What’s the Difference Between a Patient Advocate and a Geriatric Care or Case Manager?

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One of our APHA members asked me about these differences a day or two ago…  So I thought I would share my reply with you.

She had called on a nursing home to see if they had interest in recommending her services to the families of some of its residents.  The nursing home director replied that they had a team of geriatric case managers they worked with – and asked what services she, the patient advocate, could provide that GCMs could not.

Since she really couldn’t come up with a useful answer, she asked me if I knew the differences in service offerings….

A few thoughts:

1.  The first, obvious answer is that a patient advocate is available to assist anyone of any age – not limited to someone who is elderly, or at least over a ‘certain age,’ as a geriatric case manager would be.

2.  Part of the answer depends on who’s paying the tab for the advocate’s or care manager’s services.  If the nursing home or the county or state’s social services department is paying the tab, then the GCM is the not the patient’s advocate – she is beholden to the nursing home or the taxpayers.  On the other hand, if the GCM’s services are paid for by the family or the patient, then they, too, are performing patient advocacy services.

3.  Most Geriatric Care Managers don’t focus strictly on healthcare. Their work is usually broader, at least in the beginning, with some emphasis on finances, housing, and other aspects of life that change as we age.

4.  Our APHA member advocate might have stumbled on a good marketing idea, however… but not the way she thought.  We can guess that geriatric care managers may not have the skills or the interest in providing some services patient advocates provide every day, such as hospital bedside monitoring, or doctor appointment accompaniment.  It could be that patients’ advocates and geriatric care managers are “coopetition.”  (Read more about coopetition in The Health Advocate’s Marketing Handbook.

5.  One way patient advocates and geriatric care managers are identical:  they are both included and invited to participate as members of The Alliance of Professional Health Advocates.  As independent practitioners who serve patients, we want to be sure families find the help they need for their loved ones.

Do you know of additional differences or similarities?  Please share them with us.

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Is a Patient Advocate or Navigator a Qualified Medical Expense for Patients?

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In the process of writing about Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSA) I began looking at what constituted a “qualified medical expense,” which is the list of the products and services the IRS lets us pay for tax-free.  They are those expenses that we can either claim on our taxes, or pay for through the use of an HSA, MSA or FSA. (What would the IRS ever do without acronyms?  But I digress…)

After looking at the list of expenses, I began to wonder whether a patient / taxpayer who hires and pays for a health or patient advocate can deduct that expense from their taxes or account?  Are we, as advocates who improve their healthcare experiences, deductible expenses?

So I went straight to the IRS horses to see what would come from their mouths… and what came from their mouths were big, loud question marks. They don’t know.  Advocates might be a deduction.  Or they might not.

Frustratingly, the process to figure out an answer requires people willing to test the system, at their own expense, which culminates in a “ruling.”  And even then, when there is a ruling, the answers might change.  (Is this a great country, or what?)

The best way to explain this is to use a metaphor – a parallel situation that resulted in a ruling.  Acupuncture.

Years ago, patients began to deduct the cost of acupuncture from their taxes. Once in awhile, one of those patients got audited.  For the first dozen or hundred or thousand (who knows?) the deduction was not allowed because there was no “ruling.” After awhile, there were enough people who fought for the deduction (paying their CPAs or lawyers to do so) that the IRS finally came up with said-ruling that said, “OK – acupuncture is now included on the list of qualified medical expenses (AKA deductions.)”

So, a couple of notes:

The CPAs and lawyers who successfully got acupuncture reviewed did so by showing evidence that acupuncture has a medical benefit. (ha!  If your doctor doesn’t believe in the value of acupuncture, you can tell him it must work – because the IRS says so!)  Our patient advocacy parallel would be that we need to show that patient advocates provide a medical benefit.

Individuals can ask their CPAs and lawyers to ask the IRS for a “private letter ruling.” That would mean that, before the patient deducts something, he asks the IRS to rule on it.  (I thought about doing this on behalf of AdvoConnection’s member advocates, however  IRS Guy told me it has to be done by individuals, on a case-by-case basis, and cannot be done on behalf of an organization’s members.)

