How to find a good patient advocate

In 2004, Edward Moskowitz was hospitalized near his home outside Miami with internal bleeding, but after a week he was worse, his daughter Sandy Tepper says. That's when he became a human pinball. Over the next seven weeks, he was sent to rehab, grew worse, was transferred by a new doctor to a different hospital, then was bounced for insurance reasons to a second rehab facility (at 2 a.m.), despite his daughter's attempts to intervene. Ordered to physical therapy a few days later, he struggled from his wheelchair and fell to the floor, dead of apparent heart failure. He was 84.

What if someone had been there to ask the right questions and ease the family’s trauma? Enter the patient advocate, part of a growing field. Advocates, who are often former nurses or other health professionals, link patients and the health-care system. They can help get an elusive doctor's appointment, research treatments, file medical paperwork, or persuade an insurance company to cover a procedure. They might also stand in for faraway relatives by accompanying an ailing person to appointments or sitting at a hospital bedside. Some advocates work privately, on a case-by-case or hourly basis. Others work at no charge or are supplied by employers as part of benefits packages.

Unfortunately, finding good advocates can be dicey. There's no licensing or credentialing process specific to health advocates, and no regulatory body oversees them, says Laura Weil, interim director of the master's program in health advocacy at Sarah Lawrence College in Bronxville, NY, the nation's only graduate program in health advocacy. But it makes sense to follow these guidelines:

For someone who's employed: See whether his or her benefits include patient advocacy. Many large employers contract with companies such as Health Advocate, the nation’s biggest employee-based advocacy firm, staffed by registered nurses and benefits experts.

For someone in a hospital or nursing home: Ask whether there’s an in-house patient advocate who mediates between families and staff members. (But be aware that such advocates are on the institution’s payroll.)

If a chronically ill person can’t get care: Contact the nonprofit Patient Advocate Foundation, which provides free mediation services on a case-by case basis. The Web site includes resources to help navigate insurance issues as well as patient chats.

To hire a private advocate: Get a résumé, check references, and ask what experience the person has with similar cases. Obtain price estimates in writing.

Comments

[bisnaga]

This is something that I have been advocating for quite a while. I'm glad to see that the concept is being developed.

My vision of a patient advocate has at least two more elements.

A disabled patient will find it very difficult to obtain disability status. The patient needs health care providers who can describe the patient's disabilities in the best terms that Social Security and insurance companies would find favorable. The advocate would steer the patient to health care providers who can support the patient's bid for disability status.

If the advocate is part of a company, that company could become a central repository for the patient's medical records. The advocate would then be aware of all the patient's conditions and medications. In addition, if the patient is treated by another doctor either locally or far away, the needed records could be collected from one source rather than trying to determine all previous providers who might have relevant information. All services that provide test results (blood, x-ray, mri, etc) for the patient should send copies to the advocate as specified by the patient. This should become a standard practice.

[Bette Ann Moskowitz]

Patient advocates in licensed nursing homes and other long term care are called Ombudsmen and are part of a nationwide program which provides patient advocacy that is NOT on the institution's payroll (or anyone's -- most ombudsmen are volunteers). They are a powerful and effective presence and big signs all over the facility should (by law) identify the name of that institution's ombudsman and how to reach him/her.
Ombudsman Coordinator
Ulster County, New York

[Bob Jarmick]

My father is going in for double bypass on Aug 5. He's otherwise in very good health for an 80 year old - hasn't had a heart attack, etc. Does is make sense for him to have a patient advocate? I'm also looking for a list of suggestions to maximize his care and minimize ri