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.

[rph3664]

I was at Dollar General today, and posted over the cash register was the penalties for various levels of food stamp fraud.

The top level, which involved stealing and selling them, resulted in lifelong banning from the program.

Wow.

[StacieRN, RN]

Before anyone reads my post and thinks I've never been unfortunate, let me say at 22 I was a single mom with an ex-husband who wouldn't pay child support. My parents never paid a penny of my college costs. And lastly, I was diagnosed with cancer in December 2005 and had to quit work because of it.

I used to be very liberal and think we owed it to make sure everyone had health-care, that veterans were taken care of, that people had enough to feed their children, etc. That as citizen of the richest country in the world American's had the RIGHT to be well fed, housed and healthy.

I've mostly changed my mind.

I believe that:

People have the right to have ACCESS to health-care. Not to have guaranteed health-care. If I had to work my butt off to get an education so I could have a job that provided insurance then I don't see why others should get it handed to them.

People should be responsible for their OWN children. If they couldn't afford them, they shouldn't have HAD them. I managed to provide for my kid and I had enough sense to know I couldn't afford anymore. (To this day my son regrets being an only child but I know I did the right thing)

Veterans were PAID for the job they did. We owe it to them to take care of any injuries they incurred serving their country and that's all. (Monetarily speaking that is. We do owe them gratitude but nothing else)

This is America. No one is preventing poor people from improving their lot except themselves. I was the first college graduate in my family. I WORKED my way to a better life.

I feel we owe the elderly respect. I do not think they have a RIGHT to medications they cannot afford or health-care they can't pay for. By paying into the social security system they have a guaranteed income at retirement. They didn't pay for free health-care.

Health-care workers DO have the right to be paid for services rendered. Many put themselves in debt and all worked very hard to better their lives and shouldn't have to have their services devalued.

To everyone who is talking about rights. Go read the Constitution and Bill of Rights. I have. Nowhere in these documents are citizens guaranteed health-care, money to help out the poor, or a retirement income.

A citizen has the right to life (no one promised it would be long or illness free), liberty, and the pursuit (not guarantee) of happiness. NO right to health-care, food, housing or retirement income!!!

I also have yet to find any passage in these documents that gives Congress the right to tax citizens for the purpose of providing charity to others. Nor to tax us to make sure our retirement it provided for.

I should have the right to decide what percent of my salary I want to give to charity, if any. Also to decide to whom I want it to go to. I DO give to charity. But I research to make sure my money is not wasted. I want it to go to the deserving. I want it to be used wisely. I want to have the ones it is going to appreciate the fact that my hard-earned money is being given to them. And I expect thanks and gratitude in return for the GIFT.

Right now, congress takes my money and I don't get a say in who gets it. I've seen welfare recipients that drive better cars than I do and have better clothes.

The Medicaid and Medicare system is very mismanaged and wasteful.

I frequently see people receiving government entitlements that are rude and ungrateful.

I see patients and families on Medicare/Medicaid waste health-care dollars by demanding tests, procedures, medicines and hospital stays that they would not want if the money were coming out of their own pocket.

I DO NOT *OWE* ANYONE *MY* MONEY!!!!!!!

I know that a lot of people are going to disagree with this rant. Twenty years ago I thought differently. I respect everyone's opinions and their right to voice them. I ask the same courtesy in return.

[BeachBayNurse]

Don't get me started on what I think about Medicare and how we are taxed. However, a patient is a patient to me, if they are respectful, I will give them the same consideration. However, I did have a patient that was a frequent flier, very needy, Medicare, tell me one time to move quicker since she "paid my salary." It took all I had to turn and leave the room and not say, no, I just paid for your dinner and weeklong stay here:angryfire I try very hard to thank my lucky stars that I am able bodied and able to work, but I am human, and don't enjoy paying taxes!

[woody62, RN]

Don't get me started on what I think about Medicare and how we are taxed. However, a patient is a patient to me, if they are respectful, I will give them the same consideration. However, I did have a patient that was a frequent flier, very needy, Medicare, tell me one time to move quicker since she "paid my salary." It took all I had to turn and leave the room and not say, no, I just paid for your dinner and weeklong stay here:angryfire I try very hard to thank my lucky stars that I am able bodied and able to work, but I am human, and don't enjoy paying taxes!

