TRANSCRIPT
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#46 - Solo Aging & Healthcare Decisions: How Patient Advocates Can Help with Nancy Ruffner
Eric Blake:
Managing Healthcare in retirement? "Easy as pie", said absolutely no one ever, but our guest today is going to share how the pie framework can help you not only make more effective decisions with your healthcare needs, but also what she considers to be the six key pieces of your retirement journey. We're also going to discuss how all these different pieces of your life need to fit together, especially if you happen to be a solo ager. Welcome to another episode of the Simply Retirement Podcast. We want to empower and educate women to live your retirement on your terms. I'm your host, Eric Blake.
Today we're diving into a topic that has become increasingly more important, especially for those navigating aging on their own and that's patient advocacy. More specifically, we're going to be talking about independent patient advocates, who they are, what they do, and how they can support individuals making informed healthcare decisions. Joining me is Nancy Ruffner. She is a patient advocate and aging strategist. Nancy has dedicated her career to helping individuals navigate the complexities of aging with a special focus on solo wagers. That's those who are aging without that traditional family support system. She's the founder of her own practice and has helped countless individuals build the right team to support their healthcare needs. Nancy, welcome to the show.
Nancy Ruffner:
Thank you. It's my pleasure to be here.
Eric Blake:
It's been a long time coming, right?
Nancy Ruffner:
It has been
Eric Blake:
Awesome. Well see, I've been working on that intro for like four months since we spoke originally, right? Indeed. And I think the thing that sunk in with me is kind of that comparison that I use a lot of times with retirement planning and that is that the pieces of the retirement puzzle and having to fit those all together and actually the pie is a very similar concept. The only problem I have with the pie concept is the pieces of the pie seem to disappear when I'm around the pie. So that doesn't always work well, but I want to start, if it's okay with you, I want to start with just the basics and that is what exactly is an independent patient advocate? How does this profession help individuals, especially those that are going to be nearing or even already in retirement?
Nancy Ruffner:
Well, independent patient advocate is a young profession. We only came on the scene about 2009. We're comprised largely of nurses and social workers, but to the ranks we've added doctors, pharmacists, paralegals, attorneys, all with the same goal of helping the person to navigate a complex healthcare system. One that's not showing any signs of getting any easier. We are independent in that. Well, some of your folks may be familiar with patient advocates inside the hospital and they do great work. They can make things happen, but when you're discharged, they stay there and you go where? And so we journey with our client's, home, hospital, rehab, back home, got to find a new home. We're medically oriented as patient would suggest, but all the aspects of aging spill over to one another. And that's why I created the PI concept that we'll talk about. Patient advocates have niches. I'm in elder care, solo aging, but we have patient advocates that are specializing in early diagnosis first or cancer care or medical billing, insurance disputes and appeals. There are all kinds of ways to zero in and customize the services for the client who needs us.
Eric Blake:
Well, I think that's a good, didn't lead us to the next question and that's really when do you think someone should consider hiring an advocate? Because again, you brought all these different areas up that come out. A lot of our listeners might be wondering at what point should they consider hiring an advocate? Should it be a proactive decision or is this typically something that might be more reactionary when they're in the middle of a crisis?
Nancy Ruffner:
It's reactionary more often than we would like. People call us when their pants are on fire. Sometimes things are wrong. We are constantly banging the drum for anybody to be proactive when you notice change, if you suspect change because that's handwriting on the wall, there's some things that we're going to need to know to be able to provide the best outcomes for us moving forward. I would say that there are tons of ways to locate us. If you want me to get into that. You can Google an independent patient advocate and your state, so independent patient advocate, South Carolina, et cetera. And we have some professional organizations that have search by zip code directories. And so I'd like to share a couple of those. The first one is Greater National Advocates, GNA, and the website is GA now.org. And another one is what's called nac, national Association of Healthcare Advocacy Consultants or n nah a.com. But there are directories on both. Now using those directories, you can find somebody who may be located in close proximity, but I hasten to say here that patient advocates can effectively deliver services online many of the times, because we are coaching, we're interacting, we're getting in touch with your providers and helping you and your loved ones with information and navigational techniques and that can be done online.
