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.

[Altra, BSN, RN]

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.

[scattycarrot, BSN, RN]

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!

[MAISY, RN-ER, BSN, RN]

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

[teeituptom, BSN, RN]

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;):balloons: Can you imagine me as a patient hahahaha

[teeituptom, BSN, RN]

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:balloons:

I never look at the face sheet, one it bores me. two it does nothing to facilitate care. three it has no bearing on my decisions re pt care.

I dont treat any patients differently, to me they are all the same. I always have the same half smile on my face. I use the same jokes. I hum the same songs. I always use the largest bore IV appropiate for the task at hand. I have no preconcieved ideas, because after all these years everyone looks and sounds the same. Except other golfers.

[woody62, RN]

The poster asked for information and I provided it. Of course I read everyone's face sheet upon admission. How else could I decide who was worthy of my time. Some druggie vs a hard working golfer? Of course, the patient's financial issue shouldn't be an issue at all. Sometimes patient's are admitted that are from out of town. Sometimes they are critically ill and need a family member notified. Or a family member calls (how do I really know he/she is a family member). Of course this was all prior to that idiotic law that was meant to protect patients from insurance companies sharing their health information and instead blocks everyone from their family from even knowing if they are a patient. If I get asked one more time for a code word for anyone calling to find out about me, I'll scream:angryfire. I've got one daughter, one brother and one aunt, who care enough about me to inquire but if they don't know the pass word they will not even be told I'm a patient.-I'm getting off the topic.

I didn't read every patient's face sheet. In fact, I could care less about who was paying their bill. I was more interested in providing the best care I could, regardless of their socio-economic group, age, level of education, etc, etc. I once had a patient inform me she was self pay and was entitled to my undivided attention. I very politely told her, all the patients on my floor were self pay to one degree or another. And everyone was treated the same. And it was the same floor that I received that 14 K gold bracelet from a former, then dead, patient.

Now I am going off to weed the garden. And work off some of my frustration:devil:

Woody:balloons:

[leslie :-D]

Can you imagine me as a patient hahahaha

i would love, love, LOVE you as my pt.

(note to self: get retractor.)

and yes, i did have a kneejerk reaction.

my apologies.

the op did not come across as biased at all.

i hate stereotypes.

and that's what i reacted to.

leslie

[FireStarterRN, BSN, RN]

I agree, facesheets aren't exciting reading. :zzzzz:zzzzz:zzzzz

[Babarnurse]

Let me just say that I have experienced the "attitudes" of others toward people who use WIC and are on Medicaid. I am a nurse, work full time and have private insurance. HOWEVER, I am a foster parent. The children I care for are on Medicaid and get WIC. I have heard nasty comments about people on "my kind of insurance" before when filling a script. I haven't had a lot of trouble with WIC at the grocery store, but some cashiers will look at me, my purse (Dooney and Burke) and then look at my WIC checks.

Just remember that things aren't always what they seem. There may be many different reasons why someone is getting help. Yes, I agree, there are some, heck, many people who abuse the system. But, that isn't for me to worry about. Someone with broader shoulders should worry about that.

As far as caring for someone on Medicaid, most of my clients are on that, and I still give them 100%. What difference does it make? Should they get LESS care because they are state pay? I don't think so.

PS: Motorcyclemomma....I CAN read the small print and I have still taken things to the checkout that I wasn't supposed to. In the store I shop, they put the label smack between two items, sometimes it is hard to tell which is which.

[AngelfireRN, MSN, RN, APRN]

I'll go ahead and jump on the WIC bandwagon. I used to work at Wal-Mart, and we took WIC coupons. Not only would the approved items be typed on the voucher, the store had neon yellow tags by ALL WIC-approved items. It never ceased to amaze me what people would try to get by with. One instance:

A young lady came through with a case of Gerber baby juices with yogurt added. WIC did not approve those, and I told her that. She insisted that these juices were "all her baby would drink", and that "everyone else let her have them". I called over my manager, who supported me, told her that she could not purchase the juices with the voucher, and turned to leave. The lady promptly picked up a juice bottle (and this is when they were made of glass) and beaned my manager in the back of the head.

Then let's not forget the people who would come through with food stamps and WIC, claim they had no money for food, and then load up the counter with cigarettes and beer (after telling their kids that, no, they did not have enough money for a 25-cent pack of gum). Sorry, my rant.

[woody62, RN]

I'll go ahead and jump on the WIC bandwagon. I used to work at Wal-Mart, and we took WIC coupons. Not only would the approved items be typed on the voucher, the store had neon yellow tags by ALL WIC-approved items. It never ceased to amaze me what people would try to get by with. One instance:

A young lady came through with a case of Gerber baby juices with yogurt added. WIC did not approve those, and I told her that. She insisted that these juices were "all her baby would drink", and that "everyone else let her have them". I called over my manager, who supported me, told her that she could not purchase the juices with the voucher, and turned to leave. The lady promptly picked up a juice bottle (and this is when they were made of glass) and beaned my manager in the back of the head.

Then let's not forget the people who would come through with food stamps and WIC, claim they had no money for food, and then load up the counter with cigarettes and beer (after telling their kids that, no, they did not have enough money for a 25-cent pack of gum). Sorry, my rant.

I hope she called the police and had her arrested and prosecuted for assault and battery. No one should be allowed to get away with that type of behavior.

Woody:balloons:

[jojotoo, RN]

Let me just say that I have experienced the "attitudes" of others toward people who use WIC and are on Medicaid. I am a nurse, work full time and have private insurance. HOWEVER, I am a foster parent. The children I care for are on Medicaid and get WIC. I have heard nasty comments about people on "my kind of insurance" before when filling a script. I haven't had a lot of trouble with WIC at the grocery store, but some cashiers will look at me, my purse (Dooney and Burke) and then look at my WIC checks.

Just remember that things aren't always what they seem. There may be many different reasons why someone is getting help.

This situation had never occurred to me before. Thanks, it gives me something to think about.