Patients on Medicaid

Nurses Relations

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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.

Specializes in PCU, Home Health.

i am not religious, but i do believe in helping my fellow human beings. sometimes these threads truly make me ill...this is definately one of them. i just can't understand people in this industry having these ideas. how can they ever be impartial when caring for those without?>>>>>>

i have heard some pastors preach about how the church should take care of the poor and needy. this is why we are to give to the church so that the church can be an outreach to those in need. however it also says in the bible- if you don't work, you don't eat. ( something to that effect, (for even when we were with you, we gave you this rule: "if a man will not work, he shall not eat." 2 thessalonians 3:10.)

i believe that as nurses we should be constantly assessing the abilities of our patients- maybe they could not wash their own face yesterday but they can today. that means today they wash their own face. my personal belief is that god expects us to do all we can and he meets us there. (lol that makes me sound like i think i am god like- and for clarification i have no such illusion)

Specializes in nursery, L and D.
And this is my point about healthcare in this country.

Correct me if I am wrong, but I was under the impression that circumcision was considered ultimately healthier for a man. If so, why would we withhold that future health from a child?

Maisy;)

Hopefully this won't start the circ debate. Circumcision is considered to be a cosmetic surgery, with no medical purpose. Now there are some indications that it might help reduce the transmission of AIDS. There are people that feel, like I do, that this is not a good enough reason to put a baby through a surgery, and would rather the adult male make a decision about circ.

This is why medicaid doesn't pay for circ's. Lots of private insurances are refusing to pay also. Just wanted to let you know!

Specializes in ITU/Emergency.

Woody is right. No matter what type of Heathcare system you work under, people will complain. I worked in the NHS for many years and even though healthcare is free at the point of service, our ER would be overflowing with patients very similiar to the ones who overflow the ER's here. Now, they get the treatment 'free', whether they make an appointment to see the doctor or whether they come to the ER, except at the ER they usually have to wait but they will be seen that day and usually within 4 hours (thats a whole nother issue, 4 hour targets in the ER in the UK). Whereas, it can be difficult to make an appointment to see their doctor in some areas or they won't be seen for a few days. And, people can't wait with their ailments, which in my opionion is a reflection of todays society. Everybody wants instant gratification and they don't want to pay for it. And, despite the fact they are getting this 'free' treatment they still moan and complain and throw things. And, you know who complains the loudest a lot of the time and verbaly abuse the nurses and doctors? Professionals and what we call 'middle-england' and above. Many of whom could afford health insurance or at least a co-pay for an ER visit but don't have to and would kick up a stink if that was implementated. Which in my opinion it should be. So, its not just patients on 'medicaid' who act like chenoaspirit suggested, from my experience its anyone who thinks they are entitled to free heathcare. Come on over to any ER in the Uk and you will see what I mean. I think patients on insurance, tend to appreciate their heathcare coverage and don't have this 'entitle me' attitude.

Not only that, but universal healthcare does not get rid of inconsistencies between different areas and regions. The UKs healthcare system totally varies where you live. It depends on your catchment area. I worked in an innercity London ER and we were swamped with the same problems that swamp your inner-city ERs (except the daily GSW, more like weekly in the UK!) and thereby putting pressure on that particular hospital as they often get the same or less money than the affluent areas. So, universal healthcare is not this rosy ideal that illimnates disparity.

The NHS in the Uk is not great and is going through hardtimes but I still wouldn't swap it for the US system. As in perfect as it is, no-one will lose thier house over trying to get a serious illness covered.

(And, I am sorry, this is a subject for a different thread but I can't help respond to Maisey RN-ER's comments about circs. There is no research that proves that circs are 'healthier' for the man. There is so-called evidence from Africa but that research has proven to be flawed. The only proven benefit is reduction in UTI in boys in the first year of life. Thats why the American Association of Paediatrics, sit in the fence about circs and say its parents chioce, as that it is all it is.And, why its not covered by medicaid)

Specializes in Community, OB, Nursery.

self-edit

Specializes in LTC, Urgent Care.

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.quote]

when i got pregnant with my daughter, i was working ft hours, but i was only considered "staff relief". i applied for and was approved for medicaid. i only had it while pregnant (after my daughter was born, i got a position with health insurance). my boyfriend put her on his insurance. about a month later, i get this medicaid card in the mail with my daughter's name on it. apparently she qualified for medicaid for one year (which we didn't know). so we figured we'd use it to help cover co-pays, etc. that the insurance didn't. well, let me tell you. as soon as we presented that card to our pediatrician, our wait time went from 10-15 mins to 45 mins to an hour. needless to say, we didn't stay with him for long after that. but i did ask any prospective doc if he/she had hang ups for people on medicaid.

on another note,

my mother is on medicaid, since having colon ca back in 1992. she did have major medical, but the company tried to say that my dad lied (which he didn't) about her having epilepsy and dropped her just before surgery. the first few years that i went to the reviews to renew her medicaid, the county assistance people acted like i was trying to scam them. they were very demoralizing! my parents had to practically live in poverty to qualify. my dad over the years had to cash in life insurance policies, not work quite as hard (he was part owner of an automotive shop) and a variety of other things to come in below the cash income levels. fast forward a few years and pa decides that medicaid recipients have to choose a healthcare plan - an hmo of sorts. well, fine and dandy, but the 4 closest docs that i tried to sign my mom up with (all the others were at least an hour away from us) did not accept medicaid. each office told me that they had been telling the state for months that they wouldn't take medcaid patients, yet here is the state telling me that they would. she's in a snf now d/t her extensive medical history. my aunt is her poa, so i really have no idea what it's like now for the medicaid side of things. sad to say, but it's a relief to me not to have to deal with it anymore. all i really have to say for medicaid is that if she hadn't been able to qualify, she would not have been able to afford her meds and blood work and any of the other stuff she's needed over the years.

