original Medicare, start with your quarterly Medicare Summary Notice (MSN). This statement will list all the services, supplies and equipment billed to Medicare for your medical treatment and will tell you why a claim was denied. You can also check your Medicare claims early online at MyMedicare.gov or by calling Medicare at 800-633-4227.

There are five levels of appeals for original Medicare, although you can initiate a fast-track consideration for ongoing care, such as rehabilitation. Most people have to go through several levels to get a denial overturned.

You have 120 days after receiving the MSN to request a redetermination by a Medicare contractor, who will review the claim. Make a copy of your MSN, then circle the items you are disputing on the MSN. Provide an explanation of why you believe the denial should be reversed and include any supporting documents like a letter from the doctor or hospital explaining why the charge should be covered. Then send it to the address on the form.

You can also use the Medicare Redetermination Form. See CMS.gov/Medicare/CMS-Forms/CMS-Forms/downloads/CMS20027.pdf to download it or call 800-633-4227 to request a copy by mail.

The contractor will usually decide within 60 days after receiving your request. If your request is denied, you can request reconsideration from a different claims reviewer and submit additional evidence.

A denial at this level ends the matter, unless the charges in dispute meet a minimum threshold (at least $160 in 2019). In that case, you can request a hearing with an administrative law judge. The hearing is usually held by videoconference or teleconference.

If you have to go to the next level, you can appeal to the Medicare Appeals Council. Then, for claims of at least $1,630 in 2019, the final level of appeal is judicial review in U.S. District Court.

Advantage and Part D Appeals

If you are enrolled in a Medicare Advantage health plan or Part D prescription drug plan the appeals process is slightly different. With these plans you have only 60 days to initiate an appeal. In both cases, you must start by appealing directly to the private insurance plan, rather than to Medicare.

If you think that your plan's refusal is jeopardizing your health, you can ask for a "fast decision," where a Part D insurer must respond within 24 hours, and Medicare Advantage health plan must provide an answer within 72 hours.

If you disagree with your plan's decision, you can file an appeal, which like original Medicare, has five levels. If you disagree with a decision made at any level, you can appeal to the next level.

For more information, along with step-by-step procedures on how to make an appeal, visit Medicare.gov and click on the "Claims & Appeals" tab at the top of the page.

Get Help

If you need some help, contact your State Health Insurance Assistance Program (SHIP), which has counselors that can help you understand the billing process and even file your appeal for you for free. To locate your local SHIP, visit ShiptaCenter.org or call 877-839-2675. The Medicare Rights Center also offers free phone counseling 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.

My husband and I are thinking about making some modifications to our home so we can remain living there for as long as possible. Can you recommend some good resources that can help us with aging in place ideas?

Many retirees, like you and your husband, want to remain in their own home for as long as possible. But, being able to do so will depend on how easy it is to update your home as you get older. Here are some helpful resources to get an idea of the different types of features and improvements you can make that will make your house safer and more convenient as you grow older.

Home Evaluation

A good first step in making your home more age-friendly is to do an assessment. Go through your house, room-by-room, looking for problem areas like potential tripping or slipping hazards and areas that are hard to access or difficult to maintain. To help with this, there are several organizations that have aging in place checklists that point out potential problems in each area of the home, along with potential modifications and solutions.

Rebuild Together, for example, has a short "Safe at Home Checklist" that was created in partnership with the Administration on Aging and the American Occupational Therapy Association. Go to AOTA.org and search for "Rebuilding Together Safe at Home Checklist."

The National Association of Home Builders also has a checklist that offers more than 100 suggestions to help homeowners over age 50 live safely, independently and comfortably. Go to NAHB.org and search for the "Aging in Place Remodeling Checklist."

You may want to check out AARP's excellent resource that is filled with tips and diagrams to make your entire home safer and easier to live in as you age. You can access it at AARP.org, then search for "HomeFit Guide" or call 888-687-2277 and ask them to mail you a free copy.

Personalized Advice

If you want more personalized help, consider getting a professional in-home assessment with an occupational therapist.

An occupational therapist (OT) can evaluate the challenges and shortcomings of your home for aging in place, recommend solutions and introduce you to products and services to help you make improvements.

To find an OT in your area, check with your physician, health insurance provider or local hospital, or seek recommendations from family and friends. Many health insurance providers, including Medicare, will pay for a home assessment by an OT if prescribed by your doctor. However, they will not cover the upgrades to the home.

