Everybody wants something for nothing...pt's trying to "clean up"

babynurselsa, RN · Jul 5, 2006

I understand and commiserate. I find it extremely frustrating when ANYBODY expects above and beyond what is resonable to expect from others and refuse to expend any effort of their own. This is not limited to any situation.

mzkede · Jul 20, 2006

:confused: :confused:

Do you have patients (especially Medicaid patients) who think you are supposed to "give" them any and all kinds of supplies just because they say they need them? There are a couple of houses I go to (both younger Medicaid patients) who seem to feel this way. One lady I go to see wants you to leave gloves, lancets, bandages, ointments, 4x4's, betadine (I had to draw the line here, I have to supply my own betadine to use when I visit patients and it is $12 a bottle)...etc...basically, when I come for visits she thinks it's clean up time, cleans out my whole bag and levaes a list of other things if I don't have them. The other lady I go see is the same way. We have been told by the agency that Medicaid will not pay for certain supplies (like gloves) but to these patients it is no matter...am I at liberty to explain to them that they will just have to accept some degree of personal responsibility for some of the supplies used in their care? One of the patients actually threatened to turn us into the state if we didn't start delivering certain supplies on time, and these were supplies the agency told her Medicaid does not cover. What makes me angrier is that the agency forked over the supplies. Then they get on to the employees because they have so much money tied up in supplies.
Of course, certain Medicaid patients are so grateful it almost breaks your heart, but others seem to turn into little dictators.
If I was getting around the clock private duty nursing care at the tune of $15-20K monthly and the taxpayers were footing the bill, I wouldn't press it by demanding more. My father-in-law worked until he was 78 yrs. old. He has Parkinson's and mild dementia but he is not able to get the kind of services Medicaid patients (more specifically, TennCare patients) get. Not even close.

WOULD IT MATTER IF THEY HAD ANOTHER TYPE OF INSURANCE? DO YOU THINK THE TYPE OF INS YOU HAVE TELLS WHAT TYPE OF PERSON/PATIENT YOU ARE? WOW

jansailsea · Aug 24, 2006

:confused: :confused:
WOULD IT MATTER IF THEY HAD ANOTHER TYPE OF INSURANCE? DO YOU THINK THE TYPE OF INS YOU HAVE TELLS WHAT TYPE OF PERSON/PATIENT YOU ARE? WOW

I think many of us would agree if we have private health insurance, we are completely aware that the insurance companies decide what they will & will not pay for in relation to coverage.

In other words, those of us with private insurance know we can be denied services, prescriptions, supplies, whatever.

We do not expect the insurance company to pay for everything- we're used to receiving that notice in the mail telling us just how much of our coverage paid for a particular service, & what we now owe as the remainder to the physician, hospital, lab, etc.

However, when someone receives something for free, it is not unusual to encounter some who have an attitude of believing they should get anything & everything they want for free.

Also, one can encounter individuals who are trying to push the envelope by whatever means: manipulation, guilt, intimidation- regardless of the type of insurance- in order to receive something for nothing.

In the hospital setting, there are at times, patients who regardless of income, culture, education, etc., who do the same & treat nurses like their personal servants, too!

Let's keep it civil- someone has had a bad day, a bad experience- & they've come here to release their frustration & ask advice.

Let's not immediately assume we know more about the person & the situation than we do & rush to stomp on them.

Long Term Care Columnist / Guide · Aug 24, 2006

I have one question for the OP: Would your patients' behavior bother you as much if they were private pay? Or covered by traditional health insurance?

I understand the need to vent, but can't it be done without bashing low-income patients? Having been on public assistance in the past myself, I really hate it when Medicaid clients are routinely looked down upon, as they so often are on these boards. And may I remind everyone that any one of us could become Medicaid patients ourselves someday.........life holds no guarantees for ANY of us.

'Nuff said.:stone

cherricka · Aug 24, 2006

No where in motorcycle mama's post, do I see her "bashing" anyone. I see that she is venting her frustration about situations that she has come across. Unfortunately, as a community health nurse (home care nurse) you see some people possibly at their worst, or in horrible situations. When you see this over, and over, your thinking does slowly change. The difference between a good nurse, and a bad nurse, is how you treat your patient, even though you may disagree with their lifestyle, choices, etc. I also have a few patients (never mind what insurance they have), who try to squeeze anything they can out of me, including paper towels and hand cleanser.

P_RN, ADN, RN · Aug 24, 2006

i usually was clinic based for wic and epsdt , but i did ride shotgun on many a home visit. medicaid isn't the bad guy here, neither are the patients. my mom is on medicaid....so by this logic my mom is a welfare/medicaid cheat? i beg to differ.

as far as supplies for home calls, i for one didn't usually take my bag inside. our manager had us make packets (big ziplocks would do perfectly now) of what would be probably used. we used screw top urine cups to parcel out betadine and made our own 4x4 packs using exam table paper. wrapped them up like birthday presents.

goodasitgetts · Sep 8, 2006

One of the things that I have always liked about home health is that HH nurses are some of the nicest nurses I have ever worked with. How many times have we picked up medications at the pharmacy, shoveled snow, or purchased items with our own money for our patients in need? There are a lot of "users" out there and they know us when they see us! As a 12 year HH veteran I have been manipulated many, many times! Remember that this type of person is used to living off others. Before I do anything I stop and think about whether I am actually helping the person or making them dependent. Remember the old adage about teaching a man to fish rather than giving him fish so that he can feed himself for the rest of his life. Some tips on how to tell when a patient or family is trying to manipulate you-pay attention to the patient's home. Do they have old HH folders lying about from past admissions (may be knowledgable of how to manipulate the system), have you noticed them trying to manipulate someone else such as a neighbor in front of you? Does the patient have a chronic and long-standing disease and act like he doesn't know how to take care of himself (likely many have tried to teach him, people with long-standing chronic diseases can be very manipulative) Does the patient have a psych history or does he take more than one psych med (may have psych problems), is the patient evasive about giving history? Do the supplies left in the home disappear? Does the patient seem to be using a lot more supplies than he should be using? Is the patient demanding about what time of day you see him (may be hiding the fact that he is not home bound, obviously manipulative). Does what he tells you seem suspious (a patient once told me that he could not walk, never got out of his chair yet couldn't explain how he got to the toilet or how candies got next to his chair). Try doing a safety assessment of the patient's home (we should be doing this anyway). I once found that the patient who badly needed dressing supplies for his wound had more dressing supplies in his back bedroom than we had at our nursing agency! One type of manipulation that we frequently run into is the patient we "cannot" do his wound care. Ask yourself can he reach the area (if the wound is on his foot, can he put on his shoes and socks?), could he do the wound care if a mirror is used? If a patient needs some type of supplies frequently there are local agencies where the patient can get the help he needs. Remember that our goal is make the patient independent so our actions should be towards that end. :mad: