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Managing Financial Stress During a Health Event


Money is one of the hardest topics for people to talk about in a relationship. During a health crisis, practicing good money habits isn’t at the front of anyone’s mind. But, in times of uncertainty, it’s one of the most important conversations couples should have after a major health situation occurs.

27 million people were uninsured for health coverage in 2021 according to the U.S Census Bureau. Without the protection of health insurance, fixing a broken leg can cost up to $7,500, a weekend hospital stay is about $30,000, and cancer care treatment can cost thousands of dollars.

If a relationship is strained from the effects of financial stress, the added burden of healthcare costs can feel insurmountable. Here are some ways couples, therapists, and relationship counselors can use Money Habitudes to cope with the added financial stress a major health event can cause.

Impacts of financial stress

The United States saw a record high increase of Americans putting off medical care due to costs in 2022 – up 12% from 2021 according to Gallup’s annual Health and Healthcare poll. Lower income households, women, and young adults reported higher rates of postponed medical treatment for a serious condition.

When you combine money stress with other types of stress, communication can break down. This causes more stress and feeds a perpetuating cycle of conflict and miscommunication. Like other forms of stress, financial stress can feel overwhelming and can affect many areas of a person’s life, including their physical and mental health.

If the stress becomes intense or chronic, other health problems like anxiety, depression, or heart disease could occur. With the majority of Americans experiencing some kind of financial hardship, the anxiety and worry about medical bills on top of a health concern can make it hard for a couple to cope.

How can people manage money and an illness?

Medical expenses can fluctuate in their price and occurrence, which makes it harder to manage money in both the short and long term. When tensions are high, the emotional triggers of financial stress can cause people to make poor or impulsive spending decisions, making the financial stress greater.

To help couples manage their money habits, emotional wellness, and health, therapists and relationship counselors can use Money Habitudes as a tool for identifying people’s emotional financial triggers. Knowing a person’s emotional financial triggers will help when deciding on future strategies to combat negative spending habits. Here are some ways Money Habitudes can help manage money stress and start finding stability while dealing with a medical condition.

Have a conversation

When a person experiences stress, the body responds by activating our natural fight-or-flight response to prepare the body for the challenges ahead. This can be great in the event of immediate physical danger, but when stress becomes a chronic problem, our bodies never leave that fight-or-flight mode. The energy of managing physical, mental, and financial stress makes it hard to communicate in a relationship.

If a partner has a poor relationship with money, it can be hard for couples to spark healthy conversations in a positive, collaborative way. Having a conversation with the help of professional marriage or relationship counselors can help couples work on their communication skills. Once a couple can deploy proactive, rather than reactive discussions, they will have more control over their emotions and understand their spending habits.

Analyze money habits and behaviors

Trying to budget your money and stay financially afloat can be especially tedious during a health event. Unfortunately, no amount of budgeting can save a person from their own biases or emotional spending triggers if they aren’t aware of them. When a couple can start communicating in a relationship, it’s important to understand the root cause of each other’s emotional associations and behaviors around money. If you don’t understand your spending habits and behaviors, you’re not going to be able to make effective changes. The Money Habitudes personality assessment can help you set goals and bring awareness to challenges you might not be aware of.

Money Habitudes help partners navigate challenging financial situations by deconstructing habits and emotional responses to money in a fun and stress-free way. The Money Habitudes results provide couples with rich, user-friendly insights based on a person’s money personality in a way that allows them to see their spending patterns and the motivations behind them.

Take a financial inventory

Regaining a sense of financial control can feel like an uphill battle for couples dealing with high medical debts. The good thing is, once people become aware of their emotional connections with money, they can manage money more easily. But, to get out of the cycle of debt, a couple needs to know where their money is going. This is where a budget becomes a handy tool for detailing monthly income, debts, and expenses.

Once a financial inventory is in place, couples can plan ahead of time for recurring or unexpected medical expenses, like cancer treatment costs, copays, prescriptions, or emergency room visits. Having a financial inventory in place will give you more ownership of your finances and will allow you to plan for the moments that are impossible to plan for in life. With over 50% of Americans lacking the savings to handle an unexpected emergency, taking inventory now should be a priority.

