Patient advocate helps with transitions

Contracting with elderly patients, families

When Sharon Gauthier, RN, MSN, iRNPA, was a hospital case manager, she saw people return to the hospital over and over, with issues that might have been avoided if someone had better coordinated care in the community.

"After I left the hospital environment and finished my master's degree, I looked for ways I could support patients and their families and help connect the dots in the healthcare system," she says. As a result, Gauthier started Patient Advocate for You, an advocacy company based in Hartford, CT, that contracts privately with patients and family members. Her goals are to help patients transition from a hospital, rehab facility, or skilled nursing facility back to their home environment, and stay safe and healthy in the community. The majority of her clients are elderly, and many have family members who live out of state or work full time. She also has managed the care of clients in their 30s and 40s who have profound events that require hospitalization and complex care.

"It's very difficult to navigate the healthcare system. Most people think that everything will be done correctly and accurately in a medical setting. In reality, you need someone there to ensure that the information you are getting is correct and all parties involved in the care are talking," she says.

When patients transition from one level of care to another, it's extremely important for them to have an advocate to help bring all the pieces together, Gauthier says. "Having a clinical person by their side while they get acclimated to being back at home, or to a post-acute facility, is a huge advantage for patients and their families," she says.

Gauthier has assembled a 24-member advisory board that includes pharmacists, gerontologists, social workers, physicians with multiple specialties, and a caterer who provides meals for shut-ins. She calls on them for advice in managing the care of patients.

When Gauthier is hired, she meets with the patient and family to get a handle on what they want her to do. "I usually hit on an immediate issue and come up with a plan," she says. If the patient is in the hospital, she obtains a HIPAA release and talks with the case manager about the case. If appropriate, she brings together the entire treatment team for a conference with the patient and family members to discuss the patient's condition, test results, and the treatment plan. "Once the family hires me, I become the contact person for the nursing staff and physicians. They like dealing with me instead of having to coordinate with several family members. I help coordinate care and education, and provide information for everyone," she says.

When patients are approaching discharge, Gauthier gives the family options for post-discharge placement, and she checks the discharge paperwork to make sure it's readable and complete. "Patients in the hospital often have different hospitalists every week and different nurses every shift. Case managers are really pushed, and they often don't have the time to make sure everything is in place after discharge. I make sure that everything is taken care of and that the patient's primary care physician is informed," she says.

When patients are about to go home, Gauthier conducts an assessment in the home and ensures that home care and other services the patient needs are in place. She checks the medication schedule to make sure that the patient can follow it at home. Gauthier goes home with the patient and puts together their medication box for the week. She compiles a list of the medication the patient was prescribed in the hospital and faxes it to the primary care physician.

She makes sure the patient has a follow-up appointment and accompanies them when they see the doctor. She fills in the doctor on what has been happening with the patient. "Most doctor visits last less than 15 minutes. I am able to identify situations that might otherwise be overlooked or unaddressed," she says.

When patients need post-acute care, she educates patients and family members about what is available and helps them choose the provider. "I'm not working for anyone but the patient and family. When I walk into the case, I'm looking from the point of view of what is right for the patient. Unlike the hospital case managers who are required to be neutral, I can advise them on which facilities to avoid, based on my experiences working in a nursing pool and supervising nurses in convalescent homes," she says.

Once patients are placed in a post-acute facility, Gauthier monitors the situation to make sure the patient receives the required therapy and moves through the continuum of care quickly and safety. "When patients are transferred, many times, there are medication errors and pain management issues. I stay with them throughout the transition and visit them multiple times to make sure they are getting the services they need," she says.

If a patient is in the emergency department, Gauthier visits and takes the information the emergency department staff needs to initiate treatment. "The staff loves it because I have information they never would get from somebody who just presents to the emergency department. I know the staff, I know how busy emergency departments function, and I know how to get things done so the patient is either admitted or discharged in a timely manner," she says.

Gauthier charges an hourly rate of $100 for actively managing the care of patients. When the patient is stabilized, she charges a flat rate of $400 a month, plus the Internal Revenue Service's rate for mileage, that covers four hours of time she may spend filling the medicine box or taking the patient to doctor's appointments.

"The family knows me, the patient and spouse know me, so if there is an emergency, they call 911 and then call me," Gauthier says.