Undocumented Patients

CCU BSN RN · Dec 27, 2016

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.

EllaBella1, BSN · Dec 27, 2016

^^ 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.

heron, ASN, RN · Dec 27, 2016

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.

Undocumented workers pay billions in local, state and federal taxes, yet are ineligible for most safety net benefits supported by those taxes. I agree that there's something drastically wrong with this picture.

It's a hard knot to untangle. People in this country illegally are, by definition, breaking the law. That choice has consequences. But, should those consequences include the death penalty?

rearviewmirror, BSN, RN · Dec 27, 2016

the problem is not of someone being rude or even being undocumented, ilegal ailen for that matter benefiting from tax revenues without paying a cent on income taxes... The problem is why does US healthcare allows abuse in the first place. and by the way, I believe abuse does exist... just work at ERs in a metroplex, you will be surprised how many same folks you see over and over and over again, and they are not even the tiniest portion of healthcare abusers. The problem lies not within one's residence status or one's "rudeness", but why the system allows that sort of abuse.

crazin01 · Dec 27, 2016

OP, I think the way you asked the question was stated/worded gets most fired up, as immigration is always a rather heated debate. I an somewhat naive and like to give benefit of doubt to all, so I'm thinking it wasn't meant to come across that way, even though it does.

I also think you're dealing with two very independent issues:

1) Rude patients

2) Patients whom do not appear to be documented citizens of their geographic location/illegal aliens.

It's unfortunate that you've had two such patients that fit both criteria and this seems to have skewed you into having a stereotyping/judgmental attitude towards patients that are members of only one of the groups mentioned. Hopefully you will soon have an undocumented patient that is sweet as pie and they are able to sway your views.

I've had many patients who are very rude and they come from both THEE best SNF/ALF in a 50 mile radius as well as from the halfway house, where less than 50% of residents are legal citizens of the US. Attitude toward others is learned and can always be changed, so maybe these rude patients were once kind but have been treated rudely by other healthcare providers? Thus, they're just giving what they are getting? Not agreeing with it, but our actions towards others do matter and can bring about change in their actions towards others.

Yes, the non-compliant frequent flyer diabetic coming in with DKA the 4th time in a month, who is extremely rude & manipulative does get tiring. however, I can think of both legal US citizens and illegal citizens that fit this mold. (My nursing experience is all in the US, so just using US citizens for my background)

As another stated, you are the nurse, not social worker, although all team members must communicate. Our focus in a hospital setting is primarily stabilizing and discharge, whether to home or LTACH, so we have beds available to the more acute patients. Unfortunately, the broken healthcare system, lack of resources etc is a whole 'nother issue.

I love the Gilligans island stuff thrown in there...Gotta have a laugh sometimes.

heron, ASN, RN · Dec 27, 2016

the problem is not of someone being rude or even being undocumented, ilegal ailen for that matter benefiting from tax revenues without paying a cent on income taxes... The problem is why does US healthcare allows abuse in the first place. and by the way, I believe abuse does exist... just work at ERs in a metroplex, you will be surprised how many same folks you see over and over and over again, and they are not even the tiniest portion of healthcare abusers. The problem lies not within one's residence status or one's "rudeness", but why the system allows that sort of abuse.

i agree that abuse of the system exists. But the assertion that "they" don't pay taxes is just plain false.

Honest people can disagree on the issue, but let's at least keep the discussion based in facts.

srercg6 · Dec 27, 2016

no, that's just additionally. for instance a family that has a family member who needs a LOT of care - can't do a lot themselves - but some, but the family claims they are homeless (when they clearly are not) or don't have room for the person etc because they don't want to have to take care of them, and the person can't be sent to a facility because they are undocumented so they are left to use the more expensive services of the hospital as their long term care - years.

BSN16 · Dec 27, 2016

no, that's just additionally. for instance a family that has a family member who needs a LOT of care - can't do a lot themselves - but some, but the family claims they are homeless (when they clearly are not) or don't have room for the person etc because they don't want to have to take care of them, and the person can't be sent to a facility because they are undocumented so they are left to use the more expensive services of the hospital as their long term care - years.

Nobody should be obligated to care for a sick family member, citizen or not.

TriciaJ, RN · Dec 27, 2016

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.

Actually, I had a US social security card before my green card was approved. Even a social security card is not proof of legal status.

OrganizedChaos, LVN · Dec 27, 2016

no, that's just additionally. for instance a family that has a family member who needs a LOT of care - can't do a lot themselves - but some, but the family claims they are homeless (when they clearly are not) or don't have room for the person etc because they don't want to have to take care of them, and the person can't be sent to a facility because they are undocumented so they are left to use the more expensive services of the hospital as their long term care - years.

Living in an area of Texas that sees a lot of "illegal aliens" I don't care if they are or aren't documented. Everyone gets the same care & my paycheck doesn't change just because someone is undocumented.

You are talking about two separate issues. Not all undocumented peoples are rude. I have come across more U.S. residents that are just asses than illegal aliens. It's also not just undocumented people who can't take care of family members & have no money. I can't even begin to tell you about the stories my mom (who works for adult protective services) has told me. I don't remember one that she told me that was about an illegal alien. There are so many people (legally here & not) who don't have family or the finances to leave the hospital.

You need to learn to leave your personal views outside of work. If you can't I would suggest working in a different area of nursing.

Ruby Vee, BSN · Dec 27, 2016

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 they can't go to a facility because of their undocumented status?

Yes, I've seen illegal aliens live at the hospital because they have nowhere to go. I'm not sure that's abusing the system, but it happens. If someone is too ill to leave the hospital, staying in the hospital is not really abusing the system. I've seen hospitals fly patients back to their country of origin -- first class and with a team of nurse and paramedic -- because that's cheaper than having them continue to stay in the hospital. Perhaps that's the best solution to the problem. Another solution would be to bill the country of origin for their care, but that's unlikely to result in cost savings for the hospital. l

On the other hand, I've also seen legal aliens, immigrants, Native Americans and other US citizens living in a hospital because they're too ill to leave and LTC facilities won't take them for one reason or another. I doubt very much that the patient's immigration status has much to do with it.

Ruby Vee, BSN · Dec 27, 2016

no, that's just additionally. for instance a family that has a family member who needs a LOT of care - can't do a lot themselves - but some, but the family claims they are homeless (when they clearly are not) or don't have room for the person etc because they don't want to have to take care of them, and the person can't be sent to a facility because they are undocumented so they are left to use the more expensive services of the hospital as their long term care - years.

Family not wanting to take care of a patient has nothing to do with their immigration status. There may be valid reasons why a family member would not wish to take care of a patient. Maybe Daddy raped his daughter every night for years -- I cannot imagine why you would expect the daughter to then take an aged Daddy into her home (where she may have her own young children) and care for the man for possibly years. Perhaps Mother cut off all contact with a daughter who married a man of a different faith, had a child out of wedlock, or simply chose to live her own life rather than the life Mother chose for her. After forty years of no contact, Mother is ill and needs care. Are you going to force that daughter to take her in and care for her?

No one should be forced to care for someone they don't want to, family member or not. Many of those poor, lonely elderly patients are lonely for very good reasons.