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Medicare & Medicaid

Kentucky nurses and their allies seek a mandate for a nurse in every school

By Melissa Patrick

May 9, 2017

– Advocates say move would improve learning outcomes


Kari Hall, Certified Medical Assistant, with a Madison County student

Putting a full-time nurse in every Kentucky school would not only provide health care, but improve education outcomes, say advocates of the idea.


“We need a nurse in every school because we need to quit thinking about health and education as separate entities, because they are not,” said Eva Stone, an advanced-practice registered nurse and co-chair of the school-nurse initiative being mounted by nurses’ groups and their allies.


One of their strongest allies is retired educator Terry Brooks, executive director of Kentucky Youth Advocates, says he is “absolutely convinced that the non-cognitive issues that kids face, like health, have as much to do with their capacity to learn as a teaching method.”


Brooks added, “There is only so much blood that you can wring out of a turnip when it comes to teaching methods. You always want great teaching methods, but my goodness, we have been working on that for decades with results that are a whole lot more the same than they are different. So if it is not producing significant change, we’ve got to look for something else. . . . You are not hearing me say that this is a silver bullet, that, boy, a school nurse is going to fix everything, but I think the presence of a school nurse not only impacts kids’ health, but it impacts the kids’ capacity to learn.”


Those assertions are supported by research, including a recent study that looked at the association between school nurses and academic outcomes of high-school students. It showed that when there was a nurse in a public high school on a full time, every-day basis, graduation rates were higher, absentee rates were lower and ACT scores were higher,” Teena Darnell, assistant professor of nursing at Bellarmine University, said about her research.


“And traveling nurses showed no significance on any level. So if you had a part-time nurse, there was no significant difference on academic performance,” said Kathy Hager, a Bellarmine nursing professor and president of the Kentucky Nurses Association.


Hager is also a member of the “Every School Needs a Nurse, Every Day” initiative that is advocating mandates for a full-time nurse in every public school, as recommended by the American Academy of Pediatrics.


The National Association of School Nurses supports a ratio of one nurse for every 750 healthy students. This was the recommendation of the pediatrics academy until just last year, when it changed its recommendation to a nurse in every school, saying that “The use of a ratio for workload determination in school nursing is inadequate to fill the increasingly complex health needs of students.”


Kentucky has one nurse for every 1,254 students, according to a 2011 KYA report, the latest data available. The Kentucky Department of Education only records nurses hired by school boards (187 this year) and does not include any hired by different funding streams.


Darnell’s research found that 42 percent of Kentucky’s high schools had a full-time nurse, 37 percent had a part-time nurse and 20 percent of them didn’t have one at all. Among all schools, 44 percent had full-time registered nurses; 48 percent had either RNs or licensed practical nurses.


State law requires schools to “make any necessary arrangement” to provide for the immediate health needs of students. Stone said they “do that for the most part, but . . . there is no system of monitoring in place.”


When a nurse isn’t available, student health services are often provided by school employees who are trained to provide those services. Many students have conditions that need frequent attention.


Out of 655,475 students enrolled in Kentucky’s public schools last year, 20,711 were diagnosed with attention deficit hyperactive disorder, 14,054 with allergies, 55,897 with asthma, 1,142 with Type 1 diabetes and 5,259 with a seizure disorder, according to the KDE.


Vicki Williams, RN, Calloway County

Vicki Williams, school-health coordinator and one of three school nurses in Calloway County, which has about 3,400 students, said the school system has about 150 employees who have completed medication training, and others who know certain medical procedures, like blood-sugar testing, taking blood pressure and using g-tubes to the stomach.


And though she is allowed to delegate administration of insulin to other employees, Williams said she isn’t comfortable doing that. “That is where I will draw the line,” she said. “I will not train anybody to give insulin except myself and any other licensed nurse in my building.”


She said schools have many distractions and “Too much insulin is life threatening, and I don’t feel comfortable putting that on somebody who has not had more training than a quick diabetes training after school one day.”


Hager didn’t question that unlicensed employees can be trained to provide such services, but said what they don’t have are the assessment skills of a school nurse. “It takes years of experience to recognize what a person looks like with a low blood sugar reaction,” which often occurs with young diabetics, she said.


