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.
Specializes in icu, er, transplant, case management, ps.
Just want to point out that our soldiers definately EARN their money, especially these days. We should be grateful and extra gracious to THEM!!!!
One would think, with a father who served twenty-eight years, a brother who served twenty two years, and my own National Guard duty of four years I would fully support you. My father use to tell me one thing, he was doing his job, one he decided on for a career. One that anyone can decide on for a career. Don't get me wrong, I support our military but I support them no more then I support our police officers, our teachers, the sales clerk at WalMart. Sorry if I upset you but everyone earns their living. Everyone has a choice on how they earn their living.
This being said, I am entitled, as someone who has collected SSDI for the past seventeen years and who collected Medicaid for twelve months, to say that I paid into those systems, the first since the age of fifteen and the second one, since nineteen. And I am only drawing on systems that I paid into.
This is the difference between you and many (perhaps most) Medicaid recipients. You had a reason to be on Medicaid. You worked and paid into the system for the system to take care of you when you needed (need) it. Most MediCal (CA's version of -caid) pts I have experience with in my entire career have either never worked or never worked legally. Many come across the border specifically to get the free medical care that this country hands out, and then wonder why the medical expenses keep going up. Those people did not pay into the system or earn the right in any way for the government to take care of them. Same thing with welfare and food stamps.....I collected unemployment for a couple of months recently, first time in my life. When I got my home health job I called to cancel it. The rep asked me why and I said "I found another job. I thank you for the help but I don't need it anymore." He said "I wish everyone was like you!" So many people abuse the system that it makes it harder for people like you, Woody, who need and deserve the help.
I've been reading this thread for only 15 minutes or so, and I'm a bit disturbed with some of the views expressed by my virtual peers. It's sad that we are so quick to throw a stereotype label upon others without considering the individual. I take care of a young man who has two hard working parents, whose care is funded through medicaid. They are nice people who are constantly apoligizing for utilizing the funds our government and taxpayers have paid into. Recently I told them he needed to have his doctor look into some high bp readings, and there was hesitation because they didn't want to "use" the system. How much responsibility are we willing to bear when it comes to the clients who fail to seek medical help because they don't wish to be labeled? I lived on ramen noodles and peanut butter when I went to school, because my family did not approve of "charity" and I was discouraged from getting assistance. I was living with two small kids, recieving no food stamps, no educational assistance, and living off the little bit of money from my gi bill. I had an ex husband who was refusing to support his kids as well. The point is, some people who really could use the help, to heal, to be there for their kids, the people who don't abuse drugs, who are trying to get a hand, to become better, are penalized and looked down upon too. Btw, I made it thru by my d#*n self!!!!! I have no problem with medicaid, there will be abuse, but if there was no program, then who would you lean on when it all falls apart???
When I lived in Sedona, AZ years ago, a pricey area to live, we had an unsually high amount of children on AHCCHS (Medicaid). I found out the loophole they were using. If you have children and are divorced, then remarry and stay at home with the kids, your kids will qualify for AHCCHS. They do not count the income from the stepfather, since he is not the legal guardian, only the mother, who is not working since her new husband makes so much. They only count the child support from the real father as income and the child qualifies. Some of these families lived in 5000 sq ft homes and mom drove a Mercedes.
That being said, I thank every day my kids are on Healthy Families, the low income health insurance program for California. After my husband died, I could not afford the almost $1000 a month group health insurance premium offered under COBRA for Blue Cross. We do not qualify for individual policies due to preexisting conditions. So I switched to Kaiser under COBRA at the cost of $400 mth for just me. I am afraid to use Kaiser and will not subject my kids to their care (or lack of it) so I enrolled the kids in the state health care program. And if I did have them on Kaiser, my premium would be $700 a mth., something I could not afford.
Why don't I work? Read my first post and you will see. I applied to several non nursing jobs in my rural area, but none of them offered health insurance, even if I paid for it. So for now, I will stay home with the kids until I figure out what to do with my life.
Am I treated any different at my MD's office? No, I have not been. My MD will also see me for $55 cash for an office visit and I walk out with drug samples.
I understand the frustration of some posters that are angry with the system, they feel it is $$ out of their pockets. I get it.
I support medicaid, I think it helps many people...But, was does make me angry are situations like this- I had a pt. the other day...s/p fusion and plating...I think...some type of major back surgery that bought him a ticket to the neuro ICU. Anyhow..the pt. was a chronic painer...took 90mg mgso4 PO, HS and PRN...Vicodin 2 tabs q4h..percoset q4h..and there were others...to make a long story short the pt. was upset that we could not prescribe him more pain meds than he takes at home. Neurosurgeon said, let him have whatever he has at home...guess that didn't satisfy him..he ran me like a waitress all night long, barking orders at me, threating to go AMA if I couldn't make these things happen...the last straw I suppose was when I wouldnt let him go outside to smoke.....he tells me he is going AMA. I gently remind him that if he leaves AMA his insurance may not pay for his stay...his response? "It's 24 hours and insurance WILL pay for it, i've done this before"...I remind him that it hasn't been 24 hrs. and he says: "I don't care, It's not like I pay for my health insurance." The man had not worked a day in years, and NOT due to any medical condition
This is what angers me. I work hard and pay taxes and to hear such a blatant disregaurd for that-it sure does make me angry. Im not saying those on gov. assistance should thank me, all I ask is for them not to abuse the system so that the system works and is fair for everyone. I support Medicaid for those who are not abusing the system. The system is not perfect and I would rather those who need it, have it..even if it means that the abusers do as well.
