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.

[woody62, RN]

I was a junior in a diploma program, in 1965, when Medicare/Medicaid came into being. I remember all the dire warnings about both programs be a sign of socialized medicine. And we were all going to hell in a hand basket. Funny how things changed over the years. I have seen numerous people on Medicaid. And I have had to help numerous people on welfare. Funny thing, I have never seen anyone living high on the hog off welfare payments. I've never seen them in the supermarket buying prime rib and other expensive food items. And I have never seen them in top of the line, designer clothing. But I have read about them, not only here but on other messages boards. Would some one do me a favor. Please post a place, here in Florida, that I can go witness these people for myself.

The people I have seen, on Medicaid, myself included, didn't have the money to buy or even lease $100,000 cars. And they weren't dressed in designer clothing. And most of them live in the projects, both in New York City, and here in Florida. Sorry if I sound like I am doubting you all. If you know someone is cheating the system, it doesn't matter if it is a friend or relative, you have the obligation to report them to your state's Attorney General Office, as well as your local representative, both state and federal. It might take a couple of times of complaining, but I'm sure if you complain long and loud enough, someone will look into it. And if they don't, there is always the New York Times. I know a reporter on it.

Woody:balloons:

[Jo Dirt]

I read where someone said I don't hold it against the kids, it isn't their fault and talking about how irresponsible people were who got on Medicaid.

I thought I was being responsible seeing that my children had coverage in the event they became ill.

What do they expect people on Medicaid to do? Walk with their heads down and not make eye contact, not even have the nerve to put shoes on their feet, come to the clinic leading a donkey carrying all their personal belongings?

Get real.

I can't stand snobs, I just despise them with the intensity of 1,000 burning suns.

[GadgetRN71, ASN, RN]

In the welfare/public assistance population, there will always be what I call "cheats" when I'm feeling nice, and "bums" when I'm not. The system was put in place for people who were having temporary problems, it was not meant to be a way of life. Unfortunately, there are some families that are multi-generational and have no sense of shame about being on welfare for years. I have a first cousin who has 5 kids and only got off welfare and got a job when they kicked her off the system. She was bragging before that about how she cleaned up the previous Christmas when she participated in the Adopt-a Family program. She is able bodied so no reason why she shouldn't get off her fanny and get a job.

There are people who need the help temporarily, and I have no beef with them. I think the "bums" make everyone else look bad. I try to treat all my patients with kindness even though there are some I would like to smack upside the head for their foolishness. I also think there should be something set in place to kick the repeat offenders of the system. For instance, putting welfare payments on a debit card that could only be used for clothing, healthy food, and necessity items(no alcohol or cigarettes). At least there is a movement in many states to place limits on how long a person/family may receive welfare. I'm sorry, but if you know that you have trouble making ends meet, why keep having kids?(you listening, Cousin?) When I was in nursing school, the campus where I did my last semester was in the ghetto. Almost every tenement house had multiple satillite dishes on it. Guess they didn't have the money for food and shelter, but managed to get Direct TV. Nice to know where the priorities lie!:uhoh21: PS- Medicaid doesn't irk me so much-again, there are people that claim "disability" when they probably have less health problems than I do, but I think everyone should have access to healthcare. As a taxpayer, I'd rather pay for someone's prenatal care than for ciggies and beer, because if the mom has a sickly kid, that'll be just another future welfare recipient. I'm sure I sound high and mighty, but my grandparents immigrated here in the early 50's. They both got jobs and never spent one day on assistance. Their first apartment didn't have running hot water and it didn't have its own bathroom either-you had to share with everyone on the same floor. I hardly come from a rich background. I just happen to have pride and a sense of resentment when I look at how I get gouged for taxes every week.

[JOLLIEHOLLY, 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. 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.

Let me tell you something, people who really need government assistance often times don't receive it. When I was pregnant with my second child I was denied WIC because I made $10/month too much!!! Keep in mind, between my husband and I we were making 27,000/year for soon to be a family of four. Maybe if I would've just shacked up instead of marrying my husband I would've received it. Then I could walk in and claim I am single and exclude my husbands income. It is a SAD day in America, when people who do the right thing and work hard get screwed and can't get a little help. I probably would've gotten WIC if I would've said "He's just my baby daddy"(just like the rap song, people really live up to those lyrics)

[woody62, RN]

In the welfare/public assistance population, there will always be what I call "cheats" when I'm feeling nice, and "bums" when I'm not. The system was put in place for people who were having temporary problems, it was not meant to be a way of life. Unfortunately, there are some families that are multi-generational and have no sense of shame about being on welfare for years. I have a first cousin who has 5 kids and only got off welfare and got a job when they kicked her off the system. She was bragging before that about how she cleaned up the previous Christmas when she participated in the Adopt-a Family program. She is able bodied so no reason why she shouldn't get off her fanny and get a job.

There are people who need the help temporarily, and I have no beef with them. I think the "bums" make everyone else look bad. I try to treat all my patients with kindness even though there are some I would like to smack upside the head for their foolishness. I also think there should be something set in place to kick the repeat offenders of the system. For instance, putting welfare payments on a debit card that could only be used for clothing, healthy food, and necessity items(no alcohol or cigarettes). When I was in nursing school, the campus where I did my last semester was in the ghetto. Almost every tenement house had multiple satillite dishes on it. Guess they didn't have the money for food and shelter, but managed to get Direct TV. Nice to know where the priorities lie!:uhoh21:

Actually, it is a misconception that welfare is mult generational. Prior to the Clinton's change in the federal welfare law, the statistics showed that the majority of people collection bebefits were 1) mostly white, 2) collected benefits for a period of less than two years and 3) got payments at or below the federal poverty line.

