The financial impact of having a stroke

 

Managing Money After a Stroke

One way to alleviate some of the costs incurred after a stroke is to review your health insurance to ensure you are getting all the benefits you are entitled to. — Freepik

A big financial impact

The aftermath of a strokr can be expensive with medicines, assistive devices, home modifications, and caregiver costs, coupled with potential loss of income. 

The financial impact of a stroke can be overwhelming and unpredictable.

The lifetime cost of ischaemic strokes – which comprise over 80% of strokes and are caused by blockage of blood vessels supplying part of the brain – were estimated at US$140,481 (RM659,698).

This includes the cost of inpatient care, rehabilitation and follow-up care.

A study that looked at the cost of post-stroke outpatient care in Malaysia in 2015, found that the average total cost incurred was US$547.10 (RM2,569.18).

Of this figure, 36.6% was spent on attendant care, 25.5% on medical aids, 15.1% on travel expenses, 14.1% on medical fees and 8.5% on out-of-pocket expenses.

The main factor in the cost of post-stroke outpatient care was the severity of the stroke.

Increased costs was also associated with a haemorrhagic stroke – the other main type of stroke, which is caused by the bleeding, or haemorrhage, of a blood vessel in the brain.

Leading a safe and cost-effective life post-stroke requires a combination of self-care, medical management and lifestyle adjustments.

Here are some steps that can help:

> Follow medical advice

It’s important to follow your healthcare provider’s advice on medication, rehabilitation and lifestyle modifications.

This may include taking medication as prescribed, attending rehabilitation sessions, and making changes to your diet and exercise routine.

> Manage chronic health conditions

If you have other chronic health conditions such as high blood pressure or diabetes, it’s important to manage these conditions to reduce the risk of future strokes and other health complications.

> Make home modifications

Consider making modifications to your home to reduce the risk of falls and improve your safety.

This may include installing grab bars, non-slip mats and handrails.

> Use assistive devices 

Assistive devices such as canes, walkers and wheelchairs, can help you maintain your mobility and independence.

> Adopt healthy habits

Adopting healthy habits such as eating a balanced diet, exercising regularly and getting enough sleep, can help you maintain your overall health and reduce the risk of future strokes.

> Stay socially active

Staying socially active and engaged can help reduce the risk of depression and improve your overall quality of life.

Consider joining a social group or doing volunteer work.

> Manage finances

Stroke can have a significant financial impact on the family, especially if the stroke patient is the sole breadwinner.

So it’s important to manage your finances carefully.

By following these steps and working closely with your healthcare team, you can lead a safe and cost-effective life post-stroke.

Managing the financial impact

As mentioned above, no doubt, one of the biggest challenges post-stroke would be the financial impact on the patient and their dependents.

Financial burdens following a stroke may be due to medical expenses and decreased income because of the inability to work, whether it is the patient themself or a family member who has to quit their job to become a full-time caregiver to the patient.

Addressing financial needs post-stroke can be challenging, but here are some strategies that can help:

> Review your insurance coverage

Examine your insurance coverage to make sure it includes all the necessary benefits and services, such as rehabilitation and home healthcare.

Consider speaking with an insurance specialist to ensure you are getting the most out of your coverage.

> Explore disability benefits

If you are unable to work because of stroke, you may be eligible for disability benefits.

Socso provides a range of benefits for employees, including medical treatment, rehabilitation and financial assistance.

There are also many NGOs (non-governmental organisations) that offer financial assistance to stroke patients and their families, including the National Stroke Association of Malaysia (Nasam), Stroke Care Malaysia, etc.

These organisations can help with medical bills, transportation costs and other expenses related to stroke care.

> Create a budget

You and your dependents should review your daily expenses and financial commitments to see what can be adjusted to compensate for the decrease in income and increase in stroke-related expenses.

A leaner budget might have to be created for the family to follow, to ensure that you don’t go into unsustainable debt, or even bankruptcy.

What’s good for yourself

It is also important, though challenging, to develop a sense of what is good for oneself after a stroke.

Here are some methods that can help:

> Listen to your body

Pay attention to your body and how it responds to different activities and situations.