Eric Blake:
I would love to get your input. This is something you and I talked from when we first had a scheduled the time to chat about being on the podcast of what topics could we cover and just what can we do to add value to our listeners and our audience. And I had mentioned that I have a very good connection. Her name is Pam Ferris. She was actually on episode 25.
Again, if I'm understanding correctly. And I'll tell you, I have learned so much from people like you and from Pam about how valuable, what advocates do. It's just amazing. We ran into a situation with my father-in-law that we actually connected him to someone local because they kind of got in this position of, I don't know who to turn to. Is it skilled nursing? Is it rehab? What is it? He was in the hospital, unfortunately, still, hopefully he's on the final end of this, but he's been about four months. And it was got to a point where we don't know what's the next step. Who do we ask is trying to decipher all this. I always talk about when it comes to retirement planning and financial topics, being able to translate financial into English for our clients, medical into English, I couldn't, I dunno what you do. We
Nancy Ruffner:
Specialize in layperson's terms.
Eric Blake:
Right, that's good. But one of the things that was interesting is that with Pam, her business and her team, they do a lot of local one-on-one relationship management where she's actually going to the hospital when her clients are having surgery. And so that to me, again, more of a longer term relationship, whereas we have another connection who's in that field that is more, again, your pants are on fire, let's call her. And then I know yours a little bit different, but how do you decide which of those you should be thinking about or what does that look like? I guess I'm not even sure what the right question is, but when you're trying to figure all this out, who do I turn to?
Nancy Ruffner:
I understand, and there are both kinds of patient advocacy responses. There's the boots on ground, got to be there. Sometimes you need eyes on mom or dad to see how they're operating in their environment or to notice change or to interact one-to-one in response. Let's go to the doctor's appointment, let's go to the attorney or financial professional's appointment, make sure everything's understood. Make sure that any direction from financial professionals or lawyers or medical providers are followed through with. Other times there are, I consider myself a triage person. My job is to talk with you and through artful questioning, assess your matter and make recommendations. A lot of times I can coach it. I coach adult children with aging parents, here's what you do. Here's information education, here's resources, here's what you go up to the nurses station and say, and then other times, if I sense that boots on ground local or needed, then I can help connect you with that. If there are no patient advocates in your area, then we'll use one of our sister industries like aging life care certified case manager. Somebody does a reasonable fac simile and a lot of times I'm bringing them onto the team while I'm handling the rest of the stuff. They may go in and do the in-person stuff.
Eric Blake:
Are most advocates, are they local? Are they working remotely or nationally? Is there a breakdown?
Nancy Ruffner:
I don't know. I think it's changing the pandemic.
Eric Blake:
Does it even matter?
Nancy Ruffner:
Well, it matters in that if I'm online and I sense that you need boots on ground, I better get it for you. I better offer it to you. I better recommend it. I better help connect you. If it's out of my online purvey, if you will, then I have an obligation to get you where you need to be.
Eric Blake:
So let's talk a little bit about, obviously one of the first questions is always going to come up, well, what's this going to cost me? How do I pay for all this? Does Medicare cover, does health insurance cover? How does all this happen? So how does that happen? How do these services typically get paid for?
Nancy Ruffner:
We are not covered by insurance, not covered by Medicare for the most parts, and I'll tell you, we're glad about that. We are private pay fee for service. We will save you money because we can do it faster. We can get through the gatekeeper, we know the information, we can get to it. I can, my research skills are amazing and I can really, really be effective quicker. I'm not riding all over town on your nickel, if you will. There's something called the allegiance factor, and that means that you kind of follow the money. I work in direct service to patients and their loved ones. Not for hospitals, not for insurance. We take no referral fees. We work in direct service to the patients. So that is our allegiance. If I were I to work for a hospital system as a hospital patient advocate does, then I'm beholden to that paycheck and it may squelch my voice, it may limit my actions. And no, I'm, I'm a bear when it comes to my patients.
