Patients on Medicaid - page 5

by DiEd | 34,450 Views | 333 Comments

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. 3
    Quote from woody62
    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

    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.
  2. 0
    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

    Woody
  3. 0
    Quote from teeituptom
    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
  4. 0
    I agree, facesheets aren't exciting reading. zzzzz:zzzzz
  5. 6
    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.
    FireStarterRN, KellNY, jojotoo, and 3 others like this.
  6. 2
    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.
    pattycakeRN and TheCommuter like this.
  7. 2
    Quote from AngelfireRN
    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
    canoehead and pattycakeRN like this.
  8. 0
    [quote=Babarnurse;2380979]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.
  9. 3
    I've noticed that many low SES people are rude in general. I've worked many retail and nursing home jobs, and a significant portion of people stuck at the bottom stayed there for a reason: Their manners and work ethic were crap. This ensured a low income and thus Medicaid. Seriously, many people in the lower SES are taught that being street smart is the best skill one can have, and that no uppity jerk is going to tell them what to do. Yes, I'm generalizing, but it's what I've seen. Oh yeah, don't forget that whole, "The customer is always right," crap that ensures that anyone can be a Paris Hilton nowadays. Yes, I know that there's much more to lower SES than most people think (eg the welfare trap), but again, this is what I've seen.
    Last edit by PeachPie on Sep 2, '07
    monkeybug, TheCommuter, and GadgetRN71 like this.
  10. 2
    DiEd. . .your post kind of made me laugh. I worked in a VA hospital and one of the common topics among the nursing staff was how many of the vets had never ending demands and complaints very similar to what you are ascribing to Medicaid patients. The difference was that the target was Uncle Sam! I think a great many of the comments you hear and some of the behavior comes out of frustration. I was recently hospitalized myself for 11 days. It was a very boring 11 days and I had a lot of time to get stewed up over the fact that things got left off my meal trays (you made a mention of a patient's Diet Pepsi being left off her lunch tray and calling a friend and ranting about it), couldn't ever get a salt package to add to all the unsalted soups I got even though I was not on a sodium restricted diet, one of my treatments or medications didn't get done on time or, gasp, never got done. I was a captive with nothing but a lot of time to think about every little thing that was going on during each day. I got on the phone with dietary, I don't know how many times, to complain about their crummy service. And, I wasn't a Medicaid patient--just a frustrated, bored one. What's the old saying? Time is the playground of the devil. I think it definitely applies here. For people who have never had to wait and wait for the services provided by our government, the level of frustration that builds up is sometimes overwhelming. It is very easy to strike back in an acceptable way--complaining and demanding. Sometimes it's almost a game to see how far you can aggravate another person until they blow up. The trick is to realize people can do this and not fall for it. When I worked in a large city hospital that had a large indigent patient population we were advised that we would see this kind of behavior in some of the patients. We were told to remain respectful and to, in fact, take extra time to ask if their needs were being satisfied. We found that in many cases people acted a lot better when they felt they could be more trustful of the staff. This is not to say that it worked for all, but it helped to cut down some of it. We were also inserviced about the services that the hospital did provide for our indigent and Medicaid patients. It was embarrassing to me when patients knew the services they could get better than I did. So, I made it a point to learn what they were. Something I learned when I went back for my BSN was that communication skills are something that take many years to master and I know I sure didn't get anywhere near a good education about them in my ADN program. The more time I took to understand psychology, behavior and communication since my BSN program, the easier my working life has become when working with the kinds of patients people are discussing in this thread.
    sharona97 and canoehead like this.


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