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.
I think the right thing to do would be for the "greatest nation on Earth" to provide care for its most vulnerable population out of the general fund. I don't think you should have to sacrifice your house to receive this care. Even the bankruptcy courts can't take your own home away from you.
Specializes in icu, er, transplant, case management, ps.
I think the right thing to do would be for the "greatest nation on Earth" to provide care for its most vulnerable population out of the general fund. I don't think you should have to sacrifice your house to receive this care. Even the bankruptcy courts can't take your own home away from you.
But then you are encouraging all the free loaders, like myself, to take all your tax money.
I think the right thing to do would be for the "greatest nation on Earth" to provide care for its most vulnerable population out of the general fund. I don't think you should have to sacrifice your house to receive this care. Even the bankruptcy courts can't take your own home away from you.
That is provided that you are using it as a "home". Presumably, if you are in a nursing home...it no longer is your home, barring there being dependant children or a spouse there.
Sorry, but throughout history, responsible people prepared for their old age. Your home is an asset to be used for that, when you are no longer living in it. If you wish to leave it to your children then you need to work toward that goal.
Also, what has happened to family responsibility.... the kids can't take care of mom, can't pay mom's bills, yet want to be able to inherit mom's property, without paying a red cent and shoving the responsibility onto the government.
I know that elder care is difficult...my own mother drives me nuts, weighes too much for me to care for. Literally well over 350 lbs, refuses to diet, refuses to exercise, and will not throw anything away even if she is no longer able to use it. I have the regular tiffs everytime I clean house, take the plastic to be recycled (well, the religious needs butter dishes to do crafts.......9 monthes ago~!!!!), try to throw out stained and damaged beyond belief clothing ( well, maybe the service center needs those underclothes - Mom, they have blood stains - but their still CLEAN!!!!!!!), throw out leftovers (thats probably still good ...at 6 weeks old). She is deaf as a post and refuses to wear her hearing aids. And last time that she had surgery, she insisted on getting up without help, despite me telling her not to, fell on the floor and ended up having to get EMS plus the police department to get her off the floor.
But I do not expect for the government to pay for her nursing home care if she needs (and she probably will), and fully expect that her assets would be sold if she needed assisted care. I may hope to get the money that I have put into her house back, but I certainly expect that the bulk would go to pay her bills, when I am unable to physically care for her.
What you accumulate in your life should be considered part of the payment for your expenses when you no longer are able to work, with the government paying only when major assets are exhausted. And that already occurs, as is right. One does not have to like it, and again, the right thing is not the easy thing.
this thread like so many has become polarized with the us and them mentality. so i put forth the questions that bug me every time i hear a comment about the poor, social services, and supporting our fellow americans.
if we are not responsible for the health of america, who should be?
if those soldiers who suffer from ptsd and subsequent mental illness are cared for, what about those who suffer from these same disorders due to parental neglect, overwhelming circumstances, organic brain disease, or just because...shouldn't they be cared for?
for those of you who think it's okay for me or anyone else to fall back on a system i paid into...what about those born into it? born to possibly uneducated parents? how do we not perpetuate a potential problem without taking all of those children away? would you advocate for sterilization of the poor?
everyone deserves to be healthy and to have a hand extended to them.
why can't we as a nation be more supportive of our elderly? why is it necessary for assisted living to be 5k-8k per month? why don't we have senior housing that is a right instead of a waiting list? better yet, why is prevention of medical problems not covered? better to send a nurse to practice diabetes prevention, then be forced years later to do wound care, amputation care or god knows what else?
there are so many more things that could be said....
i feel truly sad when i read these threads and wonder where the naysayers live, their current/past circumstances, and how they were raised. i can't imagine anyone begrudging those who need help, and want to ask them to thank "god" for the brains they were endowed with to become nursing professionals. not everyone is so fortunate. we may all make our lives, but someone gives us that guidance or resolve. maybe, extending a hand to those in need will be the lift they need to move on, and up.
maisy:o
ps now i know why nurses can't get together for the common good. too many don't believe in it.
senior housing isn't a right because some one has to provide the housing. a persons right ends where another persons right begins. if someone wants to give a senior a house then fine, but you infringe on the rights of others when you force them to provide a house for a senior. so what about the rights of the producers, do they not have any?
senior housing isn't a right because some one has to provide the housing. a persons right ends where another persons right begins. if someone wants to give a senior a house then fine, but you infringe on the rights of others when you force them to provide a house for a senior. so what about the rights of the producers, do they not have any?
you have a right, you have a responsibility, you have a duty to take of your seniors.
the same seniors who fought in ww2, korea, viet nam, to help preserve our way of life. who raised and fed you and educated you. now because they are old, infeirm, dementia, you want to quibble over their rights. those producers would be in production if those same seniors hadnt fought for our country. if they didnt serve publicly, privately in untold different ways.
