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.

[teeituptom, BSN, RN]

WOW. this is a strange thread. Having been on both sides from time to time. I would like to say some people behave loudly to cover some of their embarassment at being in that situation. Some do so just to do so, they need no reason. They have been this way and always will be.

But, it is not how they act that is a problem....it is how you react to it.

You can't change them, but you can change the way you look at it.

Just take a deep breath and say "THANK YOU" Then in your mind say "THANK YOU, I DON'T HAVE TO GO HOME WITH YOU" Then move on to the next one LOL

In other words do not empower them to bother you, and why should you empower them. They dont harm you.

Ive never recieved public funding by the way, just in case anyone asks

[teeituptom, BSN, RN]

PS Ive been working the last few days

[It's Alisa]

My goodness, what horrible comments/statements are being left here! I live in LA, and have worked in a community hospital in the Valley, where 80%+ of the patients were on Medi-Cal, and have worked in a very well known hospital in Bev. Hills, who does not accept Medi-Cal patients. And you know what, my patients on Medi-Cal were so much more thankful, much nicer, and so much more humble, thanking me for every single thing I did for them. Where as the higher end patients, were much more demanding, argumentatitve, and overall RUDE.

to the OP, maybe you are getting these responses from people because you have preconceived notions about these patients, and its showing, so they react to it? try taking a different approach with your patients, you'll be surprised at the reactions you get.

ok, enough of my rant.

[Susan9608]

I'm sorry, but if you know that you have trouble making ends meet, why keep having kids?

Generally, when women feel like they have a meaningful role in society (beyond that of just a breeding machine) they find ways of controlling their own fertility, either through birth control or abstinence. Perhaps these women continue to have children because in their situation it's the most meaningful thing they have to do.

Thankfully there's no rule or law that states a person must be financially well-off to have children ... if there was, I bet a lot of us here would never have been born. I know I wouldn't have.

It would be ideal, yes, for parents to be able to afford all basic necessities for their children before procreating, but to say that people shouldn't have children just because they are poor just smacks to me of social darwinism.

[Jo Dirt]

I know of sevearal families that are multi-generational on welfare and I will take a picture of the tenement houses in the ghetto with the satillite dishes on them.

You can drive anywhere in the po sections of town here and see those little buggers stuck up on the roof.

My psychology professor said he used to sell tv's back when they'd deliver them to your home. He said he learned no matter how poor people were, they would always have a tv even when they would be doing without other things.

Got to have that tv.

[ayla2004, ASN, RN]

being in the UK universal heath care levels all men/women/children to receiving what they need without any stigma as the majority of those in employment contribute.

welfare however is a hot potato we want to cover those who need it without having those who spin the system, we do have sink estate were 3 generations have never really worked. however those trying to get off benefits face the situation that low paid jobs often do not cover the loss in housing benefit, and council tax benefit, may lose their children's free school meals and uniform allowance and if paying for childcare would be worse off, as well as having to pay for prescriptions. Although there are working families tax credits the government recently changed tax allowances so that poorer working families have less money.

[island40]

I have been on Medicaid, I have relatives who are addicts and that disease of addiction lead them to lose everything and end up on public health insurance and I have been fortunate enough to be able to self pay for health care as well as use private insurance. Even having been there it can still be difficult to control my Irish temper when a Title 19 card is thrown at me by the mom of a 4 yr old who has had an ear infection for more than a week comes into the ER on Saturday night because ER visits are free and the MD office visits aren't. I have not always been a prize patient and I know that hurting people tend to hurt people and the lack of personal funds doesn't make a patient a prize or a pill.

[woody62, RN]

I have been on Medicaid, I have relatives who are addicts and that disease of addiction lead them to lose everything and end up on public health insurance and I have been fortunate enough to be able to self pay for health care as well as use private insurance. Even having been there it can still be difficult to control my Irish temper when a Title 19 card is thrown at me by the mom of a 4 yr old who has had an ear infection for more than a week comes into the ER on Saturday night because ER visits are free and the MD office visits aren't. I have not always been a prize patient and I know that hurting people tend to hurt people and the lack of personal funds doesn't make a patient a prize or a pill.

I've had things thrown at me by some of the best educated, well paid individuals in the world. Income or lack of income has no bearing on one's attitudes or behavior. At least not in my experience.

Woody:balloons:

[woody62, RN]

being in the UK universal heath care levels all men/women/children to receiving what they need without any stigma as the majority of those in employment contribute.

welfare however is a hot potato we want to cover those who need it without having those who spin the system, we do have sink estate were 3 generations have never really worked. however those trying to get off benefits face the situation that low paid jobs often do not cover the loss in housing benefit, and council tax benefit, may lose their children's free school meals and uniform allowance and if paying for childcare would be worse off, as well as having to pay for prescriptions. Although there are working families tax credits the government recently changed tax allowances so that poorer working families have less money.

It seems like our two governments think along the same lines, as do some of our people. I am still waiting for directions to those cities and towns where our poor live in multimullion dollar homes, drive high price cars and still manage to collect welfare benefits, medicaid and WIC. I wonder why our governments always seems more willing to strip those that can least afford the lose of benefits? And reduce the taxes of those that really could afford to pay a lot more?

Woody:balloons:

[FireStarterRN, BSN, RN]

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.

You make a very valid point. A certain percentage of people lack the social skills to get ahead. Nevertheless, it's good not to jump to conclusions about people, and it's better not to judge.

[FireStarterRN, BSN, 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!

.

There is a goodly portion of welfare recipients who also work on the side, 'under the table'. My husband, in fact, paid a woman under the table once who was on welfare after her no good husband dumped her and her three kids for a younger chick. She needed the insurance from the welfare, plus she really needed the extra income. She eventually remarried, got off of welfare and opened her own restaurant.

[jojotoo, RN]

It would be ideal, yes, for parents to be able to afford all basic necessities for their children before procreating, but to say that people shouldn't have children just because they are poor just smacks to me of social darwinism.

Many, many poor people have children and manage to support them without public assistance. That's all I'm asking.