I worked with the Brooklyn VNA. Most of our clients lived at or below the federal poverty line. Most do not have multiple satilllite dishes on them. And very few had cable TV. Most had mininmum telephone service, disallowing long distance calls unless receiving them. And a portion of my clients cooked stew, that I learned, was composed of Laddie Beet stew beef, carrots, onion andpotatoes. I first it made me slightly nasueaous to thing some were eating dog food. But I spoke to a dietician, who told me, the beef was actually horse meat. And better for them then beef stew meat

I had similar experiences here in Florida. And a lot of them, both in Brooklyn andFlorida did not even have a high school education. And when they did, the available jobs paid minimum wage at best. And it took them out of the income allow for medicaid, food stamps and other benefits. I really couldn't blame then for not wanting to get a job that denied the benefits they received. And could not afford the benefits they lost. And benefitng from poor choices, I know a number of middle class and upper class that live above their income, are in debt up to their eyeballs. Their poor choices don't impress me either.

People also tend to think that those drawing Workers Comp are generally frauds. And living high off the hog. Know my clients and my own personal experience, nothing could be arther from the truth. My standard of living fell dramatically and so didn't the clients I worked with. The only way a person lives high off the hog, on welfare or WC is by cheating and lying. And they eventually get caught. There is always someone to turn them in. I had a client who committed WC fraud. And after a year and half, his fraud finally caught up. His wife, soon to be ex-wife, called and told me what he was doing. He lost the $65,000 he would have made in his settlement.

Like I said in another posting, please supply the names of the towns and stores where you see all the people. I would like to see them as well.

Grannynurse:balloons:

[pagandeva2000, LPN]

In my experience, it makes no difference if a person is on Medicaid, self pay or has health insurance paying his bill. A person is going to be demanding regardless of who is paying for his care. People use all types of behavior to justify their wrong doing or to excuse the bad behavior it's self.

In regard to the woman who had another child to get more Medicaid. You don't get more funds when you receive Medicaid. It makes no difference if you have one or ten children. Some state's up their assistance per child but it is not that great an amount of money. And one can no longer stay on welfare unlimitedly.

Woody:balloons:

True...I suspect that she may have received more funds for welfare for the extra child, but I have not heard of receiving more Medicaid benefits.

[Bridey]

I don't think rude, obnoxious people who have a sense of entitlement are primarily Medicare patients. I think those sorts of people come from all walks of life.

In the early 90's my mom worked in San Francisco at California Pacific Medical Center, where she ended up taking care of a very famous and wealthy baseball player. One of his doctor's orders was to "provide coffee or refreshments to his wife when she was visiting". I'm dead serious. And what do you think the nurses, including my mom, wanted to do with that order? LOL

I try to treat all of my patients with respect and dignity regardless of their social status. It's no different to me than any other aspect of their H & P. Whether they are private pay, Blue Cross, Medicare or completely uninsured makes no difference to me. I'll make sure that I provide them with the best nursing care I can and not think twice about it.

If people have an issue taking care of drug addicts, alcoholics, mentally ill patients or don't like caring for people of a different race, social status or religious background then my personal opinion is that they ought to look into a different profession.

We are not there to place judgement on anyone under our care, we're there to make sure they have compassionate and professional nursing care. So leave your biases at the door and do your job.

[crissrn27, RN]

I wish, really, really, wish, that nurses (and other HCP) DID NOT know their patients insurance status. I have seen it affect how pts are treated more than a few times. And really, what business is it of ours? We get a paycheck regardless of our pts insurance (or lack of). Get a grip, guys. If you have a hard-to-deal with pt, complain about that pt, not about if they have Medicaid or not. Geesh.

[crissrn27, 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.

Wow, I hope your manager pressed charges!

[Elvish, BSN, DNP, RN, NP]

I'll tell you what. I am usually so busy that I don't get 45 seconds to go take a much-needed pee break. So I'll be damned if I'm going to look through somebody's chart just to see what their insurance status is and then complain about it. Got better things to do.

There are people in every group who will try to take advantage of a system that was originally designed to help those who need it. There are people of all walks of life who are snooty, demanding, entitled, and think their excrement doesn't stink. And there are people of all walks who are grateful, gracious, kind, and generous. Bottom line -- I don't know people's insurance, and I really don't care.

[doe9181]

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...

I've actually had to ID these patients and when they show up multiple times a month and a year in the same car with their 3 kids strapped in their car seats I kind of know that the car belongs to them. I've known of neighbors that complain about it also because they live next to these people in this affluent suburb where I worked. I just don't think it is fair in any way whatsoever.

[Spidey's mom, ADN, BSN, RN]

I wish, really, really, wish, that nurses (and other HCP) DID NOT know their patients insurance status. I have seen it affect how pts are treated more than a few times. And really, what business is it of ours? We get a paycheck regardless of our pts insurance (or lack of). Get a grip, guys. If you have a hard-to-deal with pt, complain about that pt, not about if they have Medicaid or not. Geesh.

It is against the law for a patient's insurance info to be on ANY paperwork that makes it into the ER where I work, in California. The patients sign in with minimal info, are triaged and then seen in the ER and then go back to finish paperwork, where they present their insurance info.

We never see what kind of insurance they have.

steph