Understanding Disability Benefits For Dementia And Stroke Patients

Dementia and stroke patients may be eligible for disability benefits, but the amount they receive depends on various factors. In the US, patients may qualify for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits if they are unable to work for at least a year following their stroke or due to dementia symptoms. The SSA evaluates disability claims for dementia under listing 12.02 for neurocognitive disorders, requiring patients to demonstrate significant cognitive decline. Stroke victims may qualify under listing 11.04 for vascular insults to the brain. Additionally, patients with vascular dementia resulting from a stroke may be eligible for disability benefits under the category of vascular lesions in the brain. The amount of benefits received depends on the specific program and the patient's needs. In the UK, patients with dementia may be entitled to disability or mobility benefits such as Attendance Allowance, Personal Independence Payment (PIP), and Disability Living Allowance (DLA). These benefits are paid at different rates depending on the patient's needs and are not means-tested.

Qualifying for disability benefits

Dementia is a recognised disability, and in the US, the Social Security Administration (SSA) considers it as such. The SSA Blue Book, a document of qualifying conditions, lists dementia under the sections of neurodegenerative disorders of the central nervous system and neurocognitive disorders. The Americans with Disabilities Act (ADA) also considers dementia a disability.

Qualifying criteria

The SSA's criteria for qualifying for benefits with dementia are as follows:

• You regularly experience symptoms related to your dementia, and you have demonstrable declines in one or more of the six cognitive domains:
• You have extreme limitations in one of the following areas, or marked limitations in two or more of these areas:
• Appropriately managing yourself and adapting as necessary
• Concentrating and keeping up
• Interacting with others
• Understanding, remembering, or applying information
• Other health conditions associated with dementia

Application process

The SSA will evaluate:

• Medical evidence: This can include your medical history, exam findings, and results of relevant lab tests and imaging.
• Non-medical evidence: This includes statements made by you or by others about your impairments, restrictions, daily activities, and efforts at work.

Additional notes

• Applying with more than one qualifying condition can strengthen your disability application. Many individuals with dementia have other age-related conditions, chronic illnesses, and neurodegenerative disorders.
• You may qualify for Social Security disability benefits (SSDI or SSI) if you have symptoms of dementia that keep you from working full-time for at least 12 months.
• Stroke victims may qualify under listing 11.04 for vascular insult to the brain.
• Early-onset Alzheimer's disease may qualify under the Compassionate Allowances list, which can expedite the approval process.
• The SSA evaluates disability claims for dementia under listing 12.02 for neurocognitive disorders.

How much you could get from SSI

In the United States, you may qualify for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) if you have symptoms of dementia that prevent you from working full-time for at least 12 months. SSDI eligibility is based on your work history, while SSI is needs-based and subject to financial limits.

The maximum monthly SSI payment for 2024 is $943 for an individual and $1,415 for a couple. However, your amount may be lower depending on factors such as your income, the income of certain family members, and your living situation. For every $2 you earn from work, your SSI payment will be reduced by about $1. Additionally, if you live with a spouse, their income may also affect your payment.

If you are a child receiving SSI and live with your parents, your payment may be lowered based on your income or your parents' income. Similarly, if you live in someone else's home and do not contribute fairly to food and shelter costs, your SSI payment may be reduced by up to $334.33.

It is important to note that some states offer an extra payment called a "state supplement" to help with food and shelter costs, and this will not reduce your SSI payment.

Qualifying for SSDI

SSDI, or Social Security Disability Insurance, is a form of disability insurance available in the US. It is paid to people with a disability who have worked in a job where they paid Social Security taxes long enough and recently enough.

Dementia is a progressive decline in cognitive abilities, affecting memory, language skills, judgment, and personality. It is caused by brain damage from impaired blood flow to the brain, often as a result of a stroke. Dementia patients may qualify for SSDI if they can prove that their symptoms are severe enough to cause significant limitations in how they function.

To qualify for SSDI, patients must meet the requirements of a disability listing. The Social Security Administration (SSA) maintains a list of about one hundred medical impairments that are considered especially severe and can result in automatic qualification for SSDI. Stroke victims, for example, may qualify under listing 11.04 for vascular insult to the brain.

