Men with MS and Finances

1. Men with MS and Finances Robert T. Fraser, Ph.D., CRCCarmen Orso, RN University of Washington, RRTCSeattle, Washington

2. This is a difficult topic: • Men are a minority of the MS population • Not necessarily “self-revealing” • No research base – clinical experience/ qualitative discussion

3. Models of Response When Diagnosed: • “Head-Down,” “Keep Driving” • Personal Awareness of Limitations --accommmodate Job/Desire Other • Can’t Keep Up/Can Keep Busy – Economically Contribute in Some Way

4. Models of Response (cont’d) • Secure SSDI, Continueto Push for Work at Same Level • Secure SSDI, Misguided retraining and “Floods” – No plan • Secure SSDI, plan/utilize all resources

5. Problems coping, relateto a number of factors: • Psychological – “shaken sense of self,” loss of the bread-winner role. • Anxiety about lack of health care coverage • Lack of understanding of vocational strategies to maintain work -- FMLA, 1993 D.O.L. waiver for unpaid work

6. Problems Coping for Men(cont’d) • Societal Need for Respect as Self Supporting – will push the boundaries on Social Security guidelines • Denial of Cognition Limitations --Unreceptive to financial planning assistance or time out for plan formulation

7. Utilize all Strategies in Keeping the Job: • Medical Leave, donated? • Vacation Time • Familyl Medical Leave Act – 12 weeks • 1993 Dept of Labor Waiver for Unpaid Work (215 hrs)

8. Vocational Exploration – 5 hrsVocational Assessment – 90 hrsVocational Training – 120 hrs US 1993 D.O.L. Waiver for Unpaid Work:

9. Health Insurance Coverage • Somehow maintain last employer’s insurance • Change job, use HIPAA to secure new insurance • Use COBRA to extend insurance from last employer • Secure insurance from state “high risk” insurance pool

10. Health Insurance Coverage (cont’d) • Seek Medical Care Through VA or county/city health clinics • Seek medication through university programs/pharmaceutical company grants • Long term care and Medicaid: Income Cap Trust

11. Assessing One’s Income Stream • Short/long term Disability Insurance • Available IRA/Keough/Pension Plans, etc • SAVINGS • SSDI/SSI

12. Assessing Income Stream (cont’d) • Significant other support • Property/rental Income • Life insurance (net cash value) • Home equity/reverse mortgage • Automobile/other net assets • Inheritance

13. Realistic Assessment of Expenditures • Credit card payments • Mortgage rent • Insurances • Auto payment • Mandatory expenses • Support of children/tuition

14. With the impact of an independent certified financial planner and medical prognosis information,assess monthly financial status: • Now • Five years • Ten years

15. Debt Consolidation: • Credit counseling and payment consolidation • Direct negotiation with credit card company –fixed payment, no interest • Bankruptcy options, begin anew

16. Case of Charlie“Road Warrior Approach” • On long term disability, returns to work for a few years until incapacitated • On SSDI, rent takes most funds • Sending random minimum payments to credit card companies • Doesn’t have money for bankruptcy lawyer

17. Case of Fred • Comes to terms with his disability, secures Social Security • Does some PT work, never affects social security • Secures Section 8 Housing • Food stamp/food bank • Budgets/Reduce debt

18. In considering work, one needs to remember • On SSDI, you can earn $810 • This amount lowered with Impairment Related Work Expenses (aide, driver, specialized software, inc) • Nine Month Work Trial on SSDI • Americorps/certain Stipend Programs not considered SGA • 1993 US Dept of Labor non-paid tryout • Mixed options

19. Case of Kurt, former banker • Receives $1275 in SSDI/month • Works as an Americorps literary counselor, stipend $800 monthDoes some work for his former employer, p.t. < 4810 a monthon his own time

20. Although a personal and clinical perspective, men don’t take the time for: • FINANCIAL PLANNING • BUDGETING