What do you have to disclose to an employer?

disclose to an employerMany individuals decide to work through cancer treatment or return to work, while still managing side effects of cancer treatment with medications.  Trying to figure out what has to be disclosed to employers or potential employers is a common concern for individuals.  For more general information about disclosure and privacy, check out our Quick Guide to Disclosure, Privacy, and Medical Certification Forms.

In this blog we wanted to focus on the issue of disclosing medications to an employer.  As with most situations there has to be a balance between the interests of the employer and those of the employee.  An employee may have a legitimate desire to keep the medications they are taking confidential.  An employer may have a legitimate need to know what medications its employees are taking. For example, a school probably wouldn’t want their school bus drivers taking prescription pain medications that would hinder their ability to drive. So, what does the law allow?

The Americans with Disabilities Act (ADA) protects the privacy of medical information of eligible individuals in the workplace. The ADA includes specific rules about how much information about your medical condition you have to share with an employer or potential employer, and when.

Under the ADA, employers cannot require blanket disclosure of prescription medications being taken by all employees. However, there are some exceptions based on where you are in the hiring process and the particular type of job you do.

Prior to receiving an employment offer, potential employers are not legally allowed to ask any questions about your medical condition or general health. After a job offer has been made, employers are allowed to ask you questions about your health history or to complete a medical exam, but only if they would be required of anyone entering a similar job. Furthermore, employers are not allowed to take back the job offer based on the results of a medical exam, unless the results show that you cannot perform the essential functions of that job, with or without a reasonable accommodation.

Once you are working for an employer, you can only be asked to complete a medical exam or questions about your health history, when it is “job-related and consistent with business necessity” or if there is a “direct threat.”

The Equal Employment and Opportunities Commission (EEOC), the federal agency that enforces the ADA, has issued guidelines providing some additional information on these exceptions. In these guidelines, the EEOC uses the example of a police officer. Because there is a significant safety risk involved with a police officer using certain prescription medications, an employer may be able to demonstrate that asking a police officer about his/her prescription drug use is consistent with business necessity. On the other hand, it probably isn’t reasonable to ask a firefighter, who acts in a purely administrative role, about her medications.

Unfortunately, the EEOC doesn’t provide a list of other occupations that would fall within this exception of being “job-related and consistent with business necessity.” So it is unclear, for example, if a nurse or construction worker who operates heavy machinery would have to disclose his/her use of morphine.

The EEOC does point out that there are other laws that might apply to certain employees, such as interstate bus and truck drivers, airline pilots and flight attendants, and mine workers.

If you have access to an Employee Assistance Program (EAP) at work, and you contact an EAP counselor, the counselor may ask you questions about your medical conditions, but only if the counselor: 1) does not work for or on behalf of the employer; 2) is obligated to shield any information the employee reveals from decision makers; and 3) has no power to affect employment decisions.

Resources:

Choosing to share information about your medical condition and the laws that protect your privacy or require disclosure can seem complicated.

For more information about the ADA, visit www.eeoc.gov or read our Quick Guide to the ADA.

For information about disclosure and privacy, read our Quick Guide to Disclosure, Privacy, and Medical Certification Forms.

A Model for All Children’s Hospitals

Sadly, adults are not the only ones touched by cancer.  Kids get cancer, too.  While only triage-cancer-blog-school-reentry1% of all cancer in the United States is found in kids under the age of 15, in 2016 that means 10,380 children.  Childhood cancer has been on the rise for the past few decades.  However there is some good news out there.  Because of major treatment advances in recent decades, more than 80% of children with cancer now survive 5 years or more.

Thankfully, now we need to talk about how children transition from treatment back to school.  There is a lot of discussion about adults returning to work after taking time off to deal with a cancer diagnosis.  We talk about the normalcy, the sense of the purpose, and the chance to socialize that work may bring.  Well, for these kids, returning to school can mean exactly the same thing.  And it also comes with its own degree of challenges.  Thanks to Stony Brook Children’s School Intervention and Re-Entry Program, there is now a model of how to help children transition from treatment to school.

