Financial Resources for Adults with Cancer
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ADVICE FOR PROFESSIONALS
With the monumental changes in the healthcare system, shorter hospital stays, and the shift in cancer treatments to outpatient settings, patients carry a greater burden in trying to meet their tangible needs, work, and family responsibilities while adapting to the physical and emotional consequences of cancer. Developing creative plans to assist patients in answering concrete needs is imperative. The good news is there is help out there. Many organizations offer financial support in the form of direct funds and free or reduced cost services and products. However, patients with cancer and their families need help in the search for these resources and in negotiating bureaucratic structures.
Financial services to adults with cancer are available on local, regional, and national basis. The most basic connection to these services is the local agency or hospital social worker. These health professionals are usually the most knowledgeable about community resources and referral sources. Requests for information on where to access local funds for home care, child care, and transportation to treatments also can be found through local medical professionals, including pharmacists and home care personnel. Community resources may be identified by clergy, librarians, and school counselors. When local funds are not available, direction on how to apply for state and national funds should be requested.
The resources listed in Table 1 are available nationwide. Guidelines for assistance vary from state to state. The American Cancer Society, for example, provides funding for medical and nonmedical costs in some states with variance within different boroughs, cities, or counties. United Way agencies and the local American Red Cross often provide information about and/or direct assistance.
In addition to national resources, Entitlements for individuals are available on federal, state, and local levels. The Cancer Information Service and Comprehensive Cancer Centers located throughout the United States offer information and referral to many support services, often including financial assistance. Consider neighborhood agencies, local churches, and synagogues, which may provide direct service and financial help. The Visiting Nurse Service also may provide information about and/or direct financial assistance in some communities. Table 2 lists entitlements that are available to the underserved, disabled, and elderly and that can be accessed through local social security offices and local public welfare systems.
General rules on financial eligibility are as follows:
* Assets: In estimating eligibility, count cash, bank accounts, investments, valuables. It is not neccessary to count a home, car, income property, or ordinary belongings. Ask about such matters as insurance, if and when to "spend down assets," and how to count the finances of a spouse who is ineligible or separated.
* Income: In general, count unearned income–Social Security, Supplemental Security Income, pensions, interest, valuable gifts; and earned income–wages, etc. (Note that some of this income may not be countable, such as noncash income or a portion of earnings.) Most programs base eligibility on net income: Subtract all deductions, they can make a person eligible.
* Apply: Patients should apply even if they are not sure they qualify. Applications can usually be done by mail, phone, and authorized representative as well as in person.
Individual medical insurance coverage should be explored, as well as resources with savings plans and arrangements for borrowing funds.
Getting Help through Life Insurance Policies: For many people facing a shortened life expectancy, a new process, known as viatical settlements, provides an alternative for obtaining money by selling a life insurance policy. When a patient decides to use a life insurance policy as a source of funds, the policy should be reviewed. If it is an individual policy, look for words "cash value" or words similar to "cash." This kind of provision lets the individual borrow money from the life insurance company. It tells how much may be borrowed each year and the terms under which money may be borrowed The interest rates are usually reasonable, especially if it is an older policy. Loans against cash value do not disturb the existence of the policy and do not have to be paid back while the individual is alive. The amount of the outstanding loan (including interest) is usually deducted from the death benefit and the remainder is paid to the beneficiary. Loan proceeds are genially considered to be tax free. If someone is considering this alternative, they should get an opinion from an attorney or tax advisor to protect their interests. There are a few group life insurance polices that contain cash value, but a group policy is worth reviewing.
Many patients' financial security, as well as their social and emotional well being, is severely threatened because of the demands that treatment, side effects, and schedules impose on their lives. Financial assistance is vital to supporting patients' coping abilities, their self esteem, and sense of independence.