Patients on Medicaid - page 4

by 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... Read More


  1. 0
    Quote from HeartsOpenWide
    I have a question. When I worked in a Dr. office the pts insurance card (copy) was taped to the front of the chart so you knew what kind of insurance they had for billing and blood drawing purposes (which lab form to use). I really did not give it much though and always treated my pts the same. Now that I am in the hospital as a student (maybe I just do not know their chats that well) I have NO clue what kind of insurance a person has and could care less. It does not affect the care I give. What does the type of insurance have to do with it anyways? I have seen jerks and totally nice people with private and Medicaid/medi-cal. If anything I think health care workers should be the ones we are shaming here for treating people a certain way depending on their health insurance. Since I am in nursing school I had to get the "green card" (which is like medicaid but just for family planning) because I can not afford the $500 medication deductible my insurance requires (my parents are paying my insurance while I am in school and it is only for major medical) and I HATE going to the pharmacy to pick up my birth control because I do not want any one to see me with the "green card" because there is such a stigmata about it; and its wrong that I feel that way, but it is a valid feeling.
    Every patient admitted to a hospital has what is called a face sheet. It list their name, address, next of kin, doctor, social security number, type of insurance, employer, occupation, admitting diagnoses. It is either the first sheet in the chart or the last one. I would look at my patient's face sheet to find out who the next of kin was. And later, what type of insurance so we could determine if home health care was covered.

    Unfortunately, most nurses are like the general public. They have their preconceived ideas about their patients and their lives. And because we have our own ideas, we treat patient's differently.

    Woody
  2. 5
    Honestly, I couldn't tell you what insurance (if any) my patients have until it's brought up by the case manager or other staff.

    Unless it directly impacts their treatment and outcome (like the laborer admitted repeatedly with pneumonia because he had no health insurance, didn't qualify for assistance, and couldn't affort discharge prescriptions totalling over $400), it's none of my damned business
    sharpeimom, sharona97, Elvish, and 2 others like this.
  3. 3
    I don't run to a pts chart and see how they're paying. It's not my job. My job is to provide healthcare. End of story.

    As an aide, I don't know what if any insurance a pt has and I'm not sure the nurse does either. Who am I to judge? I don't know what tomorrow holds for me and heck, tomorrow I might be on medicaid. Not likely to happen but I'm not going to judge when that very well could be me on medicaid.
    sharona97, Jo Dirt, and VivaLasViejas like this.
  4. 4
    This is precisely why we need universal medicine. Woody's case vividly illustrates the quandry many Americans find themselves in. Who here hasn't cared for someone who delayed seeking help because of unavailability of clinic access, only to end up costing the taxpayer big bucks down the road? Or patients forced to use ERs as clinics because of our lack of an integrated healthcare system that plans for the realities of financial disparities between citizens.

    Do people actually think that looking down on poor people will make them go away? Will eliminating help for the poor make them able to afford modern healthcare? Do they really want the United States to resemble and behave like a disorganized third world nation where people die in the street and are refused healthcare for lack of ability to pay? Is that what libertarians want?
  5. 3
    Quote from jlsRN
    This is precisely why we need universal medicine. Woody's case vividly illustrates the quandry many Americans find themselves in. Who here hasn't cared for someone who delayed seeking help because of unavailability of clinic access, only to end up costing the taxpayer big bucks down the road? Or patients forced to use ERs as clinics because of our lack of an integrated healthcare system that plans for the realities of financial disparities between citizens.

    Do people actually think that looking down on poor people will make them go away? Will eliminating help for the poor make them able to afford modern healthcare? Do they really want the United States to resemble and behave like a disorganized third world nation where people die in the street and are refused healthcare for lack of ability to pay? Is that what libertarians want?
    You are so correct. Do you realize that we are the only industrialized western country that does not have universal health care coverage for all of our citizens. And what gets my Irish up is when I hear people comparing our great system to what they say is the poorly run socialized medicine of Canada, Great Britain, France, Germany, to name a few. What is so great about having the world's greatest health care system when 46 million people here have access only to episodic health care. We frequently complain of frequent flyer's, who appear in our ER's worse and worse until they are finally admitted, requiring much more expensive treatment then they would have if there was a universal health care coverage. We hand them prescriptions, expecting them to have the money or coverage to have them filled. We give them health care instructions, expecting them to follow them, without giving any regard to their own ability to afford them.

    Yes, we do have the greatest health care system in the world. Especially if you can afford to have access to it. And even if you can afford it, as another nurse has said, the expense can bankrupt a family.

    Woody
    Once again stepping down for her soap box once more
    sharona97, Elvish, and Jo Dirt like this.
  6. 5
    I never cared what insurance someone had when I worked in the ER but at the same time I can bet you if they came by ambulance for a simple laceration then they had Medicaid. People take criticism of these recipients as "attacks on the poor" and often it isnt. It is just really frustrating to see resources being misused when there are so many people out there unable to afford proper care.