Specializes in icu, er, transplant, case management, ps.
In response to two posting regarding preparation for one's old age and housing for the elderly. Years ago, when parents became elderly and no longer able to live on their own, if they had children, one would move in with the parents, his wife, who did not have to work, would take care of these elderly parents. And by in large, not many of the elderly lived beyond their sixties. We were largely a society that only the male spouse had to work. Over time, lives have changed and families now require two incomes just to live. So, planning might help but the reality is that as a society we can no longer have the luxury of having only one person working in the family and be able to care for our parents. And these days, many people, despite planning, run out of money, paying LTC facilities. And most long term care policies limit the total number of life time days they are willing to pay for.
About housing. I am 62 years old. I guess that qualifies me as being elderly. I once had a condo. I also had a mortgage. I also suffered major injures and was unable to work. My condo went to foreclosure. I have had to rent where ever I have lived since then. I have not expected anyone to pay my rent for me. I have not even expected housing to be built for me, so that I can live for less. But I do have some elderly peers that owing to different reasons, badly need subsidized housing. And they don't expect anyone else to pay their rent. As a matter of fact, our subsidized housing was totally destroyed by Hurricane Charlie. Half the people who lived there have had to move to other counties to find housing. About a third of them have died. And I don't know what has happen to the rest of them. And the housing has yet to be rebuilt. Charlotte County is still arguing with their insurance company.
But Charlotte County's Board of Supervisors did do one thing several years ago. They decided to underwrite an upscale development of townhouse, condos and luxury homes, as well as upscale shops. They forced more then 40 property owners, who already had homes, to accept their 'fair market value,' for their homes. This all started in 2000. So far, we have had three developers come in and bail out. We now have an area with no homes on it. And no developer, developing it. And even with the tax break they are offering, no property taxes being paid, including the 40 homes that were bought for the 'good of the county.' And someone is complaining about subsidized housing for the elderly.
There seems to be a real divide in society between the responsible and the irresponsible, the live for today and the plan for tomorrow people. In this society there is a sizable number of people who are not going to be responsible, never have and never will be. Medicaid is all they have.
You have a right, You have a responsibility, you have a duty to take of your seniors.
The same seniors who fought in WW2, Korea, Viet Nam, to help preserve our way of life. Who raised and fed you and educated you. Now because they are old, infeirm, dementia, you want to quibble over their rights. Those producers would be in production if those same seniors hadnt fought for our Country. If they didnt serve publicly, privately in untold different ways.
There seems to be a real divide in society between the responsible and the irresponsible, the live for today and the plan for tomorrow people. In this society there is a sizable number of people who are not going to be responsible, never have and never will be. Medicaid is all they have.
I am not and have not suggested that our elderly be thrown out in the street if they did not plan ahead. I am not objecting to subsidized housing for the elderly, that do not have assets.
I am not saying that we not care for our elderly....they are valuable and we should respect their sacrifices. Many of them also did not wish to live off the government, as that is not the way they were brought up.
What I am saying is that if you have assets, that those be used prior to the whole bill falling to the government. That there is not an inherit right to leave a major inheritance to your family, and live off the government if your family cannot pitch in. That those assets that you saved when you were working, are there to be used and should be used when you are unable to care for yourself.
Inevitably when you try to address mismanagement or abuse of resources you get people who use scare tactics to defend their position. The original poster was talking about waste for unnecessary procedures yet some give the impression that the ones who want accountability (for our money) "want to starve and kill the poor people off!"