I reviewed the publications put out by the IRS and found a few parallel expenses that are allowed.  From IRS publication 502, I see Christian Science Practitioners (who, like advocates, are not licensed), Nursing Services (these services also do not require a licensed nurse, but can provide everything from true medical services to washing and grooming) to (you’ll love this) guide dogs.  When I asked IRS Guy about guide dogs, he said they are deductible because they assist patients who are blind to get the care they need.  Honestly, of all the goods and services on that entire list, that is the best parallel for health and patient advocates – guide dogs. (In my own humble opinion.)

It seems clear that in order to become a bona fide tax deduction, a few things are going to have to happen.

1.  Patients will need to begin deducting advocate services in order to test the system.

2.  Some patients, early adopters, are going to end up paying tax and penalties for their advocacy services because no ruling will yet exist.

3.  Those patients should be able to find a CPA or lawyer to help them fight the extra tax and penalty by showing the parallel services that already exist on the allowable deductibles list, and using stats that show that patient advocates do improve a patient’s medical care.

4.  Eventually it seems like advocate services will be able to be deducted – but (like everything else) it will take awhile.

So — that big disclaimer! — I’m not an attorney, nor am I a CPA… but it’s a fair question that deserves more review, plus brave patients and caregivers who are willing to be the deductions guinea pigs by claiming these very important and necessary medical services patients’ advocates provide.

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Why Can’t Patients Be Their Own Advocates?

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Imagine… you suffer chest pains and are swept off to the ER. The pain meds leave you too groggy to make good decisions. Who will help you?

Or… difficult symptoms result in a diagnosis that leaves you stunned. You leave the doctor’s office remembering very little of what you’ve been told. Now you aren’t even sure what to do next.

Or… you’ve begun to find it confusing to keep track of all your medications. You’re concerned you’ll make a mistake. Which ones are you supposed to take with food?  Or on an empty stomach?  What about having that glass of wine at dinner – will it affect the medicines you are taking?

Next week you’ll be admitted to the hospital for knee surgery.  You have friends who have acquired infections from surgeries – one even died.  You can’t advocate for yourself when you’re drugged and in pain… who will sit by your bedside to keep you safe?

Your loved ones live too far away to be much help.  Sometimes you just need a ride to an appointment, or someone to run to the pharmacy to pick up your prescription.

These are just a few of many scenarios that require us to find some assistance to be sure we get the best care and stay safe.  Whether you have a debilitating disease, a new diagnosis, or you just feel so lousy that you can’t think straight – it’s time to call in a patient advocate to help you.

New patient advocates often find themselves having to explain what they can do to help a patient that a patient or caregiver can’t handle him or herself.  Depending on the circumstances, having a patient advocate by your side can actually make – or break – your ability to heal, or even just cope.

Can you think of other scenarios that require a professional private patient advocate?  Why not share them in the comments!

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Do I Have to Be a Nurse to Be a Patient Advocate?

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The answer is simple.  No.

So why do I ask this question?  Earlier this month, while attending the NAHAC Conference, the question was asked by a number of people.  As if the qualification to be an effective patient advocate relied on a nursing education.

Now please don’t get me wrong.  I am a huge supporter of nurses and nursing, in its many important forms.  I’ve written many times at About.com about nurses, nurse practitioners, and why I believe training as a nurse is far more patient-centered than other forms of medical training.  Most of my commentary comes from my appreciation for the “whole patient” approach most nurses provide.  I’m a fan – a BIG fan – of nurses and the nursing model for patient care.

Here are five reasons why a patient advocate does not need to come from a nursing background:

1.  Patient advocates actually perform a number of services, many of which have nothing to do with nursing.  Some are medical bill reviewers, some do research and writing about medical problems…. Nursing isn’t the right background or training for these kinds of services.