Take note of what makes you feel better or worse. and adjust your routine accordingly.

> Set realistic goals

Set achievable goals that are tailored to your abilities and interests.

This can help you build confidence and a sense of accomplishment, which can improve your overall well-being.

> Prioritise self-care

Make self-care a priority, including getting enough rest, eating a healthy diet, and engaging in physical activity, as recommended by your healthcare providers.

> Seek support

Connect with others who have experienced stroke or other health challenges.

Consider joining a support group or seeking individual therapy to help you process your emotions and develop coping skills.

> Practice mindfulness

Mindfulness practices such as meditation, yoga or deep breathing, can help you become more aware of your thoughts and feelings, and develop a greater sense of inner calm and well-being.

> Experiment and adjust

Be willing to experiment with different approaches to self-care and self-discovery, and be open to adjusting your routine as needed.

By focusing on self-care, seeking support, and staying open to new experiences and perspectives, stroke patients can develop a greater sense of what is good for themselves and their overall well-being.

In a nutshell, it is not impossible for a person to regain a normal life after a stroke.

The real challenge lies in how stroke survivors can manage their post-stroke life and deal with the challenges from then on effectively.

Remember, there will always be light at the end of the tunnel for stroke survivors!

Dr Lee Tze Yan is a senior lecturer in molecular medicine at Perdana University. Matthew Teo Yong Chang is an occupational therapist specialising in stroke rehabilitation and senior lecturer at Manipal University College Malaysia. For more information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only, and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this article. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

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Life after a stroke, post-stroke care crucial

The rise of risky Internet casinos gambling among youths

Betting among youths more popular with rise of Internet casinos

PETALING JAYA: Gamblers are getting younger and increasingly using the Internet to try their luck in hopes of striking it big.

Besides gambling in online casinos, there are also bookies as young as 13, who take bets in school on football matches.

Gamblers Rehab Centre Malaysia president David Chiang said young punters were a worrying trend, with some already becoming habitual gamblers at 15.

“Youths usually gamble over the Internet because it is not regulated. They will obviously get stopped at casinos because of their age. So they turn to online casinos instead,” he said.

Chiang said youths could also deceive their parents into believing they were conducting research over the Internet when they were actually gambling online.

Addictive vice: Two boys visiting an online casino website. Teenage gambling is becoming more rampant with easy access to Internet casinos and young bookies taking bets in schools.

 

“Parents will easily believe them because the Internet is such a huge part of the lifestyle of youths today,” he said,

Chiang said young people were able to gamble in online casinos because they could borrow credit from online brokers, who offered their services on the websites.

“If the teenage gambler loses the credit, the broker would then pay the online casino first with a credit card. The teenager has to repay the broker in cash,” he said, adding that besides betting on games like roulette and poker, young gamblers were also fond of sports betting, especially football.

“The youngest habitual gambler I know is a 15-year-old. Habitual gamblers are actually addicted to gambling but they are not aware of it,” he said.

Chiang said that while the problem of teenage gambling was widespread across the nation, another alarming trend was schoolchildren borrowing money from loan sharks to pay their gambling debts.

“Some Ah Long know the teenagers' parents are rich enough to pay off the debts so they have no qualms about encouraging them to take loans,” Chiang said.

He said young people resorted to gambling because many of them wanted a quick way to get money to buy better handphones, computers and branded goods.

The centre expects a surge in calls to its hotline at the end of Euro 2012, mostly from gamblers who have lost their bets.

MCA Public Services and Complaints Department head Datuk Seri Michael Chong said he had received six cases of gambling problems involving those aged between 16 and 18, amounting to RM200,000 so far this year.

“This is considered an increase because last year I received fewer than 10 cases. I've already got six and it is only June,” he said.

Chong said he believed the cases highlighted were only the tip of the iceberg, adding that the youths he met were already in serious trouble and needed to seek his help.

“There are many out there who choose not to seek help,” he said.

About 80% of gambling cases involve the Chinese, with the other races making up the remaining 20%, he added.

By YUEN MEIKENG meikeng@thestar.com.my 

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Young and in trouble!