The system isn't perfect and will never be. Dishearting- but I just try to think of all the honest people who need assisstance.
Not to get this off track, but just a comment to the above post.
What makes you (or rather the doc) think what that patient takes at home pre-op is going to relieve his pain after major surgery? Doesn't it stand to reason he will need more over and above his usual meds for this new acute pain?
Specializes in icu, er, transplant, case management, ps.
This is the difference between you and many (perhaps most) Medicaid recipients. You had a reason to be on Medicaid. You worked and paid into the system for the system to take care of you when you needed (need) it. Most MediCal (CA's version of -caid) pts I have experience with in my entire career have either never worked or never worked legally. Many come across the border specifically to get the free medical care that this country hands out, and then wonder why the medical expenses keep going up. Those people did not pay into the system or earn the right in any way for the government to take care of them. Same thing with welfare and food stamps.....I collected unemployment for a couple of months recently, first time in my life. When I got my home health job I called to cancel it. The rep asked me why and I said "I found another job. I thank you for the help but I don't need it anymore." He said "I wish everyone was like you!" So many people abuse the system that it makes it harder for people like you, Woody, who need and deserve the help.
I'm sorry but I have to take issue with some of what you have posted. I onced lived in San Diego. And until Christmas of 2005, I had relatives that still lived there and whom I visited. To be honest, I am kind of tired of hearing about all the illegals that are collecting social benefits in your state. If they are, they are doing it illegally. To collect welfare, medicaid, food stamps, you have to be a registered legal alien or a citizen. You can get emergency treatment but that is it.
In the middle 90's our welfare system underwent changes. People staying on welfare for years, for generations no longer is possible. And even when it was, one had to look at the education systems that many of these individuals experienced. Or I should say, the lack of education..
And while you apparently agree I have earned my SSDI, there are others out there that feel I have not. They resent the fact that I have a computer, that I have access to the net. They feel I am stealing their money right out of their pockets because I can spend time sitting, surfing the net. Somehow they reason this means I should be able to work. Kind of silly, isn't it.
Not to get this off track, but just a comment to the above post.
What makes you (or rather the doc) think what that patient takes at home pre-op is going to relieve his pain after major surgery? Doesn't it stand to reason he will need more over and above his usual meds for this new acute pain?
Im sure. maybe you misunderstood, he was on meds over and above what he was on at home...quite a bit more, ...Im all about treating pain, however there is a point where you cannont give any more...much more and we would have been intubating this pt.....My NM and I did everything we could to get this guy to stay...we were trying to work with him as was the neurosurgeon, but everytime i accomplished what he asked for, it already wasn't good enough....I called the Dr. every hour.....Did i also mention this pt was on a Dilaudid PCA with a continuous rate and lockout? That is def. a drug he DOESNT take at home. Im sure he did need more pain medication..however, what this pt. wanted was dangerous. The amount acetom. (percs and lortabs) he wanted was wayy over the daily allowance...
Trust me, we did EVERYTHING we could pain wise. I offered other drugs like fentanyl, oxyIR (scheduled) but the pt was stubborn.,.he was making demands we could just not meet and declined all the other options I and the doc suggested..literally there was nothing else we could think of....we even tried to get pharmacy to give us plain codeine (pt request) but we don't stock it!!! This O2 sats were already cruddy from all the narcs he was getting...We were willing to work with him but he didnt want to hear it. When he asked for more pain meds, we treatead him... In the end, pain was not the issue, it was the smoking, as I offered him quite a few other pain options over and IN ADDITION too.. As I got him packed up so he could leave, he ordered me to leave his wife at the bedside as she "could find her own way out" as the pt. needed to smoke. His wife tossed his pack of cigs at him and I literally had 5 seconds to get this man outside. I did offer him a nicotine patch as I know smoking is a hard habit to kick..
Im sure. maybe you misunderstood, he was on meds over and above what he was on at home...quite a bit more, ...
Ok. I misunderstood your post. I was responding to this:
to make a long story short the pt. was upset that we could not prescribe him more pain meds than he takes at home. Neurosurgeon said, let him have whatever he has at home...guess that didn't satisfy him
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, now I can be very cold, and even sometimes cruel. But even I would never say Medicaid clients should all be more gracious than those not on medicaid. This statement from you is sad. Sad coming from anyone actually
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
This gets into a very tricky area. Who is to judge. What are the SocioEconomic Selection criteria.
FireStarterRN, BSN, RN
3,824 Posts
Just want to point out that our soldiers definately EARN their money, especially these days. We should be grateful and extra gracious to THEM!!!!