"Give us a look at your credentials and work history. What was the 'aha' moment that made you realize families needed an advocate in the senior space?"
I've been a Registered Nurse for 40 years, and I spent all but one of those years in community work—home health care and hospice, in particular. I learned very early on that the patients and families I served needed an advocate! There were too many of them "falling through the cracks" by not accessing needed and available services.
“What exactly does an elder navigator do?”
Four Seasons Care Navigation services helps our clients and families navigate healthcare—it's confusing to all of us! We identify, secure, and coordinate community resources; assist with planning for the "what ifs;" advocate within the context of medical and/or hospital activity; and educate on options while accepting their choices. Sometimes we've been called the "daughter by proxy!"
"Most adult children feel like they are flying blind. What is the one thing families should know about navigating elder care that almost no one tells them?"
Medicare is an "entitlement" for a reason—beneficiaries are entitled to services that must not be withheld from them. They deserve it! Most folks don't know that they need a qualifying 3-night stay admitted in a hospital (not under observation status) in order for Medicare A to cover rehab services in a facility. It's so important that someone advocates on behalf of the Medicare beneficiary!
"What is the single most difficult part of this advocacy work—is it the paperwork, the medical system, or the family dynamics?"
No single challenge but many challenges, BUT that makes for good learning on everyone's part. A notable challenge is finding just the right place for someone to live within the individual's financial bandwidth. And, navigating the healthcare system to best advocate for our clients can be quite challenging—sometimes the waiting is the really hard part for our clients.
"Let’s talk numbers. What does pricing typically look like for a navigator, and is there any world where insurance or Medicare helps cover these costs?"
Each care manager has a different model and price structure. This work is private pay, usually per hour. Four Seasons charges a flat rate per hour or portion thereof, adding up the time at the end of each month and sending a bill to our clients. If there's no activity, there's no bill. Easy! Care Navigation or Care Management work is not covered by any health insurance. There are some long-term care insurance plans that will cover care management, and we provide the documentation needed to our clients so they can submit that with the claim to be reimbursed for services.