Undocumented Patients - page 3

What do you think about undocumented patients who abuse the hospital system? Anyone have undocumented patients who basically live at the hospital because their families can't take care of them, and... Read More

  1. by   heron
    Quote from CCU BSN RN
    In ICU, I don't have to know their immigration status.

    the issue was working in hospital, in a floor with the lowest level of care provided by that hospital. Case Management will start working on their discharge so they can go to Rehab, because they're not safe to live at home. They have no insurance, so CM tries to enroll them in medicare/medicaid/whatever. During this process it is discovered that they are not eligible due to their immigration status.

    So we're in this pickle, because we can't discharge them to an unsafe environment at home (e.g. no family, no home, etc.) and we can't discharge them to rehab without payment. So someone who medically does not require a hospital setting will stay in the hospital setting for MONTHS sometimes. Occasionally having a shift where one of your patients is healthy enough for discharge is nice. Having those shifts for months, is not.

    Doesn't matter if the person is a super nice person or a rude and nasty one. It stinks that our tax dollars will pay for this, but not for the level of care they need. It would be SO MUCH CHEAPER to send them to rehab or home with PT/VNA, but that's not the system we live in. It sucks for the patient to be in hospital for months when they don't require it, it sucks for the healthcare provider who misses out on Med/Surg experience with a healthy person padding their numbers.

    My issue with this is that it highlights a huge failure in our healthcare system, not ANYTHING to do with the patient. I happily care for whatever patient gets tossed my way, with minimal complaining. I just don't see why, if we pay for hospital, we won't pay for anything else. Hell, if this guy hadn't been too scared to go to a clinic in the first place instead of waiting for an issue to be so bad he needed hospital, I personally would've gladly had my tax dollars pay for his Amoxicillin instead of his 28 day Sepsis hospitalization, for sure.
    Undocumented workers pay billions in local, state and federal taxes, yet are ineligible for most safety net benefits supported by those taxes. I agree that there's something drastically wrong with this picture.

    It's a hard knot to untangle. People in this country illegally are, by definition, breaking the law. That choice has consequences. But, should those consequences include the death penalty?
  2. by   rearviewmirror
    the problem is not of someone being rude or even being undocumented, ilegal ailen for that matter benefiting from tax revenues without paying a cent on income taxes... The problem is why does US healthcare allows abuse in the first place. and by the way, I believe abuse does exist... just work at ERs in a metroplex, you will be surprised how many same folks you see over and over and over again, and they are not even the tiniest portion of healthcare abusers. The problem lies not within one's residence status or one's "rudeness", but why the system allows that sort of abuse.
  3. by   crazin01
    OP, I think the way you asked the question was stated/worded gets most fired up, as immigration is always a rather heated debate. I an somewhat naive and like to give benefit of doubt to all, so I'm thinking it wasn't meant to come across that way, even though it does.

    I also think you're dealing with two very independent issues:
    1) Rude patients
    2) Patients whom do not appear to be documented citizens of their geographic location/illegal aliens.

    It's unfortunate that you've had two such patients that fit both criteria and this seems to have skewed you into having a stereotyping/judgmental attitude towards patients that are members of only one of the groups mentioned. Hopefully you will soon have an undocumented patient that is sweet as pie and they are able to sway your views.

    I've had many patients who are very rude and they come from both THEE best SNF/ALF in a 50 mile radius as well as from the halfway house, where less than 50% of residents are legal citizens of the US. Attitude toward others is learned and can always be changed, so maybe these rude patients were once kind but have been treated rudely by other healthcare providers? Thus, they're just giving what they are getting? Not agreeing with it, but our actions towards others do matter and can bring about change in their actions towards others.

    Yes, the non-compliant frequent flyer diabetic coming in with DKA the 4th time in a month, who is extremely rude & manipulative does get tiring. however, I can think of both legal US citizens and illegal citizens that fit this mold. (My nursing experience is all in the US, so just using US citizens for my background)

    As another stated, you are the nurse, not social worker, although all team members must communicate. Our focus in a hospital setting is primarily stabilizing and discharge, whether to home or LTACH, so we have beds available to the more acute patients. Unfortunately, the broken healthcare system, lack of resources etc is a whole 'nother issue.


