Patient Advocacy: What is it? How do I use it?

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Patient Advocacy

Are you a member of the sandwich generation with an active family of your own in addition to parents who need increasing levels of support and care?  Has your spouse or one of your parents been recently diagnosed with a chronic illness, like dementia, heart disease, diabetes or COPD (a lung disorder) and you don’t know where to turn for information and help?  Perhaps you live in a different geographical location than your parents which makes it difficult for daily contact and healthcare assistance.   Or, you live in central Illinois and your adult children do not, and you wish that they stay involved in your medical care.   If any of these scenarios fits your circumstances, then acquiring the services of a patient advocate might be beneficial for all your family members, patients and caregivers alike.

What is a patient advocate? A patient advocate is a consultant who supports a client with a variety of needs, both in a medical setting and at home.  They may be a medical professional, a social worker, or a lay person with experience with chronic disease or with helping a loved one navigate their own health journey.  You may find them on staff at a hospital, as part of a professional medical practice, hospice, or a private patient advocacy organization.  Patient advocacy may also be offered through your insurance company or be part of one of several services that a local business may provide.

Are there differences in the type of patient advocates?  It is wise to remember who pays the patient advocate.  While advocates should have your interests as a priority, the payer may define the reason why this advocate is available.   For example, an insurance company’s patient advocate will most likely seek to control medical costs for that insurance company.  A hospital-employed advocate may want to assist a person so that they do not return to the hospital within a time period, because Medicare and insurance companies may financially penalize that hospital if their patient returns too soon.  In short, if you privately hire an advocate, you are paying for personalized guidance through a complex system to see that your care and needs are expressed and best met.

What can they do? One of the most important jobs of an advocate is to facilitate communication between the patient, family and medical staff.  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.  As medical needs increase, they can communicate to family members when the need for in-home health care becomes apparent.   Their input may be crucial in determining when the patient can no longer stay at home and/or needs to transition to a senior community, assisted living or skilled nursing facility for 24 hour care.

In conclusion, a patient advocate can help you better manage the healthcare system.  The goal of a privately paid advocate is to assist you thorough the system, facilitate open communicate between patient, doctor and family. Ultimately, your desires can be expressed, stress levels can be reduced as the best quality of life is foremost.

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Steven A. Buttice is the president of Medical Reimbursement & Management Services, Inc., a firm specializing in issues affecting seniors, including seminars and consultation on Medicare Plans, Long Term Care and other types of insurance, claims issues, and sales/service of insurance products since 1984.

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