Another option is to contact a builder who is a Certified Aging in Place Specialist (CAPS). CAPS are home remodelers and design-build professionals that are knowledgeable about aging in place home modifications and can suggest ways to modify or remodel your home to fit your needs and budget. CAPS are generally paid by the hour or receive a flat fee per visit or project.

To find a CAPS in your area visit the National Association of Home Builders website at NAHB.org/capsdirectory where you can search by state and city.

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 can you recommend that will make a kitchen safer and easier to use? My wife, who loves to cook, has had several kitchen-related accidents over the past year. We would like to modify the space to make it safer and more practical.

There are a number of simple modifications and inexpensive add-ons that can transform your kitchen into a safer environment. Depending on your wife’s needs, here are some suggestions for each aspect of the kitchen.

Floors: Replace kitchen throw rugs with non-skid or gel floor mats to reduce tripping or slipping. Gel mats make it more comfortable to stand for long periods of time.

Lights: Replace dim overhead lighting with brighter ceiling lights. Also, consider adding under-cabinet task lighting to brighten up kitchen countertops.

Cabinets and Drawers: Reduce bending or reaching by organizing your kitchen cabinets and drawers so that the items you use most frequently are within comfortable reach. In addition, you can make your cabinets and pantry easier to access by installing pullout shelves or Lazy Susans. Finally, consider installing D-shaped pull-handles on cabinets and drawers. These handles are more comfortable for arthritic hands than traditional knobs.

Faucet: If you have a twist-handle kitchen faucet, replace it with a single handle faucet. They are easier to use, especially for people with arthritis or limited hand strength. There are also kitchen faucets on the market today that will turn themselves on and off by simply touching the base or moving your hand over a motion sensor. For safety purposes, set your hot water tank to 120 degrees to prevent possible water burns.

Microwave and Stove: If your microwave is mounted above the stove, consider moving it to a countertop. This makes it safer and easier to reach. If you are concerned about your wife remembering to turn the stove off, there are automatic stove shut-off devices you can purchase and install to prevent a fire.

If you are looking to upgrade some of your appliances, here are some different features you should look for when shopping.

Refrigerator and Freezer: Side-by-side doors are convenient because frequently used items can be placed at mid-shelf range for easy access. Also, look for refrigerators that feature pullout adjustable height shelves and water/ice dispensers on the outside of the refrigerator door for added convenience.

Stove or Cooktop: Look for a stove with controls on the front, so you will not have to reach over hot burners to turn it off. Also, ask about automatic shut-off burners. Make sure the controls on the stove are easy to see. Flat surface electric or induction burners are great for sliding heavy pots and pans from one burner to the next. For gas stoves, continuous grates are good for this purpose as well.

Oven: For an oven that is easier to maintain, consider purchasing a self-cleaning oven. Ovens that feature a side-swing door are easier to use because you do not have to lean over a hot swing-down door. Also consider a wall-mounted oven, installed at your wife’s preferred height, so she does not have to bend over.

Dishwasher: Consider a dishwasher with drawers that slide in and out and is installed on a 6-10-inch raised platform. These require less bending to load and unload.

Washer and Dryer: Front-load washers and dryers with pedestals that raise the height 10-15 inches are also back-savers and easy to access.

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.

How do I go about making a family health history? Most of my relatives have died before age 65. My doctor suggested I create a family history to help identify my own genetic vulnerabilities.

An accurate family health history remains one of the most important tools to maintain your health as you age. The holidays may be an opportune time to discuss a family health portrait. Here are some things you should know, along with some tips and tools to help you create one.

Know Your Genes

Just as you can inherit your father's height or your mother's eye color, you can also inherit their genetic risk for diseases, such as cancer, diabetes and heart disease. For example, if one generation of a family has high blood pressure, it is not unusual for the next generation to also have high blood pressure. Tracing the health ailments suffered by your relatives can help you and your doctor predict things you may be at risk for, so you can take action to keep yourself healthy.

To create a family health history, you will need to start by collecting some basic medical information on your first-degree relatives, which includes your parents, siblings and children. You may also want to include your grandparents, aunts, uncles and first cousins.

You should find out the specific ages of when a relative developed health problems, such as heart disease, cancer, diabetes, arthritis, dementia, depression, etc. If family members are deceased, you should try to find out when and how they died. If possible, include lifestyle information as well, such as diet, exercise, smoking and alcohol use.

