What you need to know about hospital patient advocates

  • Many hospitals employ a patient advocate, or ombudsmen, who will help patients solve a variety of issues.

    Many hospitals employ a patient advocate, or ombudsmen, who will help patients solve a variety of issues. Stock Photo

 
By Teri Dreher
Updated 5/8/2022 7:36 AM

Just about every hospital has someone on the staff whose job it is to be a neutral facilitator between the patient, the health care team and the hospital. Known variously as patient advocates, navigators and ombudsmen, these customer-service representatives can help you with a variety of issues, from not liking the food to not understanding your medications or post-discharge care.

Writing recently in The New York Times, Tara Parker Pope related how a patient advocate at a Texas hospital arranged for her hospitalized father and stepmother to be in the same room during her stepmother's final hours. That's a great example of the good work hospital patient advocates do.

 

But it's important to understand that patient advocates who work for hospitals are generally assigned to the risk management department. They are paid by the hospital to resolve complaints, so their work is not entirely on the patient's behalf. They can do small things and are good at customer service, but their main job is to prevent the hospital from being sued.

That doesn't mean you shouldn't take advantage of their services. They can, after all, help make your hospital stay more comfortable and productive.

How to find the patient advocate/ombudsman

Ask your nurse or another member of the clinical staff to have the patient advocate or ombudsman contact you. The clinical staff should not feel insulted by your request or try to talk you out of it; after all, the ombudsman is there to help them, too.

It's also possible the clinical staff will recognize you need the assistance of the advocate to facilitate communication between you and your caregivers.

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If you're advocating for a loved one in the hospital, call the switchboard and ask for the patient advocate or ombudsman. I think you'll find that "ombudsman" is the term most commonly used, though you might need to ask for a "social worker."

What can the patient advocate/ombudsman help with?

A hospital stay raises all sorts of questions about treatments, tests, equipment, medicines, bills, who does what ... the list goes on and on. The hospital staff may do its best to answer your questions, but sometimes you don't get as much information as you'd like, or maybe you don't agree with something.

The patient advocate helps you take charge of your health care by getting you the answers you need. Their job is to make your voice heard and to work with the clinical staff to resolve your questions.

Here are a few instances where a patient advocate may help:

• You've been waiting all day for a test result and now it's early evening. You've asked several people about the result, but you haven't received it yet.

                                                                                                                                                                                                                       
 

• You've been prescribed new medications. The nurse has explained them to you several times, but you're still not clear on what they're supposed to do.

• You -- or your family -- are having trouble understanding your treatment plan and post-hospital care, and you don't feel your questions are being answered.

• Your child is hospitalized and you want to be able to remain in their room with them, but you don't know how to arrange that.

In complex cases, the advocate may deal with coordination-of-care issues. For example, a patient may have an oncology team, a surgical team and a respiratory team who may not all be speaking with each other on a given day. The advocate can be the connection between these specialists and the family.

The advocate or ombudsman may also help arrange for nursing home care following hospitalization, but their services on the patient's behalf usually don't continue after discharge.

What an advocate/ombudsman won't do

The patient advocate won't dispute your hospital bill for you or talk to your insurance company. They should, however, be able to help you get a detailed bill and direct you to resources in the hospital's billing department, where you can apply for financial aid and get questions answered.

If you need help beyond that, you might consider hiring a private patient advocate, who will review bills, dispute charges and talk to insurance companies. There are a growing number of advocacy practices that focus entirely on medical billing.

Assistance from the hospital's patient advocate or ombudsman doesn't cost you anything and may indeed give you a better health outcome. But always keep in mind who is paying them and be aware that, sometimes, their obligation to their employer has the potential to interfere with their duty to you, the patient.

• Teri Dreher is a board-certified patient advocate. A critical care nurse for 30+ years, she is founder of NShore Patient Advocates (www.NorthShoreRN.com). She is offering a free phone consultation to Daily Herald readers; call her at (847) 612-6684.

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