Gather resources and support

The cost of a medical emergency is expensive whether you have health insurance or not. For people without healthcare coverage, the out-of-pocket costs of medical bills are extremely high, where you’re expected to pay everything from lab and service fees to specialty services and other medical costs. Thankfully, it’s possible to negotiate medical bills with a hospital by setting up a payment plan or receiving special discounts as an uninsured patient. Working with the hospital’s financial department can help adjust bills around a person’s ability to pay to help ease financial burden.

Establishing healthy spending behaviors takes time. In times of crisis, people often find help to address their immediate needs for food, shelter, medical care, and safety within their communities. Once the initial crisis is over, money issues can still go unresolved. Depending on a couple’s situation, financial assistance and additional resources could be a helpful option for help with bills or managing a chronic illness.

In some cases, it might be beneficial for a couple to get advice from a professional who can help them manage their illness and their finances. Alongside other resources, Money Habitudes puts a positive spin on how to think and interact with money and helps manage financial struggles easier when health issues arise – Helping couples pave the way to financial freedom, one step at a time.

Cara Macksoud, owner of Money Habitudes



Money Habitudes: How To Be Rich in Life & Love Wins Excellence in Financial Literacy Education Award

Engaging and innovative financial education curriculum with a focus on the psychology of money and behavioral economics helps teens with personal finances and relationships.

April 19, 2012 (Press Release) – The Dibble Institute and LifeWise Strategies announce that their collaboration, Money Habitudes: How To Be Rich in Life & Love, has won this year’s Excellence in Financial Literacy Education (EIFLE) Award for Children’s Education Program of the Year in the Financial Responsibility and Decision Making category. Awards were presented at this week’s Annual Conference on Financial Education, held in Orlando.

The EIFLE financial education award is bestowed by the Institute for Financial Literacy. It acknowledges innovation, dedication, and the commitment of those that support financial literacy education. Money Habitudes: How To Be Rich in Life & Love: A curriculum about money and relationships, introduces teens to the human, emotional side of money. With a behavioral economics approach, the teen financial literacy curriculum is an important precursor to financial literacy courses. The engaging personal finance curriculum helps teens identify their personal finance patterns, how these affect their goals and relationships, and ways to use this financial self-assessment to be more successful.

“Money is such an important issue for teens – both in terms of how they relate to others and how they establish their lifelong saving and spending habits. It’s a great honor for our financial education curriculum to be recognized by the Institute for Financial Literacy,” noted, Kay Reed, Executive Director of The Dibble Institute.

How To Be Rich in Life & Love includes a teacher guide, student workbook journal, CD, posters, and Money Habitudes cards, the foundation of the program. A hands-on teaching tool, Money Habitudes cards are a fun, instructional game that functions as both a financial ice breaker and a money conversation starter. First released in 2003, separate versions of the durable Money Habitudes cards are designed for adults, young adults and teens (high school); an adult version is also available in Spanish. The cards are widely used in programs focused on financial education, asset building, life skills, marriage and relationship education, financial planning, and career counseling.

“It is often very difficult for people to talk about money. The idea behind Money Habitudes was to make talking about money fun and to help people understand their money type in an engaging, nonjudgmental, non-threatening way – whether they are adults or high school students,” said Syble Solomon, the creator of Money Habitudes. “It’s been very rewarding to partner with The Dibble Institute to help teens learn about money and especially how money messages can affect relationships.”

Overcoming the social stigma of getting financial help

Social stigma plays a big role in whether people seek out financial coaching, counseling or education. Social stigma also plays a part in whether people feel good while getting financial help. Money Habitudes is often employed in a manner to help minimize or alleviate the perceived stigma, shame or embarrassment of seeking financial help. Typically, therapists, financial coaches and financial planners use Money Habitudes to make client interactions better without even realizing how it’s related to social stigma.
There are a number of social stigma theories, but there are common elements between them. Below, we’ll largely consider Erving Goffman’s seminal stigma structure.

