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Welcome to Healthcare Redefined: Advocating for Aging Adults and Their Families, where we empower families to navigate the complexities of aging and healthcare. Presented by Your Nurse Advocate Consulting, we share real stories, expert advice, and practical tools to help you and your loved ones confidently navigate aging with dignity.
We explore topics like creating collaborative care plans, demystifying Medicare, handling healthcare crises, and preparing for the future. Join us as we transform uncertainty into understanding.
Pam Dunwald: [00:00:00] Welcome to the Healthcare Redefined podcast, where we advocate for aging adults and their families. This is where we empower aging adults and their families to navigate the healthcare maze with confidence and also with compassion. Hi, I'm Pam Dunwald.
Linda Kritikos: [00:00:14] And I'm Linda Kritikos, and I am so excited about our first podcast. We're both registered nurses and board-certified patient advocates who own and operate Your Nurse Advocate Consulting. We have over 80 years. That's a lot of combined experience supporting families just like yours.
Pam Dunwald: [00:00:33] You know, this is our very first episode, and we are so glad that you're here. You know, our goal is pretty simple. It's to be your trusted guide throughout the confusing, often overwhelming world of healthcare, especially when the system doesn't work the way it should.
Linda Kritikos: [00:00:49] Yeah, and sometimes it doesn't. So today's episode is called When Systems Fail: Managing Gaps in Healthcare. If you've ever felt lost, frustrated, or even scared when trying to get care for yourself or a loved one, you're not alone. This happens a lot these days.
Pam Dunwald: [00:01:07] You know, healthcare is complicated. Even the best hospitals and clinics, they can miss things. Maybe you've experienced delays in test results, maybe confusing discharge instructions, or endless phone tag with insurance, or getting lost in the sea of the props. These are all gaps, moments when the system just doesn't deliver.
Linda Kritikos: [00:01:29] Yeah, so let's talk about those gaps. What do we mean by that? These are the places where communication breaks down, follow-up falls through, or patients and families are felt to kind of figure things out on their own, with pages and pages of documents that they can't understand.
Pam Dunwald: [00:01:46] You know, gaps can show up in many ways. For example, discharge instructions that don't make sense to you, medication changes not communicated with your pharmacy, or maybe with other doctors or providers. There's no one, you know, really coordinating what's going on between your specialists, maybe your orthopedics not speaking to your cardiologist. There's missed referrals or lost paperwork. And then there's the insurance denials, where you, you know, they have little explanation, all they're saying is they're not paying.
Linda Kritikos: [00:02:17] Yeah. And this is really compounded as we age. So for older adults, these gaps can have really, really serious consequences, such as medication errors, preventable hospitalizations, our families feeling completely overwhelmed and underserved.
Pam Dunwald: [00:02:35] You know why does this happen? Sometimes, you know, it's just a lack of time. Sometimes there's too many cooks in the kitchen. There's not enough communication between doctors, nurses, pharmacies, insurance companies. And sometimes the system just isn't designed to support families as they navigate complex care.
Linda Kritikos: [00:02:55] So we want to make sure that you understand it's not about blaming individual providers or systems. Most healthcare professionals are doing their absolute best, and we know this. We've been part of the healthcare system for a long time, but the system has really, really gotten really big, and it's very complicated. And it's not often set up for a seamless, person-centered care experience.
Pam Dunwald: [00:03:19] You know, if you're listening, you might be an adult child caring for a parent, or maybe you're managing your own chronic condition. You know how stressful it can be to fill in the blanks. You know, calling for results, tracking down answers, and advocating for a loved one.
Linda Kritikos: [00:03:35] Well, that's where we come in. Advocates like us come in to help make your life easier. Our job is to help you see the whole picture, not just a portion of it, and connect the dots and make sure nothing falls through the cracks.
Pam Dunwald: [00:03:50] You know, Linda and I are each going to share a story. So just briefly, this would be an example of when the system failed. And, you know, this was one with my own mom. She was in the hospital for nine days, had some new health care changes, new diagnosis. She had four specialists, including a cardiologist. They put her on a new heart medication, caused her blood pressure to crash, you know, they had to use medications, IV medications to bring her blood pressure back up. Follow up after her nursing home stay. Follow up with cardiology as an outpatient. The cardiologist wanted to start her on the same new cardiac medicine they started in the hospital that caused her blood pressure to crash, and he tried to tell me - I was on speakerphone, listening in and participating - he tried to tell us that it wasn't that medication that caused her blood pressure to drop so significantly. And I had to be very firm and say, Please read the doctor's notes from the hospital because they'll tell you why they stopped it and why she can't start it. So I actually had to argue a little bit with them. And then he finally agreed, okay, we won't restart the new medication now. We'll look at it in a few months. And by our next follow-up appointment, he didn't start her on the medication. He, you know, I gave him the grace of not bringing it up again. But this is an example when the system can fail you.