The School Intervention and Re-Entry Team is made up of physicians, nurses, child life specialists, and educational liaisons who work with school personnel including teachers, school nurses, counselors, social workers, psychologists and other staff members in a joint effort to ease the child’s return to the classroom. This is a service that is free to all Stony Brook Children’s patients. Some of the services they provide include:

  • Presentations to the school faculty regarding a patient’s illness and treatment
  • Classroom presentations to the patient’s peers
  • Acting as a liaison between the hospital and the school
  • Arranging for home instruction
  • Advocating for appropriate educational service
  • Attending 504 and CSE/IEP meetings
  • Providing medical documentation to schools
  • Facilitating neuropsychological evaluations and/or other educational testing services
  • Holding ongoing phone consultation regarding school issues, placement, curriculum, accommodations, and other educational services

The program’s services don’t stop at high school either.  This year, they were able to offer a workshop specifically for students with cancer and blood disorders who are transitioning to college. The workshop was designed to educate these students as well as their siblings, parents and school personnel about their unique needs, and to empower this special population of students to realize their academic goals. There was also an expo with representatives from many regional colleges available to speak individually with students and families about their schools, programs, and services.

We recognize that all children are not being treated at Stony Brook Children’s.  But if you are a parent of a child with cancer, you are used to being an advocate for your child.  Let Stony Brooks Children’s School Intervention and Re-Entry Program be a model you advocate for at your child’s hospital.  After all, we all want our children to be healthy and successful in everything they do.

An Update to Cancer Exposure at Camp Lejeune

Cancer Exposure at Camp LejuneIn February of 2016, we notified you that the Department of Veterans Affairs (VA) has acknowledged that exposure to Camp Lejeune’s contaminated drinking water increases your risk for cancer and other medical conditions. Now the rules that will allow potentially thousands of veterans stationed at the base — or surviving spouses — to receive automatic disability benefits if they have been diagnosed with one of eight diseases, have been finalized.

If you or your spouse were stationed at Camp Lejeune for at least 30 cumulative days, between August 1, 1953, and December 31, 1987, and you have been diagnosed with adult leukemia, aplastic anemia, bladder cancer, kidney cancer, liver cancer, multiple myeloma, non-Hodgkin’s lymphoma or Parkinson’s disease, you could be eligible for Disability Benefits from the VA. You will have to submit evidence of the diagnosis and service information.

Please be aware, according to the VA, it is currently taking about 133 days to process Disability Claims.

Getting Back to Work: SSI Employment Support Programs

money-ssiSupplemental Security Income (SSI) pays cash benefits to eligible, low-income individuals who are 65 or older, or have a disability, or who are blind.  SSI is run by the Social Security Administration. There is no requirement to pay into the Social Security retirement system before you can receive SSI benefits, which is different from Social Security Disability Insurance (SSDI).  View our Quick Guide on Disability Insurance for more information.

One thing that both SSI and SSDI have in common is a system of support programs to help you get back to a well-paying job when your medical condition no longer keeps you from working. Please see our blog on SSDI Employment Supports for information on the Ticket to Work Program, which is available to both SSDI and SSI recipients.

In this blog, we would like to share a brief overview of SSI specific employment supports that help determine how much your benefit will be when you try to return to work:

Earned Income Exclusion

The first $65 of the earnings you receive in a month, plus one-half of the remaining earnings will not be counted when determining your benefit amount. This means that they count less than one-half of your earned income when they figure your SSI benefit amount.

Section 1619 – Special SSI Payments for People Who Work

You can still be eligible for SSI and Medicaid while working (under section 1619(b) of the Social Security Act) as long as your earnings remain under your state’s threshold amount, you need the Medicaid coverage, and you continue to be eligible for SSI except for your earnings (meaning you still have a disability).  After you return to work, your Medicaid coverage can continue, even if your earnings (alone or in combination with your other income) become too high for a SSI cash payment.

Reinstating SSI Benefits without a New Application

If you lose your eligibility for SSI because of your work situation, you may be able to restart your SSI benefits again at any time within 5 years, without a new application.  Basically this means if you lose your job or take a pay cut, but are still disabled, your SSI payments will resume immediately.

If you have been ineligible for SSI and/or Medicaid for any reason other than work or medical recovery, you may be able to restart your SSI cash payment and/or Medicaid coverage within 12 months without a new application.

Student Earned Income Exclusion

If you are under the age of 22 and regularly attending school, they don’t count up to $1,780 of your earned income when figuring your SSI benefit.