I paid taxes as well. As a matter of fact, I begain paying them at the age of 14 and continue to until I was 42. I thought I had planned well for myself. But I hadn't planned as well as I thought. I can't afford my prescriptions without Part D. I can't afford to see my doctor without Medicare. I can't afford to be hospitalized without Medicare. Do I appreciate what my daughter, SIL and others contribute to their taxes that pay for my benefits. You can bet your sweet bibby I do. Just like I am sure my father and grandfather did for me paying for their coverage.

If anyone has a problem with paying taxes and getting something for them, I suggest they look at the members of Congress and what they get, in terms of health care, which you pay for. Then you can complain.

Woody:balloons:

[BeachBayNurse]

I paid taxes as well. As a matter of fact, I begain paying them at the age of 14 and continue to until I was 42. I thought I had planned well for myself. But I hadn't planned as well as I thought. I can't afford my prescriptions without Part D. I can't afford to see my doctor without Medicare. I can't afford to be hospitalized without Medicare. Do I appreciate what my daughter, SIL and others contribute to their taxes that pay for my benefits. You can bet your sweet bibby I do. Just like I am sure my father and grandfather did for me paying for their coverage.

If anyone has a problem with paying taxes and getting something for them, I suggest they look at the members of Congress and what they get, in terms of health care, which you pay for. Then you can complain.

Woody:balloons:

Well, you are seeing the benefits of your taxes, my generation does not have that same guarantee of Medicare/Medicaid fifty years down the road. I have written letters, I vote, I am too busy working to do anything else. Complaining and campaigning will make you feel better, but my child can't eat politics for dinner. I don't have to like it, that is my opinion I am free to have. Yes, sometimes I can't afford my prescriptions either, life is sometimes like that.

[woody62, RN]

Well, you are seeing the benefits of your taxes, my generation does not have that same guarantee of Medicare/Medicaid fifty years down the road. I have written letters, I vote, I am too busy working to do anything else. Complaining and campaigning will make you feel better, but my child can't eat politics for dinner. I don't have to like it, that is my opinion I am free to have. Yes, sometimes I can't afford my prescriptions either, life is sometimes like that.

You are working, as a nurse, aren't you. And if you screen name indicates where you live, you are making much more then nurses in my little corner of the world. And if you can't afford your prescriptions, there is something wrong with the California Nurses Association.

You want to know why there is not going to be enough money in Social Security. I suggest you look back to the Regan years. When they changed the law concerning how much income one had to continue to pay FICCA on. Then look at what Regan, Bush, Clinton and Bush did to the Social Security Trust Fund. And what each Congress did to the Trust Fund. Taxes might not have gone up that much but Congress and each President raided the Trust Fund to prevent taxes from going up. To satisfy people like yourself who don't like paying taxes.

You think taxes are bad in this country? Try going to live and work in Canada. Then you can complain about taxes. Of course, you will not have to worry about paying for your health care and you will be able to afford your prescriptions. But then people still would complain wouldn't they.

I paid the full bill on my FICCA taxes for ten years. I was considered self employed, so no employer had to contribute to mine. You think you are paying, you don't know how little you really are paying. We live in the only Western Industrialized nation without a nation wide health care plan, without drug coverage and we complain about all those creeps, such as myself, stealing out of our pockets.

Woody:angryfire

[MAISY, RN-ER, BSN, RN]

This was an ugly thread in August, and it's tone certainly has not changed.

Any country that doesn't take care of it's poor doesn't deserve to be a world leader. It is a moral obligation of the haves to help the have nots....especially with healthcare, medication and food.

There is no excuse not to!

Luck of the draw, is the difference between being a Kennedy or being born poor and hungry. Coming from means shouldn't be a source of pride. Working for a better life can possibly, give you a better life. HARD WORK DOES NOT MEAN BIG SUCCESS(case in point migrant workers-hard work/minimal pay).

