What is a health care advocate?

People who need help with a health care crisis or with their aging parents often search the internet for answers. What they end up finding is that they need a patient advocate.

But what is a patient advocate?

A patient advocate represents and works with families and their loved ones to navigate the bureaucratic health care maze.

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Advocates provide families with resources, information and alternatives so they can feel empowered to make intelligent decisions about their health care choices, whether it’s when they are in a hospital or nursing home or living independently.

A patient advocate’s role is to protect the patient’s rights.

It is important to note that independent patient advocates are not employed by the hospitals or insurance companies. A patient advocate is an independent professional who partners with the client and no one else.

Some examples of the types of services that an advocate can provide are:

• Advocating for patients who are hospitalized and need to be sent to a rehabilitation facility for additional care, but the patient’s insurance company wants them to be discharged to their home.
A patient advocate will work with the hospital, the insurance company, the rehab facility and the family to ensure that a discharge to a rehab facility is processed when medically necessary. If the appeal fails, the patient advocate will work with the family to ensure they have the resources and assistance they need to bring the patient home safely.

• A patient advocate oversees care for people who are in a nursing, rehab or specialty care facility.
A patient advocate works with the family to provide scheduled visits to monitor the patient’s care and reports back their condition to the family.

• A patient advocate can provide medical management services where a nurse or other professional accompanies patients to medical visits. The advocate ensures that the patient understands the plan of care and any changes to medications. Advocates can also report the results of the medical visit to family members.

It is important to note that patient advocates adhere to a code of conduct, which includes practicing compassion and respect for the clients and families with whom they work as they guide and assist their clients in medical decision-making. At no time will a patient advocate make decisions about a client’s health or medical care or payment for medical services.

Whether a person or their family hires a professional advocate or advocates for themselves, it is critical to have a plan to manage one’s health. That plan should start while you are healthy.

You can be your own advocate by working with your PCP to stay healthy. You should also take time to understand your health insurance, including learning which services and medications are covered and which are not. Also review your insurance plan to determine which medical facilities, such as hospitals or care communities, are in your network. Once you know which facilities are in your network, take time to research these facilities to see which best meets your needs before you need them.

Learning to ask questions and get answers will be critical to your best health outcomes. PJC

Jeffrey Weinberg is president of Caregiver Champion, LLC and Author of “The Emperor Needs New Clothes Or Why The Caring Disappeared from Health Care.”