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.

[jetscreamer101]

Is it possible that patients on assistance programs have been treated poorly in the past so they anticipate problems?

I've had to be on assistance programs many years ago. I was treated differently, and yes, it hurt. I can still hear some of the comments directed toward me replaying in my head.

With that said, I did have an experience in an ER. A woman and her young son (11-12) came into the ER because he had vomited yesterday. Was fine today, but mom thought he should be checked by a doc. If I remember correctly she was a frequent flyer.

[Susan9608]

In my PICU, a great majority of my patients are Medicaid, not so much because their parents are poor and on welfare, but simply because their medical problems are so complex and financially debilitating that to pay for their care without insurance would financially devestate their families.

One simple hospitalization can be enough to bankrupt someone. For instance, I had an emergency appendectomy last November. Because my surgery occurred so late at night, I spent the night in the hospital, even though an appy is a relatively simple/benign procedure. The total bill was $36,000 (outrageous, if you ask), and fortunately, my insurance covered all but $250. If I had to have paid out of pocket, it would have made a pretty big dent in my savings. So for someone without insurance (as a lot of small companies and/or self employed people don't have insurance) and without savings, that bill alone could have wiped out all of their assets.

As far as the attitude of Medicaid vs. private pay insurance patients, I have actually had the opposite problem of the original poster. Quite a few of our private insurance patients/families will make comments to me like, "Well, we're paying for this ourselves, so we shouldn't have to wait." Or "At least we're not a burden on society." I've also found that a lot of private pay or private insurance patients have an attitude of entitlement because they are paying for themselves or using their own insurance. Parents will call me into the room to do things like turn the tv/vcr on or bring them a glass of ice for their soda, and they'll say to me, "Don't you know how much I'm paying for this service?"

Of course, there are obnoxious people everywhere; that's a given. But even if Medicaid patients happen to be more obnoxious than most (not that I agree with that assessment), so what? Does that make them less deserving of good care? In a service profession like nursing, it seems to me that it shouldn't matter if people are angelic in behavior or obnoxious - they still need care. Nurses still get paid (at least in a hospital setting, as far as I know), so what difference does it make to us if someone is Medicaid vs. private pay vs. private insurance? Isn't it our job to take good care of all of our patients, no matter how unlovely they may be?

[woody62, RN]

I have a rather unusual take on all these problems. When I delivered my daughter, NYS Medicaid paid for her delivery. Six weeks later I went to work and got health insurance under my employer. When she was eighteen months old, I changed employers, lost my insurance, purchased individual insurance and returned to school. Half way thru my program, I developed a medical problem. I was advised to stop working for six months but I felt trapped, as I would lose income that paid for my health insurance. I went to NYS to find out if I could qualify for Medicaid. Since I was an LPN, I was told no. Despite having health problems, despite bing told I had to cut down my work hours, they decided I was still capable of working. I continued to work and pay for my own health insurance until I moved here, to Florida, and found out what I was paying a quarter would be what I was expected to pay a month, for less coverage. I went without insurance. Fortunately I was fairly healthy. After I had my car accident and became eligible for Medicare, I opted on it as soon as I was eligible.

I have been called everything from a hard working woman to a thief for taking SSDI and Medicare. I've overheard people complain about those receiving Medicaid, such as myself, as being dregs on the hard working people. Of being lazy. I've heard people complain that their insurance is paying and they are entitled to xyz. About the only time I didn't heard complaints was when I drove to Montreal, every three months, taking prescriptions with me, seeing a Canadian doctor, get my prescriptions rewritten by him, getting them in a Canadian pharmacy, paying for them. The only time I had to be concerned was when I crossed back into New York State. I was breaking the law. I was bring medications, purchased in Canada, back here.

I have decided, I really don't care what people think of me. I paid my dues while I worked and paid taxes since the age of fifteen. I am only getting what I paid into and what I deserve. And if it is SSDI, Medicare, Medicaid, welfare. I paid into all those systems. I am a human being and I demand to be treated with respect and dignity, just like anyone else would.

Now I am stepping off my soap box.

Woody:balloons:

[RNperdiem, RN]

I think the Victorians called them the "undeserving poor". The patients you refer to are probably a small minority of the Medicaid population.

Many of the above posters have used public assistance as a temporary means of support.

Some people have so few social skills to get along in this world, are almost unemployable, and not responsible. They are probably well known to social services and the police. This is the hard core of poverty. I suspect the majority of people on assistance are just fine.

[HeartsOpenWide, RN]

I have a question. When I worked in a Dr. office the pts insurance card (copy) was taped to the front of the chart so you knew what kind of insurance they had for billing and blood drawing purposes (which lab form to use). I really did not give it much though and always treated my pts the same. Now that I am in the hospital as a student (maybe I just do not know their chats that well) I have NO clue what kind of insurance a person has and could care less. It does not affect the care I give. What does the type of insurance have to do with it anyways? I have seen jerks and totally nice people with private and Medicaid/medi-cal. If anything I think health care workers should be the ones we are shaming here for treating people a certain way depending on their health insurance. Since I am in nursing school I had to get the "green card" (which is like medicaid but just for family planning) because I can not afford the $500 medication deductible my insurance requires (my parents are paying my insurance while I am in school and it is only for major medical. I use to have and HMO that took a big dent out of my paychecks but I am a full time student now) and I HATE going to the pharmacy to pick up my birth control because I do not want any one to see me with the "green card" because there is such a stigmata about it; and its wrong that I feel that way, but it is a valid feeling.