Ways that Money Habitudes can help alleviate social stigma:

  1. Easiesocial stigma of financial helpr to walk in the door – A lot of financial programs implicitly speak to clients and participants about having problems. For example, if you sign up to attend a “Get out of debt” class, it sends the message to others that you’re in debt. That can be stigmatizing and hard to admit. On the other hand, using Money Habitudes often means going to a first class or session that carries less stigma: “Discover your money personality type” or “Learn about your financial influences,” etc.
  2. Less confrontation and judgement – When people seek financial help, many of those interactions take on the tone of an expert telling a novice what to do. It can be very prescriptive and come across as “You’re not handling your finances well. I know how to do it better. You need to listen to me and do what I say.” That can make people feel shame or embarrassment. Money Habitudes cards produce a money personality profile, but they do not tell people that they are good or bad, smart or stupid, when it comes to money. They also start the process from a place where people are more comfortable and will share and reveal stories, which isn’t usually true of other first interactions.
  3. Avoiding numbers – A temptation of financial counseling and coaching is to jump right into numbers. This frequently means collecting receipts and making a budget. Not that there isn’t value in this step, but it can be a difficult introduction if someone feels uncomfortable or incompetent with numbers, math, spreadsheets and the like.
  4. Sympathy and empathy – As Goffman theorizes, there are people who are “stigmatized” and then there are those who are “normals” who do not bear that stigma. A subset of “normals” are people who are “wise” and are accepted by the “stigmatized” as understanding their difficult situation. Going through the Money Habitudes process – either as a staff training exercise or as an activity with clients – helps people relate better to one another. It makes it easier to share stories and understand that everyone has strengths and challenges around money; the activity underscores that everyone has financial habits and attitudes that can be helpful or harmful.
  5. Not the only one – One of the most helpful outcomes of doing Money Habitudes in a group is that people have that “Oh, yeah, me too” moment where they relate to one another. It can be really helpful to hear that you’re not the only one facing a problem and that other people have the same issues and often have wisdom to share about overcoming it.

Emotional triggers and financial stress

financial stressFinancial stress is serious.  It was identified as the number one cause of stress in a 2009 study by the American Psychological Association. Financial stress is associated with increases in:

  • suicide attempts and suicide rates
  • physical illness
  • divorce rates
  • domestic violence
  • poor cognitive decisions.
  • (Financial stress is also associated with a decrease in productivity in the workplace.)

When people are in crisis, they may seek help and resources through community, military and faith-based programs.  The focus is often on addressing the immediate need for food, shelter, medical care and safety. But then what? People who have received help may then find themselves in a similar situation again even. This is true even if they had been lucky enough to receive training on financial management skills: how to budget, get out of debt, shop wisely and save. Knowledge, alone, may not be enough. Today there is more awareness that emotional money triggers have tremendous influence on our financial choices.
Recently there has been a lot of focus on understanding emotional triggers and how they influence financial behaviors. For example, a single mom works two jobs. She’s exhausted and feels guilty that a sitter is putting her kids to bed each night. She commits to saving $20 a week for an emergency fund. What are the emotional triggers that will sabotage her good intentions?

  • Will she slip because she spends impulsively and needs help with strategies to avoid or resist temptation?
  • Will she automatically give money to friends or family when they ask for help?  Then she may need to learn how to set priorities and say “no” or get some help with her fear of being rejected or hurt when she doesn’t please the person asking for the money.
  • Will she end up spending that money because her friends have different priorities and she doesn’t want to jeopardize her relationships by not joining them for a good time?  She may need counseling on self-esteem and speaking up.

Once we can help people identify their emotional triggers, we can help them find the right strategies to be prepared for the times their emotions will kick in. By helping them be prepared, they are more likely to be successful!
Money Habitudes cards will identify their emotional triggers and provide suggested activities if any Habitude is being overused.  The Professional Guide includes: (1) How to set SMART goals; (2) how to predict and overcome obstacles and (3) 67 Action Steps classified by the Habitudes they work for.

financial capability grant: housing, emergency assistance & workforce development

This financial capability grant announcement is applicable to many Money Habitudes users who are doing work in asset building.
CFED financial capability grantCFED, in partnership with Bank of America Charitable Foundation, is soliciting applications from organizations interested in joining an eighteen-month Intensive Learning Cluster to integrate financial capability into social service programs in the following sectors:

  • housing
  • workforce development
  • emergency assistance (critical needs)

This financial capability grant is limited to organizations that provide services within one of the targeted markets. Organizations who are selected to participate will receive an $8,000 stipend. The Learning Cluster will run from November 25, 2013 through May 31, 2015.
Applications are due Thursday, October 21, 2013.

