Undocumented Patients

Editorial Team / Admin · Dec 28, 2016

My job is to provide patient care. I don't care if the patient is in the country legally or illegally, if they are insured or uninsured, or any other information that isn't relevant to the performance of my job duties. There is a multitude of reasons patients have difficulty being placed in a facility outside of the hospital. There are a multitude of rude patients and family members. Immigration/citizenship status may or may not have anything to do with it.

Does your ER have a translator available on call?

Translator services are not optional. It is up to each facility to provide translator services, be it in person, via a video service, or via a telephone service free of charge to the patient. So, if there's an ER where such services aren't available, they could find themselves in hot water. The requirements do not distinguish between legal/undocumented patient status.

[h=4]Are hospitals required to provide language access services?[/h]Yes.
Here is why.
Under Title VI of the Civil Rights Act of 1964, discrimination on the basis of race, color or national origin is prohibited.
Therefore, health care providers, including hospitals, that receive federal funding, including Medicare, Medicaid and SCHIP, are required to provide language access services for their patients.

Source: Are Hospitals Required to Provide Language Access?

emmy27 · Dec 28, 2016

Are you saying they file tax returns?

Yes. It's estimated undocumented immigrants pay billions in income tax annually, either through the same employer payroll withholding (using a false social security number) that the rest of us do (which is a substantial net benefit to the system, since those monies are retained by the SS system and the workers are usually unable to ever claim any benefits) or through voluntary self-reporting and payment with an Individual Tax Identification Number.

Those hoping to eventually obtain legal residency or citizenship, especially those who were brought here as children and have few other options, understand that a documented history of paying taxes forms an important part of their eventual case for potential citizenship.

Under almost all circumstances, the IRS does not share this information with immigration services and filing for an ITIN and paying taxes in that way is very unlikely to result in deportation. It is a widely used system.

There are some undocumented workers who work under the table (just like there are some citizens that work under the table) but most employers know it's lower risk for them to pressure their employees to come up with a social security number (even if it may be fake), and then the withholding proceeds as usual- with the slight difference that the worker never withdraws anything from the system the way citizens do. And yes, many undocumented workers go a step further and file their own income tax returns, as part of the groundwork for eventual residency or citizenship proceedings.

bear94, BSN, RN · Dec 28, 2016

Meh. No different to me than "documented" patients who still meet the same criteria, "basically live in the hospital because their families can't take care of them." "can't go to a facility because *no one will take them for some bs reason." I treat everyone the same and spend more or less time with people based on priority.

kakamegamama · Dec 28, 2016

Oh. Okay. Thanks.
We did have a patient on the geriatric psych unit, Thurston Howell, who was there for months and months. But he wasn't an undocumented patient.
Whenever a patient is now there for an extended amount of time, we often ask, "Will this patient be Thurston Howell II ?"

Gilligan,perhaps?

LovingLife123 · Dec 28, 2016

Actually, illegal immigrants are a huge strain on our medical system. I see this all the time. I have seen several. Some who steal social security numbers from deceased citizens.

Their legal status has nothing to do with the care I give, ever. I don't think that is what the OP is asking. The hospital does not get any money for these cases. They get not a penny as these people have no insurance.

A hospital is a business. For those of you mocking the OP, when it's you that gets laid off because the hospital can no longer afford to keep you, you will be singing a different tune. When patient ratios go up because they can't afford to hire new nurses, you will be upset over that.

You guys can't expect hospitals to continually give away free care. Sometimes it's appropriate and ok, but trying to take care of every illegal is not feasible.

I like having a job. I like providing for my family. I give each and every patient equal care, I very rarely know somebody's ability to pay. But I do happen to know on a few occasions when we have not been able to identify somebody because they have stolen identities.

