How An RN Patient Advocate Can Manage Post-Acute Care

Patients and families are frequently scared and confused about the post-acute plan of care. Unfortunately, poor communication within facilities, and across providers is often the rule, rather than the exception. Encourage patients and family members to engage a qualified, independent patient advocate to help them navigate the medical system, understand their options, and have choices in the care they receive.

5 keys to effective post-acute care management

Hospitals face increasing pressure to reduce readmission rates, and one way to accomplish that goal is to better align with post-acute care providers.

Effective post-acute care management requires a multidimensional approach that incorporates effective communication, data analytics and clearly defined care coordination roles, according to a new white paper from Leavitt Partners. The benefits, however, are clear, as better post-acute care management can reduce readmissions, allow providers to more easily manage length of stay in skilled nursing facilities and better monitor discharge.

Post-acute care is the “next frontier” for integrated delivery networks, health systems under payment risk, accountable care organizations, bundled payment awardees and MA plans, according to the report. “However, significant complexities exist on the road toward PAC integration.”

The report offers five “essentials” to building an effective post-acute care management program:

  1. Build strong relationships with post-acute providers. Effective teaming means sharing resources and accountability while building trust across different sites of care.
  2. Identify the right site of care first, and coordinate care better. Effective post-acute management plans can apply experience and historical data in tandem to find the correct solution earlier. Once patients are discharged, coordinated care can monitor medication adherence and offer home assessments for better outcomes.
  3. Embrace data analytics. Analytics is key to value-based care programs, according to the report, but for post-acute care, effective use of data can help providers determine the best site of care for patients and provide feedback to partners across the continuum.
  4. Engage patients, their families and caregivers. This is particularly important for high-risk patients who may be receiving home care, as the role of caregiver can be overwhelming.
  5. Use technology to foster communication. Remote monitoring and video visits can allow providers to track patients after discharge while avoiding unneeded, costly stays in skilled nursing facilities. A good care coordination team will also provide clear instructions patients can follow at discharge, according to the report.

Who’s Advocating for You at the End of Your Life?

Our medical system has huge end of life issues to deal with: everything from rapidly changing technology (for whom?), to delivering quality, palliative care.  Here’s what most people agree on: they don’t want to die in pain, they want to be in control of their care, be treated with respect and dignity, and die in their preferred place called home.

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Whole-Person Well-Being is the Goal!

Since starting my RN Patient Advocacy practice in 2010, the goal for my patient-clients is for holistic health, and whole-person well-being.  This always includes consideration for the mental, emotional, spiritual, environmental, social, and physical aspects of their lives.  I use holistic health assessment tools, and encourage my clients to use the self-assessment tool that I provide for them.

How health and wellness transformed into well-being

Words matter. Over the past 60 years, we have changed the language describing our approach to health, wellness and well-being. At face value, this transition seems simple. We were first advised to seek “health” in the 1950s and then “wellness” in the ‘70s, ‘80s, and ‘90s. Now, we have moved on to “well-being.”

These terms evolved from the old notion of health as simply the absence of disease, to wellness as health and stress resilience. Ultimately, the term “well-being” now encompasses the broader social and environmental aspects of our lives.

It’s a nice story. But even in the late 1940s, the World Health Organization defined health as a state of complete physical, mental, and social well-being — not merely the absence of disease or infirmity. This includes various elements as peace, shelter, education, food, income, a stable eco-system, sustainable resources and social justice.

This sounds a lot like our modern definition of well-being.

As for the term “wellness,” Dr. Bill Hettler and the National Wellness Institute developed the idea of lifestyle dimensions in the 1970s, which had to be achieved in order to have true wellness. These dimensions included physical, emotional, spiritual, intellectual, environmental and social elements. Here and there, others tacked on other components such as relationship, finances or community.

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Again, like the term “health” before it, “wellness” was defined in the same very broad holistic way.

What’s odd about this chronology is how we keep re-writing history. For example, compare two quick internet searches: the difference between the terms health and wellness and the difference between the terms wellness and well-being.

Health and wellness are not synonyms. Health refers simply to a physical body being free from diseases, but wellness is an overall balance of your physical, social, spiritual, emotional, intellectual, environmental and occupational well-being.

Likewise, wellness and well-being are not the same thing. Well-being refers to a more holistic whole-of-life experience, whereas wellness refers just to physical health.

It’s like the film “Groundhog Day.” Health, wellness and well-being are all defined pretty much the same way. But every 30 years or so we trash the prior term as too limiting, adopt a new one that looks just like the old one and feel rejuvenated.
How can we make sense of this?