I don't appreciate the smugness of those who have "made it"...GOOD FOR YOU, now help someone else...give them the tools necessary to succeed....health, food, a safe place to sleep, and whatever else!

And, back to those of you who have made it, Thank God you have a brain that works. Brains are not equally endowed amongst the population. What makes perfect sense to some, wouldn't even occur to others. So don't judge...be glad of what you were able to accomplish and help others.

Help others...help others....help others...see a recurring theme?

Maisy;)

[Susan9608]

As far as being in control of your own fertility, that should not mean, "I'm going to have as many babies as I can, because I feel that's all I can control", it should instead mean, "I'm going to wait until I can AFFORD A CHILD AND EVERYTHING THAT COMES ALONG WITH IT to get pregnant." If that means abstinence, birth control, whatever, so be it.

I'm one of the people who mentioned something about people being in charge of their own fertility. What I said was that when women feel like they have a meaningful social role to fulfill, they find ways to control their own fertility. So instead of berating people for having baby after baby and trying to force them into some kind of birth control, I think a much better option is to educate those women and help them find a meaningful social role for themselves. I think then the choice to utilize available birth control methods will become their choices and thus will be much more effective.

A citizen has the right to life (no one promised it would be long or illness free), liberty, and the pursuit (not guarantee) of happiness. NO right to health-care, food, housing or retirement income!!!

So people have the right to "life, liberty, and the pursuit of happiness," but NO right to things absolutely necessary to achieve life, liberty and the pursuit of happiness? I'm sorry, but you just can't live without food. You can't really be free if you can't eat. And I don't think you worry too much about finding happiness if you're riddled with illness ...

I've heard a lot of people talk about how everyone should *earn* their own way and how no one should just get hand-outs. (Funnily enough, these people are never in favor of 100% inheritance taxes, but I suppose that's an entirely different issue.) Something that I think tends to get overlooked, though, is that most people receive government assistance in some form or fashion and either don't realize it, choose to ignore it, or think it's some how "different" than utilizing medicaid or welfare.

For instance, the government subsidizes housing by allowing individuals to subtract their mortgage interest from their income tax. The government also subsidizes medical bills by allowing a certain percentage of them to be deducted from income taxes owed. That's assistance.

And public schools provide "free" education. If you (the collective you, not anyone in particular) were so disadvantaged as to have to work for everything, then I'm sure you did not attend private schools. Thus, you must have attended public schools and benefited from the government provided education. Yes, citizens pay taxes towards the schools, but to that end, you're then taking hand-outs from the parents of other children and from the individual's with no children who are still required to pay the school tax.

Most people receive government assistance in some form or fashion. It seems really elitist and cold and hard to deny people things like food and health care just because they didn't "earn' it ... especially when you consider the biggest population of poverty stricken individuals in the US are children.

Plus, just because you haven't been in a situation that required you to take additional government assistance doesn't mean it can't happen. Tomorrow, on your way home from work, you could be in a horrific car accident and end up as a spastic quad. Then you could reach the life time max on both you long term disability and your health insurance. You'd have no income and no insurance coverage. How would you provide for yourself and your children? What if you weren't married and didn't have a spousal income? Or what if your husband (or wife) left you? You can't honestly think that you wouldn't then end up utilizing medicaid or social security or whatever you had to in order to survive. And I imagine you'd feel like you were entitled to it ... and that would be so, so ironic.

This was an ugly thread in August, and it's tone certainly has not changed.

You've got that right.

[pattycakeRN]

This was an ugly thread in August, and it's tone certainly has not changed.

Any country that doesn't take care of it's poor doesn't deserve to be a world leader. It is a moral obligation of the haves to help the have nots....especially with healthcare, medication and food.

There is no excuse not to!

Luck of the draw, is the difference between being a Kennedy or being born poor and hungry. Coming from means shouldn't be a source of pride. Working for a better life can possibly, give you a better life. HARD WORK DOES NOT MEAN BIG SUCCESS(case in point migrant workers-hard work/minimal pay).

I don't appreciate the smugness of those who have "made it"...GOOD FOR YOU, now help someone else...give them the tools necessary to succeed....health, food, a safe place to sleep, and whatever else!

