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Crisis Management: First, Share Your Burden

By James M. Hanes, RN, BSN

Director Healthcare Services, Interim Healthcare,

So, what do you do when you or a close family member is hit with some adverse event such as a life threatening illness or disability?  At first, you may be shaken up and experience severe, jumping-out-of-your-skin anxiety attacks and hyperventilation. But after an interval you put down the paper bag you’ve been breathing into and start coping—all the sooner and easier if you share your burden with others and accept their help. 

Your spouse, significant other, family, friends, coworkers and folks at church can provide emotional support.  You must share the situation with others, especially if you are the type who prefers to manage on your own.  Don’t be a “loner.”  Tell others about your situation and you will soon feel less anxious, and the adjustment process will begin.

It is amazing how giving and resourceful others can be once they find out about the problem.  People that you hardly know will turn up to help you out in small ways and large. These folks are angels who will transform a bad situation into a number of more manageable issues that you can and will handle with their help. 

Be accepting and thankful for their help, even when you are not in a thankful mood.  Don’t forget to make a list of helpers to include phone numbers, and then add to your list as people turn up to help.  People usually like to stick with what they do best, so make note of what they did for your future reference.  The list is a “twofer” since you can refer to it when you need specific help and it becomes a handy index for sending out thank-you cards later on.

books appropriate for the situation can be a source of strength and one book comes to mind instantly.  Harold S. Kusher, the author of When Bad Things Happen To Good People, has a lot to say in regard to dealing with adverse events. He has published several books and they are available new and used for peanuts on Amazon.com.  His books make a good gift for persons and families struggling with problems.

For those reading this that are not themselves facing a critical situation, consider that good deeds have a way of coming back to you with interest.  So,  so strap on your angel wings and look for ways that you can be a blessing to others!

One of the first issues that come to mind when facing a critical situation is how you will manage when you can’t work. There is no easy answer since every situation is different, but the important thing is to get moving, beginning with an assessment of your resources.

First, check your insurance coverage—people are wise to take out policies covering long-term care, disability and life while they are young enough for premiums to be affordable.  Dig out any old policies and review coverage, deductibles and limitations.  Look for special disease policies and riders you may have purchased, such as a cancer policy.

Disability policies are either short or long-term and replace a portion of your salary, usually 66%, with income taxes taken out or not, depending on the choice you made when the policy was initiated. This will affect the amount that you get each month. Call the company or visit their website for claim information and forms.  File a claim right away.

Long-term care and Home Health policies usually have an exclusion period from 30-90 days of service before coverage begins.  Some of them pay a home health agency directly and others expect the insured to pay the agency and then seek reimbursement.

These policies may have a daily, weekly or monthly benefit limit and there will be a lifetime limit to benefits.  Make sure you understand the policy requirements as far as dollar limits and care required under the policy. “LTC” policies are meant to pay for home or nursing facility care and both types generally have some requirement that certain duties be performed for you, such as bathing, in order for a payout to be made.  Make sure that caregivers perform and document the required care every day.

Get the claims info--you will need to pay yourself during the exclusion period and it is usually best to start out with the minimum number of hours’ help per day at first in order to minimize your cash outlay during the exclusion period. 

Life insurance policies can sometimes be tapped by borrowing against the benefit amount, and people commonly accrue several paid up policies purchased when they were younger and had minor children at home.  You can contact your life insurance company for information about terms and procedure for borrowing against the policy value or even accepting a direct cash payout.

Companies exist to provide advance payment against the value of life insurance policies, but Congress and many states have placed restrictions on these “viaticals,” which sometimes call themselves “life settlement” companies.  Be sure that you understand all the terms of any agreement you enter into with these outfits.  Some are legitimate, but they have a mixed reputation for fairness and honesty.

If you have benefits at work, you may need to file for the Family Medical Leave Act and/or to “COBRA” your benefits.  Expect to pay at least double for your monthly health insurance premiums if you resign and COBRA your “bennies.”  You may be able to drop coverage for a spouse or for family members over 18 in order to save money, but be sure that you understand all the ramifications before doing so.

Make an inventory of your savings and investments—include your home value and amount remaining on the mortgage, if any. A Reverse Mortgage can be the way to go under some circumstances and the Government Printing Office publishes an information pamphlet called, The Home Equity Conversion Mortgage at a Glance.  It is available on the web at www.hud.gov.

In general, you don’t have to pay back a HECM until you sell the home and you can remain in the home indefinitely.  There are companies that use retired actors as spokesmen for their TV ads, but Home Equity Conversion Mortgages may be available at your local bank.

IRAs, 401ks and Roth IRAs may allow you to make withdrawals without the 10% early withdrawal tax penalty when some life-changing event occurs.  The information that the plan sent you initially will have information about this and a number to call for more information.

Application for certain government benefits will be affected based upon your net worth, such as savings, investments and even life insurance.  You will want to mange your investments in a way that maximizes their value to you and your dependants. 

The government allows some investments to be moved to your spouse or dependent child before or when you apply for benefits.  To keep things legal and proper, it is best to consult an estate lawyer if you think you want to move money around.   

If you apply for Medicaid, the Caseworker may provide some guidance as to what assets you may legally move to a spouse or dependent child.  They will verify everything and will either deny your application or report you for Medicaid Fraud if you “fudge” on assets.

