Financial wellbeing is key to health outcomes. It is a social determinant of health because without money purchasing medications, engaging in health options or even travel to health appointments becomes problematic.
Yet illness prevention frameworks have clearly ignored financial counselling as part of the toolkit for effective health decision making. Debt is a determinant of health.
Financial counsellors are professionals that provide independent information, advice and support for people in financial difficulty. They are qualified professionals that work in a model of counselling, social justice and legal frameworks to relieve financial difficulty including debt. To work as a financial counsellor you must be qualified (Diploma of Financial Counselling) and maintain skills through professional supervision and continuous professional development activities. The financial counselling profession is regulated by ASIC.
Too often, financial difficulties remain unidentified, impacting on health decisions and compromising outcomes of treatments, surgical interventions, access to aged care services in the community [home care packages] and entry to residential aged care. Debt problems and infringement of financial rights can be and are commonly associated with family violence including elder abuse.
The Department of Health and Human Services (DHHS) in Victoria, has recognised the work of the Financial and Consumer Rights Council (FCRC – peak body for financial counsellors in Victoria) following a two year ‘Dignity and Debt’ project that exposed increasing debt level and vulnerability for older people in the user pay system that now exists in Australia for aged care services.
DHHS rolled out the Integrated Model of Care (IMOC), where financial counsellors, counselling and mediation services are involved alongside Aged Care Assessment teams as a key part of the Victorian Elder Abuse Prevention strategy.
IMOC is currently being trialed in five Victorian health services; Peninsula Health, Melbourne Health, Latrobe Community Health, Western Health and Monash Health. ACAS (Melbourne Health) has seen the value of engaging a financial counsellor in their team – the first to embed this model and develop a specialist approach.
FCRC has undertaken extensive advocacy in health frameworks including work with CancerVic which has included financial counselling on a trial basis in their client support services.
Cancer Australia is undertaking work on developing policy and a model of care that includes financial counselling, which is timely given the approaches developing around financial consent for those newly diagnosed with cancer. Financial consent will work to maximize the user pay aspects of care to free up money to support public healthcare, but again, without a financial counselling assessment of debt and income, consumers may still be assessed as having the means to pay when in fact debt and other issues such as gambling or addictions may prevent them from doing so.
In Victoria, following the Royal Commission into Family Violence, the Andrews government recognised elder abuse as family violence. This has enabled consideration of more robust and inclusive responses to family including the use of financial counselling.
These amazing developments mean that we can consider best practice models and different ways of working. As well as the IMOC, a number of health organisations are engaged in the Health Justice Partnerships (HJP) in hospitals, where a lawyer works within the acute health service team. Whilst this enables identification of legal issues, facilitating management of crises at the pointy end of financial abuse issues, many people don’t have legal issues. The HJP model does not address debt matters which often have a serious impact on wellbeing (including mental health), timely discharge from hospital and representation to acute services, increasing costs to the health care system.
When a person has a chronic or terminal illness diagnosis the first immediate consideration, aside from impacting their health and mental health, are financial issues. These result from loss of income, spasmodic ability to work, the need to access the income support system (Centrelink), costs of managing a health issue (medication, treatments, transport to appointment, hospital parking etc.), secure housing and other financial impositions. Loss of income impacts on the ability to manage household debt relating to utility bills, mortgage costs, rent, personal loans and increases vulnerability to financial exploitation by others, use of fringe and payday lending and increase in use of credit.
Access to financial counselling at diagnosis of a chronic or terminal health issue will provide the individual with a full financial wellbeing assessment and access to grants and tools, one example being timely access to Total and Permanent Disability (TPD) insurance, and Death insurance which are a part of most Superannuation funds these days.
The superannuation definition of Total and Permanent Disability Insurance is different to the medial definition; it means that a person cannot return to the work for which they are adequately trained and experienced. It does not imply that a person does not have capacity to do another type of work sometime in the future with retraining etc. TPD insurance entitlements can range from small amounts to $100,000 or much more depending on the policy and options a person has chosen during their working life; it’s a great way to create financial stability without accessing the capital of the super account. TPD payments can be used to create housing security (paying down/off mortgages/rent in advance; managing debt etc.).
Death benefit can be accessed in the 12 months prior to death if a person is terminal and a doctor verifies this appropriately on the Treating Doctor Report. ClientS often need assistance with these processes.
Basic knowledge about superannuation entitlements and processes can prevent people with cancer diagnoses and chronic debilitating illnesses from racking up large credit card debts whilst chasing cures or paying for additional treatments and services, or managing mortgages/rent and other debt.
A person (and their family) can go to a situation of extreme disadvantage very quickly – most of us are only one illness away from poverty. It’s always handy to do the financial wellbeing check on yourself- How long can you survive without getting paid? How long can you pay your mortgage or rent? How long can you manage the car loan? Most people find they cannot survive more than a couple of months max.
Social workers, the corner stone of ensuring patients can manage care transitions and significant health events, are often flooded with financial matters relating to individuals who are in acute/community care/rehab, and often act in the role of a financial counsellor without realising such a role exists or being qualified to do so.
Consumers may end up with issues of financial and asset loss due to inappropriate financial assessment and/or negotiation, and funds intended to assist the client in crisis (eg. family violence financial packages) are frequently used to pay debt that can be waived through financial counselling intervention. Financial Administration orders are often unnecessarily activated, causing anxiety and disempowerment of capable people.
Professionals who provide financial counselling services and do not meet the ASIC regulations (currency of practice, Diploma of Financial Counselling, membership of financial counselling sector peak body and required continuous professional development and supervision) open themselves up to being sued for financial and non-financial loss.
I encourage nurses, social workers and other health professionals to explore the availability of financial counselling for their patients, and health services to consider employing a financial counsellor in their social work teams to manage social worker workload, get better health outcomes and prevent the trauma of individual financial burdens from impacting the health system through longer stays and re-presentation for chronic issues and inability to comply with treatment and medications.
The Dignity and Debt – financial difficulty and getting older project report can be read on the Financial and Consumer Rights council website http://www.fcrc.org.au/News_Publications/Reports.htm
Information about IMOC can be found here https://www2.health.vic.gov.au/ageing-and-aged-care/wellbeing-and-participation/preventing-elder-abuse/integrated-model-of-care-for-responding-to-suspected-elder-abuse
If you are interested in learning more or would like an education session for your health team contact Bernadette Pasco by email: bpasco@fcrc.org.au
Bernadette Pasco is a registered nurse and financial counsellor; one of her current roles is Project Lead; Elder Abuse Prevention and financial counselling as part of the IMOC development in educating financial counsellors about the aged care and health systems and health professionals about financial counselling.
