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Medicare, Medicaid, and Health Care Advocacy Section

Helping With Your Clients’ Non-Legal Needs: Care Managers and Patient Advocates

By Jennifer Balmos, Esq.

Learn how care managers and patient advocates can help your clients. Each has a different role during a health care crisis or ongoing illness.

Getting a phone call in the middle of the night that a parent has been taken to the hospital is a nightmare scenario for most adult children. It is doubly terrifying for adult children who do not live close to their parents. These adult children often seek the advice of an elder law attorney, but there are still many areas in which an attorney isn’t the best resource.

A situation like this is where a patient advocate or a care manager can provide much-needed counsel, guidance, and peace of mind for families. Both provide critical services to families during a health crisis or ongoing illness, but patient advocates and care managers fill separate roles.

The Patient Advocate Foundation
Patient advocates from the Patient Advocate Foundation (PAF) help individuals with chronic, debilitating, or life-threatening diseases or illnesses. PAF’s case managers help patients find relief from the financial strain of a long-term diagnosis and serve patients and caregivers free of charge. Accordingly, patients must be screened to determine eligibility before receiving assistance either electronically or over the phone. Patient advocates provide day-to-day case management services, financial assistance for prescriptions, or specified grants.

PAF’s case management team does not help fund a patient’s care. Rather, PAF’s team helps determine if the patient might be eligible for government benefits, whether rates can be negotiated with a provider or insurer or if a denial of services may be appealed. Further, when medical expenses mean that a patient is struggling to cover his or her basic needs, a case manager can help connect the patient with assistance.

According to Christine Wilson, PAF Vice President for Advocacy Affairs, PAF assists with a wide range of issues for their clients. “It’s not unusual to have a client say, ‘I’m looking at this whole shoebox of bills, and I don’t have any idea what to do.’ Others are trying to juggle their life needs — things like buying food or paying the rent — with their medical costs. They might not fill prescriptions or cut their doses in half. We help each of these people find the resources that match their needs.”

Patient advocacy, being a relatively new field, is unregulated, though the Patient Advocacy Board offers a certification, which requires certain continuing education credits.

Care Managers
Care managers, on the other hand, charge for their services but provide a much broader range of assistance and counseling. In addition to connecting families with local assistance and navigating the maze of insurance, care managers are local, “boots-on-the-ground” advisers. Care managers conduct home visits and provide holistic solutions because they assess a patient’s emotional, social, and financial needs — not just his or her physical ailments. They work with physicians and care facilities to ensure the best possible care for the patient, particularly when a child or family member is unable to do so.

Because many have a background in social work or nursing, they already have relationships with hospitals and care facilities. They speak the same language as physicians and caregivers. Care managers can be certified through the National Academy of Certified Care Managers. All certified care managers must satisfy requirements of supervised care management experience, including working directly with clients, and complete continuing education requirements to maintain their certification. Choosing a certified case manager is the easiest way to ensure that your clients are receiving recommendations from an experienced professional.

Nicole Kulas, a Certified Care Manager and Certified Dementia Practitioner with AgeWell Care Management, notes that care managers provide a broad spectrum of services, but the consistency of care is especially important when patients are under the care of several different physicians. Care managers ask questions and advocate when the patient is unable to do so himself or herself, keep the family updated on the patient’s status, and any other changes. For families who are cohesive and hopeful of handling care on their own, a care manager can provide a care plan and put the family on the right track with optional check-ins down the road. For families with more challenging dynamics, a care manager can walk alongside them as long as necessary.

“Care managers have the years of experience needed to assess a patient’s mental, emotional, and physical needs,” Nicole said. “Adult children, who might not live near their parents, can finally have peace of mind, knowing that their parent has a trained advocate in his or her corner, showing up to appointments and always working toward the patient’s best interest.”

Aside from their advocacy, care managers can help address practical issues that arise when a medical crisis strikes. Because they do not take sides in a family dispute, care managers can provide professional, unbiased guidance to get a family on the right track. Care managers focus on ensuring continuity of care and consistently advocating for the patient’s best interest, but serving as an impartial adviser can move the needle for a family that might be paralyzed by indecision or inability to reach consensus.

Every Elder Law Attorney Should Have a Referral Ready
While larger firms may benefit from having an advocate, care manager, or social worker on staff, even solo practitioners should have a referral ready for a family in need. For crisis cases, a care manager can conduct a home assessment and implement strategies to help the client age in place, if possible. Care managers can be great resources when reviewing the least restrictive alternatives to a guardianship proceeding. Finally, a care manager may be a good fit for your client if none of the client’s family members live nearby or are involved in the client’s life.

Both patient advocates and care managers can connect patients with government benefits. Depending on your state’s rules, however, doing so could violate a statute or constitute the unauthorized practice of law. Accordingly, attorneys and care managers should consult with one another as a case progresses so that the family receives the best possible care.

Finding a Care Manager or Patient Advocate
Given the lack of regulations governing who can call himself or herself a patient advocate or care manager, checking a potential hire’s (or
referral’s) certifications or practical experience is critical.

Licenses can and should be confirmed. Below are places to check for a patient advocate or care manager.
Patient Advocates
Care Managers

A patient advocate or care manager can be a great asset to any elder law practice, allowing the attorney to provide holistic service to his or her clients during a difficult and emotional time.

For information about what a patient advocate or care manager can do, visit these websites:
Patient Advocates
Care Managers

About the Author
Jennifer Balmos, Balmos Law Firm, Bartonville, Texas, is a member of the NAELA News Editorial Board.