The changes that have occurred over time are actually meaningful. In the 1950s and 1960s, even though the definition of health was expansive and inclusive, the approach was nevertheless constrained. Companies weren’t concerned about how employees felt, just whether they were sick or not. In other words, there was a difference between the theoretical definition of health and its practical application.

This is likely the reason that practitioners wanted to broaden what they saw as an overly narrow approach. Because the definition did not square with what was actually being practiced, it seemed that there needed to be an entirely new framework to rejuvenate the tired and incomplete approach.


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So, new wellness wine was put into old bottles, and health became wellness.

The perception was that wellness was a new idea that broke from the past, moving beyond the idea that health represents just the absence of disease. This re-framing worked to popularize its more holistic aspects: the importance of stress, resiliency and better time management.

Today, the same transitional cycle is happening again as the new buzzword, well-being, takes the baton from wellness. Well-being is said to include the social, financial, and environmental elements that wellness lacked. But those who advocate turning from wellness to well-being make the same mistake as their predecessors did 40 years ago.

This kind of linguistic rebirth seems to be necessary to create a renewed sense of purpose and possibility. Yes, it’s self-delusional about its own history, but the new term nevertheless results in fresh elements added into the cultural conversation; that process has helped us to approach the original intent of “health” almost 70 years ago.

In the end, the answer to the original question about “semantics vs. substance” is that it is both, as language pushes the culture to realize the promise of its original nature. The semantics, in this case, help create substance.

Defining “alternative”, “complementary”, “integrative” healthcare

Terminology is important. From the National Center for Complementary and Integrative Health (NIH) site: “…people often use “alternative” and “complementary” interchangeably, but the two terms refer to different concepts: If a non-mainstream practice is used together with conventional medicine, it’s considered “complementary.” If a non-mainstream practice is used in place of conventional medicine, it’s considered “alternative.” True alternative medicine is uncommon. Most people who use non-mainstream approaches use them along with conventional treatments.”

Alternative medicine becomes a lucrative business for U.S. top hospitals

Chinese herbal therapies, acupuncture, homeopathy and reiki are just a few of the offerings that some prestigious medical centers now provide, despite the fact that in many cases there is no evidence the therapies work.

The rise of alternative medicine has created friction within some of these hospitals as many physicians believe it undermines the credibility of the organizations, according to an in-depth investigation of 15 academic research centers by STAT.

The issue came to the forefront earlier this year when the Cleveland Clinic decided to rethink its alternative medicine offerings and how they align with evidence-based practices after the director of the organization’s wellness program went on an anti-vaccine rant in a blog post that sparked an immediate backlash.

The clinic said the wellness center would stop selling some of the products, like homeopathy kits, on its website and focus instead on items that improve diet and lifestyle.

But the STAT investigation noted that the Cleveland Clinic is just one of many that has a hand in the $37-billion-a-year business. Other organizations include Duke University, Johns Hopkins, Yale and the University of California, San Francisco. Some hospitals open spa-like wellness centers, while others, like Duke, refer to them as integrative medicine centers.

Several of the hospitals highlighted in the STAT report declined to talk to the publication about why they have embraced unproven therapies, but critics were quick to point out that patients are being “snookered” and physicians who promote these therapies forfeit claims that they belong to a science-based profession.

“We’ve become witch doctors,” Steven Novella, M.D., a professor of neurology at the Yale School of Medicine and a longtime critic of alternative medicine, told STAT.

Others, however, say that alternative therapies have helped patients and modern medicine doesn’t offer a cure for everyone. Linda Lee, M.D., who runs the Johns Hopkins Integrative Medicine and Digestive Center, said the therapies offered are meant to complement, not supplement, conventional treatment.

But Novella worries that when these unconventional treatments are offered by prestigious institutions, patients will think they are legitimate. The problem only worsens when patients find the treatments being sold online by the institution. Thomas Jefferson University Hospital, for instance, sells homeopathic bee venom to relieve symptoms of arthritis.

Daniel Monti, M.D., who directs the integrative health center at the organization, admits the evidence behind some of these treatments is largely anecdotal but said the hospital only offers the treatment when there are few other options.

#1 Soft Skill for Workplace Communication and Collaboration

Building empathy in the workplace is my number one goal when colleagues and I use improvisational theater tools in on-site, face-to-face workshops.  It’s not about performing or comedy; it’s about broadening the soft skills of emotional intelligence.  Developing verbal and non-verbal behavior, supporting our partners, and engaging in face-to-face conversation.  A solution for building empathy in communication and collaboration.

The Science Behind What Really Drives Performance (It’s Going to Surprise You)

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Imagine you could have a skill where–in any given conversation with colleagues, clients, or subordinates–you could be keenly aware of, and even experience, their feelings and thoughts.