NotYourMamasRN · Dec 28, 2016

When I worked ER I often felt bad for many of the people I saw who did not have a SSN or ID. They had no access to primary care, so by the time they got to us, they were half dead. They couldn't afford to take their kids to Urgent Care, so they took them to the ER which they knew would not cost upfront. It must have been hard for them as parents to not be able to provide for their kids. I know that on the inside they were embarrassed but I think they figured moving here and doing the best they could was better than being butchered by a drug cartel or sold as sex slaves. Honestly, if put in that position I would come here illegally too.

NotAllWhoWandeRN, ASN, RN · Dec 28, 2016

How do you know they're undocumented?

I don't generally inquire about citizenship in report either...

MunoRN, RN · Dec 28, 2016

How, exactly, do you propose to deport a patient who is too ill to leave the hospital?

It's not all that uncommon, there are various transport companies that provide "medical repatriation" services. This sometimes refers to people who have transport coverage on travel insurance who want to go back to their home countries, but it also often refers to hospitals that pay for patients, sometimes not even conscious and able to consent, to be transported out of the country.

MunoRN, RN · Dec 28, 2016

There's a common belief that undocumented immigrants burden our healthcare system in that they use more in services than they contribute, which is actually false. Undocumented immigrants often still pay payroll taxes, to the tune of billions per year. From a recent study:

In 2011 alone, unauthorized immigrants paid in $3.5 billion more than they utilized in care. Unauthorized immigrants generated an average surplus of $316 per capita to the Trust Fund, while other Americans generated a deficit of $106 per capita. The authors conclude that reducing unauthorized immigration would worsen Medicare's financial health.

So if we define people who "abuse the system" as being those who pay less into the system than they utilize, then it's US citizens we need to get rid of, not undocumented immigrants.

DowntheRiver · Dec 29, 2016

A majority of migrant workers in my area left grade or middle school to work out of necessity to support their families so they are completely illiterate in their native language or only read at a grade school level. Additionally, translated material whether written or verbal might miss the nuances integral to communication. Furthermore, follow up questions go unanswered because you give the paperwork or verbal instructions, but you can't communicate anything else without certified assistance (having the CNA from another floor translate is not acceptable).
These unfortunate individuals are trying to stay under the radar and make a better life for themselves, isn't that the American way? Even when they do utilize appropriate channels (and many really do), they still have trouble negotiating our infrastructure and receive so much resistance to seeking help. They show up in the ED because they know there will be care offered, and usually without attitude. Unfortunately, xenophobia and bigotry is still present at times, which makes me sad. We are no more enlightened than we ever were.

This is very true, and being illiterate is part of the reason why I have to bring an ink pad with me to Outreach events so that they can "make their mark."

Down in this part of the country, those strawberries and oranges don't pick themselves, y'all.

Skippingtowork · Dec 29, 2016

Unpopular opinion...but I believe that if the patient is undocumented, especially if they are costing the exponentially high amount a hospital stay is, immediate deportation is necessary. They are contributing nothing. Yes, we need to be human and not be mean/angry to the person we are taking care of but as soon as we are made aware of undocumented status they should be made to leave the hospital/country. I say that as a daughter of an immigrant who grew up in a third world country as an American. This country is starting to look like that third world country, especially in areas with high concentrations of minorities. And situations like that cost us an unimaginable amount. In the nursing home I work at (border town) we have undocumented immigrants taking up beds. It's an extremely well ran, well staffed facility. Because the beds are being filled with non citizens, citizens are forced to go to crappy neglectful places.

If you work in a nursing home, how do the undocumented get a bed? Especially in a nice place, but the citizens go to a crappy place? You've got to know you sound like you're not speaking the truth on any level. Also if all illegals were deported instantly, all posters on this site would be gone, except for the 100% native Americans.

Skippingtowork · Dec 29, 2016

What do you think about undocumented patients who abuse the hospital system? Anyone have undocumented patients who basically live at the hospital because their families can't take care of them, and they can't go to a facility because of their undocumented status?

This situation affects all patients to some degree. Even an insured patient with restrictive provisions may find themselves in the same position. Or if the co-insurance is high, the patient may not have a choice.