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]

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:

[Jo Dirt]

I can see this isn't really a question.

Do you think people with regular insurance or those who are private pay are incapabe of being rude?

My brother-in-law is a multi (multi) millionaire. He could buy and sell every one of us. He went into the hospital and paid cash for his open heart surgery. He had some minor complications and was in intensive care a little longer than expected. He acted like such an A$$ one of the nurses admitted to my sister we've never had a patient like this.

Or do you think they just don't take the Medicaid patients into account because they are all so horrible it's just a given you can expect them to be bad?

And what's this about staying pregnant to get more Medicaid money? I wasn't aware Medicaid actually paid out any money to live on.

When I am pregnant I use Medicaid (I have four children and another on the way and they have the same father...what a shocker) and I have been so grateful for it. One of the nurses on the maternity ward commended me on what an easy patient I was to care for. I know this is anectdotal but really all we can go by here are anectdotes. At any rate, I think it's accurate to say much of the medical community looks down on those who use government assistance, though I can't worry about that.

But you know, there could be a reason so many Medicaid recipients have a chip on their shoulders. Again, I'm using anectdotes but if I'm lyin' I'm dyin'. I went to school with a girl who was telling me about when her grandmother took her son to a doctor's appointment. She waited and waited and finally when she mentioned the long wait to him the doctor said, you welfare people beat all I've ever seen. You don't have a life, where did you have to go?

My best friend who happens to be a nurse told me about when her daughter was small and got (I think it is called) a trigger finger. The doctor condescendingly told her, Ms Smith, I can't afford to take care of this for you any more than you can afford to pay me to take care of it...of course, my friend said they could probably hear her down the street as she took her daughter and left out of that doctor's office.

Then, there was the time I was in LPN school. We were sent to a walk-in clinic and they actually had a dry erase board that was divided down the middle: on one side they had "Medicaid" patients and the other side said "Other". I kid you not, they would leave the Medicaid patients waiting until the very last, taking the "others" who came in after them first.

We finally heard a woman (Medicaid) become angry when he finally did come in to see her then we quickly heard him apologize for the student nurses because they had everything mixed up:angryfire

Thank goodness, they took the students off that rotation site.

After all, I don't like to see lazy bums who only live to bum off the system, but apparently they do meet the requirements to have Medicaid, and Medicaid is paying the facility to provide care to that person so we really shouldn't speculate or even be concerned with why they are getting government services.

[VivaLasViejas, ASN, RN]

Well, as many a parent and grandparent has said: never judge another until you have walked a mile in his moccasins.

Rude, demanding, disrespectful, energy-sapping patients come from all walks of life and every socioeconomic class. So do the kind and thoughtful ones. Making assumptions about patients based on their insurance status (or lack thereof) is intellectually lazy and, to my mind, morally repugnant.

What right do we have to judge our patients anyway---are we health care providers, or the morality police? I'd hate to think that there are nurses who, when they get a rude or demanding patient, actually look up insurance status and burn with self-righteous indignation because "my tax dollars are paying for this, etc. etc." Otherwise, how do we know what their payment source is? And why does it matter?

Pardon my irritation, but treating people differently because of financial status has long been a pet peeve of mine; in fact, it's bothered me ever since my own family and I were on Medicaid ourselves back in the late '80s and early '90s. Looking at us today, you'd never know we used to scrape by on foodstamps and welfare payments, or that we once went two years without a car or a home phone. But believe me, we were about as poor as poor can get in these United States.........so if I were your patient, why would you regard me differently now that I have enough of everything to get by in life? I'm the same person I was back then---maybe a little grayer and a little wiser, but the same human being I was when we didn't have two nickels to rub together.

Yet it continues to amaze me, how differently I'm treated now that I have good health insurance and a solid middle-class lifestyle. I literally couldn't get admitted to the hospital with status asthmaticus and an O2 sat of 85% on room air when I was on Medicaid; they just gave me 3 or 4 breathing treatments and a bottle of prednisone and sent me home. Then when I had my lap chole years later, they actually kept me overnight because I couldn't keep my sats up for the first hour after surgery. I was OK before I was ever transferred to the floor, but they kept me. What a difference a few numbers make, no?

