I got floated to Med-Surg yesterday. I had a patient in her 50s who had originally come in with a blood sugar in the 600s, had been on an insulin drip originally, then transfered to med-surg.
The doctor came in and ordered her discharged. Supposedly she had been receiving diabetic teaching. This woman obviously was an utterly passive personality. To make a long story short, it took me all day to get her out the door. She could give herself an injection just fine, but she really seemed unable to learn the information. She had a history of being 'noncompliant', I'm told. The CNA told me that the woman was so helpless that she would call to have her pop can opened for her.
I didn't have very many patients, but I had the most frustrating exersise in futility I've had in a long time. I tried to explain the difference between NPH and Regular, the sliding scale, and the rest. Everyone at the nurses station kept hearing the latest chapter in the boring story. Then after hours of this I finally called the doctor after hours of this and told her that there was no way this woman could learn this. I suggested Lantus as a simpler insulin, and he said that he had to order NPH because of cost. He ordered home health and said that we "can't live her life for her". I finally got the patient to understand that, at the very least she should take the NPH in the morning and evening, and that perhaps homehealth could get her to understand the rest.
Then her husband picked her up in the front of the hospital, he wouldn't come in to pick her up. He had an old ramshackle pickup with a bunch of junk in it. He didn't say a word and wouldn't get out to help my patient who is quite obese and needed a stool they keep in the truck to get into the truck. She attached the stool by a string to the door handle so she could pull in up into the truck after she got in. I noticed a siphon hose on the floor of the front seat, among other things, I think that's how he fills up the truck with gas. They looked like characters out of Steinbeck's Grapes of Wrath. It was the most heartbreaking scene I've witnessed in a long time, one of utter poverty of spirit.
For every person that has a bad story about the misdeeds of social service, there is another family that wishes they had entered into the picture.
Woody
Unless Ma and Pa had a substantial amount of assets that would benefit the government in the event they had to go to a nursing home they would not have been interested.
I know two elderly patients (one now deceased). One would call the APS when the staffing agency was not able to staff her case for a shift. She reasoned they would come after the agency because she was not supposed to be left alone. They came once and when they found out her property had been transferred to her children longer than the 3 yr. look back period (it's now 5 yrs. as of Feb. '05) and other than that she really had no assets then everytime she would call them after that they would tell her there was nothing they could do (this happened to be the same social worker who came to our place). The patient I sit with in private duty has an alcoholic son who takes her social security money to buy drugs and alcohol. Social services has been called twice over the last year. She lives in the projects and we have not seen the first sign of an investigation.
Knowing what I know now, I can see how naieve it is to actually think APS functions to protect old people.
Don't take my word for it. Call your local DHS office and let them explain how it works.
based on the description of by op that abused is the exact term..even if it is verbal abuse this woman has learned over the years that she is worth nothing and the only thing that she has control is the retreat into her mind
LOOK BACK PERIOD??? i didn't know that it was extended to 5 yrs..the state will not allow medicare until all assets has been used up, this is a sad thing in many instances where they want their money to go to childrens education and/or their only asset is the home they live in which means if medicaid is entitled to that then they are stuck in the ltf for the rest of their lives because they have no where to go..even if they get better and could be selfsufficient
however the op did what she could..just as nursing is a 24/7 job so health care has to have agencies in place to follow thru after discharge
Specializes in icu, er, transplant, case management, ps.
Sorry, I do not need to contact DSS. In the 80's and 90's I worked with them regarding clients and my own parents. In 2006, I got the privilege of having to deal with DSS themselves as well as a LTC facility. I've worked with various state's Department of Social Service. Some were very, very good and some were very, very bad. I've run into this with doctors and other nurses. Some apparently feel that the glass is half empty. I like to believe it is half full.