Eric Blake:
It's funny that you say that word, the bear being a bear, because one of the things I have noticed is the patient advocate and I've taken the time to meet as many as I can because again, I've just learned how valuable this is. But there is definitely a personality that fits this job and it's just, I'm not going to stop until I get the right answer. Get the job done for you.
Nancy Ruffner:
That's exactly right.
Eric Blake:
Thinking about just the reason, part of the reason I ask this is the conversation did come up and it was kind of around my father-in-law to bring him up again is would not, why would some of this not be covered by Medicare or some of the insurance? Is it simply not justifiable? Is there an argument that's made for a service like Medicare not to cover these services?
Nancy Ruffner:
I don't know Medicare's argument. I know that CMS has instituted something recently called the community health worker, CHW, and that is a limited amount of services and availability that is covered by Medicare. I think you get very limited like an hour a month, what can you do in an hour? Not much. They also reimburse the patient advocate at $40 an hour. Now with us being nurses, social workers, master level doctors and attorneys, what are you going to get for $40 an hour? And I'm trying not to throw them under the bus, but our expertise is worth the fees that we have. I didn't address how much we are. I will say it varies where you are in the United States, you can imagine that the services in Boston or the Northeast or LA are going to command a higher rate than in the southeast where I am. So it's anywhere between $100 and $400. Credentials plays a part in this. If you're talking to an md, they're going to command a higher fee.
Eric Blake:
And is that an hourly fee? Yes. Okay. And is typically, do you see minimum number of hours or any typical restrictions put on
Nancy Ruffner:
That? No, it's all across the board. And most patient advocates will customize that for you. Many, most will require a down payment to begin work. And then we treat that like an escrow. We work it down. We can replenish that if we need to. Myself, my particular practice now that I have moved to is only hourly consultations, just triage, just working on problem solving, one piece of the pie. And so I'm onesies.
Eric Blake:
I like that. And I love to, this is, I dunno if you call it an argument that Pam and I made or I brought it up to her when I had her on episode 25, and I would love to get your input is that yes, there is a cost for using a patient advocate. There's no getting around that. But what does it cost you not to have a patient advocate? What does it cost you in lost time, healthcare expense, all those different things that you didn't know if you knew the right questions to ask, it could have saved you that we're talking thousands of dollars, how many hundreds of thousands of dollars depending on the circumstances.
Nancy Ruffner:
Yes, yes. Everything you just said. And yes. And again, returning to the fact that we know how to navigate the healthcare system, we see those intersections where there are mistakes, missed handoffs, errors. We can prevent or mitigate a lot of them. We can keep you from going down a rabbit hole. We can certainly research faster than you get to the gatekeeper. Our credibility, navigating and working inside the healthcare system, we know how it runs. And so we're kind of your quarterback.
Eric Blake:
Right. Well, and I think that's one of the things in our industry, there's this big conversation, I call it big because I probably hear it more often than most, but the public asking Tommy denial get asked about that question, are you a fiduciary? Are you a fiduciary? Which basically means I have to, if I'm going to work with you as your a financial advisor, I've got to put your interest before mine. I can't be selling you stuff for my benefit versus yours. And that's really what I took from what you've said, what Pam said and the patient advocates is that's what it's like. It's having somebody, a fiduciary on your side from a healthcare perspective, somebody that is not biased by, as you say, being connected to a hospital or being connected to the specific doctors, but being able to give you objective advice.
Nancy Ruffner:
Absolutely. We have ethical considerations. Patient advocacy has ethical code and we have to follow that. It's available on the board certification, bpa.org, our board certification website. We got to follow that.