Teaching financial management to young kids

Our Money Habitudes materials help people teach financial management to adults and teens. Because the hands-on activity is used like money management games, we’re often asked if there is a version for young kids.
The Money Habitudes for Teens version is designed for high school students, typically ages 15-18. Using the cards requires that one is making financial decisions and that’s not always true with populations younger than high school. Although we’ve heard stories of people successfully using the cards with junior high students and very young kids — as young as eight and nine years old — we don’t recommend the materials for these younger age groups. And at this point, we don’t have plans to develop a version of the teaching tool for very young kids. Still, many of the the individual statement cards can be used as conversation starters across most ages.
captain cash financial education for young kidsSo while we do not have a version to help teach financial management to elementary school and junior high kids, we’re certainly interested in programs that do reach this audience. After all, Money Habitudes is unique in helping teens and adults understand their habits, attitudes, values and behaviors when it comes to money — and a big part of what influences our financial habits and attitudes is what happens in childhood.
There are obviously more financial education curricula for teens and adults, but there are some that are used with much younger kids. One of those is Captain Cash from Purdue Extension. It’s recommended for third and fourth grade. It’s described as “an interactive educational program designed to teach basic financial management skills to your students.” It covers the following:

  • Money behaviors observed and learned in childhood impact adult behaviors.
  • Money management messages that children process in the home, the community, on television, and via other media shape their values, attitudes and future money habits.
  • Individuals and families are not able to respond to economic disruptions because they have not learned critical money management concepts and skills.

Communication skills in relationships

We talk a lot about the right way to talk about money. After all, money is one of the hardest topics for people to talk about. But, what happens when you don’t have a good interaction around money? There are bound to be upsets in any relationship. (That’s true for other flashpoints in addition to money.)
So sometimes it’s good to review the larger topic of communication skills in relationships, thanks to our friend Dr. Susan Heitler, a Denver clinical psychologist and marriage counselor. Although she also tackles the central issue of money in relationships, she’s put together a great toolkit of articles on communication skills:

As with Money Habitudes, there’s a focus here on understanding your own habits and attitudes – and those of your partner; self-assessment is a big part of why our money personality methodology works. There are practical tips to have good, healthy conversations. There’s also a focus on being proactive and not reactive – including learning communication skills and employing them early in a relationship. Also, there’s a sense of fun and lightness that’s especially evident in Heitler’s free online PowerOfTwoMarriage relationship quiz. It’s fast and easy – just like Money Habitudes!
Also, online relationship tests are top of mind for us as we’re working on that transition for Money Habitudes …

Bonus financial conversation starters for individuals, couples & counselors

Usually when people use Money Habitudes as financial conversation starters, they stick to the usual money personality instructions. In the typical solitaire sort, people get to see their money personality for how they are today. But, of course, our financial habits and attitudes change over time.
Here are a few bonus financial conversation starters you can do with Money Habitudes money management games. Bear in mind though that you’ll almost always want to do the basic exercise first. This provides a valuable financial self-assessment and allows you to benchmark your financial behaviors as you are today. Then you can move on to these bonus financial conversation starters when the situation is right and if you have time.
These largely help people see how our financial attitudes and spending habits and behaviors evolve and change. Like the slow rise of sea level, it can be hard for people to see how much they’ve changed over the years because it’s often a gradual process.
The financial conversation starters below can be used by couples on their own – or by professionals like therapists and marriage counselors. (Therapists and counselors may also be interested in the Bringing Money Into the Conversation guide, which includes tons of other activities and resources beyond the Money Habitudes financial conversation starters.
Of course, always bear in mind the usual suggestions to have a good conversation about money, which we’ve posted before.

