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.

[seasonedlpn]

"Two wrongs don't make one right"

Yeah...but THREE LEFTS DO!! (sorry, couldn't resist.)

I've found rude, unappreciative patients among the Medicaid groups...I work for a non-profit Hospice..what really irritated me were the patients that had NO Medicaid, our organization paid all the costs, yet a couple of them expected everything and anything they could get...yet never seemed to appreciate it. I am a professional, all of my patients recieve the same quality of care from me, yet, an air of appreciation would have been nice. I secretly resented them.

[reddice]

I am a pharmacist and medicaid patients are the bane of my professional career. YES, they can usually be picked out just by the way they, talk, act, pronounce, and demand, long before the card is ever taken out. Of course there are very well educated, driven people that are on public medical assistance and are genuinely in need. But 1 out of 20 or 40 doesnt cut it. Medicaid reciepients have such an entitlest attitude on average that it makes me sick to my stomach to deal with them.

Pharmacist in Virginia.

[teeituptom, BSN, RN]

They are all patients equally as far as i am concerned. I do not pay attention to the welfare title. I treat everyone equally well. Life is simpler that way

[woody62, RN]

I also think there should be a time when noncompliant persons are removed from medicaid roles.

I'm sorry but just who gets to decide who is noncompliant and what do they use to make this determination? Is it someone who comes into your hospital too many times? Is it someone who doesn't take all their medications like they are suppose too? Is it someone who doesn't follow the special diet you have told him he has to without finding out what type of food he usually eats? I ask because I know of many patients, who are not on medicaid, who are just as guilty. Maybe we should kick them off their insurance as well.

Woody

[InfRN]

Recently, I heard an American pediatrician who had spent time practicing medicine in Sweden on a radio broadcast. He described how incredulous he was when he first realized that he was unable to make assumptions about his patients' soc.ec.status just by assessing their status of health and nutrition as was his experience back home.

Every single kid or their pregnant mother in this country receives the exact same generous, excellent quality prenatal/pediatric care, regardless of their parents' income. It's a great equalizer and provides an optimal start in life, no matter who your parents happen to be.

Not having to worry about who's taking advantage of whom is pretty liberating.

[sarahdeez, BSN, RN]

I also think there should be a time when noncompliant persons are removed from medicaid roles.

I'm sorry but just who gets to decide who is noncompliant and what do they use to make this determination? Is it someone who comes into your hospital too many times? Is it someone who doesn't take all their medications like they are suppose too? Is it someone who doesn't follow the special diet you have told him he has to without finding out what type of food he usually eats? I ask because I know of many patients, who are not on medicaid, who are just as guilty. Maybe we should kick them off their insurance as well.

Woody

I agree it would be a difficult line to judge and probably not very realistic to do so. The fact is no one would want to make that decision. It's just very frustrating when you care more about someone's health that you dont even know than they themselves care. It's even more frustrating when you are paying their medical bills. And yes, people with all types of insurances (and without) are noncomplaint, but people who are financially responsible for their medical bills (or atleast a portion) do have an additional reason to stay healthy over those who do not pay. And based on my experience, it tends to show in their actions. It's all about personal responsibility and those who do not have it in one area (finances) do tend to not have it in other areas (health/discipline with food exercise).

**Yes I know some people use government assistance for a temporary means of getting back on their feet (which was the original intent). In my area they are a slim minority.

[Susan9608]

I think that more people get government assistance then they are aware of .... or perhaps they think it doesn't count as "assistance."

For instance, when you own your own home, you get to deduct the interest on your mortgage off your income tax. In a way, then, the government is subsidizing your housing. I believe people also get tax breaks when they have children ... tax deductions. That could be considered government assistance as well.

so maybe that's why *everyone* is nasty at some point in their lives ... because everyone (or almost everyone) is getting government help in some form or fashion.

[woody62, RN]

I think that more people get government assistance then they are aware of .... or perhaps they think it doesn't count as "assistance."

For instance, when you own your own home, you get to deduct the interest on your mortgage off your income tax. In a way, then, the government is subsidizing your housing. I believe people also get tax breaks when they have children ... tax deductions. That could be considered government assistance as well.

so maybe that's why *everyone* is nasty at some point in their lives ... because everyone (or almost everyone) is getting government help in some form or fashion.

You have made a great point. And even those that we don't think get a tax break, such as the super rich, like Bill Gates, get tax breaks. He gets breaks based on his millions of dollars he donates to his charity. But I have a point to make. There are people regardless of who pays their bills, who don't do as they should, don't follow proper diets, don't take their medications, don't follow their doctor's orders. I am just very tired of professionals complaining about Medicaid patients all the time. They just can't accept that regardless of who pays, there will always be someone who doesn't follow the rules, who is mean, who is nasty.

Woody:balloons:

[Shaggyb2000]

Clients who come in on medicaid should absolutely be more gracious than those who are not on medicaid. They have no idea what procedures cost, or the actual cost of their meds. When the welfare recipients hit their limit for the month on their coverage for drugs, which is usually a combination of hydrocodone and Xanax, they suddenly don't need it as bad and can somehow wait. The difference between someone who buys their own insurance and ones on welfare are total dependence. If everyone decided to quit working, private payers would still get coverage and the medicaid patients would not. That is why good attitudes from them shouldn't be expected but demanded.

[FireStarterRN, BSN, RN]

Clients who come in on medicaid should absolutely be more gracious than those who are not on medicaid. They have no idea what procedures cost, or the actual cost of their meds. When the welfare recipients hit their limit for the month on their coverage for drugs, which is usually a combination of hydrocodone and Xanax, they suddenly don't need it as bad and can somehow wait. The difference between someone who buys their own insurance and ones on welfare are total dependence. If everyone decided to quit working, private payers would still get coverage and the medicaid patients would not. That is why good attitudes from them shouldn't be expected but demanded.

Everyone should be gracious, not just poor people. Do you think having more money gives you a right to be less than classy to people who serve you?

[Susan9608]

Clients who come in on medicaid should absolutely be more gracious than those who are not on medicaid. They have no idea what procedures cost, or the actual cost of their meds. When the welfare recipients hit their limit for the month on their coverage for drugs, which is usually a combination of hydrocodone and Xanax, they suddenly don't need it as bad and can somehow wait. The difference between someone who buys their own insurance and ones on welfare are total dependence. If everyone decided to quit working, private payers would still get coverage and the medicaid patients would not. That is why good attitudes from them shouldn't be expected but demanded.

Wow.

I certainly hope that if tragedy ever struck you and/or your family, causing you all to need the benefits of welfare and Medicaid, that you will be as gracious as you expect everyone else to be.

I found your whole post to be extremely snotty and offensive. I hope I'm never unfortunate enough to be one of your patients; who knows what you'd find to judge about me.

[MAISY, RN-ER, BSN, RN]

Harsh words Shaggyb. Just because someone is on assistance does not make them stupid. Many are in need and had "a normal existance" at one time in their lives, before needing a "hand". I am sure most understand that their visits cost money-on the flip side, they put in the time trying to get a clinic to care for them properly and completely(to the end of their illness with postive results.)

Courtesy towards others should be universal and rudeness is by no means a monopoly held by welfare recipients or the working poor. Medicaid recipients wear many faces-they are the people you are working with, foster kids, disabled children, etc-not just generational welfare families or drug addicted disabled.

I am sorry you are seeing the "dregs" of society-I can't imagine who else would qualify for you comments. There are always abuses of systems. I am sure you work with others who do 1/2 the work you do. They are abusers too, yet many value the idea of getting paid for doing less.

Maisy;)

Everyone deserves to be healthy!