Sounds like some X-Men-like psychic superpower right? Well, what if I told you that anyone can have this uncanny ability and use its strength and charm to have successful conversations?

Well, you can. The superpower I refer to is called empathy.

But this skill–and it is a learned skill available to anyone–is often misunderstood because there are variations of it. I’ll get to the science of it shortly.

How Do You Define Empathy?

To better grasp what people mean when they talk about empathy, the most common uses for empathy fall in these categories:

1. The type of empathy where we directly feel what others feel.

2. The type of empathy where you imagine yourself in others’ shoes.

3. The type of empathy where you imagine the world, or a situation, from someone else’s point of view rather than your own.

4. The type of empathy that researchers sometimes call “mind reading.” It involves being good at reading others’ emotions and body language.

Where do you fit in?

The Research Behind This Superpower

If you’re skeptical that this is touchy-feely campfire nonsense with no business value in a transactional world, consider the research.

Global training giant Development Dimensions International (DDI) has studied leadership for 46 years. They believe that the essence of optimal leadership can be boiled down to having dozens of “fruitful conversations” with others, inside and outside your organization.

Expanding on this belief, they assessed over 15,000 leaders from more than 300 organizations across 20 industries and 18 countries to determine which conversational skills have the highest impact on overall performance.

The findings, published in their High Resolution Leadership report, are revealing. While skills such as “encouraging involvement of others” and “recognizing accomplishments” are important, empathy--yes, empathy–rose to the top as the most critical driver of overall performance.

Specifically, the ability to listen and respond with empathy (see graph below).

Ray Krznaric, author of Empathy: Why It Matters, and How to Get It, sums it up nicely:

Empathy in the modern workplace is not just about being able to see things from another perspective. It’s the cornerstone of teamwork, good innovative design, and smart leadership. It’s about helping others feel heard and understood.

This whole premise does have an air of genius about it, considering that when you take on the perspective of those you are talking with, it engages people on the spot. This can be a difference maker. That’s the good news.

The Bad News

The DDI report reveals a dire need for leaders with the skill of empathy. Only four out of 10 frontline leaders assessed in their massive study were proficient or strong on empathy.

Richard S. Wellins, senior vice president of DDI and one of the authors of the High-Resolution Leadership report, had this to say in a Forbes interview a year ago:

We feel [empathy] is in serious decline. More concerning, a study of college students by University of Michigan researchers showed a 34 percent to 48 percent decline in empathic skills over an eight-year period. These students are our future leaders!

We feel there are two reasons that account for this decline. Organizations have heaped more and more on the plates of leaders, forcing them to limit face-to-face conversations. Again, DDI research revealed that leaders spend more time managing than they do “interacting.” They wish they could double their time spent interacting with others. The second reason falls squarely on the shoulders of technology, especially mobile smart devices. These devices have become the de rigueur for human interactions. Sherry Turkle, in her book, Reclaiming Conversation, calls them “sips of conversations.”

Final Thoughts

Keep in mind that empathy shows up in different ways, as I mentioned at the beginning. It’s not just “feeling.” Think how it can translate to both verbal and non-verbal behavior so the person hearing you will feel your empathic nature. And, it goes without saying, people see right through you if your empathy is not expressed in a sincere and authentic way.

Don’t underestimate for a second its true potential. Begin developing leaders to learn this relational skill for competitive advantage.

Your ability to empathize, as a leader, will make a difference in the performance of others. And it is critical to good teamwork.

Even Physicians Need Patient Advocates When Hospitalized

As an independent RN Patient Advocate, I guide and advocate for individuals in a variety of healthcare situations.  On occasion these individuals are medical professionals, which suggests that we’re all vulnerable and confused when hospitalized.  Here are highlights of a recent recommendation letter that advises every person to engage with someone qualified to advocate for you.

“As a person who practiced medicine for more than 30 years in the Chicago area, I thought I was quite familiar with hospital medicine. But recently I was hospitalized and confronted an experience that was extraordinarily challenging.

Luckily, I had made arrangements before this totally unexpected hospitalization to have Stephanie Frederick as my patient advocate.

Stephanie was essential in communicating with the various providers and making sense of what was really going on. She also prodded them to meet with both of us to review progress.

My recommendation to anyone facing potential hospitalization is to arrange in advance for a patient advocate. Personally, I can recommend Stephanie without reservation. If you engage her services, she will make sure she understands your medical condition, medications and other vital information before you are hospitalized.

When and if you are admitted, she will be directly involved as your care proceeds and provide effective communication from you to medical providers and update you on their thinking. She will also provide information on drug interactions and dietary recommendations if appropriate.

All in all, I would hesitate facing even “routine” hospitalization without Stephanie in my corner.”

Dr. T.C., Tucson AZ