    How can you justify the following situation? A 18 yo gets drunk then drives and gets injured. We will pay for the hospital care and life long care of someone who makes a bad decision but take a 45 yo who works two jobs and who is involved in an accident or has a major medical problem then the 45 yo is forced to go bankrupt first or in most cases forced to delay care because they are saving for college or just trying to survive. And see this is why it is frustrating because people will say, "So you will just let that 18 year old die? you are heartless." No I wouldnt let the 18 year old die, I never said they didnt deserve care but I do think the 45 yo deserves care as well. We need to take care of everyone, not just the poor or the rich.

    So it is frustrating to see people waste, not respect resources and not attempt to sacrifice while others are.
  7. 5
    It's interesting to me that when nurses report, "this is my experience day in and day out ..." that this experience is invalidated by some and labeled as a lack of compassion.
  8. 6
    Quote from 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.
    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.
    I obviously read a different thread to the rest of you because I certanily don't see the need the flame the OP as eveyone esle has done, even going so far to question her nursing ability. Why jump down her throat and react to her thread in a knee jerk manner, when she clearly states that she is looking for feedback to help her understand a population groups behaviour. I really don't see that she was having a 'go at poor people', we don't know where she works or what her experiences are. For all we know ALL the medicaid people she had met and cared for have acted in the manner she states. She also states that she doesn't want to generalize or label people, implying that she isn't some ogre who hates all medicaid pateints and treats them badly, but rather wants to hear other peoples experiences and opinions. Can't we give her that without her climbing into a hole and never wanting to come out again?
    To the OP,....as for me, I am a nurse, not an angel and I don't like all my patients either. I am an ER nurse and I before I worked in the ER, I felt sorry for most homeless people but following all the experiences I have had I dislike the majorty of them. So, there may be population groups that you don't like looking after and thats ok, as long as you treat them all your pateints the same, with respect (however hard that may be) and keep your views well hidden and to yourself!
  9. 3
    Maybe these patients are so used to poor care from clinics, grocery stores, pmds, secretaries, and others that they are programmed to react. I would imagine anyone who grew up with the superior attitudes of others might become a reactor. In your face for their due.

    Is it right? No...but again, would you want to walk in those shoes?

    If a person is abused, they flinch if a hand is raised around them. Isn't this the same thing? Animals cower when a hand is raised if they have been beaten. Bullies learn that loudness and standing tall intimidates others. If threats and demands have worked for them in the past, it may be their only power in a bad situation.

    True story. One day I received two patients who were AA and from a poor area, no insurance, both young and pregnant. Horrible hyperemesis, ATTITUDE/FAMILY WITH ATTITUDE. Both had gone to city hospital where they were turned around quickly and discharged. Came to our suburban hospital-tough duo on one day(was I thrilled to have them NO). Both treated with respect regardless of their attitudes, lined and labs drawn, IV fluids infused 2 L, iv zofran administered. Families were handled like I would handle any other difficult family-FIRMLY. BOTH GIRLS AT THEIR DISCHARGE WHILE CRYING AND HUGGING ME APOLOGIZED! They felt that nobody cared for them. The clinic, the other ER, and God knows who else made them feel like they were a problem. All they needed was a nurse who was not judgemental and treated them like the sick patients they were. It wasn't life threatening, and only a common complicaton of pregnancy-but to these two girls it was everything! They could eat and drink and felt human again after a few weeks! They also received a zofran prescription-how hard would it have been for the other hospital to do?

    I hope I made these two girls understand that attitudes from healthcare professionals are as individual as they are from patients. They have a right to be treated equally, regardless of their insurance status!

    I have had other instances where I print spanish discharge instructions and other nurses (who should mind their own business) tell me they should learn English. The same thing when I ask questions in "bad" Spanish or ask them to write down their symptoms. It seems to be too much trouble for others to get the language phone, learn spanish or get a translator. Why is different for a Russian patient then a Spanish patient? In our area, the Russians have money. Again, I've heard everything from them being lazy or just abusing the system.

    I don't doubt that nurses in poor areas can tell who has medicare due to some of the reasons previously stated. My only point is that we are responsible for our own reactions to patients-good and bad. Maybe they need to know you are on their side and need to be schooled in what is and what is not acceptable in hospital. Also, what they can expect as a patient being cared for in a hospital. This may help them become better patients in the long run.
    Maisy

    PS Sorry so long
  10. 2
    Quote from earle58
    i too, was on medicaid many yrs ago.
    during that time, when i was a pt in the hospital, i was everyone's worst nightmare.
    when i got off medicaid, and was a pt in the hospital, i was STILL everyone's worst nightmare.
    so there you have it.
    hmmmph.

    leslie
    And that is what we love about you Can you imagine me as a patient hahahaha
    Last edit by teeituptom on Aug 31, '07 : Reason: forgot a point
    canoehead and leslie :-D like this.


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