Finding support - formalities and financial aspects

You might feel anxious or unsettled when a long stay in an inpatient facility comes to an end. Which doctors will see to my medical treatment? How will I cope with my everyday life at home? How can I look after my kids? How will I manage to return to work? These are some of the questions many women ask themselves. If you're worried about what will happen next once you've returned home, you can rest assured that there are places you can go to for help and support.

While you are in the hospital or in the rehabilitation clinic, you can already contact the (clinic’s) social services department. If you aren't sure who to talk to, ask the nurses or doctors on your ward about the social services. A social worker there can plan your discharge and the time after that with you. You and/or your family might be entitled to home help or outpatient nursing care. The social worker can also give you emotional and practical support in planning your day-to-day life, and help you apply for additional social or financial help to make it easier for you to return to your everyday life.

Your clinic might also offer you transitional care to make your return home as smooth as possible. At the end of this article you will find a selection of services in Germany offering information, counseling and support.

In Germany, your statutory health insurance fund (Krankenkasse) pays for all interventions that are medically necessary, including outpatient treatment, hospital treatment, therapeutic interventions like physiotherapy, and healthcare products like breast prostheses. The costs of rehabilitation are usually covered by your health insurance or pension fund (Rentenversicherung). The pension fund is usually responsible, for example, if the aim of rehabilitation is to prevent people becoming unemployed due to disability. For the costs to be covered, it always has to be prescribed by a doctor. The clinic’s social services can also help you in matters concerning your health insurance, and support you when you apply for rehabilitation or home help.

In Germany, as an employee with statutory health insurance, you get sickness benefit for a maximum of 78 weeks in three years if you are unable to work because of one illness. Within this period of time you are entitled to sickness benefit for 18 months at a stretch, or several times for shorter periods. You can apply to your health insurer for this kind of sickness benefit.

In Germany, if people with statutory health insurance have lived with cancer for a long time, the maximum amount that they have to pay themselves is lower. They then only have to pay a maximum of one per cent of their gross household income (instead of two per cent). Your health insurance fund can give you more information.

Some of the regulations on services and cost coverage differ for public servants (Beamte) and people with private health insurance. If this applies to you, it is a good idea to talk directly to your private health insurance company or benefits office (Beihilfestelle).

You can also apply for an ID card for severely disabled people (Schwerbehindertenausweis) at the pension and social security office (Versorgungsamt). If your health gets worse, you can apply to have your disability level increased (Grad der Behinderung, GdB). The ID card for severely disabled people allows you to get discounts and better job protection at your workplace.

Even with advanced breast cancer, it is still possible to have a good quality of life for a number of years. For many women, this includes going to work.

People who want to get back to work after having been ill for a long time often can't work as much as they used to right away. In Germany, the “Hamburg model“ offers the possibility of step-by-step professional reintegration. This model allows working hours to be adjusted in a flexible way. You start by working a few hours a day, and if you manage that well enough you can gradually increase your working time. To do this kind of reintegration you need to get the approval of your employer and your health insurance fund first.

But it's sometimes no longer possible to go back to work. You may then be able to re-train and go for a change of career. Your employer may also be reimbursed for the costs of technical aids to help at work, the adaptation of your workplace to account for your disability, or for any training that is needed. You can find out more about this from your local social welfare office (Hauptfürsorgestelle), employment agency, your pension fund or a rehabilitation consultant.

No longer being able to work can be a big change – not only financially, but also socially. Some women feel they are no longer an active and equal member of society. Other women leave their jobs without regret, dedicate themselves to other tasks and spend more time with family and friends.

Your priorities might change over time. Only you can find out what activities are particularly important to you and what kind of environment you are comfortable in. You might be able to talk to your employer about working part-time. It may also be possible to switch to a more flexible job, either paid or on a voluntary basis.

In Germany, under certain conditions, you can apply for unemployment benefit (Arbeitslosengeld I or II) at the Employment Agency (Agentur für Arbeit) or for social benefit (Sozialgeld) at the social welfare office (Sozialamt). The German Cancer Aid (Deutsche Krebshilfe) has a hardship fund to give small-scale, non-bureaucratic and quick help if people have financial problems caused by cancer.

In Germany, if you can't go back to work or are only able to go back to a limited extent, you can apply for a pension at your pension fund. Depending on your age and whether you fulfill additional requirements, you can apply for a regular "old-age" pension or for a disability pension. If you have disability insurance (Berufsunfähigkeitsversicherung), the conditions for getting a disability pension may be fulfilled.

In Germany, people who have cancer can apply for a special ID card for the severely disabled (Schwerbehindertenausweis). This ID card offers various advantages to compensate for the difficulties that arise due to the illness and associated treatment. For instance, those who have the ID card have better job protection, a right to more annual leave and more tax relief. They also get discounts for entry to things like museums and swimming pools. The advantages they are entitled to depend on the severity of their disability.

You can apply for the ID card straight after the first phase of cancer treatment, or retroactively. If you are in hospital or a rehabilitation clinic, the social services department can help you to apply for it. If you are at home, you can get help from places like your local citizen service center (Bürgeramt), social security authority (Versorgungsamt) or cancer information center (Krebsberatungsstelle). Your family doctor is sure to be able to help too.

In Germany, you are entitled to a wide range of support and services, including sickness benefit, home help or nursing care. There are numerous places where you can get advice and help if you want to apply for support.

Experts can help you, both with personal decisions and with financial or socio-legal issues. You can get individual advice – either over the telephone or in person – from

• the Cancer Information Service (Krebsinformationsdienst),
• Independent Patient Counseling Germany, (Unabhängige Patientenberatung Deutschland – in German, Turkish, and Russian),
• various cancer information centers (in German),
• your health insurance or pension fund,
• your social welfare office (Hauptfürsorgestelle) and equal opportunity office (Integrationsamt),
• social security authority (Versorgungsamt) and
• local (psycho)social counseling centers – the social services department or your local health authorities will be able to provide you with contacts.

You can also contact hospital social services or a rehabilitation service center. These facilities offer information on medical and job-related rehabilitation and help you to file applications. You can get the addresses from your health insurer or pension fund.