And, back to those of you who have made it, Thank God you have a brain that works. Brains are not equally endowed amongst the population. What makes perfect sense to some, wouldn't even occur to others. So don't judge...be glad of what you were able to accomplish and help others.

Help others...help others....help others...see a recurring theme?

Maisy;)

I guess this is where we differ. I simply do not feel the need to give away anything I earned. I don't have to.

And the hard work some of us did in college certainly isn't the same as the hard work a migrant worker does. Manual labor and college work are very different.

Coming from a family that worked hard to get where we are, I *am* proud.

All that said, I respect all your responses and enjoy reading them.:redpinkhe

[MAISY, RN-ER, BSN, RN]

I guess this is where we differ. I simply do not feel the need to give away anything I earned. I don't have to.

You are right you don't have to do anything....

Last night as I left my father in law in the hospital, I heard young nurses arguing with their CNA's that they didn't go to school for 4 years to wipe butts! This wasn't the only time I heard this statement yesterday. I don't know how old you are, but if you are young....there is a lot of life to live. Don't be so set in your ways...it's amazing how life throws you curve balls when you least expect it. If you are older, shame on you. You should know this and much more.

WE are all given different gifts...how nice for you, yours included the brains to make it through nursing school. No matter how others try,(with the right attitudes)...they never will! They may never graduate from any program, but that doesn't make them less "hungry" to succeed. Sometimes it's just being at the right place, at the right time....or having interests and talents developed. Who will do that for children without means?

There is talk of national service, while I don't agree it should be military...I would fully support my two college aged children giving time to worthwhile causes and aiding their fellow Americans in bettering their lives. I also think that our middle school aged kids should be giving of themselves from the time they are little. But I guess they'd have to learn that from unselfish parents.

What amazes me most, is the people who decry national healthcare and socialization....are the ones who tout their Christianity or holiness. WWJD? Again, if they are reading their bibles they know the answer....support the poor.

I am not religious, but I do believe in helping my fellow human beings. Sometimes these threads truly make me ill...this is definately one of them. I just can't understand people in this industry having these ideas. How can they ever be impartial when caring for those without?

Maisy

[Susan9608]

I just can't understand people in this industry having these ideas. How can they ever be impartial when caring for those without?

This is a very interesting question - one that I'm asking myself now and one I remember asking myself when this thread first popped up.

Some of the opinions I've read throughout this thread seem made up of social darwinism ... and that seems to me to be a particularly unusual attitude for someone in a professional of caring to have.

[StacieRN, RN]

Just a few things. I do believe in charity. I mention in my post that I give to needy programs. I just think I should be allowed to have the right to choose which charities.

I think the deserving poor, aged, children and invalids should be taken care of. But not by the government. That's not their place and they don't do it well.

As a Christan, I think the we, the people, should take over that responsibility on a local level. People should take care of their families and neighbors. People should be responsible and take care of their elderly relatives, help out their neighbors and fellow church members.

By the way, in my family, this is how it is done. None of my grandparents, or great-grandparents died in a nursing home. I'll be dead before I allow my parents to go into one.

I am a single mom (as I mentioned). My family helped me care for my son and shared out babysitting. I am a grandmother now of a beautiful 3 week old baby girl. I will be sitting with her when her mom returns to work.

When my cancer was newly diagnosed. My sister quit a nursing job four states away and moved home to take care of me while I needed it.

As far as having the right to life, liberty and pursuit of happiness but not the means, welfare programs are not the only way to fix this (or the best way in my opinion). I think that the minimum wage should be increased and that the government should rein in inflation. If our taxes were lower, then we could afford to support ourselves instead of relying on the government.

I think that anyone who's willing to work should make enough to be able to support themselves, their family, provide for their medical care and their retirement.

I am a compassionate person. I am a Christan. I love being a nurse. I like taking care of people. But the only person I took on to raise and support was my son. Anything else should be done out of my own heart. Not because it's mandated.

Just my opinion. Which, like I said, I am entitled to. I have not criticized anyone else's opinions. Just stated mine.