Property Essential to Self-Support (PESS)

They do not count some resources that are essential to your means of self-support when they decide if you are still eligible for SSI.  For example, they don’t count up to $6,000 of the equity value of a non-business rental property, if that property has an annual rate of return of at least 6%.

For more information about the detailed rules surrounding working while receiving SSI benefits, please visit https://www.ssa.gov/redbook.

This can be very confusing information, so for a complete overview of the entire SSI program go to https://www.ssa.gov/ssi/text-understanding-ssi.htm. You can also call the Social Security Administration at 800-772-1213 or visit your local Social Security office for assistance.

Understanding your options can help you get back to work and get back to normal.

Getting Back to Work: SSDI Employment Supports

triage-cancer-blog-return-to-workReturning to work after being out because of a serious medical condition can be a scary prospect.  It usually takes a person quite a long time to get approved for SSDI benefits, so the thought of giving up those benefits is alarming if you are not 100% sure you’re ready to work.  The Social Security Administration understands that fear, and has you covered, with what they call “employment supports.”

This is a quick overview of SSDI employment supports and how they work together:

Step 1. The Trial Work Period (TWP)

This is an opportunity for you to test your ability to work, during which time you will continue to receive SSDI payments, no matter how much you earn as long as you still have a disability and are reporting your work to the SSA.  The details:

  • The TWP lasts for 9 months
  • The 9 months do not have to be in a row
  • The 9 months must take place within a 60 month timeframe

Step 2. The Extended Period of Eligibility (EPE)

This period begins the month after your TWP ends.  So, if you’ve worked and received benefits for 9 months, on your 10th month you would be in your EPE.  This means you might be eligible for another 36 months of benefits depending on how much you are earning. This one is a little trickier:

  • During your EPE, you will receive benefits for any month you work and your earnings are not considered a substantial gainful activity (SGA).
  • During your EPE there is a grace period. Meaning, if you suddenly get a raise or get more hours at work and your earnings are considered substantial, you will receive benefits for that month and the following 2 months.
  • Your benefits will end if your earnings are substantial in any month after the EPE ends.

Step 3. Expedited Reinstatement (EXR)

Step 3 only comes into play if you have returned to work and your SSDI benefits have ended because your earnings are considered substantial.  EXR is a safety net, meaning it’s there for you when everything is going great, you’re back to work, and then all of a sudden your medical condition flairs up.  The details:

  • If your benefits ended within the last 5 years due to an increase in your earnings, but you still have your original medical condition, you do not have to reapply for benefits.
  • Instead, you will receive 6 months of temporary benefits while your case goes under medical review. Also, if you are found not to be eligible for benefits after that review, you don’t have to pay back the temporary benefits you received.

Please visit www.ssa.gov/redbook/documents/TheRedBook2016.pdf to get a full understanding of the rules surrounding going back to work.

Climbing the Winding Staircase: Navigating Complementary Approaches to Cancer Care

by Oncology Social Worker Rita Abdallah, LISW-S, LCSW-C, ACSW

Complementary Approaches to CancerWhen patients enter the cancer center doors for the first time, they see a tall, spiraling staircase. The mystery unfolds as they unwillingly take their first step onto the staircase. With the help of a medical team and loved ones, patients slowly take on this long and challenging climb. Some days, the way up looks clear and easy; other days the staircase seems dusty and difficult.

Swimming has been a lifelong passion for Cathy, a middle-aged woman with breast cancer. Cathy’s treatment plan included surgery, chemotherapy and radiation. At her initial oncology visit, Cathy and her doctor openly discussed when she could return to the pool. At first, Cathy adjusted her swimming routine to shorter distances. She updated the oncologist on her progress and/or setbacks. Cathy listened carefully to her oncologist for guidance. In time, she went back to swimming at her own pace. Cathy was so happy to reconnect with her body and find her old self again.

Patients soon realize that cancer is a series of steps involving physical, emotional, mental and spiritual effort. Regardless of how fast or how hard the stairs are climbed, patients desire options that minimize suffering and maximize quality of life. Outside of conventional medicine, they may discover less invasive ways of caring for themselves. Complementary Alternative Medicine, or CAM, offers cancer patients chances to feel better and reclaim some of their health choices. When it comes to using CAM and complementary approaches to cancer care, patients need to talk to their healthcare providers, ask questions and carefully evaluate the risks and benefits of each therapy.

