Counting the cost - Tony Carlin

Supporting People with Breast Cancer 2012

Counting the Cost of Cancer

Tony Carlin, Head Medical Social Worker,

St. Luke’s Hospital

Introduction

• Dealing with cancer is stressful • Practical problems can further increase one’s stress levels

• Practical guide – minimise frustration, stress and difficulties during this difficult period in your life

• Citizens Information Lo call 1890 777 121

Content

• Financial Impact of Cancer• Social Welfare• Community Welfare• Medical Cards• Work• Carers• Dealing with Financial Problems • Travel

Financial Impact of Cancer • 44% stated that cancer had made them less well off• 58% had a decrease in income• 30% reported a decrease in household income• 11% reported an increase in household income• 59% reported that there had been no change• 6% used all of their savings• 49% used some of their savings• 85% took time off work• 49% received sick pay• 16% had a family member who changed their work pattern to help the person with cancer• 24% had claimed a new social welfare payment• 61% had received a medical card since their diagnosis• 49% were in employment• 71% had travel costs, (an average of €360 throughout treatment)• 52% paid for parking• 59% had increased household bills

Social Welfare

• Different from Social Work• Essentially about payments, benefits and entitlements• Illness Benefit - Forms MC1 & MC2• Disability Allowance• Invalidity Pension• Carers Allowance/Carers Benefit• Respite Care Grant - €1700• Fuel Allowance - €20 per week (Oct.-April)• Free Travel Pass/Companion Pass• Living Alone Increase - €7.70

Community Welfare• Frequently referred to as ‘the Relieving Officer’

• Up until recently were employed by HSE (now under Social Welfare) and are generally found at Health Centres on certain days of the week.

• Issue interim payments while waiting for a payment from Social Welfare - Supplementary Welfare Allowance

• Diet and Heating Supplements, Rent Supplement, Mortgage Interest Supplement.

• Exceptional Needs Payment (discretionary payment)

• Expect to be asked to fill out a number of forms

• CWO’s decision can be appealed to the Superintendent Community Welfare Officer

Helpful Hints for Form Filling• Use black pen• Write clearly• Get help if necessary• Do not leave boxes or sections free, cross out or write N/A (not applicable)• Make sure you have signed the form in all the appropriate places• Get a letter from a social worker, doctor and nurse etc. to support your application• Have someone check the form• Make a photocopy of the form or of any additional forms or correspondence• Make sure the address to which the form is going is correct• Consider registering the letter• Check that it has arrived after one week• Always have your PPS number to hand• Get a name and remember it – write it down• If using the phone – give yourself plenty of time• Do not lose your temper – generally it doesn’t help your case• Keep checking• Get others to check for you. They will need your PPS to do so.

Medical Cards• No consistency with regard to the allocation of medical cards• No automatic right to a card because you have cancer• Means assessed – based on income limits• If income comes solely from Social Welfare you may be given a Medical Card

even if your income is in excess of the guidelines.• GP visits cards• Drug Repayment Scheme• Support letters• Two different medical card application forms under 70s and over 70s• Medical Cards now processed centrally in Finglas• Can apply and check staus of card online–www.medicalcard.ie• Can appeal decision not to grant a card – Always appeal – you’ve nothing to

lose!

Helpful Hints with Medical Cards

• Make sure you fill in the correct application form MC1 (Under 70s) & MC1a (Over 70s)

• Processed in Dublin: Client Registration Unit PO Box 11745 Finglas Dublin 11 Tel. 1890 252 919 or (01) 8647100 or Fax (01) 8661445

• Always keep a copy of application form

• Make sure to include the required documentary evidence to support your application – if not processing of application will be delayed.

• Get a letter of support from your consultant, GP, Social Worker , Counsellor etc. – everything helps

Helpful Hints with Medical Cards...cont’d

• If sending application in by post – register it.

• You can apply on line and check the status of your application

• Follow up application with a phone call within the week – check that its arrived.

• Get an approximate date as to when a decision will be made on your application.

• Always get the name of the person you are dealing with and keep a note of it.

• Get someone to assist you with phone calls etc.- make sure they have your documentation, PPS number etc.

Health Insurance • VHI, Quinn Direct, Hibernian Aviva, Occuaptional Health Plans

• Various companies and plans give you a variety of entitlements

• Always check with your Insurer as to what your entitled to by your plan.

