Nurse case managers and Patient Advocates are often a lifeline for individuals facing catastrophic or complex medical conditions. Finding one can be challenging, as can knowing how to work together as a team to ensure a patient’s safety, care coordination, and safe transitions of care from one setting to another.
In this post, I wanted to share why someone would look for a nurse case manager or an Independent Patient/Health Care Advocate. When someone finds themselves thrust into the complex healthcare system, the acronym FUDGE can explain their state of mind. They are:
Frustrated
Unsure
Depressed
Guilty
Exhausted
When someone has even one of these emotions, they can be overwhelmed and unable to work through the challenges they face as a patient or a caregiver. Having a nurse case/care manager or Independent Patient/Health Advocate with them on the journey allows them To BE THE patient or the CAREGIVER instead of the negotiator of their care. Having an advocate assist with roadblocks allows someone else to do the heavy lifting of removing them to ensure you are safe and your wishes are taken into consideration.
One of the things I felt the most when I was undergoing treatment for Brain Cancer was that I lost control. I had to allow strangers to make critical decisions for me. Thank God my husband was with me and had my case manager friends he could depend on to help him understand what was happening daily. We had a good support system and I received excellent care and recovered. But 10 years later it is still the scariest time of my life. To be clear, not everyone needs to pay for an advocate. Family members or good friends can be advocates. Many people who become patients can find their voice and ‘make things happen’ but when you are very sick and you don’t have that one person to help you looking to other areas can help.
So, how do you find a Nurse Case Manager or an Independent Patient Advocate? Professional Organizations and Certification Bodies are one way people (patients/caregivers) can help you find an advocate
Case Management Society of America
Commission for Case Manager Certification
National Association of Health Care Advocacy
Greater National Advocates
Patient Advocate Certification Board
UMBRA
Each organization has a search engine to help you find an advocate in your area. Independent Case Managers and Patient/Health Advocates charge for their services, but the value far outweighs the cost as they help you navigated the Complex healthcare system. They give you a voice, they make sure you are seen and respected, they remind the healthcare team why they are in business and they make sure you and your family understand and have realist expectations.
Hospitals, rehabilitation centers, skilled care facilities, and other inpatient care systems have case managers and patient advocates on staff to assist patients and their families. They are available as part of the hospital’s staff. One thing to consider is that because they work for the hospital, work for the organization, so they have to follow the policies of their organization first and foremost. This can lead to the patient or the caregiver not being given all of the options an independent case manager or patient/health advocate might have given them. For most issues, they can help – but with major challenges, you might want to consider hiring an independent case/care manager or patient/health advocate who can be objective to your needs.
Many health plans, including TRICARE and workers’ compensation programs, offer case management services at no extra cost. To reach a case manager through your insurance company, contact your insurer’s customer service or case management department to request a referral.
What to Expect When You Work with a Nurse Case Manager
- Immediate and Ongoing Support
Nurse case/care managers and Independent Patient Advocates often respond quickly after a major health event, meeting patients and families in hospitals or homes. They stay involved throughout the recovery process, building trust, continuity of care, and helping the patient find resources and improve communication issues. They give the patient and family a voice and help them understand what is happening and how to safely navigate the complex healthcare system.
- Personalized Care Coordination
Nurse Case/Care Managers and Independent Patient/Health Advocates work with you to create customized care plans tailored to the patient’s and the family’s medical, emotional, and logistical needs.
Each coordinate with doctors, therapists, insurers, and family members to ensure seamless communication and care delivery. They help set realistic expectations and work to ensure you have a voice in your care.
- Advocacy and Education
Nurse case managers and Independent Health/Patient Advocates help patients and families understand diagnoses, treatment options, and insurance coverage.
They advocate for timely and appropriate care, including referrals to specialists and access to resources. They also work with the team and research what you need based on your diagnosis and medical condition.
- Return-to-Function Planning
For those recovering from trauma or chronic medical conditions, nurse case managers focus on rehabilitation and return-to-work strategies if possible, based on the patient’s condition. They work to help find needed resources through programs such as disability programs, government programs, waiver programs, and community resources.
I hope this article helps you see how a nurse case manager or Independent Patient/Health Advocate can help you and your family navigate the complex healthcare system when you find yourself in a difficult situation.
If you need help finding an independent patient/health advocate or nurse case manager, feel free to email me at allewellyn48@gmail.com. I can assist you.
Resources:
Nancy Ruffner is an independent patient/health advocate who has a wealth of information on her website. Visit her website at https://www.nancyruffner.com
Karen Curtiss has good information and a checklist that you can use on your journey https://thecarepartnerproject.org/karen-curtiss-speaker
Ilene Cornia is the founder of the Center for Patient Safety. This is a great organization to learn about being your own Best Advocate https://www.pulsecenterforpatientsafety.org
Lisa Berry Blackberry is doing good work in helping consumers navigate the complex healthcare system. Here is the link to learn more. https://soulsherpa.net. She recently contributed to a new book titled The Caregiver’s Advocate: A Complete Guide to Support and Resources. You can view it here https://www.amazon.com/Caregivers-Advocate-Complete-Support-Resources-ebook/dp/B0FMGGL6ZY