Financial conversation starters for Money Habitudes

  • before and after financial conversation startersBefore and after getting married. It’s not uncommon for couples to change after being around someone else for a long time. It may be that being with someone else moderates your behavior – or reinforces it.
  • Before and after another major life event: divorce, having children, going away to school, retirement, etc. Did this major event change you at all? Was it a dramatic shift? Did it make you hesitant to spend money – or did you start spending more freely? Were you more likely to sacrifice for others? Do you think the change is permanent or is it a phase?
  • You, today and 10 or 20 years ago. The goal with these financial conversation starters is to look at how you’ve changed. And, in that context, what’s changed around you? Were you living with your parents before and now live independently? Did you have kids living with you but now they’re grown and living on their own? Was the economy different Did you have different goals for yourself? What have you gained from these years of experience?
  • How would you answer the cards differently if you lost your job? (Or, what if you went back to work?) Employment can have a big effect on our financial habits, attitudes and behaviors. Many people are spurred to think about their finances and talk about money only after this big change. But it’s helpful to be able to think about the situation in advance, when you’re not feeling like you’re in the midst of a crisis.
  • How would your mother sort the cards; how would your father sort the cards? A very common a-ha! moment for people is seeing how they are like or unlike their parents (or other formative adults in their lives). Because our own household was our own “normal” environment, it can be hard to take an outside look in on that time. If you’re always spending money on other people, it may be that this was a strong tendency for your mother that you’ve just made a habit of because it was normal. That could very well be spending too freely, never spending anything, hoarding, spending to impress others, planning every expenditure in an exacting manner, etc.
  • Sort your cards for yourself and then sort the cards as if you were your spouse or partner; do it for each other. These financial conversation starters reveal differences between how you see yourself and how your partner sees you. It helps identify gaps and misconceptions you might have about each other. One of the keys here is to refer back to the “how others see you” section on the yellow interpretation cards. If you see yourself as very frugal, but your partner sees you as overly cheap, a good conversation about how you both see money may big dividends. However, some of these differences may call for some professional coaching or counseling.
  • How would you like to be with money in 5 years? How is that different from the money personality profile you got of yourself when you do the cards for how you are today? What would you need to do differently to become that future version of yourself? Do you want to become more balance? Do you want to increase a certain dimension within your money personality? Do you want to decrease a certain part of how you see and use money today? This returns to the topic of financial goal setting. For that, try using the SMART method to set good financial goals.
  • How would you your sibling(s) sort the cards? Just as with doing the cards from your parents’ perspective, doing them from a sibling’s perspective can also be helpful. Why do you and your sibling(s) get along – or not – when it comes to money? What do you admire about your brother or sister? What do you think they admire about you? How was your childhood similar to theirs? Was your family always wealthy or always poor – or were there times when your family’s fortunes changed dramatically?

Teaching personal finance to foster care youth

The new “Protecting the Credit of Youth in Foster Care” guide recommends using Money Habitudes.  The foster care report was prepared for the Annie E. Casey Foundation by Jennifer Miller and Rebecca Robuck of Childfocus.
foster care youth credit guideA good resource for those working with youth in foster care, the report lays out why credit is such a big issue for this population:

Every year, more than 26,000 young  people age out of foster care, many with  no permanent home and no parent to  help them navigate the road to adulthood … Stolen  identities and bad credit pose yet another  obstacle on the road to independence. For youth who have faced years of instability  and uncertainty, bad credit stands in the  way of some basic life activities, such as  renting an apartment, buying a car, getting  a job, having a bank account or securing  student loans.

The Protecting the Credit of Youth in Foster Care guide adopts the youth empowerment approach with three primary goals:

  1. Educating young people about what credit is and how it can impact their futures.
  2. Clearing credit reports to help youth  on the road to financial health.
  3. Equipping youth to maintain good  credit in the future

Helping youth in foster care understand their own credit history and issues

Within the first section, “Understand Your Own Credit History And Issues,” Money Habitudes is recommended as a tool to understand one’s own financial experiences.:

Reflect on your experience with credit and identity theft. Consider your own approach to credit and financial issues. How knowledgeable are you about money and credit? Have you ever had your identity stolen, and if so, how was it resolved? Your attitude and behaviors toward credit and identity theft impact how you work with young people. Regardless of your experience, it’s important to approach young people’s financial education and empowerment in an unbiased way.

Money Habitudes is a resource on attitudes and values about money that also has tools for teens and young adults.

Money Habitudes in financial education programs for youth in foster care

The Money Habitudes activity is often used with young people in high school classes. It’s also used in community classes and counseling – including within the foster care system. Money Habitudes works well as a money management activity for both adults and youth because it looks and feels like a game. It makes it fun and easy for people to talk about money and understand their spending habits. It shows people their money personality and helps people see and understand what has shaped and influenced their financial habits and actions. It can be used as an ice breaker activity or as a stand-alone class. It is often used as a lead-in module for a series of financial education classes.
It is used as:

  1. money conversation starter
  2. financial ice breaker
  3. money personality quiz

Two versions of our money management games are typically used with youth in foster care: Money Habitudes for Teens or Money Habitudes II for Young Adults (18-25). In addition, our award-winning high school finance curriculum for teens is used in foster care programs. It includes both financial skills and relationship skills. Read a case study about foster care financial education using Money Habitudes …