Our health care system is not exactly user-friendly for anyone, let alone seniors.
With myriad bills to decipher, a complicated Medicare/Medicaid process, multiple doctors and appointments to attend, medication to manage, emergency room and hospital stays, things can become so overwhelming that older folks might end up not receiving the care they need.
Health advocates (also called patient advocates or health care navigators) are professionals who work one-on-one with clients of all ages to navigate the medical system, says Joanna Smith, president of the National Association of Healthcare
What advocates do varies widely, from accompanying a client to the doctor's office to helping them get second opinions to locating a new living environment. They might also perform health care research or find the best insurance plan. "It is a wide swath of services, and not every advocate does everything," Smith says.
If you've never heard of health advocacy, you're not alone. "It's a new and exciting field," Smith says. "When I first started (in 2005) I couldn't find anyone doing what I was doing in California. Now we have 225 members all over the country. What is propelling it is that medicine has gotten very complicated and it's not going to get any simpler."
For seniors, the goal of advocacy is to prolong independence and help maintain their health through management and oversight, especially when a relative is unable to do so.
"I often get inquiries from members of the sandwich generation who need help with their elderly parents who live out of state," says Raquel "Rocky" Gabriel-Bennewitz of Chicago Health Advocates. "Often when they seek out private advocates, they're already near the crisis point."
Among the many services she performs are managing medication, referrals for eldercare, finding non-medical care providers, accompanying clients to appointments, and assembling multidisciplinary teams.
"It's tailored to the client and family," she says. "If they are going for surgery, I can accompany them. I can research their dietary needs and connect with nutritional experts, or do insurance appeals."
Gabriel-Bennewitz has been a registered nurse for 30 years. She got into health advocacy after taking an advocacy certification course for RNs.
Amie Hyman, a licensed social worker based in Willow Springs, started her company, Heartfelt Solutions for Seniors, five years ago after years of managing her mother, Anne's, 13 doctors and 12 medications.
"When you think about it, the medical system is difficult to navigate for the healthiest of us, but add memory issues, sickness, and age, and it becomes almost impossible," she says. "I help cut through all the red tape and get older people the care they need."
Helping clients schedule and attend their doctor appointments is a big part of what she does.
"As you get older, the more and more doctors you have. I make the doctor appointments, record contact lists for all their doctors and their specialties, and a list of prescriptions and what they do. I take them to the doctor. I check with them throughout the week, to help them remember what they want to tell the doctor. I make sure all their questions get answered in English. Afterwards, I help carry out the care plan, changing or getting medication, schedule tests, follow-up appointments, and make sure they do it and get there."
Medication management is another critical piece of this puzzle, she adds.
If an emergency room visit or hospital stay is needed, she attends the discharge meeting, and makes sure any changes to the senior's care are done.
Hyman also provides money management, mail management, medical insurance management and referrals, and can assume the role of Power of Attorney if requested.
There when family can't be
Like Gabriel-Bennewitz, Hyman's typical client is someone who does not have kids, or their kids are out of state or too busy to help them.
One of Hyman's clients, Victoria (last name withheld) is an 84-year-old living independently in her South Side home for 45 years. She has children living out of state with whom she connects via phone and e-mail. Victoria's daughter hired Hyman to take her to medical appointments and follow up on the details.
"I'm having a problem with short-term memory, so it's helpful to have someone listening and taking notes," Victoria says. "Amie makes a monthly list of which doctors and which times, and also my medication list, which she updates." Victoria attends about six doctor appointments a month.
Hyman also helps organize Victoria's paperwork. "Amie has helped me set up a filing system, and that has been extremely helpful to me," she says. "She never makes me feel dependent."
Assembling a team
As health advocacy is an emerging profession, no state has yet licensed health advocates. However, there are optional certifications, such as the one Gabriel-Bennewitz holds.
When hiring an advocate, Smith recommends asking about their background, requesting references of other clients, and getting a written service agreement that stipulates the services, costs, what to do in an emergency.
Rates vary widely. Smith says they range nationally between $50 and $200 an hour in the San Francisco Bay area, where she charges $175. The Chicago area price range would be lower, she says.
Since services and experience vary, look for a health advocate that has experience with the particular situation you need help with, be it doctor appointments or research or bills, she advises. "Every advocate needs a cadre of people behind them that they turn to with complex situations and specialized knowledge. Ask who they have as their own resource pool that they turn to," Smith says. "This is a team sport."
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