In the case of dementia, the most common disability listing that patients qualify for is neurocognitive disorders (listing 12.02). To get disability approval, patients need to demonstrate "significant cognitive decline" in one or more areas, including:

• Executive functioning
• Perceptual-motor
• Learning and memory
• Complex attention
• Language
• Social cognition

The SSA will review medical records for evidence of an "extreme" limitation in one or a "marked" limitation in two of the following work-related areas of mental functioning:

• Understanding, remembering, or using information
• Concentrating and completing tasks
• Interacting with others in a socially appropriate manner
• Adapting or managing oneself

Even if patients don't have marked or extreme limitations, they can still get disability approval if their dementia symptoms have been ""serious and persistent" for two years and they live in a highly structured setting.

If patients don't meet the criteria for a listing, they may still qualify for SSDI if they can demonstrate that their medical condition prevents them from working at their old job or any other job. The SSA will conduct a Residual Functional Capacity (RFC) assessment to evaluate physical and mental capabilities and determine if there is any job the patient can do, taking into account age, education, and other factors.

The process of applying for SSDI can be long and complex, and applicants have a better chance of approval with legal representation. It is recommended to consult an experienced disability lawyer when applying for SSDI.

Compassionate Care Benefits

Compassion is an essential component of good-quality care. However, the level of compassion in health systems for people with dementia is often suboptimal, which can negatively impact clinical outcomes and patient experiences.

Understanding Compassion

The Latin roots of the word "compassion" include the verb "patior" (to suffer) and the affix "cum" (with). In healthcare, compassion can be defined as:

> a virtuous response that seeks to address the suffering and needs of a person through relational understanding and action.

Healthcare professionals conceptualise compassion as:

> acting with warmth and empathy, providing individualised patient care and acting in a way you would like others to act towards you.

Factors Influencing Compassionate Care

Three key factors influence the delivery of compassionate care to people with dementia:

• Patient factors
• Student factors
• Connection

Patient Factors

The presence of challenging behaviours in patients with dementia, such as violence, aggression, frustration, or distress, can reduce the level of compassion they receive.

Student Factors

The amount of experience that healthcare students have with people with dementia, as well as their knowledge and clinical and communication skills, can influence the level of compassion they are able to provide.

Connection

Compassion is enhanced when healthcare students understand the person behind the dementia diagnosis, their life, their family, and their preferences. This knowledge helps students recognise the person's humanity and maintain their dignity.

Benefits of Compassionate Care

The benefits of compassionate care are relevant to all health and social care sectors. Formal carers and others do not require an in-depth knowledge of the disease to incorporate acts of kindness and deliver care in a humane, compassionate manner.

For example, in a study of bereaved carers of people with dementia, a participant noted an act of kindness from a hospital secretary:

> [S]he said “I believe your husband likes nice coffee, he can have a nice cup of coffee with me” so she brought special cups in, biscuits and special coffee for him.

Challenges to Providing Compassionate Care

There are several challenges to providing compassionate care, including routinisation, traumatic events, and compassion fatigue. Additionally, there may be a lack of training and support for care staff, and the hard work of caring is often undervalued.

Other financial assistance

There are several other sources of financial assistance for individuals with dementia and their caregivers. These include:

• Tax credits and deductions: There are tax credits and deductions that are relevant, but not specifically designed for people with dementia. The Tax Credit for the Elderly or the Disabled can save families thousands of dollars per year. Additionally, medical and dental expenses, as well as costs associated with residential memory care homes and home modifications, may be tax-deductible.
• Reverse mortgages: A reverse mortgage allows individuals aged 62 or older to convert home equity into income while remaining the homeowner. However, it may not be a suitable option for individuals with dementia who may need to move into a care facility in the near future.
• Caregiver mortgages: A type of reverse mortgage where a parent can use their home equity to pay their adult child for in-home care. This can provide compensation for caregivers, protect the home from Medicaid estate recovery, and minimise inheritance taxes.
• Alzheimer's care loans: These are bridge loans intended for periods of less than two years, for families who have an immediate need for care but will have access to funds in the future.
• Non-profits and foundations: Local non-profit organisations and national foundations may provide services such as free or reduced-rate respite care.
• State-specific, non-Medicaid programs: Many states offer financial assistance for individuals with dementia, either through specific dementia programs or more general age-related care programs. These programs typically have limited funding and may have waiting lists.
• Adult day care services: Most states offer some financial assistance for adult day care, which can provide support for caregivers during work hours. Medicaid and VA Pensions may also cover the cost of adult day care.

Frequently asked questions