That's MY JOB!

Nurses General Nursing

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Hoosier_RN, MSN

3,960 Posts

Specializes in Dialysis.
And you know something I found out? AL does take medicaid.. But they don't want to! They turn patients away for ones who will pay more money.

Not all do. That is strictly up to the owners. Most won't take medicaid as they get rebursed very little and are expected to provide full services as if it were private pay. The whole medicaid system stinks. Yes it pays for a range of services, but finding providers willing to accept them is a chore

%D#2

298 Posts

Not all do. That is strictly up to the owners. Most won't take medicaid as they get rebursed very little and are expected to provide full services as if it were private pay. The whole medicaid system stinks. Yes it pays for a range of services, but finding providers willing to accept them is a chore

I just feel so bad.. I visit patients who got kicked out and luckily they have great nurses in the snf who are caring like I am. I just wish it wasn't all about money. But it is.. In every profession. It just stinks because I come from a long line of nurses who went into this for the nature of caring for people and being a good nurse. Sure I love the pay check.. But I wouldn't want to do anything else. I treat my patients like they were my own family

djh123

1,101 Posts

Specializes in LTC, Rehab.

Yeah, you took away one of their Profit Centers! (That's my latest joking-but-not-really-joking term for my residents - from the company's point of view).

Woopsadaisy

13 Posts

I believe and I live by the motto: Patients Over Profits"!!!

You did good. Don't sweat the admin/bottom liners. They have a different job to do.

Just my 2 cents.

1056chris

72 Posts

Specializes in med/surg.

Hospitals sometimes think the more patients the better they are doing. Through my long years as a RN so many duties have changed. Along with this has come "service excellence" smile do as much as you can , follow the orders, and keep families coming in. I am glad you did what you did. It shows that we think of whats best for the patient. Sometimes what is best for the patient is not best for the facility. Patient comes first in my book. Hold your head up and keep working. That 4k is probably peanuts to what they are bringing in.

Karou

700 Posts

Specializes in Med-Surg.

Seriously good job for advocating for that patient! That does take guts to do. Heparin is a high alert medication and this was a major safety issue. Because of you, this patient got to an appropriate setting to be monitored closely.

Being a strong patient advocate is (in my opinion) one of the most important things a nurse can do, but not always the easiest.

You were a good and prudent nurse, hats off to you!

TriciaJ, RN

4,328 Posts

Specializes in Psych, Corrections, Med-Surg, Ambulatory.
Hospitals sometimes think the more patients the better they are doing. Through my long years as a RN so many duties have changed. Along with this has come "service excellence" smile do as much as you can , follow the orders, and keep families coming in. I am glad you did what you did. It shows that we think of whats best for the patient. Sometimes what is best for the patient is not best for the facility. Patient comes first in my book. Hold your head up and keep working. That 4k is probably peanuts to what they are bringing in.

Yes, I'm wondering what they're equipped to provide for the $4000/month. What are their real costs and just how much profit do they rake in?

%D#2

298 Posts

Yes, I'm wondering what they're equipped to provide for the $4000/month. What are their real costs and just how much profit do they rake in?

Well we have the nurses (2 on days with two med techs) but now they're saying we don't need med techs so they're cutting the budget even more. We have one evening nurse (me, and one part timer who works my days off). This is for service of 50 patients.. Ten which are subacute and 40 which are AL. We have a vibrant living assistant, happy hour which includes a musician who comes in for about an hour. Dining services. The usual rich community assisted living.

So there is a variety of staff and great things they provide for residents but they're making 200k a month and we haven't even filled up completely yet. I will have 90 patients when we fill up. And maybe a med tech if I'm lucky.

I don't know if that even explains what you're asking as I am not good when it comes to business aspect. I'm just the nurse lol

bgxyrnf, MSN, RN

1,208 Posts

Specializes in Med-Tele; ED; ICU.

I once worked at a little hospital that used "swing beds." For the uninitiated, it's a Medicare program to help subsidize the rural, critical-access hospitals by paying them a higher rate for "swing" patients who are essentially SNFers who meet certain criteria to be held in the acute ward to achieve specific therapeutic goals.

We had a patient who presented through the ED and was admitted to the floor. They made her a 'swing' patient by getting a doc to endorse that she was terminal though in fact she had no acute disease processes and was no more terminal than any other bed-ridden geriatric patient. If placed in the attached SNF she would have received all of the SNF services including socialization, recreation, etc. Instead, she laid in a bed getting ignored except for the q2h turns. Her meals were often luke-warm because we often didn't have staff available to immediately feed her when her tray arrived.

We talked about this among the nursing staff and approached the case manager who basically copped to the truth that it was purely a financial decision to hold her in the acute ward for as long as they could (plan was for 6 months!).

Finally, one weekend the doc was rounding and I asked him, "She doesn't seem to be actively dying... wouldn't she be more appropriate for the SNF wing?"

The doc, probably recognizing that he'd been had by the system and realizing that he was flirting with Medicare fraud by declaring her terminal, said, "Yeah, she'll be going over to the SNF."

I replied, "What's holding her back? I talked to them earlier and they said that there's a bed available and the intake is already done."

He smiled and said, "She can go right now. I'll write the order."

He did and over she went. The next day, there was hell to pay. The case manager was beside herself and said, "The CEO is livid. That just cost us $60,000. He wants a list of names!!" Later the DON came through and made similar comments. Ultimately, I guess the combination of me being a solid nurse and their being chronically short-staffed and having trouble with recruiting kept me employed but I was really scared.

I know I did the right thing for the patient but, faced with a similar choice, I'm not sure I'd make the hard (and right) decision for fear of my job and my career. Fortunately, in the ED I've never been faced with such situations and expect not to.

I get the need for revenue, I really do. The system needs money in order to operate. But ultimately, our service is delivering the *appropriate* care to our patients and if we cannot financially survive in doing so then so be it and shame upon anyone who looks at a patient purely as a revenue stream to optimize rather than as a patient or even simply as a customer...

Not to mention that more than one nurse was heard to make mention of dropping an anonymous line to CMS alerting them to the situation over which we surely would have been fined and perhaps even sanctioned.

sammiesmom

144 Posts

Money, money, money that is sad. A family member once asked me if she can take her newly admitted mom back to the nursing home because she still has to pay them while she is at the hospital. I am at the point in my career that I do not argue with family so I told her you can take your mom home, you can talk to the physician and you can sign leaving against medical leave form. And then she changed her mind.

sammiesmom

144 Posts

Good job. You know 2 million neurons die every minute when stroke strikes. So they are ok with slowly killing her and rendering her invalid. Pretty soon they will lose income from her anyway because she will die.

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