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Should "charity" begin at my home?

One of my home care patients can't afford his medications. I know he desperately needs them, so I've been using my own money to purchase them. Lately though, I've been strapped for cash. If he doesn't take some of his medications he could end up in the hospital. But if I keep buying them, I could wind up in the poor house. What should I do?

-- Jessie, RN

At your home, yes. At your client's home, no.

Jessie, it's obvious you care about your client. But everyone who responded to your dilemma agrees on one thing -- you cannot and should not continue buying his medications. Readers offer you a number of valuable options to consider, including: 

• Work with the pharmacy.

• Talk to the doctor.

• Contact the drug companies

• Look into government/additional resources.

Work with the pharmacy

Julia West, RN, writes about her own dilemma and its solution.

"Nurses are by nature caring people and want to help, but you should NOT be buying your patient's medications. Ask his doctor about some less expensive alternatives or samples. Also, some pharmacies have assistance programs. Help your patient fill out the paperwork for these programs.

"My husband and I both have chronic illnesses, and money is tight. If we can't afford a full prescription, sometimes we pick up enough for a week or two until we have more money coming in. Most pharmacies will work with you this way."

An anonymous reader also understands your client's problem from a "been there" perspective.

"My husband takes several heart medications, and we were often unable to afford them. His doctor told us about a program at Wal-Mart that allows you to get your medications for $4. Most of the meds are that price, although some are a little higher. But the prices are better than the $45-$85 we were paying. You might want to see if this would help your patient."

Talk to the doctor

Pam, RN, thinks it's time to speak to the doctor.

"Tell to your client's doctor that he can't afford his meds. The doctor may change to cheaper meds or stop some. Also, many drug companies provide meds at no cost to patients if a doctor fills out a request."

Sherri, LPN, also believes the doctor should be involved.

"Some drug companies offer medication programs. Ask your client's physicians if they know of any programs for his meds. It's not your responsibility to pay for them; just get the information you need, and assist him with paperwork."

Maureen Kearns, LPN, cites another reason to contact the physician. "Ask his doctor about the meds. Doctors' offices often get samples from drug companies."

DAK, RN, also believes samples may be an option to consider, for more than one reason.

"Ask the doctor about 'freebies' for this gentleman. You shouldn't have paid, nor should you continue to pay, for his medications. You might get yourself into a pickle that can become a little too sour."

Contact the drug companies

Karen Carrillo, MSN, RN, suggests turning to the companies that make your client's medications.

"Several drug companies provide medications free of charge or at a nominal cost to those who really need them. Look online for the company that makes each drug, and download an application to take to the patient's doctor. Some pharmacies also have resources for patients in their areas."

An RN also thinks you should go to the drug companies.

"Help him sign up for a patient assistance program with the pharmaceutical companies. Most of them have discounted or free drugs based on need."

Pamela Martin, RN, agrees that you should contact the pharmaceutical companies.

"Many drug companies offer free medications for indigent clients. Contact different drug companies to see if they have programs, or initiate a referral to his social worker. Sometimes, the medication may need to be changed. Usually, an equivalent medication can be substituted that is offered by the company providing the benefits. Although your generosity is to be commended, you cannot save the world by yourself. Next time, search out social programs that are available."

Julia, LVN, echoes these thoughts.

"Help your patient by contacting the companies that make his medications, and see if they can help him by either lowering the cost or giving them to him for free."

Look into government/additional resources

Sandy Levy, LPN, describes a multi-pronged approach.

"Get in touch with the pharmaceutical company, to see if it can provide the medication. Many times, these companies have discounted or even free meds for low-income people. The company may request a letter of explanation from the physician and some form of income verification.

"Also, call your local hospital, senior center or public health clinic, to ask if a resource is available for medications. Some churches may even help. And get the patient's family together to see if they can help buy his meds. If each of them just puts in a little, it really adds up."

Doris, LPN, thinks you might want to start with the Internet.

"I think you're a wonderful person and obviously a very caring nurse. However, you can't continue buying his medications. There are special programs that offer reduced-price or free medications. Research them online or let the home care agency you work for do it. Your agency probably has referrals to help him out as well and, quite possibly, a social worker who can review his financial situation. Hope this helps!"

Victoria Howard, LVN/LPN, reminds you of government programs.

"Oh, Jessie, I know the feeling all too well of trying to be the caregiver to all. Sweetie, you can ill afford to do this. You could wind up in real trouble -- financially and professionally. You are the nurse, not the pharmacist. Programs like Medicaid should help with your patient's meds.

"Be very careful. We can't fix everyone. It just isn't possible. And stop purchasing your patient's meds. I feel for both of you. Does he have family that could help?"

Max Hahnen, director of hospice business development, writes of possible solutions, especially if your client qualifies for hospice care.

"I appreciate your willingness to support your patient's medication needs. You have identified a widespread problem for many of our patients. A couple of thoughts: In many areas, elder care programs offer assistance. Also, if your patient is hospice-eligible, the hospice agency may pay for medications related to the terminal condition. Shop around at area pharmacies. You may find a variance in prices of up to 60 percent. Best of luck."

Judith Merritt, LPN, also advises you check multiple resources.

"Help your patient find alternative means of paying for his meds. The Council on Aging might have some ideas for you, and his physician may give him sample meds. If your client has family, they could be your biggest resource, even if it doesn't seem so now. With his permission, review all the insurance he has. And talk with your supervisor. He or she needs to know the situation and may have the solution you're seeking."

An RN cites another place to look for help.

"Talk to the social worker, and ask if he or she has any suggestions. Call the drug company or companies and explain the situation. Sometimes, they can help out. And ask your client's doctors about any samples they could share."

Cheryl, RN, suggests an additional resource to consider.

"Refer your client for a social work evaluation, to assess the management of his finances and to determine the appropriate social service agency that can assist him in obtaining some type of entitlement such as Medicaid or help him apply for a discount prescription card. As nurses, we need to remember we can't solve all our patients' social/financial problems. Let's utilize the other specialty services available to meet their needs."

Rose Ann Russell-Rosier, pharmacy & marketing manager, gives you other options.

"Patient assistance is the answer to your situation, if your client doesn't have prescription coverage. Also, visit Medicare.gov to check out your patient's current prescription options under Medicare Part D. He may qualify for extra help, which means Medicare will pay his monthly premium and annual deductible. He will be responsible only for a small co-pay to his pharmacy, if he has a fixed or limited income."

An anonymous reader also believes a government program may be the answer. "See if your client's eligible for public assistance."

An anonymous reader has another thought for you. "Call his insurance company or family to let them know he needs assistance."

An LPN encourages you to get assistance from within your company. "Go to your supervisor and get some help. And make sure this person isn't poor mouthing you. He could have money hidden away. And you're enabling him."

And finally, an anonymous reader would go to a beneficent group first.

"Ask your church to take on this patient's medication expenses. Ask his doctor about samples. And talk to a social worker."

Jessie, don't think you're the only one who can help your client. Speak to his physician, contact pharmaceutical companies, or rely on one or more of the other resources suggested by our readers. In short, give your client your assistance -- but never your money.