PALLIATIVE CARE STUDY DAY 2010

1. PALLIATIVE CARE STUDY DAY 2010 Financial Aspects of Family Support Ciara Savage, Senior Medical Social Worker, Beaumont Hospital.

2. Role of Social Work Mission Statement: “ To provide an effective Medical Social Work service which facilitates optimal social and emotional well-being among patients and those affected by their illness.”

3. Psychosocial Assessment • Primary tool in a Social Worker’s kit! • Initial and ongoing understanding of patients circumstances. • Evaluate psycho-social functioning. • Wide ranging questions. • Based on Interaction and Holistic view.

4. Psychosocial Assessment • Building of trust between worker and patient/ family member. • Stressors identified – often financial. • Advocacy – central to MSW work

5. Common Financial Concerns • Loss of Income • Costs of treatment • Costs of ongoing care arrangements • Costs of travel to care • Delays in application process • Increased GP/ Medication fees. • Sick Leave

6. Recent Research • National Cancer Registry Ireland and Irish Cancer Society (Sharp and Timmons, 2010) • Significant financial impact a diagnosis of cancer can have for patient and family. • Travel and medication costs can be major burden.

7. The whole person exists in context Family History Relationships Communications Expectations Family Needs MIND Self Esteem Psychology Cognitive Intelligence BODY Physical Attributes Medical Conditions Community/Society Family Networks SPIRIT Meaning Will Power Religion Determination Value Systems Laws Socio-Economic Policies Discrimination Oppression Culture/Ethnicity Resources Environmental Needs - Housing –Money- Facilities-Material Conditions Framework for holistic assessment - the whole person exists in a context: From Good Pracices in Palliative Care : A Psycho social Perspective (1998) David Oliviere, Rosalind Hargreaves & Barbara Monroe.

8. Financial Stress Can have far reaching consequences: • Impact on relationships • Impact on Self-Esteem • Impact on treatment • Physical manifestations of stress

9. 45 year old male Lung cancer Self-employed Married- 2 dependent teenage children Wife works part-time Mortgage Issues: X qualify illness benefit Wife’s means assessed for DA/SWA No medical Card Large Mortgage No income protection Case Example

10. Case Example cont. Potential Plan: • Get in touch with local CWO re. SWA/ mortgage supplement etc. • Medical Card Application – Advocate on behalf • Approach ICS etc, with permission • Support throughout treatment

11. Illness Benefit Invalidity Pension Disablement Pension Social insurance payments based on PRSI contributions. What’s Available?

12. Disability Allowance Long term Social assistance payment Age range 16 – 65 Disability expected at least one year. Means Tested What’s Available?

13. Weekly allowance Paid to people who do not have enough means to meet their needs and those of their qualified adult or any qualified children Payable while awaiting claim for social welfare benefit/ assistance or pension if no other income. Means tested Supplementary Welfare Allowance

14. Supplementary Welfare Allowance • Rent Supplement : assistance with rent in private rented accommodation. • Mortgage Interest Supplement: assistance with the cost of mortgage interest repayments. • Diet Supplement: assistance with the cost of a special diet prescribed by your doctor or hospital consultant. • Heating Supplement: assistance with the cost of heating a home in certain circumstances. • Exceptional Needs Payment: once off payment to help meet essential exceptional expenditure, which a person could not reasonably be expected to meet out of their weekly income. • Urgent Needs Payment: assistance in emergency situations.

15. Carer’s Benefit - Social insurance payment based on PRSI contributions. Compliments the Carer's Benefit Scheme with regard to leave. Carer's leave allows employees to leave their employment temporarily for a period up to 104 weeks to provide full-time care for people in need of full-time care and attention Unpaid Jobs kept open for carer for the duration of the leave. What’s Available?

16. Carer’s Allowance Social assistance payment Means tested Can be on Carer’s Leave What’s Available?

17. Access free of charge to: - Family Doctor or GP services - Community health services - Dental services - Prescription medicine costs - Hospital care Means tested Income assessed after tax and PRSI is deducted, rather than total income.  Allowances made for expenses If the costs of meeting your medical needs cause financial hardship allowance made. Medical Cards

18. Other Schemes • Long-term illness • GP visit card • Local Authority Grants • Tax relief – employing a carer etc. • Concessions for Disabled drivers

19. Disability allowance Illness benefit Supplementary Welfare Allowance (SWA) Carer’s Benefit Carer’s Allowance €196.00 personal rate; €326.10 with qualified adult SWA including one child, €225.80 €213.00 Under 66 €212.00; 66 or over €239 Rates (selection)

20. Charities • Irish Cancer Society - Financial aid; travel2care • Marie Keating • Protestant Aid • Marie Curie • Sick and Indigent Roomkeepers’ Society • Local Hospice Groups

21. Useful Resources • www.welfare.ie • www.citizensinformation.ie • www.cancer.ie • www.mabs.ie • www.hse.ie (to get health centre details etc)