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.

[Crux1024]

Women who received WIC vouchers were even worse. These women always had major attitude problems.

So, YOU were the cashier I kicked in the head!!

LOL..

Seriously though, I used WIC through both pregnancies and until my kids turned 1 and were off of Formula. That stuff could be expensive, and I only used it until I didnt need it anymore, even though I did qualify after that ...

All the women I encountered while in the WIC office were nice, you wouldnt belive how horribly those offices (at least in my region) were run. Not a lot of staff, but lots of customers..and waits were loooong. If you missed your appt, you couls kiss that months vouchers goodbye.

[ICRN2008, BSN, RN]

As far as I'm concerned, it is irrelevant whether or not my patients are on Medicaid or not. The only time I even need to know how they are paying for their visit is if they need to be connected with the social worker, case management or the financial counselor.

I agree that people in general tend to be rude these days, but to lump all people on Medicaid/public assistance into the same group is unfair.

Because I work with kids, I am able to say to them "Ill get you that if you say 'Please' and 'Thank you' ". I did have one teenager who said "Never mind, I don't want it then", which just blew me away. It it really that hard to be polite? :uhoh21:

[perfectbluebuildings, BSN, RN]

As far as I'm concerned, it is irrelevant whether or not my patients are on Medicaid or not. The only time I even need to know how they are paying for their visit is if they need to be connected with the social worker, case management or the financial counselor.

I agree that people in general tend to be rude these days, but to lump all people on Medicaid/public assistance into the same group is unfair.

Because I work with kids, I am able to say to them "Ill get you that if you say 'Please' and 'Thank you' ". I did have one teenager who said "Never mind, I don't want it then", which just blew me away. It it really that hard to be polite? :uhoh21:

sorry... that is just funny!!!

[woody62, RN]

I was on Medicaid when I gave birth to my daughter. And my daughter was on WIC afdter having all three of my grandchildren. I can't understand why someone would have a problem with what is covered and what is not. It is printed right on each check. I know because I sometimes would buy her groceries.

Woody:balloons:

[puddingpie]

Well, you have offended me and others.

are you serious?, first of all medicaid does not mean cash, medicaid is health insurance, everyone should be entitled to, I am glad there is that system that offers this and often available for the working poor as well. And since you are referring to middle age people on medicaid, what is that suppose to mean? should they be ashamed or are they less of a person? because, you have no idea what the real world is like obviously; (you must be ahh young or clueless or both, I will excuse your ignorance this time, looks like you've been schooled.

situations change, people lose jobs, lose spouses, lose there minds.

You are a Nurse? You should know being a nurse is having compassion? empathy etc...

Rudeness comes in walks of life, rich or poor.

[FireStarterRN, BSN, RN]

To tell the truth, I rarely even check out how people are funding their hospital visits. It's not of interest to me so I haven't noticed any corelation between insurence status and behavior.

I suspect that unpleasant behavior permeates all social classes. I grew up in a rich neighborhood and there were some totally obnoxious, demanding, self centered people there. Today I had the sweetest patient who was with the carnival, passing through town, and he needed a new hart valve. He was so nice and very humble even though I'm sure he was poor. We transfered him to the VA.

[Neveranurseagain, RN]

Here is my experience with medicaid pts.

Yes, some of them can be rude and obnoxious--I agree. But remember that medicaid is a program for unemployed or low income people (or supposed to be, but that is another story). Some people who are unemployed or low income are that way because they have some sort of mental illness. Remember dumping all the mental health pts. out of institutions in the 70's? Well, now they and anyone else with a personality disorder, are all trying to cope with the rules of society. And do they get their mental illness treated and take their medications as they are supposed to? Are you kidding? These are the people who will never be employable and end up on medicaid. Do you think the person who is rude and obnoxious to you as a nurse is going to get a job in a bank and work with the public?

Remember, the people who are the most difficult to get along with are usually mentally ill...be glad you are not.

[TheCommuter, BSN, RN]

you have no idea what the real world is like obviously; (you must be ahh young or clueless or both, I will excuse your ignorance this time, looks like you've been schooled.

You feel insulted, so you have turned around and said some derogatory statements about the OP without knowing anything about this person. There's no need to fight fire with fire. Two wrongs don't make one right.