Eric Blake:
That's a good point. Then are there certain certifications or anything?
Nancy Ruffner:
There is a board certification, B cpa, board certified patient advocate, and not all advocates need to have that. It's a nice credential that only came about in 2018. It took us four or so years to develop a credentialing exam. It does standardize us somewhat, but there are plenty of patient advocates that have been long running and effective in their positions that aren't board certified or I like to muse. They already had between four and 16 letters behind their name.
Eric Blake:
Well, I think that, again, kind of comparing to our industry, the CFP, the certified financial planner designation. I know a ton of great advisors who don't have the CFP, but it can stand out. It can make people feel a little more confident when you're working with an advisor that has one. So I think at least being aware of what those credentials are, and as you've indicated, just asking the right questions, making sure you're finding somebody that can help you in your specific situation is really going to be key.
Nancy Ruffner:
I would also add that most patient advocates offer a complimentary consultation, so get on the phone with them for 15 minutes and feel each other out. You're trying to decide if they're the best fit. The patient advocate is trying to decide if they can be the most effective person for you.
Eric Blake:
Kind of going off track just a little bit, but is there two questions, three questions that you would say, Hey, be sure you ask your patient advocate this.
Nancy Ruffner:
And a lot of the professional organizations that GA now.org and that n na h a.com will have articles, what to ask, how to interview a patient advocate. And I would use some questions like, have you experienced this kind of scenario before? What is your experience in X, Y, Z? Your concern? And ask and point blank, do you feel like you're the right person for the job or do you need to refer me out now any, I'm a social worker undergrad, but I learned that back when dinosaurs were roaming the earth, that the first thing that you do if you are not all things to all people and you have a moral obligation to get people where they need to be 40 years later, I'm doing that.
Eric Blake:
Perfect. So one of your specialties is, as I indicated in the introduction, was that you focus a lot on solo aging and that's a topic that I know resonates with many of our listeners. Can you share more about solo aging, what that means and why it's becoming such an important area of focus?
Nancy Ruffner:
I would be delighted. Solos are persons who by choice or circumstances are functioning without the traditional support system provided by family. We are, I don't think you have to put an age on it, but we're people who are aging alone. More people in America live alone than in other countries. 28% now of people over 65 are living alone. And it's because we don't have this built-in support that some might call it challenges. I call it opportunities. We get to build our team, choose our family. I talk about this thing called a micro board and it's basically your team, your village of care, and we put people in place. We select the folks that be in the seats that we think we're going to need. We can seat and we can unseat, but we're always preparing our team for what we think we're going to encounter.
If we're smart, we'll have a plan B. Solo aging is, it's a big topic. It's a hidden in plain sight demographic. You can't, can you look at me and tell that I am one? I am, but that makes me a great person to talk about this. But it is an emerging demographic. People are figuring out, well, who will care for me? Who will come see about me? Or like we always like to talk about is who's your 3:00 AM person? Who's your middle of the night person? Who can you call when you need help in the middle of the night? And so patient advocates help construct your microboard or help you think about who are you going to need to see this all the way through? You're going to need a doctor, you might need an attorney. You're definitely going to need a financial professional to help you position and fund the caregiving, pocketbook, whatever that looks like. But you're going to need some insurance savvy or a good contact person there. Housing may come into play when I talk about my pieces of the pie,
Eric Blake:
That
Nancy Ruffner:
Pie bleeds all over the plane because medical problems will have you soon reviewing your legal documents, will have you soon reviewing your insurance. And then there's this, how are we going to fund whatever's going on now and in the future? And what about housing that's going to change likely or how can I stay where I am and safely and prevent that change? And then support, which is the biggest category or piece of the pie or most important seat is finding community.
Eric Blake:
Awesome. So if you would just go through those, what you consider those six key areas. I know you've kind of touched on a lot of 'em already, but just so we have a full framework of what that looks like. What are those six pieces of the pie?
