Practical 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.

Please note that much of the following information – particularly about specific healthcare services and insurance – describes the situation in Germany. You may find that things are different elsewhere.

While you’re in the hospital or in the rehabilitation facility, you can already contact their social services department (Sozialdienst). 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 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 hospital or facility 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, the rehabilitation 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.

If people with German 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 1 percent of their gross household income (instead of 2 percent). Your health insurance fund can give you more information about this.

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’s a good idea to talk directly to your private health insurance company or benefits office (Beihilfestelle).

Even with advanced breast cancer, it’s 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 being 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 returning to work gradually. This model allows working hours to be adjusted in a flexible way. You start by working a few hours a day and then – if you manage that well enough – you can gradually increase your working time. To do this return-to-work program, your employer and health insurer have to agree to it 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), rehabilitation consultants and other people at your employment agency or pension fund.

No longer being able to work can be a big change – not only financially, but also socially. Some women feel they’re no longer an active and equal member of society. Others 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’re 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 or Bürgergeld) at the Employment Agency (Agentur für Arbeit). 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.

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). The aim of this ID card is to compensate for the difficulties that arise due to the illness and associated treatment. For instance, the ID card offers you better job protection, a right to more annual leave and more tax relief. You can also get discounts for entry to things like museums and swimming pools.

The possible benefits depend on how severe the disability is. If your health gets worse, you can apply to have your disability level increased (Grad der Behinderung, GdB). This application to be reassessed is known as a Neufeststellungsantrag.

You can apply for the ID card straight after the first phase of cancer treatment, or at a later point. If you’re in hospital or a rehabilitation facility, the social services department can help you to apply for it. If you’re 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’re 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, (UPD – Unabhängige Patientenberatung Deutschland),
• 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.