You are a Nurse? You should know being a nurse is having compassion? empathy etc...

Nursing is a whole lot more than having 'compassion' and 'empathy.' A nurse can be competent without having compassion and empathy. I'd honestly prefer to be taken care of by someone who has compassion, empathy, and all of the stereotypical 'BS' qualities that are expected of nurses, but there are many competent nurses in the workforce who do not fit the "angel of mercy" image.

[kanzi monkey]

I gotta go to work, so I'll be fast (and perhaps inarticulate)

Many people in this country refuse to understand the gap between people with money and people without it--the bourge/the proles. Seriously. We are so backwards.

Most if not all industrial countries have some kind of socialized medicine--so HCP's don't ever have to consider financial status when providing healthcare.

[MAISY, RN-ER, BSN, RN]

Imagine a patient asking for tests and an extra day in the hospital...that used to be the norm, not the exception. Now, imagine this patient is on medicare with minimal access to healthcare. As that patient, I too would ask to get everything over with, asking for those extras while I was already there. There is nothing like trying to get a physicians appt or specialist to see you with medicare, unless things have changed they aren't required to see you unless you were seen by them or referred to them by a hospital.

As far as, asking for medical things that can be purchased in grocery store. You are right, it's cheaper to buy with your own cash-but medicaid will not reimburse. What if that cash is for your meals, or rent?

There is nothing quite as "special" as requiring any assistance. This is especially true of people who have never needed it! So, I can imagine the world of rudeness that awaits them due to their currant financial status can be frustrating, and just a little"unpleasant". That may explain any attitude you may feel from a medicaid recipient.

It's back to walking a mile in someone's shoes....when I was much younger, my ex left me with a baby and toddler. At that time, you couldn't get childcare for children that weren't toilet trained. I had no money, no insurance, a flaky husband who walked out and was really in a bind. I was in my mid 20's and had always had insurance. What an eye opening experience. I received wic and medicare-the grocery store clerks felt they had the right to treat me anyway they wanted to due to my wic checks and sure you could go to a clinic for pediatrics and sit there for 8-10 hours and maybe get seen that day or not. I was lucky that my personal physician(who agreed to take the very low medicaid payment) would see my children and care for them. He always gave me medicine samples-I wasn't forced to buy anything. I was lucky. I'd always worked, been a contributing member of society and was using a benefit that was there for people who got into trouble. It was a couple of years, then it was back to work as usual. I never forgot what those people like me went through....again...I was lucky, I never truly suffered.

Everytime I read a thread that beats on people that are poor I really get angry. A bad choice in life, a wrong turn, a bad marriage or life changing illness is all that stands between making it or not making it in life. It's easier to understand an attitude from a young nurse, but I have a problem with older nurses who have been around the human condition awhile longer. Everyone's experience is unique-we can only do our jobs without prejudice and advocate for those extras if the patient needs it.

Rudeness knows no socioeconomic class, race, religion, age, etc. , but it affects both medical staff and patients. Definately not reserved for poor patients!

"Judge not, lest ye be judged"

Maisy;)

[StrwbryblndRN]

Two years ago just before I was to start nursing school my husband was the bread winner and had the best insurance you could get. (hospitaizations were $0 and very little came out of his check to pay for insurance) We had plenty of money and had planned for me to go school and we would have no debt when I graduated.

Then all he$$ broke loose. He lost his job and could not find another for awhile and still had to wait 90 days after hire for insurance.

We went on medicaid for the children for awhile and it really hurt to be treated differently. We went to a large and very popular peds office that had Saturday and late hours of operation. Yet as wonderful as they may sound, I was treated differently. Being that I know they usually treated people well I would have just summed it up as just how there were with everyone. We ended up having to change offices.

I never know my patients insurance status. I do not want to know. It is not a part of my practice. Besides nothing should change my quality of care being given to my patients.

[cheshirecat]

Reading all these posts makes me feel so sad.

People should not be judged by how much they have in their pockets/wallets.

Probably the rude medicaid patients would be rude if they where multi-millionaires, that is just the type of person they are. But I bet they are outnumbered by the nice people who are also on medicaid a thousand to one.

Thank god for socialised medicine. At least if I lose my job, I know that my families and my healthcare will not be compromised.