Nancy Ruffner:
Well, slowly they are medical, legal, financial, insurance, housing and support. With medical, we are making sure that you are plugged in with a good gp, general practitioner or primary care provider. But you may have some specialists on your team too, depending on what's going on with you physically and cognitively. And we're beginning to educate and play that tape all the way through relative to the legal. We're getting your legal ducks in a row. And it's not just wills and estates to patient advocates. The most important legal document are your advanced directives. Let's think about who's going to speak for us if we can't speak for ourselves. And that's an important part of the team to build an important seat to fill on the microboard people that will carry out your wishes. And by doing so, we remain more independent in calling the shots that way relative to financial.
Again, the caregiving pocketbook, what does it look like now? Am I going to need tap into government programs? Do I sell my house? How do I do that properly? And what better time to figure out best tax brackets? And if there is going to be any kind of money from the sale of a home, for instance, that's going to fund care that needs to be done carefully and with strategy and some savvy to create the wins there. Insurance, selecting your Medicare programs and part D every year, that's a big one. Finding a good ethical insurance broker or using your government funded ship program. Ship. SHIP is a state health insurance program and it's a special team in every state that you can connect in that will educate and not steer. And then housing, knowing about housing, can I stay where I am now? How do I make it safe?
How do I mitigate anything that may happen? But okay, that senior living is attractive for me. We have conversations in my niche about that golden girl houses making a big comeback. What are the pros and cons? What are the pitfalls? What are the advantages? How much does it cost? And lots of conversations and illuminations that provide that let you know we have options. And the last one, support, which is the biggest one. Building community, got to have a group of go-to folks, got to have purpose and intent to get up out of bed every day. There are a lot of people that are invested in lifelong learning that brings them joy. And then your 3:00 AM person, just thinking about who that's going to be. Now, each of these pieces of the pie, you got to have conversations with your team just to use one of them. If I'm designating my person with durable power of attorney or financial power of attorney, they need to know what I want, but backing it up, I need to know what I want. I need to know what my options are and to decide. Then document and then talk to my designated person so that they can carry out my wishes. And in doing all this, that's power. That's real independence.
Eric Blake:
Right? Well, and I think it just comes down to me, it seems knowing you don't have to have all the answers, you got to know who to ask.
Nancy Ruffner:
That's right.
Eric Blake:
And knowing that you have the confidence in that person, that they can steer you in the right direction, whether that's your financial planner, your patient advocate, just knowing, having the confidence to say, if I pick up the phone, I can get an answer.
Nancy Ruffner:
You nailed it right there. It's not so as important to have the answers as to develop your question and know where to carry it.
Eric Blake:
Well Nancy, this has been such an incredibly informative conversation. If someone listening today wanted to reach out and learn more about your services, how can they get in touch with you?
Nancy Ruffner:
I have a website, nancy ruffner.com. They can email me@nancynancyruffner.com. I am very active on LinkedIn and also have a very robust Facebook page. Nancy Ruffner, patient advocate, aging strategist, and our role with information and current events and things that provoke your thought to get you started on your journey.
Eric Blake:
Perfect. And we're going to make sure we share all of these links and resources in the episode summary. Nancy, thank you so much for joining today. Your insights on patient advocacy and solo aging are invaluable, and I know our listeners will benefit from everything that you've shared today to our listeners. If today's episode resonated with you, I encourage you to reach out to Nancy, check out her website or Facebook page to learn more about how a patient advocate can help you or even a loved one. As always, if you're looking for more guidance on retirement planning, tax strategies, and making sure you have a financial future that is secure, feel free to reach us@blakewealthmanagement.com. You can find more information on our website. Also, if you are wanting the links and resources to this episode, you can visit www.thesimplyretirementpodcast.com. That is it for today's episode of the Simply Retirement Podcast.
Until next time, please remember, retirement is not the end of the road. It is the start of a new journey.
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