As a social worker and caregiver to her 89-year-old parents, Sharon Depcinski knows firsthand the complications that can arise when families try to navigate a complex health care system.
So does Brian Plachta, attorney and shareholder at Grand Rapids-based Plachta Murphy & Associates. He practices elder law and estate planning, and he sees his fair share of clients who are stressed and fighting with their families over care-giving issues.
He and his fellow attorneys recognized they needed a different kind of expertise to help clients mend family relationships and prevent court fees.
“Sometimes, somebody with a medical background needs to take a bird’s-eye view of what is taking place,” he said.
The firm brought on Vicki Poleni as its first professional medical advocate about four years ago, and later hired Depcinski, as well.
“I talk about it as being a professional problem-solving role,” Depcinski said. “We assess the situation, figure out what’s needed and try to identify what we can do about it. Do we need to connect them with a community resource?
“There are times there are community resources, veteran resources in the community, mental health services or different entitlements out there.”
Procedure for referring clients to the medical advocates works like this: An attorney meets with a client, and it becomes clear they need interpersonal and medical help.
The firm calls in Depcinski or Poleni, and they set up a private meeting to get to the bottom of things.
Theoretically, Plachta said, the attorneys could have continued to refer their clients to outside social workers for help. But having medical advocates connected to the firm provides continuity.
“Typically, people were uncomfortable reaching out to a third party,” he said. “By having a social worker on our staff, we could combine the legal and medical aspects and provide that service in one place.
“We’re in a position of trust with our clients … we’re attorneys and counselors at law, and it falls into the counselors at law practice.”
Besides being a caregiver herself, Depcinski has a tapestry of work experiences that have prepared her for this role.
“I worked for a couple hospitals in the area and a couple hospice agencies and Gilda’s Club,” she said. “I’ve been a social worker for 20 years and have dabbled with a lot of things. I am currently employed with Spectrum Health Hospice, as well.
“I definitely feel like having worked in the medical setting for almost 20 years has given me a wealth of experience as to how to navigate the health care system. I know the right questions to ask and the language to use.”
Plachta said the approach works, even in the strangest cases.
“One (example) is, we had a family where I did power of attorney and patient advocacy for the mom, whose health had declined with dementia. There were seven kids. The one son drugged the mom and took her to a nursing home. The other kids were all upset. They said, ‘Can we sit down and talk about what are the legal limits with what a sibling can do?’ I said, ‘Yes, but let me bring in a social worker.’
“I went through power of attorney and those issues … then said, ‘What are the family dynamics?’ One was a brother who was not disclosing financial information to the rest of the family. They didn’t know what was going on in the house when he went over there. And of course, he had drugged the mother.
“Over a period of six months, we worked with them and they learned how to communicate. It saved them a lot in court fees.”
Depcinski said sometimes mental health issues are intertwined with other problems.
“Here’s a real-life example with the details changed,” she said. “(The firm) had a family where the patient had appointed somebody as his power of attorney for health care. As things went on, he was getting challenging to work with, and the sibling he had appointed was getting ready to wash their hands of the situation.
“They pulled in the social worker, and we talked with the family to find out their needs. We also talked to the patient to get medical records, and lo and behold, we found out that the patient had a history of depression and had stopped taking medication.
“Once he got started on the medicine again, it made him easier to deal with, and the sibling was willing to remain involved as health care power of attorney. We were able to come to a better working situation for them.”
Sometimes, Depcinski and Poleni don’t have the right expertise to deal with a case, so they work with contractors whose specialty is navigating government benefits.
“Brian might be working with a family on estate planning, then pull me in, then they might realize (the client is) a veteran and needs help with wartime benefits, so they pull in (a government benefits specialist),” she said.
Plachta said the firm uses medical advocates for bereavement and divorce issues, as well as professional matters.
“An area that might come in is business relationships,” he said. “If you have two or three members of a business who are fighting over an issue, a social worker can come in and say, ‘What are the white elephants in the room?’, help them work on their issues or help them realize it’s time for one of the members to leave the business. How can we do that in a way that is helpful?”
Plachta said about 20 to 25 of the firm’s clients take advantage of medical advocates’ services. He and Depcinski agreed the need will increase over time.
“I think that it’s a really cool, exciting new frontier,” Depcinski said. “We’re just starting to understand the gaps in the systems where people could use some support and don’t know where to turn, so this gives us the opportunity to help them access that support if needed.”
Plachta said he believes his firm is the only one in the area that has hired in-house medical advocates.
“I think it’s something that’s growing, and we’re just at the trailhead of the need for this type of thing,” he said.
“The U.S. Census Bureau says that in 2029 … there will be a 75 percent increase in (the baby boomer) population and in the needs they will have. It’s a brand-new area that needs to be dealt with. It’s going to have huge implication for the medical system and the need for finding other resources to help patients.”