by Bridget Blitz

As a palliative care social worker, I provide home visits to patients and families to explore how they are coping with complex medical issues, which resources they need, how we might add services that could reduce caregiver strain, and talk to them about their goals of care and about their wishes for the life they have left. Startling to me, within these discussions, is the depth of fear and anxiety about finances that leave these individuals struck with more than a horrible illness. They now have to absorb the real possibility of being without a permanent home in addition to adapting to new treatments, symptoms, sudden unemployment, struggling to perform daily tasks and considering eventual death.

Moving through cancer treatment may mean reducing work hours with resultant smaller paychecks; taking time off from employment for an unpaid leave or quitting work; paying for high-cost cancer medications; being charged for hospital and physician visit copayments, or losing health insurance. All these factors may result in a dramatic reduction in income and in the ability to continue paying for basic needs such as rent, mortgage, food and other bills.

Some patients we meet have to surrender jobs when they are diagnosed with cancer, leaving them with no income and a precarious living situation. Applying for Social Security Disability often takes months and requires precious energy that many of those with cancer do not have. Other benefits such as food stamps (SNAP), Medicaid and subsidized housing demand applications. Once on such benefits, life can become somewhat easier, financially, although maintaining all these resources takes a detail-oriented focus to ensure that renewal applications and deadlines are not missed and that prolonged hospitalizations do not result in unpaid bills.

When a patient loses his or her health insurance after a cancer diagnosis, there is a necessary scramble to ensure coverage. Paying for COBRA insurance (Consolidated Omnibus Budget Reconciliation Act) after losing a job and/or health insurance is one option but often a prohibitively expensive one, even with regular income. Applying for Medicaid is often not an option because the patient may still have some resources that are counted, such as more than one vehicle or assets or life insurance valued over a certain amount. Some hospitals have a financial assistance plan for which a patient can apply to receive help with hospital bills. These plans may vary, however, in whether they cover outpatient visits and cancer treatment. There are some cancer care grants available which can help supplement the assistance received. What I have found, however, in applying for help with patients, is that if the grant cannot cover the entire debt or if other agencies cannot be found to commit to cover the remainder of the debt, the fund will not assist the patient. For instance, if $4,000 is owed on a mortgage and a cancer fund grant is $500, before that patient will receive $500, the grant staff needs proof that the rest of the debt, $3,500, will be paid by other sources such as family, friends or other programs. Trying to obtain assistance can be a circular argument since no grant program will commit without all the others committing first.

Do not think that cancer’s insidious effect on finances challenges only those in poverty. I have seen cancer push patients into financial bankruptcy and foreclosure whether they have a small home, a large home, or several homes. The financial symptoms of cancer might grow exponentially, starting with a job loss or a reduction in employment hours and possibly end with a forced move out of a familiar home. Forced moves cause more financial burden due to the expenses of moving trucks, hiring movers, changing over utilities and other challenges. Families may have to surrender beloved pets with the move, which adds further trauma and anguish to an already stressed system.

Sometimes, as a palliative care social worker, I am staring down into a large, dark hole that contains someone with cancer and his or her family. Like the oncologist who has no more aggressive treatment to offer, I can offer support, hope, prayers, and compassion. We can apply for benefits, appeal to pro bono attorneys, create solutions and continue talking. Cancer creates a hole that people stand in at times. Cancer’s financial symptoms may scrape the dirt away from under the patient’s and family’s feet, ripping the foundation of an already dire and precarious floor right out from under them.

Bridget Blitz, LCSW, ACHP-SW is a palliative care social worker with Optimizing Advanced Illness Support (OACIS) at Lehigh Valley Health Network, Pennsylvania. When not providing social work home visits, she is either hiking or desperately working toward completing her first pull-up, to win a bet with her thirteen year old son.