Patients on Medicaid

[DiEd]

I hope not to offend anyone out there, but I would appreciate some feedback on taking care of young to middle-aged adults who are on medicaid. It seems that so many (I realize not all) are some of the most difficult patients to care for; they often are rude, demanding, and unappreciative of nursing care. I have cared for many who demand tests/procedures/an extra day or two in the hospital/supplies that they don't really need; doctors often admit to just giving them what they want, rather than arguing. I have had medicaid patients say to me after I suggest to them, they can probably purchase an item for cheaper at the store, "Oh I don't care, I'm on Medicaid". Recently, a woman openly admitted that she had another child because she wanted more Medicaid money. When a woman has six kids by different men, and lives off Medicaid, I asked myself, "how does this happen"; aren't there people out there monitoring this system". About a year or so ago, I was taking care of a woman - and because the census was extremely low, patient-nurse ratio was 2:1 (unusual but nice). Anyway, I took so much extra time visiting with, caring for and going way beyond what I really needed to do to ensure quality nursing care, and at lunch, her Diet Pepsi wasn't on her tray. She gets on the phone and proceeds to rant and rave about this to a friend. I could hear her end of the conversation. Yes, she was a Medicaid patient.

Wow, I was blown away and got quite upset. I can't believe these are isolated incidences. Many nurses I work with are able to identify Medicaid patients just by their behavior.

As I said earlier, I don't mean to offend, but I am interested to learn if others out there in the nursing world encounter the same type of thing. I realize it is not right to label or generalize people, and I don't let it affect how I care for people; I certainly don't like the way I feel when confronted with this behavior. Any responses are welcome.

Thanks.

[teeituptom, BSN, RN]

Why am I not surprised. Are we taking you away from hitting that cute little dimpled ball around:lol2:

Woody:balloons:

Played yesterday and today.

[woody62, RN]

Played yesterday and today.

Again why am I not surprised. It seems that to some there are only two things that are important in their lives-masking money and hitting a dimpled little ball around:lol2:

Woody:balloons:

[ricced]

could anyone tell me what's the difference between medicare and medicaid

[rph3664]

I can see this isn't really a question.

Do you think people with regular insurance or those who are private pay are incapabe of being rude?

My brother-in-law is a multi (multi) millionaire. He could buy and sell every one of us. He went into the hospital and paid cash for his open heart surgery. He had some minor complications and was in intensive care a little longer than expected. He acted like such an A$$ one of the nurses admitted to my sister we've never had a patient like this.

Or do you think they just don't take the Medicaid patients into account because they are all so horrible it's just a given you can expect them to be bad?

And what's this about staying pregnant to get more Medicaid money? I wasn't aware Medicaid actually paid out any money to live on.

When I am pregnant I use Medicaid (I have four children and another on the way and they have the same father...what a shocker) and I have been so grateful for it. One of the nurses on the maternity ward commended me on what an easy patient I was to care for. I know this is anectdotal but really all we can go by here are anectdotes. At any rate, I think it's accurate to say much of the medical community looks down on those who use government assistance, though I can't worry about that.

But you know, there could be a reason so many Medicaid recipients have a chip on their shoulders. Again, I'm using anectdotes but if I'm lyin' I'm dyin'. I went to school with a girl who was telling me about when her grandmother took her son to a doctor's appointment. She waited and waited and finally when she mentioned the long wait to him the doctor said, you welfare people beat all I've ever seen. You don't have a life, where did you have to go?

My best friend who happens to be a nurse told me about when her daughter was small and got (I think it is called) a trigger finger. The doctor condescendingly told her, Ms Smith, I can't afford to take care of this for you any more than you can afford to pay me to take care of it...of course, my friend said they could probably hear her down the street as she took her daughter and left out of that doctor's office.

Then, there was the time I was in LPN school. We were sent to a walk-in clinic and they actually had a dry erase board that was divided down the middle: on one side they had "Medicaid" patients and the other side said "Other". I kid you not, they would leave the Medicaid patients waiting until the very last, taking the "others" who came in after them first.