What is CAM?

According to the National Center for Complementary and Integrative Health, CAM is defined as:

  • If a non-mainstream practice is used together with conventional medicine, it’s considered “complementary.”
  • If a non-mainstream practice is used in place of conventional medicine, it’s considered “alternative.”

Other useful terms are “Integrative Medicine” which coordinates conventional and complementary approaches within care settings. The National Center for Complementary and Integrative Health officially uses “Complementary Health Approaches” to cover categories ranging from natural products to mind and body practices.

Talking to your healthcare team about CAM

When it comes to talking to healthcare providers about complementary health approaches, patients are hesitant to take that first step. AARP and The National Center for Complementary and Alternative Medicine asked 1,559 people age 50 and older about their use of CAM and why they don’t talk about it at the clinic. Respondents reported that doctors don’t ask about their CAM approaches and patients don’t know they should disclose this information. Some patients believe doctors don’t have time to talk, lack knowledge about CAM and/or discourage patients from using it.

In the cancer setting, it is crucial for patients and the healthcare team to talk about complementary approaches. When chemotherapy, immunotherapy, surgery, transplants and radiation may be a part of the treatment plan, the healthcare team appreciates a full picture of all healthcare choices made by patients. Open and ongoing communication is essential for reducing and avoiding contraindications, undue harm or unknown reactions.  An excellent resource, full of tips, worksheets and resources is a downloadable workbook published by the National Cancer Institute called “Talking about Complementary and Alternative Medicine.” It also includes a great list of questions for patients to take with them to their medical appointment. If patients don’t have the energy or want help with this conversation, they should bring a trusted family member or friend for support.

Risks and benefits of CAM

Doctors and patients share similar challenges with it comes to determine which complementary approaches are proven, safe and effective. Some therapies are not regulated while others are not standardized. The body of knowledge is fast growing but limited depending on use of complementary therapies for specific cancer stages and disease types. Studies may involve animal subjects but not human testing because of unfamiliar side effects. The American Cancer Society has more detailed information on this subject.

Climbing CAM stairs

Once patients get closer to selecting a doctor-approved complementary therapy, they begin the search of a professional to get help. Use these tips to ensure the experience is a positive and favorable one.

  • Check out the latest research on a specific CAM approach
  • Ask your health insurance provider if coverage available
  • Get referrals from friends/family/healthcare provider
  • Find out the practitioner’s education, training, licensing and certifications
  • Call local cancer organization
  • Carefully search online and check sources
  • Try your chosen CAM approach a few times. If it isn’t working out, try something else or take a break. Don’t buy pricy packages or invest lots of time until this option meets your wellness objectives.

To learn more about CAM and Cancer, register for our free live webinar on February 22, 2017. Oncology Social Worker Rita Abdallah will present Complementary Alternative Medicine (CAM) and Cancer: Show Me the Proof! Register today! 

Infections – The Ugly Side Effect of Chemotherapy

triage-cancer-blog-infectionsWe are all familiar with the common cold, flu and ear aches.  These are all infections – either caused by bacteria or viruses.  Sometimes these infections need to be treated with prescription medicines, but often times our body just gets over an infection.  This is because our miraculous bodies have a built in protection called white blood cells.  When we develop an infection, our immune system produces more white blood cells to fight the infection.  This is the process in a typical, healthy person.

Unfortunately if you have cancer, you are not a typical, healthy person.  On top of the cancer itself, the treatment of cancer can make you sick.  Chemotherapy, while it may be saving your life, can also be putting you at risk of contracting an infection.  Chemo is a powerful drug that goes into your body and kills the fastest growing cells in your body – the good and the bad cells.  So the chemo kills your cancer cells, but it also kills your white blood cells.  Remember, white blood cells are the things you need to fight infections.  Generally, you will experience the lowest white blood cell count 7-12 days after your last chemo dose, and it could last for up to a week.  This period of time is called your “nadir,” meaning lowest point.  At this point you are at the greatest risk of getting an infection.  During this time you need to be extra diligent in protecting yourself against, and watching for signs of, an infection. Infections during chemo can be life threatening and may delay your ability to receive your next life-saving chemo treatment.

What are the signs of an infection?