File for SS Disability right away.  Get the application on line, or from the local Social Security office.  It can take a while for benefits to “kick-in” so don’t delay.  Unless your situation is a “slam-dunk” for disability, or you are almost 65 anyway, consider getting a law firm that specializes in Social Security Disability to help with the application process.  Even if they charge a fee, the monthly Social Security check coming in each month adds up and you can get Medicare benefits after two years on Social Security disability.

See a lawyer, preferably one who specializes in insurance, disability and estate planning issues, or who belongs to a firm that handles these issues “in-house” specialists.  They can advise you on legal ways to ensure that your resources are not needlessly depleted.

File for Medicaid.  If you are of modest means, the state Medicaid program may provide some assistance with medical bills and if needed, a skilled nursing facility.  Depending on your circumstances, the Medicaid Program, as imperfect as it is, may be needed at some point.  Applying early will at least tell you if you qualify and your responsibility, if any, for a share of the cost.

Look for “other” resources.  For example, the Veterans’ Administration Aide and Attendants program can pay for in home care or residency in an ALF for a veteran or spouse of a veteran.  To qualify, the veteran has to have served at least one day during wartime, but it is not a requirement that the Veteran was in an actual war zone. 

The Aide and Attendants Program is a VA “special pension” which can provide almost $2000 per month for a veteran, or half that amount for the spouse/widow of a veteran in order to pay for homecare, a nursing home or Adult Living Facility.  Information may be available through the Disabled American Veterans-D.A.V., but the V.A. may try to steer you away from the program.  We have application information at Interim Healthcare, but you may need a firm that helps with the paperwork because the forms involved are tedious, which you probably guessed.

Consider trusts or bankruptcy   These things are not a do-it-yourself job and require serious thought and understanding to determine if they are right for your situation.  The lawyer that you saw regarding insurance/disability/estate planning will “do” trusts and may have an associate who specializes in bankruptcy. 

There are law firms that specialize in low cost trusts, and firms that specialize in low cost bankruptcies, but you have to decide if they are right for your circumstances.  Their services may be limited to filling out and filing the paperwork.  

Downsize.  Consider selling your home and moving to a smaller home or apartment in order to save money or to raise money from the equity in your home.  If you do think moving is an option, consider where you move.  Will you have easy access to medical facilities?  Will you move closer to family, but far away from supportive friends?

An apartment near family may be a good choice and will mean a lot less effort to keep clean. (Church and work friends make great movers).  A smaller home or condominium offers savings, especially if it can be paid off with equity from the sale of your present home. You can move to a family member’s home and rent your home out for income or to cover the mortgage payments.

Do you have expensive toys?  That bass boat or mammoth RV in the yard (which you use but twice a year anyway) has value now but may become a deteriorating “white elephant” in the near future.  Medicaid allows you and your spouse to keep just one automobile for personal use.  Selling off your classic ‘59 Corvette in the garage may be painful, but will ease application for Medicaid if and when that time comes.

Seek discounts from medical providers.  Medical insurance may be too expensive to maintain if you are not working.  Some physicians, hospitals and outpatient centers may give you a hefty discount for paying cash for procedures.  It can’t hurt to ask and you must not hesitate to do so.  After all, providers incur costs surrounding insurance billing and they do not always get paid what they bill insurance (if at all).  But don’t just ask the clerk up front, unless they say yes.  Ask to speak to the office manager or speak to the physician during your visit.

And finally, no matter the situation, be thankful for the resources that you have, the people who help you and for the promise of a better existence that is available to us all.

This story was submitted by Patricia Engelfield. Patricia is a registered nurse at North Florida Regional Medical Center in Gainesville, Florida. 

                                 Pat's Story 

After twenty years of being an orthopedic nurse, I retired only to return the next year to oncology nursing. Even before becoming a registered nurse, I knew the importance of yearly mammograms.  Before Thanksgiving, 2001, I went for my mammogram. The Monday after Thanksgiving, I received a call that I needed to come back for an ultrasound. I was not too concerned as this had happened before and nothing was found. This time however, I could tell by the look on the radiologist's face, that she had seen something. There was no lump nor tenderness. She sent me to the hospital for a needle biopsy. More than any other illness, we all fear the word "cancer".  Even before the biopsy, I talked to a surgeon about surgery if it was needed. Several days later the physician called.  It was a ductal carcinoma in situ, an early cancer usually treated with a lumpectomy. I had surgery on December 6 and was back to work the next week. I was to start 6 weeks of radiation treatment in mid January.  During that period of time, I flew to Ohio for Christmas and then to London for a week. Everyone that I knew had put me on their prayer list.  I knew that God had always been with me  and would remain with me whatever the outcome. I had much emotional support from family and friends. I really never felt much fear until I went to the radiation oncologist to be marked for the radiation treatment. There is something about having your breast marked with magic marker that brings home the fact that this is serious business.  I did well with the treatment and was able to continue working. I had a mammogram every six months for the first two years and now continue with yearly mammograms. I will no doubt always have some dread before each mammogram but do not dwell on it. I have been blessed with good health and live life to the fullest.  I am one of three nurses on my unit at the hospital who have had breast cancer. The other two had mastectomies and chemotherapy but each have survived cancer free for over ten and fifteen years.  The three of us have been named heroes by the Susan Komen Breast Cancer Research Foundation. One nurse makes angels for the patients, one does art work for the floor and I make