Many factors can trigger depression in children and teenagers.

BY the time she was six years old, Amy (not her real name) had already been sexually abused by her father for four years.

Amy never told anyone about it because her father had said it was their “little secret”. The secret was blown when Amy's uncle somehow found out about it, and informed her mother about the abuse.

Sadly, instead of believing her, Amy's mother turned her anger on the child, insisting that Amy must have been lying.

Dr Lai: Every time they get a compliment, it’s like a deposit for their self-esteem.

With her mother furious with her, Amy believed that she must have done something wrong, and that she was responsible for the mess her family was in. She took it upon herself to somehow make things right. She killed herself.

While this case did not happen in Malaysia, experts say there is definitely a disturbing trend where children as young as six years old are expressing suicidal tendencies.

Penang Hospital consultant (child and adolescent) psychiatrist Dr Lai Fong Hwa says he started noticing suicide cases among Malaysian children in the last five to 10 years.

“Kindergarten-going children can suffer from depression. Actually, even children who are four or five years old can suffer from depression, but usually these cases are due to biological causes rather than external causes,” he says.

Many factors can trigger depression in children and teenagers that, if left undetected and undealt with, could lead to suicide.

One factor, he explains, is the overemphasis on academic performance and achievement, even among pre-schoolers, which makes schools an extremely stressful environment.

“Some parents have the tendency to say things like If you want mummy to love you, you must get straight As in your exam.' What happens is the child then equates academic performance with whether his parents will love him. So if the child doesn't do well, in his mind, his parents don't love him anymore.

“Even though parents may have good intentions, they should never say things like that because it can have serious negative repercussions. What they should say is We will love you no matter what',” says Dr Lai.

Children, he says, need what is called an “emotional bank account”.

“Every time they get a compliment, it's like a deposit for their self-esteem. But every time they are criticised, the account gets depleted. What's important is that they should always have a good emotional bank account, because otherwise, when difficulty comes, they have nothing to draw from.”

He adds that children these days are constantly drummed with the message that they're “not good enough” because society expects them to achieve certain academic standards.

In the younger children, this stress can cause them to fear school.

“If a child has been quite happy attending school, and then suddenly fears school a few months down the road, it shows that something is not right. School should be fun, not torture. This is why I encourage parents to send their pre-school children to playgroups, rather than to classroom-environment kindergartens,” says Dr Lai.

Apart from academic achievements, shoving a child into multiple co-curriculur activities can also be extremely stressful.

According to Childline project director Michelle Wong, the helpline has received calls from children who are stressed out from having “too many exams”.

“One girl contacted us, saying she was having piano, violin, ballet and school exams all in the same month, and she could not cope with the pressure. She didn't know what to do,” Wong says.

Dr Lai adds that when a child has so much on his plate, the actual time spent with his parents is usually minimal, which is unhealthy for the child.

One question he frequently uses in his clinic when testing children on who they turn to for support is: “If you are alone on an island, and you can wish for one person to be with you, who would it be?”

“A normal child below the age of 12 would usually name their mother, or father, or a sibling whom they're close to. If they've been brought up by their grandparents, then it's also quite normal for them to name a grandparent.

“But when a child starts wishing for a friend instead, it shows that he doesn't look to his family for support. This can be dangerous as his friends are not likely to be able to fully help him should he get into any problem,” Dr Lai explains.

His concern is very real. In the last few weeks, there have already been several sudden deaths involving students under the age of 18.

Last month, a 14-year-old boy hung himself after having a fight with a friend. Another 17-year-old boy hung himself over “academic issues”.

In another case, an 11-year-old boy who fell to his death from the 14th floor of a flat in Penang left behind a handwritten note. His family has, however, denied it is a suicide note, saying that he had always written letters to express himself.

Early this week, a 12-year-old boy in Sabah hung himself with his shoelaces he was apparently upset over not being able to return to his hometown to see his grandfather.

Dr Ng: Children often use acting out as a way to express their inner distress.

“The trend is worrying. Children shouldn't be killing themselves,” Dr Lai says.

