1. Men with MS and Finances Robert T. Fraser, Ph.D., CRC Carmen Orso, RN University of Washington, RRTC Seattle, 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, Continue to Push for Work at Same Level  Secure SSDI, Misguided retraining and “Floods” – No plan  Secure SSDI, plan/utilize all resources

5. Problems coping, relate to 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 hrs Vocational Assessment – 90 hrs Vocational 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 month Does some work for his former employer, p.t. < 4810 a month on his own time

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