A health advocate’s role varies, depending on the patient populations and goals.
“We have cases that we follow for short or long periods” says Jeanne Stanton, RN, BSN, MHA, care manager, LifeSpan Care Management of Haddonfield, NJ.
On any particular day, Stanton might call a client to assess his or her emotional, behavioral, and other issues. For example, Stanton called one client on a recent holiday and asked how she was doing.
“This particular client had decided she didn’t need me, saying, ‘I don’t know what my kids are doing. I’m fine,’” she recalls.
Stanton continued to help her because her children wanted their mother to receive help in the event of a physical or cognitive decline. From the brief phone call, Stanton gathered a lot of information from the woman’s tone of voice, words, mood, and whether she exhibited shortness of breath.
“The phone call went very well because it turned out she was alone. There was no family with her and no plans for the day, and I knew that in the past she was a very social person,” Stanton says. “She wasn’t upset during the conversation, and she didn’t say, ‘Why are you calling me? I fired you.’ She said, ‘It’s so nice of you to call me today. Let me tell you about my friends.’”
As the woman chatted about her friend’s health and recovery from a stroke, Stanton used the opportunity to ask how her client was doing with her breathing.
Afterward, Stanton called the family to report that she had spoken with their mother for 15 minutes and she did not appear to be short of breath and she was excited and in good spirits.
“If she had sounded depressed or short of breath, that would have prompted a visit to the home,” she says.
Often, clients seen by patient advocates have cognitive disorders. Care management plans often include methods for helping them with daily tasks, sleep, and preventing infections, says Bobbi Kolonay, RN, BSN, MS, CCM, president of Holistic Aging & Options for Elder Care in Pittsburgh. The organization’s patient advocates are nurses with case management backgrounds.
“When you have some kind of cognitive disorder, one of the things is you can’t initiate tasks,” Kolonay says. “Cooking is a step-by-step process, and you have to do something sequential.”
Clients often have poor nutrition, so health advocates make recommendations for how they might improve their health, she adds.
“When we get involved, the client becomes more autonomous,” Kolonay says. “The family has been missing that huge component of knowing someone local they can rely on, and we become that person.”
Kolonay and Stanton describe the ways health advocates work with patients:
• Help patients cope with care transition hiccups. A long-term care facility or assisted living facility might tell a patient and family that the patient is no longer appropriate for that facility or that the patient is refusing necessary assistance such as a private pay home health aide, Stanton notes.
“The client declines, saying, ‘I’m paying you. Why should I pay someone else?’” she explains. “The family calls us in to work with the team of staff.”
Health advocates collaborate with the patient’s healthcare team and help everyone reach an agreement on the care transition or any necessary changes.
“We develop trusting relationships with clients and their families, and then we have to develop trusting relationships with the team,” Stanton says.
Sometimes, the health advocate can convince the long-term care facility to give the patient a little more time to make the transition. If problems persist, then the health advocate might suggest the family seek help from a physician, social worker, community resource, or even a healthcare attorney, she adds.
• Prepare a life care plan. “We’re running a business, so the first thing is we have a contract for services that everyone signs,” Kolonay says. “Then, we create a life care plan.”
Clients might be at home, in the hospital, or in a long-term care facility when the health advocate first meets them.
“Typically, they’re in the home, but we go wherever they are,” she says.
• Assess the home environment. “The first visit is an assessment visit. We use an assessment form that goes through geographical information and payer source information and religion, contacts, and all of those kinds of demographic questions,” Stanton says. “It also goes through a physical assessment, actually taking vital signs, asking questions, and getting specifics about treatments.”
The in-home assessment partly is a trust-builder. (See story on advocating and building trust through observation in this issue.)
“If I can’t develop trust, I’m not going to get very far,” Stanton says. “As you start to talk with the person, you uncover things that even their family doesn’t know.”
• Check on medications. During the initial assessment phase, Stanton finds out which medications the patient is taking and the dosages.
“If I see a problem like noncompliance with the medication, then part of my recommendation on the plan of care is to hire someone or find a family member or neighbor or church friend to help the patient organize medications,” Stanton says.
“I try to find the most effective way of handling these issues,” she notes. “There are a lot of things you can do without having to pay someone.”
The cost of any kind of help is a barrier for patients, even if they can afford it. “Seniors are thinking, ‘This is all I have, and now you want me to spend it all?’” Stanton says.
• Discuss the plan. “If clients are on their own, I talk to them about the plan, but not until the entire assessment phase is over and I’ve written the plan,” Stanton says.
“If the family and client and I see that it’s hard to get the walker through a space, or maybe the client is having difficulty on steps to reach a bedroom on the second floor, then I might talk to the family after I leave and say, ‘These are the things I saw that are more emergent than the other things that you might want to handle right away,’” she explains.
Most of the houses Stanton has viewed are cluttered, largely because people collect things over time. People have memories attached to their items, making it challenging to convince them to get rid of it or even to move things, she says.
Patients might have the attitude of “These are my things, and this is where my chair has always been, so why should I move it now?” she adds.
• Offer alternative health services. When Kolonay began working as a health advocate, she realized she needed more than what she had already learned to effectively help elderly patients.
“I developed a holistic approach, learned holistic therapies, and studied overseas,” she says. “I studied in China for two months, learning traditional Chinese medicine. Then I went to India and studied Ayurvedic medicine.” (Information is available at: http://bit.ly/2xxZGQh.)
Kolonay also traveled to Peru to study Peruvian medicine, learning as many alternative therapies for aging patients, as she could.
“I’m a certified holistic nurse, and to become that I had to learn a lot of different modalities of alternative medicine, including clinical aromatherapy and use of herbs,” she says.
For example, clients sometimes experience urinary tract infections that can worsen and become chronic. Conventional antibiotic treatment sometimes can be ineffective and result in needing stronger medication that can lead to adverse events, Kolonay notes.
“We recommend an herbal supplement that has cranberries and herbal ingredients that push bacteria out when the person urinates,” she explains. “It’s helped quite a few of our clients, and it has no side effects.”
This type of treatment was used for years before antibiotics were invented, Kolonay notes.
Alternative treatments also can work well with clients’ insomnia.
“You do not want to give a sleeping pill to an older adult because it processes through their bodies much more slowly, and there are a lot of side effects,” she says. “We look for alternatives, like sleep diaries that help a person keep track of when they’re sleeping and when they’re not.”
Often, older people will sleep some during the day and then stay up part of the night. They can change this habit by using the herb melatonin before bed, through exercise, or by taking a salt bath with Epsom salts, Kolonay says.