Psychosocial Implications of Liver Transplant

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Laura Erica Nicholson
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1 Psychosocial Implications of Liver Transplant Employment Post Liver Transplant: Is Transplant a Barrier or an Opportunity? The Psychosocial Evaluation for liver transplant: UCSF Liver Transplant Program: 1.8 SW Function as integral members of Liver Transplant Team & Selection process Psychosocial assessment Confirm and educate re: support care needs Substance Evaluation/Treatment recommendations Contract for Abstinence and random toxicology screening Linkage with resources: Support Groups/Community Services Supportive counseling/adjustment to illness PACT Score: Tool for Rating Patient Candidacy Employment Pre-Transplant Employment history reviewed during SW evaluation Employment potential post transplant discussed: mixed reactions Spectrum of patients: those continuing work until transplant /on short-term disability or long-term disability Defining Employment & Parameters for Review today Employment: income producing job Age group: 20 s 50 s Homemakers do add significant percentage to total statistics but excluded for purposes of this presentation 1

2 Employment Post Transplant Barriers WHY? #1-Income and # 2-Insurance (or the reverse!) Disability benefits generally fall in the 55% range of prior income Disability benefits will END with successful transplant Medical recovery issues Patient s perception of his/her recovery Inability to return to previous employment: need for training or further education Return to work can promote a sense of wellness & a return to normalcy which are vital elements of recovery and sense of self worth The Economy : the reality of temp/part-time employment without benefits Literature Reviews:1990 spresent Overall findings: Employment in high 20 th percentile high 40 s percentile post transplant High correlation of return to work for patients gainfully employed pre-txp, at a higher income level (reflective of education or training) and patients with NO disability benefits Duke & UCLA studies: Patients drawing disability over 6 mos. demonstrated lower return to work rate Ongoing health problems: whether real or perceived lowered rate Rates higher for higher physical functioning/non-diabetic and those with steady prior work history 2

3 DeBaere study (April 2010) Kidney ranked highest return to work rate at 58.5% followed by heart, liver and then lung at 28.1% Volunteerism rate was comparable to the general public: 17% of transplant patients vs. 21% for general public Programs to support return to work Federal/State programs promoting return to work: Department of Rehabilitation Social Security Administration Ticket to Work (TTW) and Self Sufficiency Program offering career counseling/job search/vocational training These programs offer protection of benefits (SSDI/SSI/MediCal) for those enrolled Get Organized! Helpful Websites Programs available but patient needs to be organized, motivated and have support to get through the bureaucracy Programs can be intimidating and patients fear loss of benefits during work trial periods As social workers/health care providers our role is to help the patient identify a realistic plan and support them through the process

4 Literature Review References: Articles referenced to follow: Span from the mid 1990 s-2010 Available in full text Saab S, Wiese C, Ibrahim A, et al. Employment and quality of life in liver transplant recipients, Liver Transpl 2006;13: Rongey C, Bambha K, Vanness D, et al. Employment and health insurance in long-term liver transplant recipients. Am J Transplant 2005; 5: Sahota A, Zaghla H, Adkins R, et al. Predictors of employment after liver transplantation, Clin Transplant 2006; 20: Hunt CM, Tart JS, Dowdy E. et al. Effect of orthotopic liver transplantation on employment and health status. Liver Transpl Surg 1996; 2: Newton Sarah E. PhD, Recidivism and Return to Work Post transplant. J Substance Abuse Treatment 1999;1-1: De Baere C, Delva D, Kloeck A, et al. Return to work and social participation: Does type of organ transplantation matter?. Transplantation 27 April 2010; 89: Paris W, Calhoun-Wilson G, Slentz B, et al. Employment and the Transplant Patient. The Journal of Rehabilitation; 63, 1997 Olbrisch, M E, Levenson, J L, Psychosocial Assessment of Organ Transplant Candidates, Psychosomatics, 1995 Volume 36 Number 3; Thank You 2010 Transplant Symposium Sherry Laemmermann, ACSW Clinical Social Worker UCSF Liver Transplant Program sherry.laemmermann@ucsfmedctr.org Robert Blackmond Financial Counselor Liver Transplant Program 4

What does a Liver Transplant Financial Counselor Do? Liver Transplant Financial Counselor Patient Insurance Advocate I m so sick; why do I have to talk about $$ right now?

5 What does a Liver Transplant Financial Counselor Do? Liver Transplant Financial Counselor Patient Insurance Advocate I m so sick; why do I have to talk about $$ right now? Patient Educator In Insurance Financial Gate Keeper for the Medical Center Insurance Contracts Letters of Agreements (LOA) Authorizations Money is the last thing patients want to talk about when they are sick!!! Patient Insurance Advocator Appeals (Letter of Agreement) Medi-Cal SOC Appeals COBRA ends (63 day conversion) Patient Insurance Educator Financial Shock Therapy The cost associated with Liver Transplant can exceed $1,000, Do I have to pay $1, ???!!!! National Transplant Foundation 5

coverage Benefit Summary (Deductibles, Out-of-Pocket Maximums, Co-payments, Coinsurance)

medication cost? Copayments Range approx.

6 Patient Insurance Educator (cont.) Liver Transplant Liver Transplant Evaluation Day (Pre/Transplant/Post) Do you have enough coverage Benefit Summary (Deductibles, Out-of-Pocket Maximums, Co-payments, Coinsurance) Coverage Limitations (COBRA, Donors, Disability Insurance)? Are you eligible for Medi-Cal? Fund Raising Medications Cost approx. $6,000/month for first 1-6 months post transplant Patient exercise How much does my medication cost? Copayments Range approx. $130 up to $3,700 for co-pay Post Transplant Financial Expectations (Follow up appointments, labs, medications) Prescription Assistance Program (PAP) Must Financially Qualify Must be a US Citizen LIVER TRANSPLANT = LIFETIME FINANCIAL COMMITMENT Thank you! Questions/Answers 6

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