2.  Patient advocates are facilitators, but they are not decision-makers.  Patient advocates do not perform medical functions.  They provide options and background information to their patients, but never make decisions on their patients’ behalf.  Since they aren’t making medical decisions, they don’t even need a medical background.  (Not to say a medical background wouldn’t be helpful.  It might be.  It just isn’t necessary.)

3.  No matter what the background of the patient advocate, he or she knows when it is time to find helpful resources to help his or her client.  If the advocate is a nurse, then she knows when to call in a doctor or an insurance expert.  If the advocate is not a nurse, then she knows when to call in a nurse if one is needed.  That means a patient advocate can have almost any type of background and experience…. He will simply set up his system of resource people accordingly.

4.  Patients who need an advocate’s help are all over the map when it comes to what they can afford.  Someone who is not a nurse, or does not have medical training, will charge less (or should charge less) in many instances than an advocate who does have nursing training, making him more affordable than someone who does have a nursing or medical education.

5.  Finally – to make my points – some of the best known and most effective patient advocates, real pioneers in our emerging business of patient advocacy, have no nursing experience or education in their background.  Ken Schueler, perhaps the premier patient advocate in the United States and abroad, does not have an MD or RN after his name. (He did study at Sarah Lawrence in its patient advocacy course.). Elisabeth Schuler Russell learned her skills while advocating for her baby daughter.

Smart advocates will find their training where they can, when they need it, for a particular reason.  For example, an advocate who decides to focus on cancer patients might take courses in understanding oncology.  Or an advocate who needs help understanding extensive medical terminology might take a course to better understand it.

All nurses are patient advocates.  But not all patient advocates need to be nurses to begin with.

If you are considering a career as a patient advocate, then start where you are planted.  But start.

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Updates on this post:

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Share your experience or join the conversation!

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What Does a Patient Advocate Do?

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That’s a good question — what does a patient advocate do? And there are a handful of answers, depending on the kind of help you need.

Some advocates help you with insurance claims, or review your hospital bills, then negotiate those that are wrong. Others might sit with you at home while you convalesce, or help you understand a difficult diagnosis and an extended list of treatment options. In fact, there’s a long list of services patients or health advocates might provide.

Most of these are simple to understand, because this kind of help has actually been around for awhile. The type of patient advocacy that seems most confusing – but can have the biggest impact on your positive medical outcomes – are medical / navigational advocates.

These advocates will sit with you in the doctor’s office and ask questions, or will help you make a difficult medical decision, or will sit at your bedside to monitor your hospital care, to be sure you get the right drugs, or don’t acquire an infection.

Here’s a metaphor to help you better understand why this is important: Fifty years ago, if you wanted to buy a house, you found someone willing to sell, and the two of you worked out all the details. If you needed a mortgage, you got it from a bank or a savings & loan. If you needed a lawyer to draw up the deed, then you hired one.

But over the years, particularly as credit problems started to arise and the legal requirements got tougher, we began to see real estate brokers establish an expertise as the go-between – between the seller and the buyer. These brokers have a much larger bank of knowledge than someone who only buys or sells a home two or three times in a lifetime. They understand the process, know home values, mortgage options, negotiation, legal requirements – they know far more about everything related to the transaction of buying or selling a home than most of us do. Today, very few home transactions take place without a real estate broker to orchestrate them.

Unfortunately, the healthcare system (no matter what country you live in, or what political party is in office) has become so tenuous that patients really do need a go-between to help them navigate. If you are in the US, you have an additional burden dealing with health insurers. Doctors can’t do it alone anymore, nor can nurses. Without that expert to step in and shepherd us, we patients may succumb not to our disease or condition, but to the problems in the system that is intended to help us.

There is excellent care available! But it takes these experts — these professional private patient advocates — to find it and make sure we patients access it.

Whether you need help navigating the maze of healthcare — or help with your medical bills, insurance claims, home health, eldercare, a midwife or doula – or even legal help – you can find it at AdvoConnection.

Update: December 2017

 

Are you considering becoming a patient advocate? You might be interested in:
So You Want to Be a Patient Advocate? Choosing a Career in Health or Patient Advocacy

Find even more resources for health and patient advocates here.

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