Fever is the number one and most serious sign of an infection.  Take your temperature anytime you feel warm, flush, chilled or generally unwell.  At your nadir you may not be able to fight this infection on your own, so you need to call your doctor if you temperature is 100.4ºF or higher for more than 1 hour, or a one-time temperature of 101ºF or higher.  Seriously, night or day, call your doctor.  Make sure you:

  • Keep a working thermometer near you, and know how to use it.
  • Keep your doctor’s phone number with you at all times. Make sure you know if there is a different number to call when the office is closed.  Do not hold out through the night, waiting for your doctor’s office to open.
  • If you end up going to the emergency room, tell them right away that you are undergoing chemotherapy. You cannot wait around in a germ infested waiting room while your infection is left untreated.

Other signs of infection include:

  • Chills and sweats, with no fever
  • Change in a cough, or a new cough
  • Sore throat, or mouth sore
  • Shortness of breath
  • Nasal congestion
  • Stiff neck
  • Pain when you urinate
  • Unusual vaginal discharge or irritation
  • Increased urination
  • Diarrhea and/or vomiting
  • Redness, soreness or swelling near surgical wounds or ports
  • Pain in the abdomen or rectum

If you experience any of these signs or symptoms you should call your doctor immediately.

Can you reduce your risk of infection?

Every school age child knows that you can avoid a cold or flu by washing your hands.  As a cancer patient receiving chemo, you need to be absolutely obsessive about this.  Good old soap and water are the best choice, but hand sanitizers are a good second choice. You should wash your hands:

  • Before, during, and after cooking food
  • Before you eat
  • After you go to the bathroom
  • After you change a diaper
  • After you touch your pet, or clean up after your pet
  • After touching the trash
  • Before treating any wound

Beyond washing your hands, you should also maintain good oral and body hygiene, use disinfectants to keep your household clean, avoid coming into contact with sick people, and try to avoid getting scraped or cut.  You should also avoid undercooked or raw meat and eggs, avoid unpasteurized or raw products, and wash your fruits and vegetables really well.

Undergoing chemotherapy is uncomfortable enough without getting an infection.  Be overly observant and very, very clean and you can minimize your chances of getting infections.

Working for Yourself, Retiring with Uncle Sam: Social Security for the Self-Employed

triage-cancer-blog-self-employedAnyone who has ever worked for someone else has likely seen the Social Security deduction on their paystub (there are some employees who pay into a private retirement system). This is the tax that is automatically deducted from your pay check each pay period for Social Security retirement benefits. This money (6.2% from your employer and 6.2% from you) goes directly into the Social Security pot. We contribute now and then in retirement we receive a Social Security retirement benefit.  It’s a pretty seamless process.

But what if you’re self-employed?  If you operate a trade, business, or profession either by yourself or with a partner, you may be considered self-employed. Working for yourself can feel quite liberating, but it can be very confusing when it comes to paperwork.  Now that you’re writing the paychecks, you need to report your earnings and pay taxes to the IRS and Social Security Administration.  But how?

The simple answer is that you report your earnings for Social Security when you file your federal income tax return. If your net earnings are $400 or more in a year, you have to report your earnings on Schedule SE, in addition to the other tax forms you have to file.  And now that you’re working for yourself, you have to pay the entire 12.4% tax on up to $118,500 of your net earnings.

Don’t despair!  As a self-employed person, paying into Social Security allows you two income tax deductions.

  1. You can reduce your net earnings from self-employment by half the amount of your total Social Security tax. This means that you can take 6.2% off your net earnings (net earnings are you’re your gross earnings, minus any allowable deductions and depreciation). So if you report net earnings of $100,000, you can take $6,200 off that before you figure your Social Security tax.  This is similar to the way employees are treated under the tax laws, because the employer’s share of the Social Security tax is not considered wages to the employee.
  2. You can also deduct half of your Social Security tax on IRS Form 1040. But the deduction must be taken from your gross income in determining your adjusted gross income.

One of the benefits to paying into the Social Security retirement system in addition to having retirement benefits, is that if you are no longer able to work because of a medical condition, you may qualify for Social Security Disability Insurance.

This is an introduction to a complex topic, so we encourage you to talk to a tax or accounting professional.  You can also visit the Social Security Administration site, where they have a guide on this topic.

Congratulations on being your own boss and best of luck to you!