We finally heard a woman (Medicaid) become angry when he finally did come in to see her then we quickly heard him apologize for the student nurses because they had everything mixed up:angryfire

Thank goodness, they took the students off that rotation site.

After all, I don't like to see lazy bums who only live to bum off the system, but apparently they do meet the requirements to have Medicaid, and Medicaid is paying the facility to provide care to that person so we really shouldn't speculate or even be concerned with why they are getting government services.

When I worked in retail pharmacy, I had colleagues who would do things to Medicaid patients like tell them it would be an hour and make them wait an hour even if it wasn't busy. I also worked with one guy (not for very long but for other reasons) about whom other employees said they had seen him taking amoxicillin, cough syrup, etc. into the bathroom. We all knew he was probably spitting in it or urinating in it or maybe even worse. Thing is, the chance he would one day be on Medicaid is probably greater than everyone reading this put together because even though he was a single guy who made $30 an hour (standard pharmacist pay in the mid-1990s) and insurance there cost $10 a week, he didn't carry it because he said he was healthy and didn't need it.

I think that woman who kept having kids was doing so to get more welfare money, not Medicaid. As for people being cut off after 5 years, you're now having people who coach their kids to act up in school, or act like they are retarded, so they can get SSI for them. This is why people who have been declared permanently and totally disabled are being re-evaluated from the ground up to see if they still need benefits.

My grandmother was on Medicaid for the last few years of her life; who do you think pays the vast majority of nursing home bills? Most Medicaid dollars are actually spent on people like this.

[rph3664]

could anyone tell me what's the difference between medicare and medicaid

Medicare is the health insurance program for the elderly; everyone over 65 who has a Social Security number is automatically eligible regardless of income or assets. Dialysis is also paid for by Medicare (long story as to why this is so) and younger people who have been declared totally disabled can receive it as well.

Medicaid is for people with low incomes and small assets. The rules vary from state to state. Some people who are income eligible but have more assets can get what's called a spend-down, where they pay a deductible each month before their benefits kick in. Most of the spend-down people I have encountered were elderly, or AIDS patients.

Medicare was passed in 1965 and Medicaid a year later.

[rph3664]

I work in a family practice clinic and from my own personal experience, if there is going to be any patients that will not call and cancel their appt. or reschedule, it'll be the ones on medicaid, they just don't show up. Then after 3 times they are dismissed from the doctor and wonder why. Our clinics no longer take any new medicaid patients, due to the fact of low reimbursement and continuous no-shows. I'm not judging but the mass majority of our junkies are on medicaid, the mass majority of our rude ones are on medicaid. OP can dispute this but when I see 30-35 patients a day and 1/4 are medicaid, 1/2 of them won't even show up to their appt. So what do they do, they go to ER. Some of the stories between patients going to ER's, walk-ins and our family practice clinic is a joke within itself. Keep abusing the system, I have nothing else better to do with my tax money. I would never be rude to a patient to their face, but I'm human and I do voice my opinion with other direct care co-workers of this repetitive abuse of the system. I truly do try and me sympathetic due to the fact that I was a welfare child and my mother abused the system and I hated it then and I hate it now. I never look down on the children because they have no choice, but with the parents, if it looks like a chicken, walks like a chicken, you know the rest.

I mentioned this on another thread, but I used to live in a city of 300,000 and the newspaper decided to investigate why so few dentists take Medicaid. Did they ever come out of the woodwork, and were willing to use their names and photographs! They said that they usually do not show up for their appointments, nor do they call to cancel, but they always have the means to get hair weaves, gold tooth caps and sculptured nails, and can go to an amusement park that is 3 hours away and costs $30 a person to get into. When they do show up, they are often abusive to the staff, and their children are so out of control, every dentist they interviewed had had to call the police at least once to get the situation under control.

My dentist does a lot of pro bono work, and she said the story was absolutely true. This situation does a grave disservice to people who are disabled or have fallen on hard times for whatever legitimate reason (widowhood, spousal desertion, serious illness, job loss, etc.) or for that matter people like my late grandmother.