So..........the take-home lesson here is, never generalize about patients, or ANYONE for that matter. If you don't know the person's circumstances, if you don't know how they came to be the way they are, you can't judge. I know it's perfectly frustrating to have a patient who does nothing but kvetch, nag, whine, cry, demand, complain, and otherwise treat us like something they scraped off the bottom of their shoe, but why bring socioeconomic status into it and point fingers at the less fortunate just because they don't usually fight back? Just because we can?

Coming down off the ol' soapbox now.

[leslie :-D]

i honestly don't know what you're referring to.

'rude & obnoxious' permeates all social classes.

it's unfortunate you've had these experiences.

personally, i've met a lot of difficult people.

nurses included.

leslie

[TheCommuter, BSN, RN]

I work at a LTC/SNF that caters to private pays, insurance, and a mix of Medicaid patients. However, my elderly Medicaid patients are on the program because they have exhausted their personal finances due to advanced age. Once their houses have been sold and their savings accounts depleted, they now qualify for Medicaid.

However, I was a grocery store cashier years before I got into nursing. I don't care if I sound judgmental, but I could tell who the food stamp customers were by simply observing their behaviors (and shopping basket). They tended to be extremely rude, whiny, argumentative, and expected to be served from head to toe. These people frequently picked fights with other customers who were waiting in line. Their shopping baskets were filled with cookies, chips, cake mixes, sodas, bubble gum, frozen chicken nuggets, frozen pizzas, and other unhealthy food choices. Unlike shoppers who paid with cash or check, the food stamp customers seldom purchased produce or fresh meats.

Women who received WIC vouchers were even worse. These women always had major attitude problems.

[leslie :-D]

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

[kstec, LPN]

I work in a family practice clinic and from my own personal experience, if there is going to be any patients that will not call and cancel their appt. or reschedule, it'll be the ones on medicaid, they just don't show up. Then after 3 times they are dismissed from the doctor and wonder why. Our clinics no longer take any new medicaid patients, due to the fact of low reimbursement and continuous no-shows. I'm not judging but the mass majority of our junkies are on medicaid, the mass majority of our rude ones are on medicaid. OP can dispute this but when I see 30-35 patients a day and 1/4 are medicaid, 1/2 of them won't even show up to their appt. So what do they do, they go to ER. Some of the stories between patients going to ER's, walk-ins and our family practice clinic is a joke within itself. Keep abusing the system, I have nothing else better to do with my tax money. I would never be rude to a patient to their face, but I'm human and I do voice my opinion with other direct care co-workers of this repetitive abuse of the system. I truly do try and me sympathetic due to the fact that I was a welfare child and my mother abused the system and I hated it then and I hate it now. I never look down on the children because they have no choice, but with the parents, if it looks like a chicken, walks like a chicken, you know the rest.

[Jo Dirt]

Women who received WIC vouchers were even worse. These women always had major attitude problems.

I've never had WIC but I've learned just by standing behind them in line at the store (and having to wait 30 minutes so they could redo their items) that no, you don't get the giant boxes of cereal and the super large cartons of juices.

Never knew about their attitudes, but they need to learn how to read the fine print.

[VivaLasViejas, ASN, RN]

Moderator's Note:

Hmmmmmmm.........I guess I missed the notice that August is National Pooh-Pooh-the-Poor month.

There are already two threads elsewhere in the forums that serve the same function. While we encourage vigorous debate---and realize that there is a wide variety of opinions on this as well as many other social issues---we ask that the discussion be kept polite and respectful toward all.

Thank you in advance for your cooperation.

[Daye]

i cannot support the generalization b/c some of my nicest, most greatful, loving patients have either been medicade or someone who paid for their surgery/medical care with a homemade pie or some token b/c that was the best they could do.

my dr would receive the gift as if it were a million dollars, never letting anyone feel they were less deserving than the next patient who might have all the money necessary to cover expenses. he sure has taught me a lot.

(funny that a lot of people think a dr can write off loses but they cannot)

[HeartsOpenWide, RN]

I have seen both. When I worked in a family practice I saw people on medi-cal (like medicaid but in California) drive up in 30,000 pick-up trucks and then proceed to complain to me that their wife is trying to get half of the selling price of their house ($250,000) in the divorce. I have seen people come in smelling like a $5 pack of cigarettes to get a scrip of OTC meds because if it is on the doctors Rx pad they get it from the pharmacy for free....

I also worked on a mobile medical unit that used motor homes to go to the homeless shelters and give medical care ; these people were some of the most THANKFUL people I ever met, and they really had nothing.