Patient Advocates —A New Player in the Solo Safety Net

Mary B. Young

Financial planners, estate lawyers, Aging Life Care™ Managers, accountants and daily money managers— there’s a whole cadre of professionals just beginning to awaken to the Solo population. Slowly, they’re catching on to the fact that Solos need different options and face different challenges than clients with spouses or partners and adult children to support them as they grow older.

Now, a new group of professionals has emerged: Known as Independent Patient Advocates, their mission is to provide clients with information to help them make the optimal healthcare decisions and to intercede for them, when needed, to ensure they receive optimal care. Independent Patient Advocates know the ropes. They can help clients prepare for medical appointments, so they get their most important questions answered, take notes, and do a debrief afterwards. They can educate patients about their diagnosis or treatment options. If clients are hospitalized, the Independent Patient Advocate can help them navigate the maze. If they’re unable to advocate for themselves, there’s someone else who can advocate for them.

In short, says Brookline-based Ailene Gerhardt, the job of an Independent Patient Advocate is “to amplify the voice of the patient” within a system that isn’t always listening. That includes not just medical professionals and institutions, but also insurers, billing departments, and benefit programs such as SSI and Medicare.

How Patient Advocates Differ from Other Professions

Gerhardt was part of the first cohort of patient advocates to earn the board-certified patient advocate (BCPA) credential from the Patient Advocate Certification Board in 2018. Today there are over 1,000 practitioners in the U.S., 35 of them in Massachusetts. It’s still a new field and one that’s distinctly different from other professions. Unlike the in-house care managers and nurse advocates who work for a hospital or insurance company, Patient Advocates are independent. The patient is their employer, so there’s never a trade-off between an institution’s interests and the patient’s.

And unlike Aging Life Care professionals (ALCP), an Independent Patient Advocate focuses only on healthcare and related expenses. The ALCP’s portfolio is broader—for example, assessing a client’s ability to live independently, weighing the options for home care and continuing care, recommending assistive technologies to support daily activities, and other services.

When Gerhardt began building her practice, Beacon Patient Solutions LLC, her clients’ ages and family situations ran the gamut. Over time, however, it struck her that Solos are particularly vulnerable in a medical crisis. Today, about 60 percent of her clients are Solos.

Typically, an Independent Patient Advocate gets involved after someone receives a serious diagnosis or is experiencing a medical crisis. But if you’re a Solo, says Gerhardt, it pays to initiate the relationship ahead of time to ensure that someone has your back, should you need it. “If you can’t speak for yourself, if you don’t have someone to advocate on your behalf, you may end up falling through the cracks,” she says.

Diagnosing Solos’ Needs

Gerhardt has made many public presentations about aging Solo. The Solos in the audience invariably raise issues about the barriers they face in planning.  Many, for example, don’t have a health care proxy or even an emergency contact person because they’re not sure who to ask. Or they’re looking for someone to help them think through important decisions, not only about healthcare, but also about finances, living arrangements, and even whom or what to name as their beneficiaries. Some Solos say that they’ve postponed—or even skipped—a routine colonoscopy because it requires that they bring someone else to the appointment. Many Solos put off dealing with even more mundane matters like identifying people who agree to feed their pets, water their plants, or take in the mail if the need arose.

After hearing these concerns repeatedly, Gerhardt launched the Solo Agers Advocacy Initiative.  She consults with “members” one-on-one to help them get their house in order: clarifying their healthcare needs and priorities; lining up their support system; and organizing their medical records, advance directives, prescription information and emergency plans. By learning about their healthcare issues and priorities in advance, she’s prepared to advocate for the Solo client in a medical crisis, if needed.

Gerhardt also offers Navigating Solo, a six-part, virtual discussion group where participants can raise issues, explore solutions, and learn from each other. One of the initial lessons, members say, is that they’re not alone in being Solo.

Building an Infrastructure for Solos

The most common question Gerhardt gets from Solos is one that continues to stump her: Can she recommend professionals in financial planning, estate planning, psychotherapy or another field who have expertise working with Solos? So far, the list of names falls far short of the demand.

That’s why she’s also focused on the Bigger Picture: building an “infrastructure” where none existed before, a network of professionals attuned to Solos’ needs in all areas, not just healthcare. Too often, she finds, providers are dimly aware of Solos, but have no idea how that population differs from the couples and families they typically serve. They might not realize that the language and client tools they use—or even their websites—may be irrelevant to Solos or appear to be exclusionary or even offensive.

Working with Solos individually or in small groups isn’t enough, she says. Not everyone can afford this out-of-pocket expense, nor is it widely available. The entire landscape of professionals, institutions, community services, and public policies—in fact, all of the systems that have anything to do with aging—will need to wake up to a demographic reality: The percentage of older adults who are Solo has grown and will continue to grow. Every node in the elder-support network—from senior housing to financial and state planning and other legal services—needs to be asking itself this question: How well do we understand what Solos need and want? And how well are we addressing it?

CRN202212-1145543

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