[Katie82, RN]

I work as a case manager for the medicaid population. I spend half my time trying to get them to do the right thing and the other half cleaning up the mess when they don't. You are correct that they are demanding and rude, but a majority are uneducated and unsocialized who are defensive because they know that many people perceive them as being less than equal. I am not defending them by any means. I work very hard for my patients, and I do so with the understanding that I will not tolerate rudeness or attitude. My patients are only rude to me once, I have no problem firing them, as many doctors are now doing.

[maryloufu]

I have only skimmed this thread- so if someone already said this I am sorry.

I went on Medicaid when I got pregnant at the end of nursing school and we were rolling pennies for gas broke. The whole process of bringing in all of my records and waiting for my appointment, and then talking to the caseworker was all very stressful to me. I felt like I was under the microscope and that everyone thought that i was a bad person. I dreaded each time I had to visit that office. Maybe this causes some people to become tough and very aggressive with their requests.

WIC was not so bad. I had fun with the nutritionist because I asked her questions that she had to go look up. She was very nice and I think that we learned many new things together.

I do not enjoy working with difficult people, but I find that a great many of them can be disarmed with humor. However some people don't like my humor and things get worse. But in any case- I just do my job and drink heavily when I get home. (JK)

[rph3664]

That seems strange to me that physicians would do that. My best friend if a doctor and he says his biggest revenue is medicad patients. And he never has any trouble getting paid from medicaid, he says it's sometimes three months before the insurance companies get around to paying and then they are always denying payment on certain things.

He certainly doesn't live in Illinois! They have been as far as a year behind in Medicaid payments.

Many rural hospitals and nursing homes, and independent pharmacies, have had to close because of this.

I saw a post on the Filipino Nurses thread about how "we don't treat paying patients that way." I forget the whole story but you get the idea.

[rph3664]

Wow.

There but for the grace of God...

By the way, if you are ever a patient, please remember that others are paying for your bill. I hope you show proper gratitude, appreciation, humility and respect.

Yeah, well, if you are an insurance patient, someone else is paying that bill too.

[rph3664]

Dialysis is also paid for by Medicare (long story as to why this is so)

And I might as well explain why. You people who work in dialysis care, feel free to correct me if I am mistaken.

When Medicare was passed, health insurance was not the ubiquitous thing it is now, and dialysis was quite new, and a lot of people who needed dialysis were not able to get it because they couldn't pay for it. So, it was bundled into the Medicare plan, and there are enough people of all ages who need it, even though most dialysis patients are elderly or totally disabled, they have kept it as a Medicare program.

My cousin, who turns 40 this year, uses a PD method where he connects himself to a machine at night because his kidneys failed due to a disease he inherited from his mother (and in itself killed her a few years ago). Thanks to this method, he is able to work as a veterinarian (he is not in private practice but works as an animal pathologist) and take care of his wife and their two young children. And Medicare is the primary payer for his dialysis expenses. My parents were initially surprised to hear this, but I explained it to them and it made sense.

[pattycakeRN]

This is an interesting thread, and I really do enjoy reading everyone's opinions and thoughts- even those that make me think, "WHAT?!"

I don't even look at insurance info. Too busy, don't really care.

As far as being in control of your own fertility, that should not mean, "I'm going to have as many babies as I can, because I feel that's all I can control", it should instead mean, "I'm going to wait until I can AFFORD A CHILD AND EVERYTHING THAT COMES ALONG WITH IT to get pregnant." If that means abstinence, birth control, whatever, so be it.

My mother and I came here when I was 3, all the way across country so my grandparents could watch me. She worked full time and went back to college at 30, to get her LPN license and provide for me, both materially and as an example of what you can do if you really really want to better yourself. She is amazing. :redpinkhe Thank God she had the courage to change her life. Never once did we have to be on assistance.

That said, I agree that we should treat our patients all the same- no VIPs, either. That's a whole nother can o worms, as they say. My biggest peeve is when people (all of em) ***** because they don't like the food, or having their blood drawn, or being woken up for necessary tx, etc. It's the HOSPITAL. NOT the HILTON. Here's your sprite and saltless saltines, thankyouverymuchgoodnight.

And please don't set your cell phone alarm for when your pain meds are due. :icon_roll