An elderly patient has arrived at the ED. She fell and possibly broke a hip. She is alone, or with a neighbor. But no family or close friend is with her, and she is confused.
It is a common but difficult situation. “The providers will be making decisions without any sense of the patient’s preferences,” says Liz Barlowe, MA, CMC, president-elect of the Aging Life Care Association (ALCA), formerly the National Association of Professional Geriatric Care Managers.
At this point, it is imperative to contact the family — who may live in another city some distance away. As the case manager, you feel empathy for this patient, wishing you could do more to help.
One solution is to contact a privately paid care manager/health advocate. This is a service that has emerged to fill a need of the “sandwich generation” — adult children trying to coordinate care for elderly parents who live far away.
The ALCA serves to connect consumers with paid care managers in every region of the country. This position has several labels; the ALCA refers to this position as Aging Life Care Professional, but the titles “care manager” and “nurse advocate” also are used.
The care manager/health advocate often is a nurse, social worker, gerontologist, physical therapist, occupational therapist, or other health-related professional. A bachelor’s degree is required; certification also is recommended. “We have standards of practice and a pledge of ethics members must adhere to,” Barlowe explains.
While the majority of clients are geriatric adults, some are younger adults with physical or developmental disabilities, brain injury, mental health problems, or chronic illness.
Barlowe describes the relationship between care manager/health advocate and the patient/client.
“Just as everyone ages differently, everyone views their future — and their health challenges — differently,” she notes. “Some clients want as little intervention as possible, while others want to see the doctor immediately if something minor comes up, and they want us with them.”
The care manager will spend time with the patient to really understand his or her values and goals. “Some issues they won’t even tell their families, but they share with us,” says Barlowe. “Too often, older people don’t feel people are listening. We can advocate for them and empower them, give them their voice again.”
Michael Newell, MSN, RN, is founder-president of LifeSpan Care Management LLC, a firm that offers health coordination and advocacy services.
“We believe a good nurse is able to see a problem before other people see it, address that problem before most people know there is a problem,” says Newell. LifeSpan Care Management is based on a rehabilitation nurse model.
“The health advocate helps the patient to function and live as independently as possible,” he explains. “That includes suggesting adaptations in lifestyle, adaptive equipment, and other support that helps people remain safe in their own homes. That’s what most people want and what we try to do.”
Adult children appreciate the assessment that a care manager can provide: identifying their parent’s problems and goals, and finding solutions.
Care managers attend doctor appointments and take notes. “A lot of times, the patient can’t articulate the problem,” says Newell. “A health advocate will have a plan going in — what needs to be addressed, what the doctor should know, medication issues.”
The advocate can raise a red flag if a new medication has contraindications with another medication the patient is taking. “Doctors tend to spend more time with the patient if someone is with them who is recognized as an advocate and has some medical training,” Newell says.
When it is time to transition the patient to a care facility, the care manager can be an invaluable resource to families. “The healthcare system is so complex, that’s where families really rely on us,” Newell explains.
“We act in a fiduciary capacity to help them sort through all the options — rehabilitation and assisted living facilities, nursing home care, or hospice,” Newell adds. “We help them figure out how to pay for it — what insurance, Medicare, and Medicaid will cover.”
The care manager also can recommend local facilities based on their direct experience, adds Barlowe. “We are inside these local facilities all the time, and we know their strengths and weaknesses. We don’t get any kind of kickback for recommending a facility; we are hyperfocused on that patient and getting them the very best care.”
After discharge arrangements are made, the care manager will smooth the transfer process. He or she will be there to organize a care conference to ensure the patient’s needs are addressed. The care manager also will check on the patient regularly to ensure optimal care.
Both Newell and Barlowe encourage hospital case managers to refer patients and families to the ALCA website. “We know the hospital case manager has limited time and resources to help families make these very difficult decisions,” Newell says. “We can work with the family to get the best care for mom or dad, and avoid paying out-of-pocket as much as possible. It’s to the benefit of all concerned.”
The cost for this service varies across the country, and is rarely an issue for family members. “They want what’s best for mom, but can’t quit their jobs. When they hire a care manager, they get an advocate who is available 24/7, including middle of the night or Sundays. When there’s an emergency, we are there right away to make sure our client is safe and getting what’s needed,” says Barlowe.
She encourages healthcare professionals to consider this role as a career opportunity. “It’s very satisfying,” Barlowe says. “You really build an intimate relationship with the client and their family. We get to know our clients very well, help them with healthcare coordination and decisions, and promote their optimal aging journey. I always say we are the experts at aging, we may not know everything, but we can find an expert who does.”