Advocacy is a broad term used for seniors that confuses both professionals as well as the lay person. “An advocate is one who pleads the cause of another and provides a voice for those who are not heard, making sure that important issues are addressed” (Mason, Leavitt, Chaffee, 2012). I have been a Registered Nurse for over 19 years and when I say “I’m a nurse” people know exactly what I do. I became a patient advocate over a year ago and now when I say “I’m a patient advocate”, people look at me and say “are you an attorney, are you a politician? What do you do? This is a good question and my answer is a lengthy one as this position has many different ways I promote health and independence. I am rare and much sought out for my knowledge, support and peace of mind I give my clients and families.
Not all patient advocates are created equal and we will discuss what exactly an advocate does in detail as well as what to look for in terms of experience and knowledge. Because patient advocate does not have any current regulations, anyone off the streets can call themselves an advocate. So, how do you find a qualified advocate and someone you can trust to take care of your client or loved one?
A good patient advocate should have an assessment process that address all aspects of the client’s needs: medical, physical, psychological, psycho-social and vocational needs. In order for someone to be truly happy all areas of their life need to be optimized. An advocate should have a holistic approach to assessing the person. An assessment of one to two hours is not ideal as it cannot address all aspects of the person’s life and most times cannot get to the root cause of the problem. I have been asked to only address one situation that is the “problem” and this simply cannot be done and should be viewed as a short cut that will ultimately have negative consequences on you or your family member. Some advocates will address the “one problem” just to get the client, but the family soon realizes that after that is addressed a new “problem” arises. This is because the underlying cause of the problem was not addressed.
An example of one common situation is when a family asked me to find a long term care facility for their parent who was becoming increasingly confused and the family was worried they were no longer safe to live at home. After conducting the full assessment it was determined the client was only slightly confused but was prescribed the same medication from different physicians not in communication and then was filling these medications incorrectly in his medication tray. After communicating with his physicians, figuring out correct medication, correcting electrolyte imbalance caused by the medication errors and then providing a medication dispensing tray to properly dispense the medication moving forward, the client was able to stay in his home. The son stated “he is acting like he was two years ago, I can’t believe the difference”. This would never have been caught if we would have just taken the family at their word and “found the parent a nursing home”. By trying to save money the family, it would have cost the family around $7,000 a month by an unnecessary long term care placement long before it was truly necessary.
When looking for a patient advocate look for a Registered Nurse or those companies that employ Registered Nurses as the advocate. R.N.s have been providing care coordination and advocacy since the turn of the century. Nursing defined by the American Nurses Association (2001) states: “Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human responses, and advocacy in health care for individuals, families, communities, and population”. Nurses are natural advocates through their education and training. The nursing process works for patient advocacy. Ask if the patient advocate follows the nursing process of: assessment, nursing diagnosis, planning, implementing and evaluation in addressing all aspects of life, not just one area.
Questions to ask a potential advocate are:
What degrees do you have? You should be looking for an RN or those who employ RNs. Not to say a social worker is not sufficient for some situations, but most seniors have many medical needs including multiple physicians, multiple medications, and chronic conditions that need managed. The Center for Disease Control and Prevention, (2011) cites almost 80% of older adults have one chronic condition and 50% have at least two; infectious disease and injuries take a disproportionate toll on older adults. As the story above proves, a social worker may be able to make an appropriate placement in a nursing home, but if you want to determine if a nursing home is even needed in the first place, an experienced RN is a better fit.
How do you refer to community resources? Some advocates get paid by making referrals to certain companies. If the service is “free” you may ask how they make money. Most people do not work for free. If I would get paid a certain wage by how many people I referred to X nursing home, or X home health agency, I may be swayed to refer a client to these agencies to make more money. Although the agencies where there is no reimbursement from outside agencies for pay are more expensive, they work for only you ensuring the referral they made is for only your benefit, not the benefit of their pocketbook.
Do you follow up after making a recommendation? Our lives and needs are constantly changing and what works best for you or your family today may not work best tomorrow. Ask your advocate if they will make follow up visits at least once a quarter to make changes in the plan of care needed to reach the long term goals set. A diligent advocate will check to make sure all referrals are fully vetted, meaning the advocate will make sure if they refer to a home health agency for aid work, that agency conducts employee background checks, and are fully bonded and insured and have a good reputation in the community.
Who are your employees? If the owner is a RN make sure the employees also have RNs as they are the ones working with you or your family. Ask if the employees are background checked and insured. You can also ask what training the employees have, and ask to meet the employee that will be working with you or your family member. If the company has nothing to hide they would be happy to oblige you in introducing you.
What is your area of expertise? Some advocates only work with people who are having an acute episode in the hospital. Some advocates specialize in geriatrics, or special needs children. Some advocate in finding physicians or coordination of care. Larger organizations may have many areas of expertise to draw from and have a wide array of knowledge and expertise. Just make sure you choose an organization that meets the needs you are looking for.
Lastly, meet the advocate in person and check out the license for restrictions with your state board of nursing. We all have instincts and let that guide you if this is the right person to care for you or your family member. Make sure your personalities are compatible and you can trust this person can work together with you to promote health and wellbeing. Ask about assessment techniques and don’t always go for the cheapest as discussed. You pay a lot for a car that will eventually break down, put priority on your health and well-being, you deserve the best. And, a good patient advocate, even if the up-front cost is more, can help save money by: keeping you or your family out of the hospital, keep out of long term care facilities, and you can’t really put a price on peace of mind.
“The voice of a nurse is powerful. The nurse’s experience and expertise provide the knowledge and professionalism needed to make a difference” (Hearrell, 2011).
American Nursing Association (2001). Code of Ethics for Nurses with Interpretive Statements. Retrieved from http://nursingwolrd.org/mainmenCategories/EthicsSTandards/CodeofEthicsforNurses/Code-of-ethics.pdf
Centers for Disease Control and Prevention (2011). Helping People to live long and productive lives and enjoy a good quality of life. Retrieved from http://www.cdc.gov/chronicdisease/resources/publications/aag/aging.htm
Hearrell, C.L. (January, 2011). Journal of American Nursing. Advocacy: Nurses Making a Difference. 37.1 (p. 71-73).
Mason, D.J., Leavitt, J.K., Chaffee, M.W.. Policy and Politics in Nursing and Healthcare (6th ed.). A framework for Action in Policy and Politics. Elsevier, St. Louis, 2012.
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