Undocumented Patients

srercg6 · Dec 27, 2016

Please do not misunderstand. As nurses we take care of anyone who needs help. The situations I'm speaking of is when families leave them at the hospital because they don't want to deal with it, and the hospital has no where to send them because of their status so the hospital ends up incurring the long term costs usually at taxpayer expense. These are folks that COULD be taken care of at home, but their families don't want to. I don't think it should be an option to leave "anyone" at the hospital for that reason, undocumented or not, but in the case of undocumented is different because the hospital can't locate a facility to take them long term because of their status, where as if they were citizens the hospitals could find a long term care facility to take them, and the hospital could help them get Medicaid/medicare to help facilitate that, whereas with undocumented they can not. Has nothing to do with caring for someone who is sick and needs our help - this is past the point of needing our help for that - they are ready to go home status, but can't. I just feel there should be something in place to help these people so that we are not using the hospitals at the much higher costs to the public. There should be facilities that can help them, or avenues they can take in these instances - some sort of medical exemption status or something.

srercg6 · Dec 27, 2016

I don't understand how someone who is "undocumented" meaning they do not have any type of government issued number/permit/ID/social security or ID numbers in order to pay any kind of taxes with - how these people are paying taxes?

I know that DOCUMENTED temporary immigrants who are not necessarily citizens, but who have work visas, or temp visas for which they must reapply, or if they are here on another status such as political asylum -etc - all those people have numbers are are paying taxes - they are DOCUMENTED. they are also eligible for Medicaid/medicare and would not be in the predicament I am speaking of.

Undocumented do not have ANY VALID id numbers, and there fore are not paying any kind of taxes (except sales tax at a store where they pay cash). They get jobs down at the corner and are usually hired under the table to split funds from someone who is documented-and those people can't claim them or file taxes for them because they have no valid ID's. they do not have insurance, because they don't have numbers - they are undocumented. They do NOT pay any kind of taxes, nor do they qualify for any kind of medical programs which is why they are stuck in our system.

DowntheRiver · Dec 27, 2016

Public Health/Community Health Nurse chiming in here.

In my neck of the woods (that sees A LOT of Refugees) Refugees are given Medicaid for the first 8 months upon entering the country. This can be extended for several reasons, mainly if they comply with routine healthcare, obtaining proper employment, have a chronic health condition that needs to be monitored, etc. They have to go through two physicals, get bloodwork, vaccinations, and other referral services. I work with Refugees.

I also work with undocumented migrant workers. It is very hard for them to get documentation status, typically because they do not have a birth certificate, if one even existed. They then don't have the money to hire a proper attorney to help then with this issue and all the loopholes they have to jump through.

emmy27 · Dec 28, 2016

I don't understand how someone who is "undocumented" meaning they do not have any type of government issued number/permit/ID/social security or ID numbers in order to pay any kind of taxes with - how these people are paying taxes?
I know that DOCUMENTED temporary immigrants who are not necessarily citizens, but who have work visas, or temp visas for which they must reapply, or if they are here on another status such as political asylum -etc - all those people have numbers are are paying taxes - they are DOCUMENTED. they are also eligible for Medicaid/medicare and would not be in the predicament I am speaking of.
Undocumented do not have ANY VALID id numbers, and there fore are not paying any kind of taxes (except sales tax at a store where they pay cash). They get jobs down at the corner and are usually hired under the table to split funds from someone who is documented-and those people can't claim them or file taxes for them because they have no valid ID's. they do not have insurance, because they don't have numbers - they are undocumented. They do NOT pay any kind of taxes, nor do they qualify for any kind of medical programs which is why they are stuck in our system.

Not having a valid social security number stops someone from registering for medicaid/medicare, but it does NOT necessarily stop people from paying payroll taxes. Many, many undocumented immigrants use fake social security cards to obtain employment, and those employers deduct taxes and submit W-2s for them like for everybody else. When the IRS cannot identify the owner of the nonexistent or outdated SS number, the W-2s are filed in anticipation of a possible correction or claim of the work towards eventual retirement by someone, and the money? The money goes in to the SS trust fund and is used to pay for current retirees. It's estimated this creates a net positive in the billions annually for the SS system, since the people using these false SS ids and paying these taxes are only rarely able to claim the benefits they funded.