Are You An Unknowing Beneficiary of a Life Insurance Policy?

Shockingly, there is nearly $1 billion in unclaimed life insurance benefits out there, pexels-photo-187107according to Consumer Reports.  That means that millions of people who were supposed to receive a life insurance benefit didn’t know they were supposed to receive it and did not pursue a claim.  Thankfully, the National Association of Insurance Commissioners (NAIC) are doing something about it.

NAIC recently launched a new online tool called the Life Insurance Policy Locator.  This tool will help consumers search for possible life insurance policy or annuity proceeds anywhere in the nation.  One of the problems consumers had in the past is that they may have suspected they or a family member was the beneficiary of a life insurance policy or annuity, but didn’t have key information like the policy number or the name of the insurance company. With the Life Insurance Policy Locator you can simply start with the person’s name.  Obviously, the more information you can provide is better, but not necessary to submit a request.

This is how it works:

  • Submit a request
    • NAIC will then ask participating companies to search their records to determine whether they have a life insurance policy or annuity contract in the name of the deceased.
    • If you are a beneficiary or authorized to receive information, companies that have policy information for you will respond directly to you.
    • It may take up to 90 business days to be contacted. The insurance company may require additional information from you like a notarized death certificate and documentation of your legal authority to request or obtain information about the deceased.
    • This service is completely free.

If you think that you might be a life insurance beneficiary, it doesn’t hurt to submit a request and see if part of that $1 billion could be yours.

Being Aware of Our Environment: Asbestos and Mesothelioma

Most of us are aware of the toxins in our environment that could be detrimental to our health, like pollution, mold, and secondhand smoke. But many people don’t really think mesotheliomaabout another danger that could be hidden in their walls, the shingles on the roof, or the brake pads of their car: asbestos. Asbestos is a natural fiber that has been mined for decades because of its fire resistant properties. When disturbed, we can inhale these fibers and then they stick to the linings of our organs. Because they’re so durable, our bodies can’t break them down and get rid of the foreign toxin. Instead, anywhere from 10-50 years later, the symptoms of Mesothelioma might start to show.

Mesothelioma, a rare cancer, is known to be caused by exposure to asbestos. The cancer can develop in the lining of the abdomen, chest, or lungs. Pleural mesothelioma, or the type that develops in the lungs, is the most common resulting in 80% of cases. Regardless of the type, patients typically see nonspecific symptoms at first. The earlier symptoms of mesothelioma can include shortness of breath, chest pain, or lack of appetite. This leads to many believing they have the flu or another common, less serious ailment. Being aware of potential asbestos exposure is essential for an early diagnosis. It’s important to also remember secondhand exposure as a serious risk, if any loved ones have worked with asbestos. Though there are only 3,000 cases diagnosed each year, it’s estimated that 20 million people are at risk of developing this cancer and another 125 million people worldwide are exposed to asbestos in their workplaces each year.

Since this disease is so difficult to diagnose, it can sometimes take months for an official diagnosis to be made. In most cases, the disease has already progressed to a later, harder to treat stage. As such, the prognosis for mesothelioma patients is generally very poor. . Recently, there have been great strides made in developing better mesothelioma treatment methods and diagnostic techniques. Immunotherapy, for example, has shown promise for mesothelioma patients in a variety of clinical trials. Initiatives like the Cancer Moonshot 2020, a collaboration like no other to cure cancer, and Microsoft’s Project Hanover, which seeks to use artificial intelligence to solve cancer, also bring hope to patients for the future.

Though a cure for mesothelioma  is still likely a ways off, there are steps we can take to help eliminate and prevent further mesothelioma cases. Asbestos is still not banned in the United States, even though 52 other countries have banned the toxin because of its health risks. Recent progress, however, gives hope for a future ban. Over the summer, the Frank R. Lautenberg Act was passed to amend the Toxic Substances Control Act, which allowed the U.S. Environmental Protection Agency (EPA) to evaluate existing chemicals for environmental and public health risks. On November 29th, their list of the first ten chemicals they will investigate included asbestos. Though this news doesn’t promise a ban on asbestos anytime soon, it’s a huge step in the right direction.

In the meantime, the best prevention is to continue raising awareness on the dangers of asbestos and educating loved ones. Together our voices can help make a difference in banning asbestos and saving millions of lives!