Oncology Social Work

What is the Family Medical Leave Act (FMLA)?

The Family Medical Leave Act is a federal law that allows eligible employees to take up to 12 weeks of unpaid, job-protected leave each year.

When is it appropriate to request leave under the FMLA?

You can claim FMLA leave if you or a close relative (your child, spouse, or parent) require care because of a serious medical condition.

Is my employer required to offer FMLA leave?

Not necessarily. Private employers with more than 50 employees and all public agencies regardless of number of employees are required to offer FMLA.

Do I qualify for FMLA leave?

In order to qualify, you must have worked for your employer for:

• At least 12 months in the past seven years
• 1,250 hours in the past 12 months.

How long can FMLA leave last?

You can take FMLA leave for 12 weeks (continuously or intermittently). Employers can choose one of four 12-month periods:

• A calendar year
• A 12-month period from the date you first take leave
• A rolling 12-month period
• Any other fixed 12-month period

Unused weeks do not roll over to the next 12-month period.

How is my health insurance coverage affected by taking FMLA leave?

If you have health insurance through your employer, this coverage remains in place. You (the employee) remain responsible for paying your portion of the insurance premium.

Is there a time frame in which I need to apply for leave under the FMLA?

Yes. Request FMLA leave as soon as you know you will need time of. Your clinic nurse can help you fill out FMLA forms and make sure they are signed by a physician. An employer can deny an FMLA leave request but must provide an appropriate reason for denial.

Do I have to tell my employer about my illness?

No. Although your employer is entitled to medical certification from a physician to verify your eligibility for FMLA leave, you do not have to specify your diagnoses.

Do I get paid through the FMLA?

No. The FMLA does not provide an income benefit.

How does paid time off (PTO) work with the FMLA?

You can use PTO or paid sick days at the same time as FMLA leave in order to maintain your income.

Can I lose my job while taking FMLA leave?

Your employer must reinstate you to the same (or an equivalent) job following your FMLA leave. Some professions, such as military service members and airline fight crews, have special rules under the FMLA.

Additional Resources:

• Triage Cancer
• Department of Labor

What’s the goal of home health care?

Home health care is intended to help you meet specific rehabilitative goals that are indicated by your medical team.

What services are provided?

Home health care services include:

• Wound care, injections, medical management, education, and other skilled nursing needs
• Physical therapy, occupational therapy, speech therapy, and other skilled rehabilitation needs. (You must be able to participate in therapy and make daily progress toward rehabilitative goals.)
• Some home health care agencies can provide an aide to help you with bathing, toileting, and other personal care. To qualify for a home health aide, you must have a need for skilled medical care. Check with your home health care agency about the availability of aide services.

How is this paid for?

Your health insurance might pay for home health care services.

Do I need a physician’s order?

Yes. Your physician must state that you have a need that requires a licensed medical professional to provide care for you at home.

To qualify for home health care, you must be homebound (i.e., not working or driving) or in a condition that requires considerable and taxing effort for you to leave home.

How often do staff come to my house?

Typically two to three times each week, or as determined by your physician’s orders and an initial assessment by the home health care nurse. These visits are relatively short (15 - 45 minutes) and cannot be scheduled for nighttime or weekends.

What is custodial care?

Custodial care is a flexible service that helps you with activities of daily living rather than with specific medical goals.

What services are provided?

Custodial care services include common activities of daily living (ADLs):

• Bathing, dressing, hygiene, transfers, toileting, ambulation, and other personal care needs

And services include instrumental activities of daily living (IADLs), such as :

• Meal preparation
• Medication reminders
• Transportation for shopping, medical appointments, pharmacy trips, and other errands

How is this paid for?

Custodial care is typically an out-of-pocket expense. In Dallas-Fort Worth, this care is often $20-25 per hour, although the rate might vary depending on the number of hours you need. If you have long-term care or qualify for Veterans Aid and Attendance benefits, you might have coverage for custodial care.

Some insurances (particularly Medicare Advantage & Medicaid plans) do have attendant care benefits. Patients can directly call their insurance providers to find out if they have benefits. Patients may also speak with their social worker about eligibility for care through the Department of Health and Human Services.

Do I need a physician’s order?

No. Because these tasks are not performed by licensed medical professionals, a physician’s order is not necessary.

How often do staff come to my house?

Custodial care staff can stay all day, overnight, on weekends – even 24 hours a day. You coordinate with the care company to arrange a schedule that works best for you.

What’s the goal?

Custodial care is a flexible service that helps you with activities of daily living rather than with specific medical goals.

What is disability insurance?

Disability insurance is a benefit that provides some compensation or income replacement for non-job-related injuries or illnesses that render you unable to work for a limited period of time.

Who provides short-term disability insurance?

Your employer might provide short-term disability insurance if you (the employee) elected and paid for this type of coverage. Some people elect to pay for a private policy instead.

Who is eligible for this benefit?

Only full-time employees (30+ hours/week) are eligible.

Is my employer required to offer this policy?

No. Only a few states (CA, HI, NJ, NY, and RI) require employers to offer short-term disability policies.

Do I need to file or apply for this benefit? How long will that take?

Yes. Many policies have a requirement for how many days you are out of work before you can submit a claim. Speak with your employer’s human resources department for more information.

How much will I get paid?