LOOK BACK PERIOD??? i didn't know that it was extended to 5 yrs..the state will not allow medicare until all assets has been used up, this is a sad thing in many instances where they want their money to go to childrens education and/or their only asset is the home they live in which means if medicaid is entitled to that then they are stuck in the ltf for the rest of their lives because they have no where to go..even if they get better and could be selfsufficient
Yes, 5 yrs., and I just love the play on words and mind games the government uses to try to show they are working to protect old folks from people who want to hurt and use them, which is most always family.
If your grandma signs over her property to you they call it a forced property transfer and if she was to need nursing home care less than five years after you forced her to transfer it to you and she applied for Medicaid they would seize the property auction it off and use that up before she could qualify for Medicaid.
And if you're the child of an old person and live in one of 31 states where they have filial responsibility laws you will be responsible for that parent regardless of whether they transfer their property to you or not. In fact, the state can come after your own property and money to seek compensation for care of your parent.
The DON where I used to work has parents in nursing homes. She was going to sell her house and move closer to her job. The nursing home found out about this and was poised to take every cent from the sale of HER house to pay toward what it was costing to care for her parents.
It sounds like a nightmare or a sick joke but it is very real.
And it's irrelevant what happened with DHS back when. We are talking here and now, especially after February 2005.
Basically, they are wanting to do away with inheritance and also see there is no middle class anymore.
And if you're the child of an old person and live in one of 31 states where they have filial responsibility laws you will be responsible for that parent regardless of whether they transfer their property to you or not. In fact, the state can come after your own property and money to seek compensation for care of your parent.
The DON where I used to work has parents in nursing homes. She was going to sell her house and move closer to her job. The nursing home found out about this and was poised to take every cent from the sale of HER house to pay toward what it was costing to care for her parents.
It sounds like a nightmare or a sick joke but it is very real.
This is horrible; I had no idea. It is indeed a nightmare.
Specializes in icu, er, transplant, case management, ps.
I'm sorry but Medicare has no eligibility requirements as far as finances. Medicare is not a needs based type of insurance governed by the federal law. You can either become eligible for it, at a certain age or iff you have been on SSDI or disabled for twenty four months. I become eligible for it in January of 1991. I had been unable to work for the previous two years, plus five weeks.
I did become eligible for Medicaid almost immediately when I was injured and lost my source of income. Medicaid is based on a needs standard. And each state sets the maximum amount of income and assets that one can have. I am not eligible for it now, in Florida. But in New York state I would only have to spend down $100 to be eligible for NYS Medicaid. NYS sets a much higher maximum allowed income then Florida does.
Medicaid and Medicare are two separate types of coverage. Medicaid is administered by the state, which sets its maximum allowed income, total amount of assets and what they will and will not cover, including the total number of allowable prescriptions a month.
Medicare, will administer by private companies in various states, sets no income determinations. Sets no limit on the number of prescriptions, although they do set a monetary limit, for their providers, until one reaches the 'donut hole', then you much pay until you reach the next level, where they pay 95%. And you can skip the donut hole if you agree to pay a higher premium to your Part D provider. The first year, I did and I paid $63 a month. Last December, I received a notice from my provider that starting on January 1, 2007 my rate would jump to over $90 a month. I decided to drop the higher costing plan and went with the donut hole. With any luck, I will just make it to the end of December.
Please do not confuse the two types. One is needs based and one is not. One does not care about your ability to continue to work or your income and the other focuses solely on your income and assets.
I, too struggle with trying to help the patient help himself/herself. I have finally reached the conclusion that everyone has the right to make decisions about their own life, even if the decision is a bad one. At some point the patient first described in this thread made the decision to not think for herself or take charge of her own life. She has spent years doing that and NOTHING you will say will change it. The best you can do is teach survival skills and give contact information (although few ever call me I do give my office number). Your energy is better spent on someone who is willing to learn.
Sorry, I do not need to contact DSS. In the 80's and 90's I worked with them regarding clients and my own parents. In 2006, I got the privilege of having to deal with DSS themselves as well as a LTC facility. I've worked with various state's Department of Social Service. Some were very, very good and some were very, very bad. I've run into this with doctors and other nurses. Some apparently feel that the glass is half empty. I like to believe it is half full.