Linda Kritikos: [00:05:10] Another system, another issue in regards to how the system can fail is a little different story than what Pam had just shared. I had a client that was diagnosed with cancer, and he was getting pretty much debilitated. He really couldn't do a lot for himself anymore. So he had asked for Your Nurse Advocate Consulting to help him, and I did, and took him on as a client. And one of the things he was asking for is someone just to come into his house to help him prepare breakfast, help him get up in the morning, because he was having a really difficult time getting in and out of bed and meeting what we call activities of daily living and being able to be independent in his home setting, doing basic things. So we interviewed several agencies and picked a couple, and I told them that there's no staffing guarantees, as staffing is an issue with all of these agencies. And they basically told us, both of the agencies, that there was no guarantee that they could possibly provide care all the time, and that sometimes we'd have to be without. So I told him, because of his condition and his failing condition, I suggested that we put a backup plan in place. So I'm very glad we did. We put a backup plan in place because I got a call early in the morning, about 630 in the morning from him, he was very upset, saying, My care staff isn't here. They didn't show up. They haven't been here. They were supposed to show up at 5 a.m.. Nobody showed up here. It was 630 in the morning. Nobody was there. He said, I can't get out of bed, he says, and I haven't gotten my pain medication. What am I going to do? So I said, It's okay. Take a breath. Calm down. We put our backup plan in place. The backup person showed up. The backup person was able to provide the care. I followed up with the agency to find out why this happened, why he wasn't notified. Things were then corrected, put into place so that this didn't happen again. But again, sometimes it's these very simple things that cause the system to fail, and it's not necessarily anyone's fault. It just happens. Let's look at what you can do if you find yourself in one of these gaps. So here's a few tips that we found, both Pam and I have been helpful with others, and that's keep a notebook. Write down every doctor appointment, medication, and question you may have. Always ask for written instructions. Don't leave without clear, easy-to-understand directions. A lot of times they'll give you an after-visit summary. Sometimes it's not as concise as you would like it, so please make sure you have the information on there that you need. Also, know your medications. Keep an up-to-date list and double-check it every single time you go to a provider. And make sure if you have multiple providers, that you give it to all providers, so everybody is on the same page. And please don't be afraid to speak up. Use your voice. If something doesn't feel right, it probably isn't. So please ask for clarification. And always build your support team. You don't have to do this alone. Reach out for help. And that's what we're here for.
Pam Dunwald: [00:08:21] nd you know, one of the things that we can do is in the show notes, we actually have a free resource for you along these lines where you can prep for the doctor appointment. We have a nice form to fill out. So when you go in there prepared with your questions written down, you're less likely to forget them because you're not going to feel rushed. You're going to have them right in front of you. So remember, it's okay to ask for an advocate, whether it's a family member, a friend, or a professional like us. Having someone in your corner can make all the difference.
Linda Kritikos: [00:09:00] So at Your Nurse Advocate Consulting, we are fully independent. So that means we don't work for a hospital. We don't work for an insurance company. We don't work for a clinic. We work for any insurance company. We are truly your advocate. We are here to help and work for you.
Pam Dunwald: [00:09:19] You know, we help families really navigate the tough stuff, the care planning. How do you get a caregiver in the home? What happens when your loved one has dementia and you need more help? We help with doctor's appointments. We participate. We can help with medication management. You know, in those moments when the system just isn't enough.
Linda Kritikos: [00:09:37] So really, if you're feeling overwhelmed or you just need a second set of eyes or you just want another opinion, please reach out to us. We offer a free newsletter, virtual support, and a community of people who really do get it.
Pam Dunwald: [00:09:52] You know, we want to thank you for joining us for our first episode. We hope you feel that you've been seen, heard, and supported.
Linda Kritikos: [00:10:00] So if you like today's show, please subscribe! Share it with a friend. Check us out on our website at Your Nurse Advocate Consulting dot com, for free resources and all upcoming events.
Pam Dunwald: [00:10:13] You know, and if you have a question or a story you'd like to share, or a topic that you'd like us to address, you know, please email us. That would be great. And that's just at info@YourNurseAdvocateConsulting.com. We'd love to hear from you.
Linda Kritikos: [00:10:27] And remember you're not alone in this journey. Together, we can bridge the gaps in healthcare, one story and one family at a time.
Pam Dunwald: [00:10:35] Thanks for joining us. We'll see you next time.