Seniors who are struggling to manage medical appointments, referrals, treatment decisions, communications, or other aspects of health care can use patient navigators to help navigate the complexity.
Navigating health care in later life can be challenging. Managing multiple providers, chronic conditions, medications, and frequent appointments can be a lot to juggle at once. Even if you have a partner, child, or friend who can help, they may be just as confused about the healthcare system as you are.
If you’re looking for someone who can break down the complexities of healthcare, you might want to consider a patient navigator. These workers can help older adults understand their options and coordinate care, taking some of the weight off your shoulders.
Keep reading to learn more about what patient navigators do, who may benefit, and how to find one.
What are patient navigators?
A patient navigator is a trained healthcare professional or community worker who helps people move through the complex healthcare system, overcome barriers to care, and coordinate care. They can work at hospitals, health systems, community organizations, or private practices. Some patient navigators focus on specific medical conditions, such as cancer, while others support broader care coordination. Job titles, training, and responsibilities can vary by organization.
Patient navigators can help older adults access and coordinate care, but they’re not necessarily a licensed medical provider who can make treatment decisions on their behalf.
How can patient navigators help seniors?
A patient navigator can benefit seniors in several ways, including:
- Coordinating appointments and follow-up care: Patient navigators can help schedule specialist appointments and coordinate referrals. They can also track follow-up visits after hospitalization and treatment, and help seniors prepare questions for their healthcare providers.
- Explaining healthcare options: They can break down instructions, available services, and next steps in a way that is easier for older adults and their loved ones to understand. Patient navigators can connect people to community resources, transportation, or financial assistance when available. If there are concerns about insurance or medical bills, these professionals can also help them identify questions to ask their insurance providers and doctors’ offices.
- Helping patients overcome barriers to care: Patient navigators can help address challenges like transportation, language differences, limited support at home, or difficulty accessing appointments. They can also connect people to appropriate resources and services and help family caregivers understand how to support care coordination.
Typically, patient navigators facilitate communication and access to care rather than diagnose conditions or replace medical providers.
When might a senior benefit from a patient navigator?
Patient navigation may benefit older adults who:
- Manage multiple chronic conditions or see multiple specialists
- Have received a new diagnosis that requires ongoing treatment
- Are returning home after a hospitalization
- Need help understanding referrals, follow-up instructions, or available resources and support
- Live alone or have limited family support
- Have caregivers who are struggling to coordinate appointments and services
Patient navigator vs. patient advocate
The terms patient navigator and patient advocate are sometimes used interchangeably, but they can offer different types of support. Both can help older adults feel more confident managing healthcare, but their primary roles differ.
Here’s a quick breakdown of each role:
Patient navigators:
- Help coordinate care and access services
- Focus on navigating the healthcare system
- May assist with referrals, appointments, and resources
Patient advocates:
- Help patients understand and speak up about their care
- Focus on patient needs, concerns, and rights
- May assist with communication, insurance, or billing concerns
There can be some overlap between the two roles, and responsibilities can vary by organization and individual. If you decide to seek a patient navigator or patient advocate, ask about which services they provide to ensure they’re the right fit for your needs.
Where can seniors and families find a patient navigator?
If you’re interested in a patient navigator, here are a few ways you can find a professional:
- Ask your provider or healthcare team for recommendations or referrals.
- Contact the hospital to see whether it offers patient navigation or care coordination services.
- Review your health insurance plan to see if it offers care management or navigation services and what eligibility looks like.
- Look for condition-specific organizations that may offer navigation or advocacy services for people with certain illnesses or diseases.
Does Medicare cover patient navigators?
Yes, Medicare Part B covers certain principal illness navigation services for eligible beneficiaries with serious illnesses. To qualify, the illness must be expected to last at least three months and put the patient at significant risk of hospitalization, nursing home placement, worsening symptoms, physical or mental decline, or death.
Coverage and out-of-pocket costs depend on the service and the patient’s Medicare coverage. Visit Medicare.gov or contact Medicare to see if you qualify and what you may pay.
If you’re struggling to manage appointments, referrals, treatment decisions, or other aspects of healthcare, a patient navigator may be able to help.
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