Is that health care helper actually a hindrance?

As a patient advocate, I frequently get calls from attorneys and insurers because something doesn't "smell right" with one of their clients or subscribers.

Case in point: An attorney called me recently about one of her clients, an elderly man without family. He told her he wanted to leave his money - it's in the millions - to his privately hired, paid-in-cash-only "friend" turned caregiver. The attorney thought that sounded suspicious, and so she asked me to investigate.

I went to the man's house. The caregiver wouldn't let me speak to him, but the house was a disaster - piles of stuff everywhere and clearly not a good environment for anyone, let alone an elderly person. I asked the caregiver if I could bring someone in to clean it up, but she refused.

I tried again a few days later. This time, the caregiver told me the man did not want to talk to me and said not to come back again.

Well, as Shakespeare wrote in "Hamlet," "something is rotten in Denmark." My hunch is that the caregiver knows the man is leaving her all that money and is trying to protect herself. Worst case scenario: This could be a case of elder abuse. One of the signs of an abusive relationship is the abuser cuts the victim off from others.

I don't know yet how this case will be resolved. It's possible a judge or social service agency will order an investigation. It's possible a nonprofit, such as SAGAS (Seniors Alone Guardianship and Advocacy Services), could be asked to step in. It's also possible the man will die and the caregiver will come into a very large inheritance. It wouldn't be right, but it could happen.

But this case started me thinking about the caregivers and other health care professionals we invite into our homes (or our parents' homes) and how, as clients, we can protect ourselves from those who a.) are not what they say they are or b.) would take advantage of someone who's not able to fend for themselves.

I'll start with my own profession. How do you know someone is a true patient advocate and not simply calling themselves that? Here's what I suggest:

• Decide what you need from an advocate. Is it help with insurance claims, a medication review or coordination of care? Then insist on an in-person interview.

• Ask the candidate for their credentials. Some have backgrounds in nursing, social work or insurance. In addition, a certification from the Patient Advocate Certification Board ( has been available since 2018. I also run a training program for nurses who want to go into patient advocacy.

• Ask how they are compensated. Professional patient advocates are paid by the client, so that's where their allegiance lies. Get an estimate of costs.

• Make sure they are available when you need them and will provide written reports of their activities.

• Insist on their giving you references.

Caregiving is another matter. Someone can call themselves a caregiver, or even a nurse, and have absolutely no training or qualifications. But there are ways to protect yourself and your loved ones.

Decide what kind of care is needed, whether it's simply housekeeping and help with activities of daily living (meals, dressing, bathing, etc.) or home health care (giving medications, taking blood pressure, etc.). Insurance doesn't cover these services, so make sure you get what you're paying for by:

• Working with a licensed agency that should provide you the credentials, training and background checks of the workers they deploy.

• Again, insisting on in-person interviews and observe interactions between the care recipient and caregiver. Repeat as many times as necessary to find the right fit.

• Not "setting it and forgetting it." I recommend a third party - family member, neighbor, patient advocate - check in regularly to ensure the patient is receiving appropriate care and the living conditions are in good order.

• Ensuring there is a durable power of attorney, especially if your family member has cognitive impairments. You don't want them, for example, changing their will without notifying someone.

And finally, with all of these professionals, if something doesn't "smell right," investigate it rather than ignore it. It's unfortunate, but there are some "caregivers" out there who are looking out for themselves more than their patients.

Hiring a caregiver for yourself or a loved one is a tough job. Don't settle for less than you deserve.

• Teri Dreher is a board-certified patient advocate. A critical care nurse for 30+ years, she is founder of NShore Patient Advocates ( Nurses considering becoming an advocate can call Teri at (312) 788-2640.

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