[CHATSDALE]

maybe they are embarrassed to be on medicaid

if you have been independent all you rlife it is rough to be suddenly down and out

[woody62, RN]

I have a question. When I worked in a Dr. office the pts insurance card (copy) was taped to the front of the chart so you knew what kind of insurance they had for billing and blood drawing purposes (which lab form to use). I really did not give it much though and always treated my pts the same. Now that I am in the hospital as a student (maybe I just do not know their chats that well) I have NO clue what kind of insurance a person has and could care less. It does not affect the care I give. What does the type of insurance have to do with it anyways? I have seen jerks and totally nice people with private and Medicaid/medi-cal. If anything I think health care workers should be the ones we are shaming here for treating people a certain way depending on their health insurance. Since I am in nursing school I had to get the "green card" (which is like medicaid but just for family planning) because I can not afford the $500 medication deductible my insurance requires (my parents are paying my insurance while I am in school and it is only for major medical) and I HATE going to the pharmacy to pick up my birth control because I do not want any one to see me with the "green card" because there is such a stigmata about it; and its wrong that I feel that way, but it is a valid feeling.

Every patient admitted to a hospital has what is called a face sheet. It list their name, address, next of kin, doctor, social security number, type of insurance, employer, occupation, admitting diagnoses. It is either the first sheet in the chart or the last one. I would look at my patient's face sheet to find out who the next of kin was. And later, what type of insurance so we could determine if home health care was covered.

Unfortunately, most nurses are like the general public. They have their preconceived ideas about their patients and their lives. And because we have our own ideas, we treat patient's differently.

Woody:balloons:

[EmmaG, RN]

Honestly, I couldn't tell you what insurance (if any) my patients have until it's brought up by the case manager or other staff.

Unless it directly impacts their treatment and outcome (like the laborer admitted repeatedly with pneumonia because he had no health insurance, didn't qualify for assistance, and couldn't affort discharge prescriptions totalling over $400), it's none of my damned business

[bethin]

I don't run to a pts chart and see how they're paying. It's not my job. My job is to provide healthcare. End of story.

As an aide, I don't know what if any insurance a pt has and I'm not sure the nurse does either. Who am I to judge? I don't know what tomorrow holds for me and heck, tomorrow I might be on medicaid. Not likely to happen but I'm not going to judge when that very well could be me on medicaid.

[FireStarterRN, BSN, RN]

This is precisely why we need universal medicine. Woody's case vividly illustrates the quandry many Americans find themselves in. Who here hasn't cared for someone who delayed seeking help because of unavailability of clinic access, only to end up costing the taxpayer big bucks down the road? Or patients forced to use ERs as clinics because of our lack of an integrated healthcare system that plans for the realities of financial disparities between citizens.

Do people actually think that looking down on poor people will make them go away? Will eliminating help for the poor make them able to afford modern healthcare? Do they really want the United States to resemble and behave like a disorganized third world nation where people die in the street and are refused healthcare for lack of ability to pay? Is that what libertarians want?

[woody62, RN]

This is precisely why we need universal medicine. Woody's case vividly illustrates the quandry many Americans find themselves in. Who here hasn't cared for someone who delayed seeking help because of unavailability of clinic access, only to end up costing the taxpayer big bucks down the road? Or patients forced to use ERs as clinics because of our lack of an integrated healthcare system that plans for the realities of financial disparities between citizens.

Do people actually think that looking down on poor people will make them go away? Will eliminating help for the poor make them able to afford modern healthcare? Do they really want the United States to resemble and behave like a disorganized third world nation where people die in the street and are refused healthcare for lack of ability to pay? Is that what libertarians want?

You are so correct. Do you realize that we are the only industrialized western country that does not have universal health care coverage for all of our citizens. And what gets my Irish up is when I hear people comparing our great system to what they say is the poorly run socialized medicine of Canada, Great Britain, France, Germany, to name a few. What is so great about having the world's greatest health care system when 46 million people here have access only to episodic health care. We frequently complain of frequent flyer's, who appear in our ER's worse and worse until they are finally admitted, requiring much more expensive treatment then they would have if there was a universal health care coverage. We hand them prescriptions, expecting them to have the money or coverage to have them filled. We give them health care instructions, expecting them to follow them, without giving any regard to their own ability to afford them.

Yes, we do have the greatest health care system in the world. Especially if you can afford to have access to it. And even if you can afford it, as another nurse has said, the expense can bankrupt a family.

Woody:balloons:

Once again stepping down for her soap box once more

[Noryn]

I never cared what insurance someone had when I worked in the ER but at the same time I can bet you if they came by ambulance for a simple laceration then they had Medicaid. People take criticism of these recipients as "attacks on the poor" and often it isnt. It is just really frustrating to see resources being misused when there are so many people out there unable to afford proper care.

How can you justify the following situation? A 18 yo gets drunk then drives and gets injured. We will pay for the hospital care and life long care of someone who makes a bad decision but take a 45 yo who works two jobs and who is involved in an accident or has a major medical problem then the 45 yo is forced to go bankrupt first or in most cases forced to delay care because they are saving for college or just trying to survive. And see this is why it is frustrating because people will say, "So you will just let that 18 year old die? you are heartless." No I wouldnt let the 18 year old die, I never said they didnt deserve care but I do think the 45 yo deserves care as well. We need to take care of everyone, not just the poor or the rich.

So it is frustrating to see people waste, not respect resources and not attempt to sacrifice while others are.