When to Hire an Elder Law Attorney (and How to Do It)
Elderly care is incredibly expensive: rooms in nursing homes and assisted living facilities can cost more than $10,000 a month . And this is before any treatments, prescriptions or other needs are taken into account. It’s also incredibly complicated because you often have to deal with multiple insurance policies , government agencies , and multiple agency employees, not to mention doctors, nurse practitioners, and other healthcare professionals.
In addition to the financial, medical, and logistical challenges, we may face the emotional toll that caring for an aging parent or loved one can take on us. It’s not surprising that most people wait until a crisis develops before making important decisions about caring for an elderly loved one, whether that be the initial decision to institutionalize them or the decision to add services to their care plan (with the additional costs involved). ), or the need to move them to another location with more services – and how to pay for it all . If this is you and your family, now is the time to consider hiring a patient advocate or private health care manager.
Why You May Need a Patient Advocate
Most people have a hard time understanding how expensive and complex it can be to care for older adults. Many long-term care insurance policies cover only the most basic expenses , and only about 75% of older Americans have long-term care insurance at all. If your parent or loved one has insurance, there may be multiple policies (I have one from an old job that I haven’t paid for in years but is still valid) combined with Medicare benefits – and you’ll still have to pay for many things out of pocket.
This complexity presents a challenge when it comes to figuring out what your parent is actually insured for and getting different insurers to pay out. Denial rates are difficult to estimate, but nearly everyone has been denied a seemingly obvious health insurance claim , and it’s not uncommon for families to have to appeal elder care denials multiple times before they finally receive a covered service or procedure (you didn’t live long enough to go to the insurance company’s “audit committee”). A patient advocate can help you figure it all out, help you draft letters of appeal, and work with medical providers to write letters and medical orders that will trigger insurance coverage.
Then things get even more complicated because these facilities experience staff turnover like there’s no tomorrow, with the average nursing home changing over half of its staff each year. It’s a really crappy job in many ways: it’s emotionally and physically draining, doesn’t pay very well, and is often quite dangerous, so it’s no wonder nursing homes and other institutions struggle to retain staff . But this churn means that every time you feel comfortable with a physical therapist, nutritionist, or other caregiver at a loved one’s facility, the likelihood that they will leave and you will have to start over is pretty high. A patient advocate can be the person who monitors staff and makes sure your loved one doesn’t miss out on any opportunities just because someone quit.
Brief description of what a patient advocate does
Simply put, a patient advocate or private care manager is a consultant who understands the laws in your area, the labyrinth of insurance policies and mechanisms, how Medicare and Medicaid work, and the assisted living facilities closest to you. and nursing homes. . They can perform many incredibly useful services, including:
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Translation. If you only understand half of what doctors and nurse practitioners are telling you, a patient advocate can put it all into simpler terms.
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Billing. A patient advocate can help you review bills to make sure you are overpaying and that your loved one is getting everything they pay for.
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Care. A patient advocate can also help you determine the type and level of care your loved one needs. Your parent may only need a little help with daily activities, or they may need 24-hour assistance to get to the bathroom or feed themselves—an attorney can objectively recommend what is needed. And an attorney can make sure that the stressed, overworked doctors and nurses at the facility pay attention to your loved one, even when they are overwhelmed.
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Interaction. A patient advocate can also act as a buffer between you and the facility staff and as the main negotiator, allowing you to live most of your own life while someone else argues with nursing home management about how often your mom showers every week.
Patient advocates can also often identify resources, from government programs to insurance benefits, that you might not otherwise know about.
How to Hire a Patient Advocate
You shouldn’t wait until there’s a crisis to bring in a patient advocate when someone you care about ends up in a nursing home or assisted living facility; they can be a decisive advantage from day one. If you’re not sure where to find a patient advocate, there are a few different avenues you can try:
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Insurance. Some health insurance and long-term care policies include patient attorney fees, so start by checking your coverage. If your loved one’s insurance covers it, they likely have a list of network or participating attorneys you can contact.
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Object. Some hospitals, nursing homes and other facilities have a long-term care ombudsman . They are paid by the institution, but their role is to protect the interests of the patients under their care. Most states have an LTCO program that you can apply for.
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Private rental. You can hire your own patient advocate. The National Healthcare Advocacy Association has a directory of professional patient advocates that can help you find qualified candidates in your area. If you hire your own, it might be worth filing a claim with your insurance company—after all, your worst-case scenario is just denial.
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Non-profit organizations. There are non-profit patient advocacy organizations, such as the Patient Advocacy Foundation , that offer free or heavily discounted patient advocacy services.
Old age brings many challenges, and caring for aging people can be just as difficult. If someone you love is heading to a nursing home or assisted living facility, consider hiring a patient advocate to help you sort it all out.