Recently I started looking for a place for my mom to live. I found this process confusing. So, what should I look for when looking at senior living communities? John H., Dunlap, IL

Additionally, ensure that you:
Look for the signs.
Sometimes the answer is not for them to leave, but to augment the environment. Being vigilant about the signs of your parents being overburdened and assisting with altering their environment can keep them happy and healthy in their home longer.
Whatever happens, research assisted living homes now for the future. Figure out who offers what and where, and have an idea long before anyone needs a facility which you may prefer. Living By Your Design has a free senior community referral service that can help you match your needs and wishes with available communities in the area.
It is important to note, however, that insurance agents can still be involved in this process, and many resources can be used other than Healthcare.gov. We advise you always speak to an ACA insurance professional to find what coverage you need and help to navigate this process beyond just pricing premiums.
Also - Open enrollment ends very soon, January 31st, 2016, meaning that unless your son, or any party interested, were to meet the specific criteria to apply out of the enrollment season - the window to apply for ACA insurance is closing fast.
As with any insurance, consider what level of coverage is needed for the individual. Many healthy 26 year-olds only seek catastrophic insurance with minor coverage for things like visits, and little worry for out of network services. This will vary radically on a case-by-case basis, so figure out what level of coverage works best for you. Of course, talking to a professional agent will likely be a huge help.
First — If you are thinking of switching now, you are acting at the right time. You have until February 14, 2016 (it is always January 1st to February 14th each year) to opt in or out of MAPD, without special exceptions granted in certain circumstances year-round.
Second — This is truly a numbers game, if number crunching is not your cup of tea, please consult a professional, the following is for the DIY folks only!
To figure out if switching is right for you, find out approximately how much it will cost for your procedure, new medication, and each day you expect to spend in the hospital under MAPD and add all of that together (do not forget to take in to account your deductibles, out of pocket maximums, etc.). Now, divide that number by 12 and add it to your monthly premium, this number is your expected cost per month under MAPD. Now, if you find that your expected monthly costs are far higher under MAPD than Medicare with supplemental plans, then your answer is simple.
Finally — If you want to disenroll from an MA-only or a MAPD plan and return to Original Medicare during the allotted time mentioned above, you have a special election period (SEP) to join a Part D prescription plan.
Of course, you should always speak to a professional before committing to any large changes such as this, but it is always a good thing to have a general grasp on your insurance coverage for the year at the start of the year.
In a medical setting, patient advocates can accompany clients to doctor appointments or outpatient rehab sessions. As a result, they can communicate with medical staff and family members about the patient’s ongoing condition, medical compliance and related concerns. They can also help with the filing of insurance and medical claims. Through home visits, they develop a relationship with the patient and monitor health progress by taking vitals, overseeing the correct use of medical supplies and equipment as well as keeping track of medication usage. They may also make suggestions for physical changes to the home environment to ensure safety by assessing fall risk and potential hazards due to limited mobility.
Ultimately the patient advocate can serve many functions, but their primary function is to advise and assist throughout the treatment process. Patient advocates are often vital for major decisions in the change of care or environment, such as when it is too risky to have a patient living alone, or when to begin worrying about quality of life over aggressive treatment. Ultimately, it is the job of the advocate to help patients and their families navigate the healthcare system.
For instance, an insurance appointed advocate will likely have some level of the insurance company’s interests in mind. While it is unlikely they would ever provide bad or dangerous advice for the patient, they will likely have the reduction of cost to the insurance company in mind.
Advocates can also be appointed by the hospital itself, but they may also have their own goals in mind. Many hospitals receive a small penalty for patients being readmitted to the hospital within a certain period, and a hospital appointed advocate may have this or other things in mind when recommending a course of action.
While the difference may be slight, being the sole employer of a patient advocate does insure that their allegiances lie solely with the patient and their families. Perhaps just receiving a consultation from a private advocate to supplement your appointed advocate would suffice, but it is definitely something to keep in mind.
For instance, if one seeks long term care in a facility based upon a struggle with dementia, usually two of 5 or 6 triggers are required for the insurance company to deem payment of the claim to cover the facilities costs necessary. These triggers are very specific, such as whether or not the person needs 24 hour care, and if not whether or not they can properly bathe or dress alone, and triggers such as eating without assistance. Assistance could mean standby or substantial assistance. Standby assistance is much easier to meet.
The reason this question comes up so often is that these triggers, and the failure to prove them to insurance companies, can often lead to a lack of payment for coverage that has been purchased and is, in fact, owed. The difference between understanding the triggers in insurance plans purchased, or to be purchased, can be the difference between many thousands of dollars in payable claims each month.
My advice: seek professional help both when purchasing your LTC plans and when it comes time to make a claim.
It is important to remember you are not alone. Utilizing tools now can take you a long way in the future.
If considering home health care the questions you should ask are things like:
Similar questions can be posed for facilities, and you can find a good deal of information on local facilities at http://www.livingbyyourdesigninc.com/facilities
The key to any plan for later years is tailoring to fit your family’s specific needs. Remember, your parents are the captain of their ship.
Jargon and industry terms are sometimes difficult to understand, for many families going through this time in their lives. When we say the term ‘legal documents,’ typically we are referring to Powers of Attorney and a will, or any preparatory legally binding document that gives direction for the future.
Primarily, this includes the following, all of which should be discussed in detail with all parties involved and should only be done through a lawyer:
There is a lot to say on this matter, and each family will have different needs. My recommendation is to secure legal advice if there have been changes since you last had legal documents drawn up, and assess where your family’s greatest needs are.