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Going on Offense: Who Deserves an Advocate’s Help?

“Only rich people can afford an advocate.”

Or: “Doesn’t providing private patient advocacy services only to those who can afford them, just create one more division between the “haves” and the “have nots?”

Or: “Not everyone can afford an independent patient advocate. It’s unfair some people can’t be helped.”

Anyone who has worked in advocacy or care management has heard one or more of these statements, or at least one from the same playbook. It’s an objection meant to put us on the defensive, as if, since private advocacy can’t be provided to everyone, then we shouldn’t provide it to anyone.

Don’t let anyone put YOU on the defensive this way! It’s a foolish argument. Here’s why:

We’ll begin with a simple statement: anyone who needs an advocate or care manager, anyone who is challenged by the healthcare system (whether or not the patient even realizes he or she isn’t getting what is needed), anyone who could enjoy a better outcome than will happen with no assistance from an advocate…. deserves the support of an advocate.

Few people would disagree with that statement.

The foolish question is whether everyone deserves the help of private, independent advocates.

It’s foolish because the answer is obvious – of course everyone also DESERVES the help of a private advocate!

The question is whether they can afford to PAY someone to help.

And, sadly, not everyone can afford such a service. That’s true! Not everyone who needs an independent advocate can afford to pay for an independent advocate.

But is that unusual? Not at all! There have always been people who could, or could not, afford what they need and want. Not everyone who needs a home can afford a home. Not everyone who wants a college degree can afford a college degree. Not everyone who needs a lawyer can afford a lawyer. Etc., Etc., Etc.

NO ONE CLAIMS – ever – that since not everyone can afford a home, or a college degree, or a lawyer – therefore no one should have them! It’s just understood that not everyone can. It may not be right. It may be uncomfortable. But it is what it is.

And, similarly, not everyone can afford to hire an independent advocate. But that doesn’t mean that no one should have the ability.

This gets me thinking about other aspects of our lives where the “haves” might be defined a little differently, too.

  • Millions of kids go to private schools, including religion-based parochial schools – not because their parents have a lot of money, but because their children’s educations are so important to them that it’s worth the extra expense.

    Not everyone can afford to send their kids to a private school. But doesn’t that mean that, therefore, no one should send their kids to a private school.
  • We used to get TV over the broadcast airways. Then along came cable TV companies. Their service was superior to over-the-air rabbit ears, but not everyone could afford (or wanted to pay for) a cable subscription. Today most of us have some sort of paid subscription for better service than over-the-air. No one ever suggested that since some of us could not afford such improved service then none of us should have access.
  • Another example: when the internet was first available to the public, not everyone could afford it. Only those who could afford an internet subscription had access. No one said then that since everyone couldn’t access the internet, then no one should.

    Eventually internet access became available to everyone through local libraries and schools.

Of course, we can also hope there comes a time, even if it’s years from now, when independent advocacy becomes more easily available to those who don’t have the means today.

But for now, I say – don’t let anyone put you on the defensive about your work as an independent advocate. Your work is important to anyone who can afford to pay you. Just because someone else might object, or not be able to afford your services (or would prefer not to, even if they can), doesn’t mean you shouldn’t continue your important patient-client support.

Instead: double down! Defend your profession! Go on the offense! Proudly make it clear that you are there to help those who can afford, and are willing to pay for your services because that’s how you stay in business so you can help even more people.

As a group of professionals, we must continue to assert our incredibly valuable role as being available to those who can afford our help, and dismiss the objections of those who would argue against our role for any purpose.


8 thoughts on “Going on Offense: Who Deserves an Advocate’s Help?”

  1. I do not get on the defensive when people comment about the cost of an Independent Patient Advocate. I deal with this in a different way. I do Pro Bono (free) advocacy at least once a year. Example: I got a call for help for a young man who was hospitalized for a severe infection. The caller was a neighbor, and they made it clear that the family could not pay. They said the young man was quite upset about the hospitalization. Did he not understand why he was hospitalized? Was he missing his friends ? So I paid him a visit and asked him what was making him worry so much. He said that he was supposed to be enrolled in the metropolitan college, he was missing orientation and was upset because he thought he would lose his scholarship. All it took was a phone call to the college and I was able to tell him that he was enrolled, did not lose his scholarship, and could do orientation on line.
    Of course I am selective about choosing short term clients, but all was well with this situation and he was relieved and I felt good about giving back.

  2. Excellent example. Many of the issues people face and cause them anxiety can be addressed with a short visit/call. Another way to address this is to have a sliding scale on costs, or a corporate rate (if you are working with an organization/employer, vs. an individual.
    I would also like to see Independent Advocates find ways to include the at-risk population and those who can’t afford an advocate. Has anyone applied for grants in your community? Has anyone considered adding a not-for-profit arm of their company? Just a thought!

  3. Rosalie E Weatherhead

    And the best line yet is one that you told us long, long ago. I answer that I don’t get reimbursed by insurance companies and that’s a good thing because then you know my loyalty is to You! I also tell them that NOBODY is going to work harder for you than I am. You can maybe find someone to help you cheaper, but will they know what to do? Will they do it in a way that provides the best outcome possible? Will they do it in a timely manner? I will and have a proven track record to show it.

  4. I’m not a fan of the message. There’s much criticism about the profit-driven nature of healthcare. As advocates, we?re supposed to be there for the most vulnerable. Let’s be careful We cannot become part of the problem. Just sayin?

    1. Brad – I don’t believe you read carefully enough. Your criticism of the message is for a very different message than what I wrote, and for a stance I would never take.

  5. I am just gettinig started and am very apprecciative of all the tips and educational offerings that you provide through the Alliance website.

    Thanl you,r
    TJ Lamd MSN, RN,CCRN-R
    RN Advocates of West Valley

  6. I also do pro bono work AND have adjusted prices for people who cannot afford my hourly fee. If that makes me a poor business person so be it, I do this to help people, the same reason I became a nurse AND got involved in healthcare in the first place. I also had a client that switched from a more expensive advocate to me so there was a $ 100 difference per hour and he told me to use the extra money to help someone . So I did, I used it to help a young woman on disability and Medicaid get set up with doctors for get crohn’s disease and get back on get medications through grants. It’s the right thing to do.

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