There is going to have to be change here in the US. We simply cannot keep up with the costs. Medicaid costs continue to rise to take up a good portion of a state's budget. There has already been cuts to many programs designed to help the poor or disabled. In my state they recently closed a facility that did accept many people with no insurance or those on Medicaid. So by doing nothing to control costs or reduce waste we are literally throwing limited cash (even though it doesnt seem limited) out the window.
It is just common sense to me that the money is going to run out, I am not trying to start a debate on spending but I dont think anyone can deny we have spent close to 500 billion dollars on wars in the past few years. We have had a major natural disaster in Katrina. And most of our middle class and working poor are literally taxed to death, ridden in debt and have record low savings. Now when the baby boomers start to fully retire and get a bit older, how are we going to keep up with Medicare and social security?
The Medicaid waiver program or what it is called in your state is one of the most cold hearted programs I have seen. Especially when only one spouse is sick. To get care you sign your home over to the state, but the state will "let" your healthy spouse live there until they die. Most elderly have such pride in what they have worked for they would rather (and often do) die in poor conditions with little or no assistance rather than give the state their home. And as far as protecting some major inheritance, you can bet if they have that much money they have hired financial planners or lawyers to make sure everything is in order. There are several loopholes in the program to still allow property to be transferred.
In my experience, I havent but have you ever seen a nursing home or state Medicaid program take a $100,000 + home from someone? Do they then sell it?
Specializes in icu, er, transplant, case management, ps.
In 1975, the legislature of New York State passed a law mandating that all elective Medicaid admissions have prior approval and all emergency admissions had to be reviewed and approved within a twenty four hour period. A special department was set up within the NYS Department of Health, to implement the program. The program was essentially aimed at NYC, where more then 60% of the state's Medicaid budget was spent. A hospital could opt out and set up it's own peer review system to essentially take over the state's system. Needless to say, within two years many of the non-profits opted to set up their own program. The for profits did not accept Medicaid back then. Within four years, the program lost it's effectiveness. The hospitals, surprise, surprise, found more then 95% of the elective admission necessary. And 100% of the emergency admissions necessary. So much for gaining control over the spending of Medicaid dollars.
But what I found interesting, most of the money went to paying hospitals, shared health facilities, nursing homes for care of Medicaid patients. And the remainder went to the physicians. NYS published each quarter a print out of which doctors and facilities earned what and how much. Surprise, surprise, the vast majority of Medicaid dollars, in every state, are paid to facilities and doctors, with very little oversight there really is. It is truly rewarding to blame the person using Medicaid for the ever expanding amount of money spent. And it is much harder to bring to track the facilities and doctors who 'earn' big bucks off of your state's Medicaid system. If anyone is truly interested in curbing the amount of money spent, on Medicaid, they need to encourage, demand much more oversight and denial to the facilities and doctors who milk the system for all it is worth.
I worked for NYS, back in the 70's. I have revisited the state system during the 80's, 90's, and 2000's. The program went from effective to one of the most ineffective systems I have ever seen. And the blame is on the shoulders of facilities and doctors. I suggest some try thinking along these veins, when criticizing Medicaid. And perhaps taking a look at their own state's expenditures.
I am not and have not suggested that our elderly be thrown out in the street if they did not plan ahead. I am not objecting to subsidized housing for the elderly, that do not have assets.
I am not saying that we not care for our elderly....they are valuable and we should respect their sacrifices. Many of them also did not wish to live off the government, as that is not the way they were brought up.
What I am saying is that if you have assets, that those be used prior to the whole bill falling to the government. That there is not an inherit right to leave a major inheritance to your family, and live off the government if your family cannot pitch in. That those assets that you saved when you were working, are there to be used and should be used when you are unable to care for yourself.
Are you talking about Medicare and Social Security now? Because these are fundamentally different from medicaid in that, while the resources remain, all seniors are eligible. MOST of my tax money is paid to these things--some years more goes to SS than to fed taxes. For all the money we pay, by law, into these funds, I would hope that as an elder I could at last take advantage of some of the benefits and enjoy my retirement without being concerned that I was unable to leave anything for the younger generations of my family.
FireStarterRN, BSN, RN
3,824 Posts
I think the right thing to do would be for the "greatest nation on Earth" to provide care for its most vulnerable population out of the general fund. I don't think you should have to sacrifice your house to receive this care. Even the bankruptcy courts can't take your own home away from you.