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.

[PeachPie]

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.

[Daytonite, BSN, RN]

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.

[EmmaG, 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.

No offense, but you don't need to explain anything. These people need to get over it and mind their own damned business. And trust me, whenever I'm in a checkout and hear these comments being made, I tell 'em that too.

[doe9181]

The only thing that aggravates me about medicaid patients stems from when I worked as a pharmacy tech while in nursing school. When patients would come through the drive thru in their 60,000 dollar mercedes or bmws and be on medicaid. Now how the hell did they pull that off? And then they get upset when their over the counter meds aren't covered. Kiss my rear! I had no insurance at the time and had to cater to these liars. It really upset me.:angryfire

[RNmom08]

Quite honestly I feel it's none of my business. Yes, we are paying taxes and funding Medicaid but still it's none of my business how they act or check out their groceries. We still need the healthcare for people who need it - end of story. I have not lived in another persons shoes to know what their life has been like to make them grumpy, demanding, rude, or even kind and polite.

For those who are not kind and polite I guess all I can do for them is say a silent prayer to myself for them that they may find peacefulness here in their lives and not be so demanding and grumpy tomorrow.

[Jo Dirt]

The only thing that aggravates me about medicaid patients stems from when I worked as a pharmacy tech while in nursing school. When patients would come through the drive thru in their 60,000 dollar mercedes or bmws and be on medicaid. Now how the hell did they pull that off?

I don't know, but ask what their secret is and share it with us!

[EmmaG, RN]

I don't know, but ask what their secret is and share it with us!

I'd like to know that as well. Because I'm sure that they've checked the registrations of these cars and these people are the actual owners. And that they have detailed knowledge of the drivers' financial status, work history and home life. After all, it couldn't be that they have borrowed a friend/relative's car, or that someone else is picking up a prescription for the person covered by Medicaid. It couldn't be that someone has fallen on very hard times.

Naw, that could never happen...

[VivaLasViejas, ASN, RN]

On the other hand, I have known people who managed to live very well while on the system. My youngest niece was one of them..........she owned a Ford Explorer, lived in a nice neighborhood in a 3-bedroom house, had a cell phone and bought brand-name groceries, all while on welfare. I never did figure out what her angle was, because I certainly didn't live like that when my family was on assistance!

However, Emmanuel Goldstein is right: we DON'T know the circumstances of each individual who appears to be thriving while on the public dole. It's easy to turn up our noses at those we think are abusing our tax dollars to indulge in a lifestyle that we ourselves can't afford; far less so to take everything on a case-by-case basis and judge each situation individually, so that we can identify and punish the ones who truly ARE abusing the system, rather than making life even harder for those who are using it as a stepping-stone to a better life.

[leslie :-D]

i once worked with a cna who 'appeared' to live well.....nice house, gorgeous car, her kids w/designer clothes.

she was quite verbal about being on section 8, receiving public assistance, medicaid.

i asked her what her secret was.

she said something to the effect of, "i know every single system and loophole, here in america".

wonder what that means?

leslie

[EmmaG, RN]

On the other hand, I have known people who managed to live very well while on the system. My youngest niece was one of them..........she owned a Ford Explorer, lived in a nice neighborhood in a 3-bedroom house, had a cell phone and bought brand-name groceries, all while on welfare. I never did figure out what her angle was, because I certainly didn't live like that when my family was on assistance!

Used to be that a mother couldn't apply for assistance if her husband/bf was living in the home. That has changed (at least in VA) and from the experiences of some I know, if she is unmarried, they don't count his income.

[Multicollinearity, BSN, RN]

When I was a child, my father became permanently disabled. We went from our nice upper middle class lifestyle, to on welfare and medicaid, after exhausting our own resources.

I can still remember being treated differently at doctors' offices. The only thing that changed was the medicaid card my parents had to present.

I would agree there there are some common problems among low income groups. That is just common sense. It is unfair to treat everyone on assistance as though they behave like some problem people, though. I remember that unfairness. It felt bad.

[Babarnurse]

Multi:

I'm sorry you had to deal with that and I agree, it does feel BAD. I felt as though I had done something wrong, when in fact, it was quite the opposite. Just like in your situation, it isn't like your family was sitting around eating bon-bons. You had a major life change. I'm sure, given the choice, your family would have preferred to never receive state assist.

Lori