It's also possible to pay taxes with a tax id number, similar to the way that anyone can pay taxes in a foreign country without citizenship if necessary. The IRS, happy to take people's money, does not share this information with immigration services. Proof of a history of paying income tax is considered an important part of a case for obtaining citizenship even for those who first arrived without the proper documentation.

Some undocumented immigrants do work under the table, but many do not, and their economic contribution is significant- arguably more so than most, since they pay in to the system but do not withdraw. Please educate yourself before spreading this common and silly piece of misinformation about it being impossible for undocumented workers to pay payroll taxes.

The Truth About Undocumented Immigrants and Taxes - The Atlantic

DelaneyB · Dec 28, 2016

Unpopular opinion...but I believe that if the patient is undocumented, especially if they are costing the exponentially high amount a hospital stay is, immediate deportation is necessary. They are contributing nothing. Yes, we need to be human and not be mean/angry to the person we are taking care of but as soon as we are made aware of undocumented status they should be made to leave the hospital/country. I say that as a daughter of an immigrant who grew up in a third world country as an American. This country is starting to look like that third world country, especially in areas with high concentrations of minorities. And situations like that cost us an unimaginable amount. In the nursing home I work at (border town) we have undocumented immigrants taking up beds. It's an extremely well ran, well staffed facility. Because the beds are being filled with non citizens, citizens are forced to go to crappy neglectful places.

Avid reader · Dec 28, 2016

Response to Delaney.My views were shaped post Katrina after volunteering for six months. The only people who appeared to be working to rebuild New Orleans were the Undocumented. American workers fled or were scamming the system for something or the other. These people were abused, robbed, harassed, threatened etc and generally stoicly put up with their woes and continued to rebuild when very few others would. It made me aware of the value of their service and the horrendous conditions they endure just to be here, putting into perspective, just how bad it probably is, re the conditions they are fleeing from.

I think their situation is far more complicated than simply abusing the system.

DelaneyB · Dec 28, 2016

I definitely understand your point. Again, I live on the border and grew up in South America. It's not like these people are scum of the earth awful and undeserving. They were very loving to me to the most part. My grandmother doesn't even speak English, her whole community is spanish speaking. All groups of people have good and bad, and I just unfortunately think that negatives outweigh the positives. I do think it's scummy the way they are taken advantage of because of their lack of education/knowledge of the language. I've seen despicable things. Of course any patient should be given a translator ans have things thoroughly explained.

allnurses Guide · Dec 28, 2016

Please do not misunderstand. As nurses we take care of anyone who needs help. The situations I'm speaking of is when families leave them at the hospital because they don't want to deal with it, and the hospital has no where to send them because of their status so the hospital ends up incurring the long term costs usually at taxpayer expense. These are folks that COULD be taken care of at home, but their families don't want to. I don't think it should be an option to leave "anyone" at the hospital for that reason, undocumented or not, but in the case of undocumented is different because the hospital can't locate a facility to take them long term because of their status, where as if they were citizens the hospitals could find a long term care facility to take them, and the hospital could help them get Medicaid/medicare to help facilitate that, whereas with undocumented they can not. Has nothing to do with caring for someone who is sick and needs our help - this is past the point of needing our help for that - they are ready to go home status, but can't. I just feel there should be something in place to help these people so that we are not using the hospitals at the much higher costs to the public. There should be facilities that can help them, or avenues they can take in these instances - some sort of medical exemption status or something.

Do you have any idea of what a pay for service stay in a SNF/Rehab costs. It's about $10,000.00 a month. If a person has Medicare and needs rehab a patient can get 100 days of care. The first 20 days are 100% covered by Medicare. After that Medicare pays 80% while the consumer pays 20%. Medicare closely monitors the progress of patients in rehab and the minute the patient the patient stops progressing in rehab they (Medicare) stops paying and the patient goes on cash pay unless they have long term care insurance. You see Medicare does not pay for custodial care. Home care agencies charge about 30 dollars and hour so 24 hour care at home runs about $25,000.00 per month. These figures are correct. I myself have had to do a lot of research in this area as my mother has Alzheimer's. Her care is not covered by Medicare and it's completely out of pocket and costing around $7800.00 a month. She has a large trust set up by my dad that pays for everything but even that money won't last forever.