This is so sad, its all about human decency, which seems to be lacking in our modern day world. I, just yesterday, dealt with an INCREDIBLY rude person who is employed with local County Housing Authority, I had to ask her to quit interrupting me to let me finish my sentence, and asked her if she was this rude to all of her clients. I explained to her that I had worked as nurse for almost 30 years, and would have been disciplined if I had spoken to my patients in the disrespectful way she just spoke to me. Only then did she change her demeanor.

Sad ,I wonder how she treats some of the other folks she deals with, some who's cognitive abilities are affected, those who are frail, scared or unable to stand up for themselves.

I know this has nothing to do with Medicare, but we as a society must hold those who are in the position of dealing with the poor,ill, or disenfranchised to a standard of human decency. I will be reporting her behavior to the regional director in my part of the country.

I have called for doctor's appointments and before I even say why they are asking about my insurance info. I did advise the doctor that it comes across as uncaring. Ask about the patient's complaint first, and then ask for their insurance and financial info. The doc agreed and the policy was changed.

I also don't expect to pay a penny before I see the doctor in a doctor's office setting. That's just bad business. lol

A personal observation...I work with an aide who has 1) a brand new truck 2)has the cell phone that you put in your ear to wear 3) has gone on two cruises in the past 6 months 4) just moved into a new house last summer and 5) cannot afford to pay for health insurance so the kids are on a state-funded insurance program and she goes to the free clinic. So why am I driving a 5 year old car and paying $400 per month plus a $4000 deductible for health insurance???

mc3

Specializes in ER, PACU, Med-Surg, Hospice, LTC.

Second, I was commenting only on those fools that have issues with people who collect SSDI and they feel they shouldn't. I am aware of one such fool, who has always maintained that I am stealing her money because

1. I have a computor.

2. I am online.

3. I drive long distances sometimes, without her knowing exactly how long it takes but I can work because I can drive.

4. I went to graduate classes, there for I am able to work.

Neither she nors others know what the SSA defines as disabled. And people should really educate themselves.

This is an excellent point!!! I believe there are many people uninformed/misinformed about what the Government considers a Disability. I've posted this before in another thread, but I will post it again.

Am I Disabled?

Anyone can apply. If you feel you are disabled, it's free to put in an application.

The Government is very strict though. Believe me, they would rather have people working.

Being approved can be a very long process. It can entail a lot of paperwork as well as a lot of Doctors appointments. In CA, it can take over 2 years to be approved!

Anyway, I got off topic. Here is my experience with those on Medicaid. They can be nice and they can be rude, just like my insured patients or those patients paying out-of-pocket. The real difference at my Hospital is that the rate of leaving AMA is much, much higher in those receiving Medicaid. I truly believe it is because there are no repercussions for packing up and walking out in the middle of a treatment. Yes. I know that is their right to leave, but when they are in the ER the next week and the next week for the exact same problem that they refuse to finish treatment for, it can be very frustrating. The insured/OOP patients finish their treatments more often. Maybe because they know there is going to be a bill sent to them and they want to get better and not have to come back to the Hospital? I don't really know.

A personal observation...I work with an aide who has 1) a brand new truck 2)has the cell phone that you put in your ear to wear 3) has gone on two cruises in the past 6 months 4) just moved into a new house last summer and 5) cannot afford to pay for health insurance so the kids are on a state-funded insurance program and she goes to the free clinic. So why am I driving a 5 year old car and paying $400 per month plus a $4000 deductible for health insurance???

mc3

Two words regarding the aide: CREDIT CARDS.

JMHO.

Some auto dealers give new car loans to anyone who breathes on a mirror, and often live to regret it. Betcha that truck gets repossessed very soon.

Does she get a lot of child support (I understand some states do not take this into account for health programs) or does she have a wealthy boyfriend or relatives who slip her money on the side?

Specializes in IM/Critical Care/Cardiology.

Might that be in your equation in Charlotte County?.........

I hear ya Woody.

Specializes in IM/Critical Care/Cardiology.
Why is it my responsibility to work and pay into a system so someone else can inherit wealth they never earned? How is that different from using the system to pay your way so you won't have to get up and go to work?

Heron,

May you never have a catastrophic event in your life, after all those years you've worked or are working towards and then poof, your assetts are above the legal limit to qualify for help when your short and long term disability run out and your savings and your 401K so you will have the gov't whether it is SSDI or Medicaid or Medicare left to help you. And do you think they are going to tell you no? They will help you with their monies received from you and your work years along with all other decent working people, and educated. Why, because you will be in need.

It's easy to have the opinion that people on these systems are worthless when actually many have worked as hard if not harder than you and something terrible happened in their life. In other words, IMO be careful for what you wish for, yes there are abusers and generations of abusers of these systems,but belive me they are the minority.

State run programs are getting smarter about women with lots of kids learning a skill, changing their mindset, trying to stop the abuse. And it just isn't woman, I don't mean to imply that.

And the poster who gets it concerning our military heroes thank you. Our gov't isnt perfect, I've not met a perfect person yet, have you? Your check has monies taken from it for this sort of problem and when it happens, believe me it is a problem. And your contribution from your check will be used to help you, and you will still have to beg your creditors and settle for things you can't even imagine.

I mean no offense, but I sure miss the 40,000 I lost due to someone who did nothing more than misdiagnose me. That's all it takes.;)

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