Undocumented Patients - page 2

What do you think about undocumented patients who abuse the hospital system? Anyone have undocumented patients who basically live at the hospital because their families can't take care of them, and... Read More

  1. by   Avid reader
    What happened to Thurston Howell lll, Lovey Do? Are you going to Gingerly step around this answer or give a Skipperly response or Gilligan out?
  2. by   Davey Do
    Quote from Avid reader
    What happened to Thurston Howell lll, Lovey Do?
    The patient is currently being cared for at...

  3. by   nursel56
    How do you know they're undocumented?
  4. by   catsmeow1972
    I recently just had such a patient. This patient had been at another local hospital for a number of months, with some pretty definitive issues, which just by reading the H&P and history, those months seemed medically justified. This patient was on my unit because the daughter brought her in with issues related to noncompliance with the directions from the previous facility (antibiotic compliance and the like, probably due to the price.) The person made some significant progress with us, but could have benefited from some time in a facility for PT/OT, etc. That was not going to happen due to no money, insurance or anything. There's probably one indigent bed in existence and that comes available every 20 years or so.
    So we come to a point where, as an acute care facility we can't do anything more for them. Home was not an ideal situation but doable. The problem is that the lack of compliance will land them in the ER for small things that a primary care clinic could handle before it got bad, if she could even get into the local indigent care clinic. And so the circle begins again.
    I did find it a little odd in this situation, that there was enough money available to pay cash for a medical transport home, but not to much impetus to make steps toward getting documented. That being said, there are probably many underlying things going on that I know nothing about. My take on it is that, as the bedside nurse, my job is to take care of the patient's immediate needs, not play social worker. It's a crappy, stupidly expensive utilization of medical resources but it's nothing that I am in a place to allow my personal judgement cloud my responsibility of caring for my patient.
  5. by   GrumpyRN
    Quote from Davey Do
    We did have a patient on the geriatric psych unit, Thurston Howell, who was there for months and months. But he wasn't an undocumented patient.

    Whenever a patient is now there for an extended amount of time, we often ask, "Will this patient be Thurston Howell II ?"
    OK, you really needed to explain that one for us Europeans. I thought you were really, really violating HIPAA. . Had to google it to find out.
  6. by   FutureNurseInfo
    I guess I will be playing a devil's advocate here. I do agree with the commenters on here about caring for the patient no matter the status. However, I do also understand where the OP comes from.
  7. by   heron
    Quote from FutureNurseInfo
    I guess I will be playing a devil's advocate here. I do agree with the commenters on here about caring for the patient no matter the status. However, I do also understand where the OP comes from.
    I don't. Would appreciate an explanation.
  8. by   KelRN215
    My patients are children with terrible diseases. I couldn't possibly care less about their immigration status. I am grateful that they have made it to a place where they can receive treatment for their illnesses.

    My most recent one was a teenager from Central America. He came, on his own, to the US with a note from his parents that he was seeking refugee status. He, a minor, was detained by INS for a month before being sent to live with a family friend. A few months later, he was diagnosed with leukemia. In the US, ALL has a very high survival rate. In the rural village where his family lives, he most likely would have died. How he was able to get on Medicaid is not my concern. I am happy that he made it here before he was diagnosed and will likely survive his cancer.
  9. by   traumaRUs
    In the last few years, our big hospital has actually paid for airline tickets to send them back to their country of origin. These were dialysis dependent pts who did not have insurance coverage and therefore the big two dialysis companies wouldn't touch them in the outpt environment.
  10. by   MrChicagoRN
    Quote from nursel56
    How do you know they're undocumented?
    Lack of a valid social security number is often the first clue.

    We have a good number here in Chicago. My last hospital had a patient there for more than a year before finally airlifting them home.
    Most are not rude, just grateful for whatever care they can get, and staying under the radar.
  11. by   TTLS
    Lack of SSN does not necessarily mean undocumented status. When I first came to this country on a dependent visa (H1) I did not have a SSN because my visa status did not qualify me for one. However I had legal presence.
  12. by   CCU BSN RN
    In ICU, I don't have to know their immigration status.

    the issue was working in hospital, in a floor with the lowest level of care provided by that hospital. Case Management will start working on their discharge so they can go to Rehab, because they're not safe to live at home. They have no insurance, so CM tries to enroll them in medicare/medicaid/whatever. During this process it is discovered that they are not eligible due to their immigration status.

    So we're in this pickle, because we can't discharge them to an unsafe environment at home (e.g. no family, no home, etc.) and we can't discharge them to rehab without payment. So someone who medically does not require a hospital setting will stay in the hospital setting for MONTHS sometimes. Occasionally having a shift where one of your patients is healthy enough for discharge is nice. Having those shifts for months, is not.

    Doesn't matter if the person is a super nice person or a rude and nasty one. It stinks that our tax dollars will pay for this, but not for the level of care they need. It would be SO MUCH CHEAPER to send them to rehab or home with PT/VNA, but that's not the system we live in. It sucks for the patient to be in hospital for months when they don't require it, it sucks for the healthcare provider who misses out on Med/Surg experience with a healthy person padding their numbers.

    My issue with this is that it highlights a huge failure in our healthcare system, not ANYTHING to do with the patient. I happily care for whatever patient gets tossed my way, with minimal complaining. I just don't see why, if we pay for hospital, we won't pay for anything else. Hell, if this guy hadn't been too scared to go to a clinic in the first place instead of waiting for an issue to be so bad he needed hospital, I personally would've gladly had my tax dollars pay for his Amoxicillin instead of his 28 day Sepsis hospitalization, for sure.
  13. by   EllaBella1
    ^^ exactly what CCU said. Or sometimes it's even worse. We recently had a patient who was a post cardiac arrest with an anoxic brain injury, but not brain death. The family wanted everything done. Trach/PEG, etc. The patient is minimally functional- essentially the only thing he does is breathe over the vent and occasionally opens his eyes. He is an undocumented immigrant. So now we have basically an LTACH patient, stable, who will live out the rest of his life in one of our hospital's trach to vent PCU beds, simply because his family continues to insist that everything be done, but they are unable to pay for any of his care/private placement, and he's not eligible for medicaid.

    Edited to say that I'm not saying that he isn't deserving of care in any way shape or form. Just saying that our system/way of managing this scenario is clearly broken.