Depression among children and teenagers, more often than not, may appear as irritation or agitation, as opposed to the typical expression of sadness, says clinical psychologist Dr Ng Wai Sheng who has served in various settings including children social services, substance abuse rehabilitation and inpatient and outpatient psychiatric settings.

“This may partly explain why adults often overlook depression in young people. Depressed children and adolescents may be mislabelled as “angry” or “moody” kids. For young children, their behaviour may be confused with Attention-deficit hyperactivity disorder (ADHD).

“Children often use acting out as a way to express their inner distress, resulting in some being labelled as the bad kid'. Another common sign is the deterioration in academic performance and motivation, which may lead to the mislabelling of being lazy' or not smart enough',” she explains.

Divorce between parents has also frequently been linked to depression among children, but Dr Ng says it is not so much the divorce per se but rather how the divorce is handled that could be the determining factor.

“There is evidence to show that when a divorcing couple handles the matter prudently and maturely, and remain supportive of their children, the children continue to fare well in their lives,” says Dr Ng, a Fulbright alumni.

This includes communication between the parents and the child, whereby the child is assured of continuous love and support, and there is emphasis that the child is not responsible for the parents' decision.

However, she notes that the stigma of belonging to a single-parent or blended household could pose a challenge for children in Asian societies.

Senior community consultant paediatrician Datuk Dr Amar Singh says that based on his 30 years of experience working with children, child abuse (physical, emotional, or sexual) is also a trigger factor for suicide among children. For teenagers, peer relationship (including boyfriend or girlfriend problems) is also a common cause.

So, what can be done about children and teenagers who are suicidal?

The key is communication, say the experts.

“A majority of those who commit suicide would tell at least one person before they carry out the plan, so look out for the warning signs (refer to graphic above). If one suspects that a child/adolescent may have suicidal tendency, it is important to stay with the person, and raise the issue sensitively but directly with the person. Talking about death or suicidal thoughts does not mean you're putting ideas in the person's head'. That is a myth!

“Instead, talking about it openly, albeit with care and respect, gives the child the opportunity to share with you what's already in his head, and allows you to show that you care about him. Discussing the issue also provides for at least a 50% chance for him to consider alternative options to suicide. Avoiding the subject means you lose even that 50% chance of influencing him,” says Dr Ng.

Dr Amar, who is also Head of Paediatric Department Ipoh Raja Permaisuri Bainun Hospital, agrees.
“Many Malaysians are afraid to talk about this issue, but they need to realise that drugs aren't always the solution (for depression).

“You need to probe and ask the right questions, and you most definitely need to talk about it,” he says.

Stories by LISA GOH lisagoh@thestar.com.my

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Reaching out for help

The need to be assertive

Image by craig.martell via Flickr

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LET'S COMMUNIC8 By ALEX CUMMINS

One should be allowed to say ‘no’ and make a stand on an issue without feeling guilty or harassed.

RECENTLY, I met a female friend in Putrajaya who looked upset. I then decided to take her out for coffeee to find out the cause of her worries and stress.

My friend then confessed that she was unable to bring herself to tell a male member of her team that his sexist remarks to female team-mates were hurtful and that he should refrain from doing so.

I told her to be assertive and that she should tell him that such negative remarks should stop immediately.

“I am a woman and women aren’t like that,” she responded.

Since she is of a gentle, passive nature, I offered her some tips on being assertive and how it could help improve confidence and self-esteem.

Assertiveness is about having the confidence to have your say, to live your life without resorting to passive, aggressive or even manipulative behaviour.

It’s also about being not afraid to state your own needs while listening to the views of the other person, which in turn boosts your confidence and self-esteem.

A complicating factor in all this is about an individual’s childhood and culture.

For example, people who grew up with very strict parents and dominant older siblings may be less assertive.

Also, certain cultural values in which stereotypical behaviour of submissiveness, especially amongst girls, is bound to make behaviour at the work place more challenging.

However in some instances, whatever one’s childhood or cultural background, passive or aggressive behaviour may be a means of achieving their desired goals and it comes naturally.

Just observe some men who yell or women who sulk, or vice versa!

