By Signe Gleeson, RNC, CCM, MS
No one should face aging and illness alone. Too often, older adults find themselves without an ally or advocate when they are most vulnerable. Illness and infirmity can diminish the best of us. This is more dramatic for older adults. It is not uncommon for an ill or hospitalized older adult to appear more confused, frail, and incapable than they actually are.
This is why an increasing number of families call on an elder care advocate for assistance. At ElderCare Solutions, we support older and disabled adults and the people who care about them. Our role as elder care advocates is to help older adults achieve their goals and implement their choices when they can’t do it themselves.
Informed advocacy plays a critical role in ensuring the needs, desires and values of a disabled or older adult are recognized, respected and protected. It can be easy and expedient to make assumptions or assign a label to an older adult. It is tempting for physicians and family members to globalize an individual’s physical or cognitive limitations and to disregard the older individual’s strengths and capabilities as short- and long-term decisions are made. But as advocates, we recognize that a deficit in one area does not necessarily translate to deficiencies in other domains. For instance, an older adult who does not know the date may be well able to express his or her wishes regarding treatment.
When an individual is voiceless and/or seen with a limited perspective, the advocate gives a voice and a full sense of the person on their behalf. Advocates seek information about the individual and anticipate their present and future needs. We help to take some of the emotion out of the decisions for care, treatment and medical intervention. Part of our role is to consider the result of intervention and how it will affect the individual’s functioning.
We often see situations where a doctor may make a recommendation for a medical procedure without fully understanding the patient’s circumstances. Most people have a hard time questioning doctors. For older adults, this is particularly difficult. Family members may accede to the advice or pronouncements of professionals without questioning assumptions made with limited information or thoughtful consideration of the older individual. One of the strongest contributions we make as patient advocates, beyond our clinical skills, is to ask questions and paint a picture for the physician or family member of who this person is as an individual, how they live their life and what they value.
When to Call an Elder Care Advocate
Elder care advocates are often called in when an older adult is resisting assistance or intervention. We are also asked to assist when family members are in conflict over difficult care issues. These conflicts can arise between the elder parent and his/her children or between siblings. Our role is to be objective, provide expert assessments of the older adult’s individual needs and make specific recommendations for their care. As the advocate for the older adult, we can provide a point of view from which other family members can make decisions.
Effective advocacy involves:
- A willingness to listen to and learn about the individual/the whole person — their values and how they derive meaning in life
- A willingness and ability to intelligently investigate and even uncover options, ask questions, and, when needed, challenge assumptions and conclusions
- Being an active participant in decisions and bringing the individual into the discussion to the full extent possible.
Health care advocacy requires both fearlessness — identifying and confronting conclusions that are at odds with the best interest of the individual — and humility — openness to ongoing learning about the person and how to best discern and advance his or her needs. Health care today has increasingly become a business, in which hospitals, nursing homes and housing facilities may have interests or values that are at odds with the interest and values of the individual. That makes it increasingly important to take a “buyer beware” stance to ensure that vulnerable individuals are well served.