I, too struggle with trying to help the patient help himself/herself. I have finally reached the conclusion that everyone has the right to make decisions about their own life, even if the decision is a bad one. At some point the patient first described in this thread made the decision to not think for herself or take charge of her own life. She has spent years doing that and NOTHING you will say will change it. The best you can do is teach survival skills and give contact information (although few ever call me I do give my office number). Your energy is better spent on someone who is willing to learn.
Never give up. You never know when a change will happen for the best.
I never give up. I still havent made that Hole in One, but I keep trying
It sounds as though this woman has been subjected to years of mental abuse. She is so convinced that she is worthless that she has become "worthless." It takes a lot of work to get past that.
Specializes in Rehab., Home Health, Geriatrics, MR/DD.
I've lived and worked in home health care in south Mississippi for several years now.....and one thing i have noticed with some families is that this 'type of family', sometimes it tends to be a generational thing......their family lived this way, the family before did, etc.....and for whatever reason some are just unable or unwilling to work towards bettering themselves or their lives....when one combines poverty and a lack of education for years and years and years.....well, this is what you get.......to tell the truth, i had to laugh about them using the rope to pull the stool into the truck, because for people like this it shows 'their form' of resourcefulness...to me and you....it's like the Beverly hillbillies, but to them, hey, it worked and for people like that, that is resourcefulness ...i used to take care of a man in a family who would allow the goats and chickens to run through the house, the old lady dipped skoal.....and the old man pulled a gun on the nurse one day....cause he wasn't gonna let no blankety blank woman tell him what to do.......well, being from the south and having worked with these types of people i spoke to him at 'his level', and got him to put the gun down, and it all ended well......my point i'd like to make is for families like this....they are not going to change......the hospital IS a luxury to them....but they have pride too....and if they perceive you don't treat them with respect, they will give you the same disrespect in return....sometimes if time permits just going really over board with service, ie: what can i get you, what can i do, i'm here for whatever you want, etc....will actually be a type of reverse psychology for them, because their pride dictates that your treating them like their helpless or ignorant, and their pride won't stand for that.....suddenly you have a compliant patient...of course this doesn't always work, but sometimes it does......pride is a funny thing....especially in the poor and uneducated....sometimes it's all they've got.......
i don't always enjoy working around these types of families...because they will never change(well a 'few' make it out).....but i do know how to talk to them at their level so at least i can get the teaching across....metaphors work great.....especially cars.......a car is a great metaphor for the human body....or whatever works....find out what the patients interests are, and then use that as a metaphor and you'd be surprised what you can get across to these 'ignorant' people....see, they just appear ignorant to me and you but if you look at the resourcefulness it takes for a family of say six to live through such great poverty i think one would be very surprised at what these people are capable of......we as educators just have to put it in their terms in a non condescending manner and they can learn....they are not stupid, they just haven't had the benefits that many of us really take for granted...
well i hope this post helps.....one thing i've learned is not to prejudge people because they will suprise you, if you just look for what is 'good' about them.....
Jo Dirt
3,270 Posts
Unless Ma and Pa had a substantial amount of assets that would benefit the government in the event they had to go to a nursing home they would not have been interested.
I know two elderly patients (one now deceased). One would call the APS when the staffing agency was not able to staff her case for a shift. She reasoned they would come after the agency because she was not supposed to be left alone. They came once and when they found out her property had been transferred to her children longer than the 3 yr. look back period (it's now 5 yrs. as of Feb. '05) and other than that she really had no assets then everytime she would call them after that they would tell her there was nothing they could do (this happened to be the same social worker who came to our place). The patient I sit with in private duty has an alcoholic son who takes her social security money to buy drugs and alcohol. Social services has been called twice over the last year. She lives in the projects and we have not seen the first sign of an investigation.
Knowing what I know now, I can see how naieve it is to actually think APS functions to protect old people.
Don't take my word for it. Call your local DHS office and let them explain how it works.