Income benefits are usually 50 - 80% of your earned base wage.

How long does this benefit last?

Benefits typically last three to six months. Some policies last up to one year.

How much does a disability insurance policy cost?

When employers offer a policy, typically 1 - 3% of your annual gross wages retain that policy. Costs vary depending on factors such as weight, tobacco use, gender, age, profession, ZIP code, preexisting conditions, and more.

What is disability insurance?

Disability insurance is a benefit that provides some compensation or income replacement for non-job-related injuries or illnesses that render you unable to work for a limited period of time.

Who provides long-term disability insurance?

Your employer might provide long-term disability insurance if you (the employee) elected and paid for this type of coverage. Some people elect to pay for a private policy instead.

Who is eligible for this benefit?

Only full-time employees (30+ hours/week) are eligible.

Is my employer required to offer this policy?

No. Fewer than one in three workers in the U.S. have long-term disability policies.

Do I need to file or apply for this benefit? How long will that take?

Yes. Many policies have a requirement for how many days you are out of work before you can submit a claim. Speak with your employer’s human resources department for more information. (Be aware that when short-term benefits roll to long-term benefits, you must also apply for Social Security Disability Insurance.)

How much will I get paid?

Income benefits are usually 40 - 60% of your earned base wage.

How long does this benefit last?

Benefits typically last one to two years, with some policies lasting as many as five years. Other policies end when you reach Social Security retirement age.

How much does a disability insurance policy cost?

When employers offer a policy, typically 1 - 4% of your annual gross wages retain that policy. Costs vary depending on factors such as weight, tobacco use, gender, age, profession, ZIP code, preexisting conditions, and more.

What is disability insurance?

Disability insurance is a benefit that provides some compensation or income replacement for non-job-related injuries or illnesses that render you unable to work for a limited period of time.

Who provides Social Security Disability Insurance (SSDI)?

SSDI is a federal program managed by the Social Security Administration.

Who is eligible for this benefit?

Applicants must:

• Be disabled, be unable to work for at least one year, or have a condition that will result in their death
• Have (or have had) a job that pays into the Social Security system
• Have 40 work credits as measured by the Social Security system. Workers under age 31 may qualify for SSDI based on a prorated number of work credits. (Each working year earns four credits. Twenty credits must have been earned in the past 10 years.)

Even if you are not a U.S. citizen, you may qualify for SSDI benefits through your work history, military service, or other criteria.

Is my employer required to offer this policy?

Not applicable.

Do I need to file or apply for this benefit? How long will that take?

Yes. After you submit an application, the Social Security Administration generally takes three to five months to make a determination. Compassionate Allowance applications take roughly 19 days to process. If your application is approved, there is a five-month waiting period to receive your first payment. After receiving SSDI benefits for 24 months (two years), you automatically qualify for Medicare.

How much will I get paid?

Benefit payments depend on your average lifetime earnings. If you receive other government benefits, those might affect your SSDI payment. In 2020, the average monthly SSDI payment for an individual was $1,258. You can visit the Social Security Administration website to calculate an SSDI benefit estimate.

How long does this benefit last?

It depends. If you are awarded SSDI benefits, the Social Security Administration may periodically review your case to see if you continue to meet criteria for these benefts. It is possible to receive SSDI benefits until you reach retirement age.

How much does a disability insurance policy cost?

SSDI is funded by payroll tax contributions by U.S. workers and their employers.

What is hospice care?

Hospice is a type of care available to terminally ill patients who have decided treatment is no longer desired or helpful.

Who provides this service?

Hospice care is managed by an agency whose specialized team comprises a physician, nurse, aide, social worker, and chaplain. The hospice team supports patients, families, and caregivers. Medication and equipment for patient care are provided through a hospice agency.

How is this paid for?

Most insurance plans pay hospice benefits when they are ordered by a physician who has verified that a patient has a qualifying diagnosis. Agency staff typically visit patients at home to provide care. Patients living in residential facilities can also receive hospice care; however, insurance will cover only medical care, not room and board expenses for longterm stays in a facility.

What is a nursing home?

This is a residential facility where patients might live when they need long-term assistance with activities of daily living (ADLs).

What services are provided?

Nursing homes provide residents with nursing care, custodial care, meals, and transportation to/ from medical appointments. Most rooms are shared by two people.

How is this paid for?

Payment for a nursing home might come from a long-term care insurance policy, Medicaid, Veterans Affairs benefits, or personal funds. Medicare and other medical insurance do not cover this service.

What is a skilled nursing facility?

Upon discharge from the hospital, you might stay at a skilled nursing facility for a limited time period while receiving skilled nursing services or rehabilitative therapies. Skilled nursing facilities are not long-term residences.

How is this paid for?

Medical insurance often covers a stay for up to 21 days (with certain qualifcations). Patients may stay up to 100 days with a co-pay (or as indicated by their private insurance).

What is rehabilitation?

Physical, occupational, and speech therapy are available to patients in inpatient, outpatient, and home-based settings. If you need more than three hours of therapy per day, your physician might refer you to a rehabilitation facility for a brief period of time ( three to 14 days) to receive these services.

How is this paid for?

Most medical insurance plans pay for this service when the care is medically indicated by your physician. The amount of rehabilitation service allowed per year might be limited.