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Navigating the complexities of the medical system can be a daunting proposition for patients and their caregivers alike. It sometimes seems like knowing what to ask your doctor, understanding everything they’ve just told you about your condition and keeping track of all your medications and their instructions requires a medical degree.


You don’t actually have to go to medical school, but it can help to have a medical professional alongside to guide you. That’s the idea behind Nurse Advocate Partners, a private pay service that provides registered nurses and nurse
practitioners to accompany patients and caregivers on their medical appointments and help explain all aspects of their care.

In the latest edition of our Caregiving Chronicles Q&A series, we speak with Karen Balerna, RN, BSN, Clinical Director of Nurse Advocate Partners, about the services she offers and what patients and caregivers should know about navigating the medical system.

Caregiving MetroWest: What is Nurse Advocate Partners? What kinds of services do you offer?
 Nurse Advocate Partners is a patient advocacy firm. We spend time with our clients making sure they understand all aspects of their medical care and all the options available to them. Our goal is to make sure our clients have someone who understands all their medical needs to help them make informed decisions regarding their care. We hire only registered nurses or nurse practitioners as our caregivers. Here are just a few of the services we provide to our clients:

•    Accompany clients to their doctor’s appointments
•    Provide transportation to and from appointments, if needed
•    Make sure our clients understand what their doctors are telling them during their visits
•    Make sure our clients have all their questions answered satisfactorily from all their doctors
•    Coordinate care between all providers
•    Maintain a complete and updated list of all medications
•    Available to answer questions
•    Maintain open communication with loved ones to provide them with up-to-date information on care (given permission, of course)

CGMW: Tell us a little about your background and why you decided to start Nurse Advocate Partners?
I graduated from Boston College with a BS degree in Nursing and I’ve been a nurse for over 26 years. I decided to start this business after a personal experience with my father. Like many nurses, as my parents got older and had more complex medical issues, I started attending their various doctors’ appointments. My father was diagnosed with colon cancer that had spread to other areas of his body. His primary doctor wanted to do a procedure on him that I didn’t think was appropriate and would worsen his quality of life without the chance of prolonging it. My father and I had already had discussions about the procedure and he had told me he didn’t want it done. When his doctor went in to talk to him about the procedure, he presented it as if there were no other options. I decided to sit down with some other doctors who were involved in his care to see what else we could do to keep him comfortable and let us take him home. One of his doctors presented another option that was less invasive and seemed like a better choice. This situation made me think of other people in similar circumstances who don’t know to ask for other options and what could happen to these people.

CGMW: Why is it important that all of your workers are registered nurses? How does that background and experience help your clients?
It’s important to us that our advocates are registered nurses so that they have the medical knowledge and experience of working as a team with physicians, physician assistants, and nurse practitioners. Many times clients don’t understand what the physician is saying but they don’t feel comfortable asking, or the physician is in and out so fast they don’t have the chance to ask. We develop a close relationship with our clients so they feel comfortable asking us the questions they may not feel comfortable asking their doctor. Sometimes just reviewing the information that was presented to them at their appointment can be helpful. Often times the client thinks of a question after the doctor walks out the door or the next day and we are available to answer the question or find out the answer for them.

CGMW: One of your primary services is accompanying clients to medical appointments to help them communicate with their health care providers. Whether they have a nurse advocate accompanying them or not, what should patients and their caregivers do to get the most out of those visits? What questions should they ask before, during and after a medical appointment?
 The best piece of advice I can give to anyone when they go for a doctor’s visit is to write down your questions ahead of time in a notebook, bring the notebook with you, and write the answers down in that notebook. So many times clients tell me they have lots of questions to ask the doctor, but then they start asking the doctor about their family and the questions get forgotten. Keeping an updated list of current medications is also extremely important. All of our clients see multiple doctors and sometimes one doctor doesn’t know that a medication has been changed by another doctor. Don’t assume your doctor knows your medications! If a doctor starts you on a new medication, ask them what the medication is for. We always bring an updated list of medications to appointments with us. When medications change we always make sure the client receives an updated medication list. Lastly, don’t have a procedure or a test without asking the following questions: What is this test/procedure for? What is the expected outcome of the procedure? What are the risks involved? Does the benefit outweigh the risk?

CGMW: Do you work with clients of all ages or do you specialize in elder care?
 We can work with clients of all ages. However, we have found that the greatest need is really with the elder population. We have decided to focus our company on providing advocacy services for the elderly but we would certainly work with clients outside that demographic.

CGMW: What is the nurse advocate’s relationship with the caregiver? Do you work directly with caregivers or only through the patient?
We are available to both the client and their family caregiver, making sure they are aware of any changes in medications, when follow up appointments are, informing them of the results of tests.  We also can give suggestions on such things as safety around the house, ways to get the patient to drink more fluids, especially as the weather gets warmer, and the importance of nutrition.  It is also very important that the caregivers take care of themselves, so we encourage them to do something for themselves; take walks, have lunch with friends, go to a social event.

CGMW: How do people pay for your services? Does Medicare, Medicaid or private insurance cover any of the costs?
 Our service is private pay. We are typically not covered by insurance. The benefit to this is that we work only for you and not for the insurance company.

CGMW: For people who may not be able to afford having a nurse advocate, is there any advice you could offer to help patients and caregivers navigate the medical system?
 When a diagnosis is made and it doesn’t seem right or you want to be sure, don’t be afraid to get a second opinion. Also, it is often difficult to get an appointment with a specialist so I always suggest taking the first available appointment to get you in the door, but ask to be placed on their cancellation list. I have called offices a couple times a week to check to see if there are any cancellations in order to get clients in to see specialists sooner.

CGMW: You provide help with discharge planning. What should patients and their caregivers know about the discharge process?
 Typically we will meet with the social worker prior to discharge from a hospital or rehab to make sure we have the necessary services in place before the client goes home. If there are skilled nursing needs, the client will be referred to a visiting nurse agency for those needs by the hospital/rehab. We review the medication changes with the discharging nurse to make sure we know what medications the client is on and when the last dose was given. We also work closely with the pharmacist to make sure the changes are carried through to them so the client is on the correct medication and correct dose when they go home.

CGMW: Where are you based and what is your coverage area? Do you cover clients and appointments throughout the MetroWest region?
 We definitely cover clients and their appointments throughout the MetroWest region. We are growing our network of nurses to provide our services throughout the state but are currently focusing on Eastern Massachusetts, However, given enough notice, we should be able to provide advocacy services in any area of the Commonwealth.

CGMW: Is there anything else readers should know about Nurse Advocate Partners?
 We match up nurses with clients so that the same nurse is always attending the appointments with the client. This way there is a relationship of trust between the client, the client’s family and the nurse advocate, as well as the physician and the nurse advocate. The nurse advocate makes the follow up appointments for the client making sure the appointment time works for both of them so that they are able to attend the appointment. If something comes up, like an illness or an emergency, we will try our best to have another nurse fill in, or we can reschedule the appointment if it is appropriate to do so. If you would like more information about Nurse Advocate Partners you can go to our website NurseAdvocatePartners.com or call Karen Balerna RN/Clinical Director 508-930-2738 or Andy Powell Director of Operations 508-333-4400.

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