    I love the Gilligans island stuff thrown in there...Gotta have a laugh sometimes.
  4. by   heron
    Quote from rearviewmirror
    the problem is not of someone being rude or even being undocumented, ilegal ailen for that matter benefiting from tax revenues without paying a cent on income taxes... The problem is why does US healthcare allows abuse in the first place. and by the way, I believe abuse does exist... just work at ERs in a metroplex, you will be surprised how many same folks you see over and over and over again, and they are not even the tiniest portion of healthcare abusers. The problem lies not within one's residence status or one's "rudeness", but why the system allows that sort of abuse.
    i agree that abuse of the system exists. But the assertion that "they" don't pay taxes is just plain false.

    Honest people can disagree on the issue, but let's at least keep the discussion based in facts.
  5. by   srercg6
    no, that's just additionally. for instance a family that has a family member who needs a LOT of care - can't do a lot themselves - but some, but the family claims they are homeless (when they clearly are not) or don't have room for the person etc because they don't want to have to take care of them, and the person can't be sent to a facility because they are undocumented so they are left to use the more expensive services of the hospital as their long term care - years.
  6. by   BSN16
    Quote from srercg6
    no, that's just additionally. for instance a family that has a family member who needs a LOT of care - can't do a lot themselves - but some, but the family claims they are homeless (when they clearly are not) or don't have room for the person etc because they don't want to have to take care of them, and the person can't be sent to a facility because they are undocumented so they are left to use the more expensive services of the hospital as their long term care - years.
    Nobody should be obligated to care for a sick family member, citizen or not.
  7. by   TriciaJ
    Quote from MrChicagoRN
    Lack of a valid social security number is often the first clue.


    We have a good number here in Chicago. My last hospital had a patient there for more than a year before finally airlifting them home.
    Most are not rude, just grateful for whatever care they can get, and staying under the radar.
    Actually, I had a US social security card before my green card was approved. Even a social security card is not proof of legal status.
  8. by   OrganizedChaos
    Quote from srercg6
    no, that's just additionally. for instance a family that has a family member who needs a LOT of care - can't do a lot themselves - but some, but the family claims they are homeless (when they clearly are not) or don't have room for the person etc because they don't want to have to take care of them, and the person can't be sent to a facility because they are undocumented so they are left to use the more expensive services of the hospital as their long term care - years.
    Living in an area of Texas that sees a lot of "illegal aliens" I don't care if they are or aren't documented. Everyone gets the same care & my paycheck doesn't change just because someone is undocumented.

    You are talking about two separate issues. Not all undocumented peoples are rude. I have come across more U.S. residents that are just asses than illegal aliens. It's also not just undocumented people who can't take care of family members & have no money. I can't even begin to tell you about the stories my mom (who works for adult protective services) has told me. I don't remember one that she told me that was about an illegal alien. There are so many people (legally here & not) who don't have family or the finances to leave the hospital.

    You need to learn to leave your personal views outside of work. If you can't I would suggest working in a different area of nursing.
  9. by   Ruby Vee
    Quote from srercg6
    What do you think about undocumented patients who abuse the hospital system? Anyone have undocumented patients who basically live at the hospital because their families can't take care of them, and they can't go to a facility because of their undocumented status?
    Yes, I've seen illegal aliens live at the hospital because they have nowhere to go. I'm not sure that's abusing the system, but it happens. If someone is too ill to leave the hospital, staying in the hospital is not really abusing the system. I've seen hospitals fly patients back to their country of origin -- first class and with a team of nurse and paramedic -- because that's cheaper than having them continue to stay in the hospital. Perhaps that's the best solution to the problem. Another solution would be to bill the country of origin for their care, but that's unlikely to result in cost savings for the hospital. l