Some relatives may not want to share their medical history or they may not know their family history. Typically, any information you discover will be helpful for creating a family health portrait.

You may be able to get information on deceased relatives by ordering a copy of their death certificate. The certificate will list their cause of death and their age at death. To get a death certificate, contact the vital records office in the state where your relative died, or go to VitalChek.com.

If you were adopted, the National Foster Care & Adoption Directory Search, ChildWelfare.gov/nfcad, may be able to help you locate your biological parents so you can get their medical history.

Helpful Tools

To get help putting together your family health history, the U.S. Surgeon General created a free web-based tool called "My Family Health Portrait," which can be accessed at phgkb.cdc.gov/FHH/html. The tool can help you collect, organize and understand your genetic risks. You may choose to share the information with your family members and doctors.

Another free resource that provides similar assistance can be found on the Genetic Alliance's website, FamilyHealthHistory.org. The online tool entitled "Does it run in the family?" allows you to create a customized guide of your family health history.

Handling the Results

If you uncover serious health risks that run in your family, do not despair. While you cannot change your genes, you can change your habits to increase your chances of a healthy future. By eating a healthy diet, exercising and not smoking, you can offset and sometimes even neutralize your genetic vulnerabilities. This is especially true for heart disease, stroke, type 2 diabetes and osteoporosis.

A family medical history can also alert you to get early and frequent screening tests. This can help detect other problems, such as high blood pressure, high cholesterol, and cancers including breast, ovarian, skin, prostate and colon cancer, in their early stages when they are most treatable.

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.

Because of my mobility problems, I am thinking about getting a walk-in bathtub that’s easy to get into and out of but could use some help selecting one. What can you tell me about walk-in tubs, and can you recommend some good companies that make and install them?

Walk-in tubs are a good option for mobility challenged seniors because they are much easier to get into and out of than a standard tub. They may help prevent slips, trips and falls. Here is what you should know.

The Basics

Walk-in bathtubs are uniquely designed with a watertight, hinged door built into the side of the tub that provides a much lower threshold to step over, usually 2.5 to 7 inches, in comparison with a standard tub threshold of 15 inches.

In addition to the low threshold, many walk-in tubs also have built-in seats, grab bars, anti-slip floors, anti-scald valves and handheld showerheads. Many higher-end models offer therapeutic spa-like features that are great for seniors with arthritis and other ailments.

The kind of tub you choose will depend on your needs, preferences and budget, and the size and layout of your bathroom. The cost of a walk-in tub with professional installation ranges from approximately $3,000 to $10,000.

Here are some other things you should consider:

Tub size: Walk-in bathtubs vary in size. Most models have high walls between three and four feet high and are between 28 and 32 inches wide, but will fit into the same spaces as your standard tub without having to reconfigure the room. There are also bariatric walk-in tubs that have wider door openings and larger seats to accommodate people over 300 pounds.

Wheelchair-accessible: Most walk-in tubs have an inward opening door, but if you use a wheelchair, an outward opening door may be a better option because they are easier to access.

Tub options: The most basic and least expensive type of walk-in tub you can get is a simple soaker tub. But, there are many other options available. There are aero therapy (air jets) tubs, hydrotherapy (whirlpool water jets) tubs, aromatherapy tubs that mix fragrant essential oils with the water or combination tubs with multiple upgraded features. Tubs with an in-line heating system will keep your bathwater warm while you soak. Tubs with self-cleaning systems may also be a priority.

Fast fill and drain: One drawback to using a walk-in bathtub is that the bather must sit in the tub as it fills and drains, which can make for a chilly experience. To help with this, consider a tub that has fast-filling faucets and pump-assisted drainage systems, which significantly speed up the process. These options may require some plumbing modifications to your bathroom.

Warranty: The best walk-in bathtubs on the market today are made in the USA. Look for companies offering a lifetime “leak-proof” door seal warranty and lengthy warranties on both the tub and the operating system.

Where to shop: To get started, contact a few companies that will send a local dealer to your home to assess your bathroom and give you product options and estimates for free. Most companies offer financing with monthly payment plans.

Unfortunately, original Medicare does not cover walk-in bathtubs nor do Medicare supplemental (Medigap) policies. However, some Medicare Advantage plans may help with the cost. There are also many states that offer Medicaid waivers that will help pay for the purchase and installation of a walk-in tub to those that qualify. The VA offers some programs that provide financial aid too.