Assertiveness is a better option for desired outcomes because unlike the emotional basis of passive or aggressive behaviour, it is rooted in thinking and planning.



It is a savvy assessment of your needs and feelings in the light of practicalities, and the other person’s position. It can be learnt and is appropriate for men and women. It is also sensitive to different cultural values.

Assertiveness is also based on “rights”. They include the treatment of other people as equals, regardless of gender, race, age, disability or status.

Being assertive also means that one is able to to ask for what he wants, and to be listened to seriously. An individual should also be allowed to have this own opinions and to say “no” without feeling guilty and to change his mind and to hold to his own values.

As an exercise in self esteem-building, try saying out loud to your reflection in a mirror that you can do and carry out the tasks that worry you.

Keep telling yourself that, “I can do statistical work” or “I will make a good presentation”.

Do this several times a day. It does help, especially when you support confidence-building with practical steps like reading a book on basic statistics or on presentation skills. Situations that require assertiveness are usually stressful.

Fortunately, there is a simple exercise which will help relieve physical symptoms of stress like a rapidly-beating heart, sweaty palms or even a high-piched voice.

Before meeting the other party, press both palms of your hands together with the fingers pointing upwards and your forearms horizontal, until you feel the pressure in the heels of the palms and under your arms.

Breathe in and out slowly through a slightly open mouth, tightening the muscles between the ribs as you exhale and then relaxing them before you start the inhalation. Do three or four repetitions. It works.

If you read a previous article on body language you will remember that your body cues must match your words.

Adopt a relaxed stance, have good eye contact; hold your arms loosely at your sides or in your lap if seated; face tand lean slightly towards the other person.

Speak at normal conversational volume. Try to end with a smile.

The language of assertiveness is clear, direct and concise. This is about you: what you feel and want.

It is essential to use language appropriate to the person you are talking to, and not fall back on vocabulary, concepts or jargon beyond the other person’s understanding.

Assertiveness is not about superiority or cleverness.

“Should” and “could” are words to be used with caution when you want to be assertive.

“Could you do that for me?” “Could I ask for time off for all that overtime I worked?” “You should stop making sexist remarks!”

They create confusion to the listener about the legitimacy of your request.

The assertive wording would be “Please do that”; “I would like time off ….”; “Stop making….”

“Hope” is another word which interferes with your choices. You chose to work late because you can and want to. “I hope I can work late” implies doubt.

Assertiveness is thinking and speaking positively with confidence. It’s also about an honest evaluation of the situation and the other person and his/her opinions and needs before you even raise an issue. Is compromise possible? Are there personal considerations with the other person that need to be taken into account?

Avoid implied character criticism. “Please do/do not do something” is clear but neutral. “Why can’t you just do/not do…” implies a criticism of a specific character rather than a specific task in hand.

If what you ask for creates strong emotion in the other person, acknowledge this with a defusing statement such as: “I see you are unhappy with what I have just said, but I think it’s important for you to know my position and for us to have an open chat about it”.

Recognising the other person’s opinion is another good way of keeping the situation on an even keel: “I understand what you are saying BUT…..”.

Never use antagonistic phrases like: “Let me repeat”, “Are you listening?” or “Don’t interrupt”. And criticism without suggesting a solution is irrelevant and not at all helpful.

If you are in the position of having to apologise for a mistake, do it once, not repeatedly.

Be specific about why things went wrong. Don’t over-elaborate. Everyone makes a mistake now and then, even the boss.

Criticising a colleague is tough. But it will win you respect in the long run provided you do so in private and are fair, firm and specific.

Try and thank the other person if possible at the end of the conversation.

“Thank you for giving me the time to talk about this” or “I’m glad you understand”. Such statement will make both of you feel better.

Assertiveness is a way of life. It won’t always bring you a happy outcome.

However, it will make you comfortable with yourself and generate respect amongst colleagues and friends.

By the way, it may interest you to know that my friend feels a lot better now after being successful in putting an end to the sexist remarks in her office!

■ Alex Cummins is a trainer with the Professional Development Unit of the Brtish Council in Kuala Lumpur.

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