You say why can't these families take them home and care for them. Undocumented workers are often classified among the working poor and they are likely all working just to keep food on the table and a roof over their heads. They do not qualify for govt assistance. Hospital's walk a fine line because if they truly feel the patients is unsafe to be home alone they won't send them home. If grandpa goes home and falls and breaks his hip there will be lawsuits and hell to pay. That is why they keep them.

I don't believe I have ever been totally aware of what a patient's citizenship status was until I worked SNF. I just don't consider it relevant to the care I care I give. I try not to overthink things too much. Like a stealth bomber I swoop in, do my job and swoop out.

Hppy

allnurses Guide · Dec 28, 2016

I don't understand how someone who is "undocumented" meaning they do not have any type of government issued number/permit/ID/social security or ID numbers in order to pay any kind of taxes with - how these people are paying taxes?
I know that DOCUMENTED temporary immigrants who are not necessarily citizens, but who have work visas, or temp visas for which they must reapply, or if they are here on another status such as political asylum -etc - all those people have numbers are are paying taxes - they are DOCUMENTED. they are also eligible for Medicaid/medicare and would not be in the predicament I am speaking of.
Undocumented do not have ANY VALID id numbers, and there fore are not paying any kind of taxes (except sales tax at a store where they pay cash). They get jobs down at the corner and are usually hired under the table to split funds from someone who is documented-and those people can't claim them or file taxes for them because they have no valid ID's. they do not have insurance, because they don't have numbers - they are undocumented. They do NOT pay any kind of taxes, nor do they qualify for any kind of medical programs which is why they are stuck in our system.

Actually many undocumented worker's are using stolen SS numbers and are working on the books for legitimate employers. Many states have very strict laws with regard to hiring Illegal Aliens. So the person must present a number either made up or stolen in order to work.

Hppy

KelRN215, BSN, RN · Dec 28, 2016

Unpopular opinion...but I believe that if the patient is undocumented, especially if they are costing the exponentially high amount a hospital stay is, immediate deportation is necessary. They are contributing nothing. Yes, we need to be human and not be mean/angry to the person we are taking care of but as soon as we are made aware of undocumented status they should be made to leave the hospital/country. I say that as a daughter of an immigrant who grew up in a third world country as an American. This country is starting to look like that third world country, especially in areas with high concentrations of minorities. And situations like that cost us an unimaginable amount. In the nursing home I work at (border town) we have undocumented immigrants taking up beds. It's an extremely well ran, well staffed facility. Because the beds are being filled with non citizens, citizens are forced to go to crappy neglectful places.

How, exactly, do you propose to deport a patient who is too ill to leave the hospital?

Avid reader · Dec 28, 2016

Did a brief stint at a Pharma company which helped me understand healthcare costs somewhat. The majority of healthcare dollars are for administrative purposes, salaries for the Audis and Porsches and the lavish lifestyles. Companies hire lobbyists who push their agenda, aptly demonstrated by Mylan epi pen or the Shkreli debacle. The question should be, why is our country the only industrialized nation without a healthcare system? Do you think we are smarter than everyone else or simply more greedy and corrupt? Find out what the CEO of each of the hospitals or institutions make? Is physiology so different in other countries that our cardiologists should start of at mid six figures? Don't respond with our care is better because research clearly shows that it isn't!

The Best Healthcare Systems in The World | Fair Reporters

Kooky Korky, BSN, RN · Dec 28, 2016

Quote from srercg6
What do you think about undocumented patients who abuse the hospital system?

Firstly, they cannot abuse the system G6 because of set protocols, secondly, they generally have little power because of their status and are probably scared and thirdly their rudeness is maybe as a reaction to you because your responses appears to imply a condescending attitude with maybe some xenophobic overtones! Maybe you need to review yourself because a person's status is not part of our purview! Maybe you have a preference of what wounds you treat or medications you administer? How about which Drs orders you follow?

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