• VHI will not give cover for a pre-existing condition for five years

• Scans - check that the scan is eligible for benefit

• Convalescence – amount of allowance depends on the plan

• All private insurers give a contribution towards breast care products

• Nurseline Service 1850 247 724/ Best Doctors – Second opinion service

• Accommodation Benefit - €100 per day up to €1500 per year

Insurance Policies

• Insurance policy taken out prior to diagnosis • Post diagnosis – may be excluded• Specified Illness Cover – once off lump sum

(25% of salary)• Income Continuance• Hospital Cash Plans €100/day, €50/day.

Medical Expenses• If no medical card or no health insurance and you require hospital admission, you are

required to pay €75 per night for a maximum of ten nights for one calendar year

• If you pay tax, you can claim back expenses for you and your dependents - MED 1 Form

• Can also claim for all breast care products

• Claim at the end of the tax year

• Enclose P60 and receipts

• You may be able to claim back a percentage of money paid for GP visits, Nursing Home fees, private carers fees, balance of any claim not paid by private insurance, on the first €100 paid for drugs while on the drug repayment scheme.

• VAT can be claimed back immediately for any medical equipment purchased e.g. stair lift, nebuliser etc

Medical Expenses – Inability to Pay

• Threatening letters from Debt Collection Agencies

• Waivers of medical expenses

Hardship Scheme – Inpatient/Outpatient Charges

• Health (Amendment) Act 2005 4(b)(4)

• HSE may reduce or waive charge imposed on a person if it is of the opinion that, having regard to the financial circumstances of that person, it is necessary to do so in order to avoid undue financial hardship in relation to that person

• A person or their representative may make a request to the Authorised Officer to reduce or waive the charge for maintenance on financial hardship grounds. Financial Hardship needs to be demonstrated to the satisfaction of the Authorised Officer that the money remaining with the person having taken the charge into account is insufficient to meet their reasonalble needs.

• Contact: Senior Executive Officer, Acute Hospitals and Services for the Elderly Programme, Dr. Steeven’s Hospital. (01) 6790700

Disability Payments and Work• If on Disability Allowance, you can do rehabilitative work and keep your social welfare payment.

• Can earn up to €120 per week without it effecting your payment

• Maximum that can be earned is €422.50 (Disability Allowance) while still retaining minimum payment of €3.00

• Therapeutic work should not exceed 20 hours per week

• Need to get permission from the Department of Social Protection.

• A letter from your doctor and /or social worker helpful in this regard.

• You can also participate on a FAS/Solas training course or a Community Employment scheme but you will not be able to keep your social welfare payment.

• FAS/Solas Training Allowance at same rate as social welfare allowance as well as a training bonus

• If you are getting Invalidity Pension or Illness Benefit, you can participate in a Fas training course and keep your social welfare payment.

• If you wish to work you must transfer to the new Partial Capacity Scheme (with the exception of voluntary unpaid work).

• Work which you do on the Partial Capacity Scheme does not have to be considered rehabilitative

• Need to be on Illness Benefit for at least six months before you will be considered for approval

Carers

• Caring can take many forms• Caring is stressful• Stress can effect you physically and emotionally• Carers Association• National Careline 1800 240 724• Carers Allowance, Carers Benefit, Respite Care Grant• Carers Leave – 104 weeks• Home Care Packages – no guidelines on how to

qualify – a person needs 10 hours or more• Private Carers

Financial difficulties

• Money Advice & Budgeting Service (MABS)

• MABS Helpline 1890 283 438 (9am-8pm Monday – Friday) or email [email protected]

• Offices throughout the country

• Free Service

• Confidential Service

Financial Difficulties• Financial Assistance may be provided by a number of charitable

organisations

• It is not an entitlement or a grant!

• Financial problems must be directly related to cancer

• For those in dire circumstances or in crisis

• Will only be applied for when all other avenues have been explored

Travel

• Source of great difficulty and stress for patients

• Public transport, taxis, petrol costs, parking

• CWOs reluctant to pay travel costs – discretionary and depends on the area

• Some hospitals provide transport – not ideal

• Volunteer Driver Scheme – Care to Drive

• Travel2Care Scheme

Travel2Care• Must be attending or have attended one of the designated cancer centres, Beaumont, St.

Vincent’s, St. James’s, Mater, Limerick, Galway UH, Cork UH or Waterford RH

• Scheme now covers all cancers

• Patient must be travelling 30 km or more to the disignated centre

• Scheme administered by Irish Cancer Society

• Two separate forms

• Form A – Investigations –to be filled in by patient and partner

• Form B – Ongoing treatment – to be filled out by health care professional and signed by patient

• Forms available from ICS, ( Siobhan Dixon (01) 2316619), ICS Website or from the Breast Care Clinics

• Look for assistance in filling them in

Questions?