Freelance Patient Advocate for Nursing Home Residents?

  1. Please respond to this and tell me what you think.

    I want to have my own business.
    I am concerned about the plight of elderly residents in nursing homes.

    I came up with the idea (or rather, it occurred to me), of being a freelance patient rep.
    Of course, one would have to secure permission to look at the resident's medical records from their POA -
    but, being a Registered Nurse, I think that a service of visiting a resident and also being their patient rep could be something to get into.

    My first idea was a visiting service, X number of times weekly, to talk, deliver a gift basket, read the Bible, etc.
    Then I thought, well I am a registered nurse: if I had permission to access their medical records/charting, AND examining them for skin breakdown/hydration status, that would go a long way towards making sure they received PROPER CARE and it would reassure the family (who would be the ones hiring me.) They would be hiring me to ensure that their family member was receiving good care. Being a RN, I could discern whether they are or aren't, and I could visit with them at the same time!

    What do you all think of this idea?

    What with all the understaffing in nursing homes, I think it's a good idea. I'm interested to hear your opinions!
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  2. 4 Comments

  3. by   Town & Country
    Can I get some opinions?
  4. by   cenote
    The problem with your idea is reimbursement. Many families could not afford to pay an RN to check on their loved ones. I don't think an insurance company would pay for such a check up unless you were a nurse practitioner (and then I beleve it would have to be in response to an illness since they are "supposedly"
    being well cared for by the nursing home.

    Also, you may well have a problem with the nursing home itself since you'd literally be checking up on them. Logistically, it would b difficult and require travel time and expense and enough patient load to justify the trip (i.e. more than one pt per home).

    I am a 53 year old student nurse with 25 years of business experience and bachelor's degree with a concentration in business. I too am planning to make nursing a business but will focus on reimbursable services. You might begin planning your venture by researching what different nursing/care services are insurance paid or have the potential. Its pretty involved and detailed but may guide you in a direction with potential for profit and growth.

    Also, consider overhead and what amount you will need to operate for "X"
    number of months/years while you build the business base. Decide how much you must have considering your present lifestyle, bills, etc. Factor in the sevices of a good accountant/consultant to structure your cash flow. Office set up is expensive , so are support personnel. Consider partnering with other nurses.........work prn to get you through. Do LONG term planning and statistical analysis of the market before you jump into anything.

    Research your idea. See if its been done before. Read about business successes of other nurses in other areas of the country. Its all about doing your homework.

    I could go on, but you get the picture. I think nurse entrepreneurs are the coming thing and there are so many areas of true shortage and need. We just have to discover where the demand is (the need), what the supply (competition) is and How WE GET PAID and go from there.

    Good luck. Hope this helps. God Bless.
  5. by   Town & Country
    The problem with your idea is reimbursement. Many families could not afford to pay an RN to check on their loved ones. I don't think an insurance company would pay for such a check up unless you were a nurse practitioner (and then I beleve it would have to be in response to an illness since they are "supposedly"
    being well cared for by the nursing home.

    Well, I think that most people would pay for this - I could be wrong, though.
    I'm planning on going through the families, not insurance companies.
    That never even dawned on me; I know they wouldn't pay for it.


    Also, you may well have a problem with the nursing home itself since you'd literally be checking up on them. Logistically, it would b difficult and require travel time and expense and enough patient load to justify the trip (i.e. more than one pt per home).

    I realize I wouldn't exactly be a welcome visitor at a nursing home if I were checking up on them, but IF THEY ARE DOING THEIR JOB, what is there to hide?
    You know?
    If they are taking good care of resident "X", why should they be defensive? That in itself would be suspicious.
    Of course, I realize someone bustling around the nurses' station and so forth could be a bit annoying, but I don't think it would necessitate hostility (unless they had something to hide...) And that is what I would be there to find out.
    As far as travel, I am going to be doing that alot anyway...I was planning to start small, here where I live.


    As far as "market analysis" and all that sort of thing, I'm not planning to do that.
    This is just a simple thing, a simple service.
    The only expenses I would have would be my gas, my time, and a website.

    Thanks for the advice!
  6. by   Agnus
    I believe your idea is an excellent one. It is an idea that has already been implemented by others.

    Those nurses who engage in this are in private case management. That means the family hires you on a private basis to case manage the care of thier loved one.

    I ran into this when I was doing hospice. One of my patients had a very loving daughter who engaged the services of a private case manager while her mom resided in assisted living. She also had the benefit of our hospice service.

    The assisted living facility had a NP. Unfortunately the NP had her own agenda that was contrary to both hospice and contrary to what the family wanted.

    A new facility was found with the recomendation by the social worker at hospice.

    The independent case manager apparently consulted for the daughter and often acted as a go between.

    There is nothing wrong with hiring an advocate which is what I believe you want to be. That person would focus on one person not dozens or hundreds in a facility. When I worked hospice we were kind of in this position, when we visited hospice patients who were in facilities.

    We had access to the patient records and were a common site at the nurses stations. We had a good working relationship with facility staff. The staff often came to us when there were problems. We acted as a go between patient, and staff and family and staff.

    We helped the staff undrstand family wishes. We were a welcome sight at nearly every facility (one was well.... one facility was a very poor facility and gave us a hard time) We did patient care, administered pain and nausea meds, we did dressing changes etc. Hospic vistits at nursing homes was no different than home visits.

    No there was no more a privacy issue than with any thing else. Hospice worked for the family not the facility.

    The private case manage that I spoke of worked for the family not the facility. In both cases there was access to records without hippa violation.

    In both cases we were generally welcomed by the facility and other professionals and were treated with curtesy.

    The problem is are you working in an economically deprived area? If so you will be hard pressed to find work.

    If on the other hand you market to educated and or upscale professional type of families you will have better suecss.

    This unfortunatley is a $$$ driven venture that you propose. You need a marketing area that can support that. You need people educated enough and careing enough to recognize the value of your service and to embrace it.

    I may want your service. That does not mean I can afford to hire you. It does not mean I am willing to pay for such a service. Get the picture?

    It is a good concept but can you sell it? Can you sell it well enought to survive yourself?

    You need to look at the demographics of where you are going to offer this. A market analysis is important. Trying to sell ice at the artic circle will likely not be very sucessful. Then you need to have both marketing and selling skills. All business is about marketing and selling.

    There will always be nay sayers. Are you a person of action or are you a cautions person? The action oriented risk taker is the one you will have to be.
    Last edit by Agnus on May 10, '04

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