    On the other hand, I've also seen legal aliens, immigrants, Native Americans and other US citizens living in a hospital because they're too ill to leave and LTC facilities won't take them for one reason or another. I doubt very much that the patient's immigration status has much to do with it.
  10. by   Ruby Vee
    Quote from srercg6
    no, that's just additionally. for instance a family that has a family member who needs a LOT of care - can't do a lot themselves - but some, but the family claims they are homeless (when they clearly are not) or don't have room for the person etc because they don't want to have to take care of them, and the person can't be sent to a facility because they are undocumented so they are left to use the more expensive services of the hospital as their long term care - years.
    Family not wanting to take care of a patient has nothing to do with their immigration status. There may be valid reasons why a family member would not wish to take care of a patient. Maybe Daddy raped his daughter every night for years -- I cannot imagine why you would expect the daughter to then take an aged Daddy into her home (where she may have her own young children) and care for the man for possibly years. Perhaps Mother cut off all contact with a daughter who married a man of a different faith, had a child out of wedlock, or simply chose to live her own life rather than the life Mother chose for her. After forty years of no contact, Mother is ill and needs care. Are you going to force that daughter to take her in and care for her?

    No one should be forced to care for someone they don't want to, family member or not. Many of those poor, lonely elderly patients are lonely for very good reasons.
  11. by   srercg6
    Please do not misunderstand. As nurses we take care of anyone who needs help. The situations I'm speaking of is when families leave them at the hospital because they don't want to deal with it, and the hospital has no where to send them because of their status so the hospital ends up incurring the long term costs usually at taxpayer expense. These are folks that COULD be taken care of at home, but their families don't want to. I don't think it should be an option to leave "anyone" at the hospital for that reason, undocumented or not, but in the case of undocumented is different because the hospital can't locate a facility to take them long term because of their status, where as if they were citizens the hospitals could find a long term care facility to take them, and the hospital could help them get Medicaid/medicare to help facilitate that, whereas with undocumented they can not. Has nothing to do with caring for someone who is sick and needs our help - this is past the point of needing our help for that - they are ready to go home status, but can't. I just feel there should be something in place to help these people so that we are not using the hospitals at the much higher costs to the public. There should be facilities that can help them, or avenues they can take in these instances - some sort of medical exemption status or something.
  12. by   srercg6
    I don't understand how someone who is "undocumented" meaning they do not have any type of government issued number/permit/ID/social security or ID numbers in order to pay any kind of taxes with - how these people are paying taxes?

    I know that DOCUMENTED temporary immigrants who are not necessarily citizens, but who have work visas, or temp visas for which they must reapply, or if they are here on another status such as political asylum -etc - all those people have numbers are are paying taxes - they are DOCUMENTED. they are also eligible for Medicaid/medicare and would not be in the predicament I am speaking of.

    Undocumented do not have ANY VALID id numbers, and there fore are not paying any kind of taxes (except sales tax at a store where they pay cash). They get jobs down at the corner and are usually hired under the table to split funds from someone who is documented-and those people can't claim them or file taxes for them because they have no valid ID's. they do not have insurance, because they don't have numbers - they are undocumented. They do NOT pay any kind of taxes, nor do they qualify for any kind of medical programs which is why they are stuck in our system.
  13. by   VaccineQueen
    Public Health/Community Health Nurse chiming in here.

    In my neck of the woods (that sees A LOT of Refugees) Refugees are given Medicaid for the first 8 months upon entering the country. This can be extended for several reasons, mainly if they comply with routine healthcare, obtaining proper employment, have a chronic health condition that needs to be monitored, etc. They have to go through two physicals, get bloodwork, vaccinations, and other referral services. I work with Refugees.

    I also work with undocumented migrant workers. It is very hard for them to get documentation status, typically because they do not have a birth certificate, if one even existed. They then don't have the money to hire a proper attorney to help then with this issue and all the loopholes they have to jump through.

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