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Melissa Patrick

CAPABLE Program Helps Seniors Age in Place

By Liz Seegert

April 25, 2017


We know that most older adults want to age in their own homes and communities, but the environment, health disparities, and lack of home and community supports can make that impossible. More public pressure and outreach can help change the situation.


credit: Johns Hopkins School of Nursing

I was pleased to attend a recent panel at the Association of Health Care Journalists conference which addressed this important issue. One speaker, Sarah L. Szanton, Ph.D., ANP, FAAN, a professor at Johns Hopkins School of Nursing in Baltimore, discussed a vital community based research study, called, CAPABLE, which helps seniors stay safer, and remain in their homes longer.


CAPABLE — or Community Aging in Place – Advancing Better Living for Elders, combines handyman services with nursing and occupational therapy. The program helps to improve mobility, reduce disability, and lower healthcare costs, according to Szanton, who developed the initiative. The results will help to determine if certain services can help older adults maintain their independence longer.


“The highest health care spending happens not when people have several chronic conditions, but when they have functional limitations, she said. “It’s completely unaddressed in current health care system.”


CAPABLE targets individual goals in self care – activities of daily living (ADLs) like bathing and dressing, and independent activities of daily living (IADLs) like cooking, cleaning or food shopping, she explained. It is client-directed, not client-centered, so that goals of the individual are addressed.


An older person may want something straightforward, like the ability to bathe alone. That can be addressed by installing grab bars in the shower. The capacity to cook for one’s self may mean the difference between staying independent at home or being forced to move into a faciltiy. Relatively simple fixes, like adjusting shelves, lowering cupboards or purchasing a microwave are simple, low-cost solutions that go a long way. Improving a person’s confidence while reducing their risk of falls when navigating stairs, can be taken care of by installing handrails on both sides of the staircase. It could determine whether an older person sleeps in their upstairs bedroom or on the living room couch.


CAPABLE clients received six occupational therapy and four RN visits over four months. Szanton said the program has shown “remarkable success,” for less than $3,000, per client. This includes a $1,300 handyman budget. In a randomized clinical trial and as a CMS demonstration project, CAPABLE “significantly reduced” the number of ADL issues over a five- month period among the study population, whose average age was 71.


Additionally, she said, depression among participants improved without medication. And, over the course of two years, the program saved Medicare about $10,000 per patient in preventive health costs, like fewer falls.


Preliminary results were published in the Journal of the American Geriatics Society in 2015. More recently, Szanton co-authored a policy-centered discussion about the importance of home and community based interventions in Health Affairs.


I asked Szanton what was perhaps an unanswerable question: while the Centers for Medicare and Medicaid Services promotes lowering costs, reducing hospital admissions and encourages aging in place, why doesn’t Medicare actually pay for some of these simple ideas that could save thousands of dollars per person over the long term? Apart from supporting small demonstration programs like this, how serious is the government about addressing the needs of the fast-growing older population, who only want to live out their lives in their own homes?


By educating journalists at panels like this one, Szanton is optimistic that the public will pressure policymakers to stop talking about what a good idea aging in place is, and start doing more to actually make it happen.




Liz Seegert
Liz Seegert is a health care journalist and directs the media fellows program at the Center. She serves as topic editor on aging for the Association of Healthcare Journalists, writes for a variety of print and online publications and coproduces HealthCetera Radio on WBAI-FM. She tweets @lseegert. 


By Diana J. Mason

March 16, 2017

Source: Bipartisan Report;

This week the Congressional Budget Office scored the American Health Care Act, also known as Trumpcare even though he doesn’t want it branded with his name (wonder why…), the bill that Paul Ryan and the Republicans put forth to repeal and replace the Affordable Care Act, or Obamacare. The CBO, as it’s called, is a nonpartisan Congressional office for assessing the potential impact and cost of legislation put forth by Congress.

The CBO reported that the bill will reduce federal deficits by $337 billion over the 2017-2026, but 14 million people will lose their health insurance in 2018 and 24 million by 2026. Paul Ryan is said to be playing up the cost savings to get conservative Republicans on board with supporting the legislation and he may be successful in the House of Representatives. But the bill will be blocked if three Republican Senators vote against the legislation.

Today on HealthCetera, we’ll discuss Trumpcare, what it does and its impact on people and community health centers. HealthCetera producer Diana Mason discusses the major features of Trumpcare and why it will increase the number of people in the country who are uninsured.

So tune in on Thursday, March 16, 2017 at 1:00 on WBAI, 99.5 FM in New York City or at Or you can listen anytime by clicking on the following link:

Diana J. Mason
Diana is a founder of the Center for Health, Media & Policy, and HealthCetera Radio. She is the President of the American Academy of Nursing, the Rudin Professor of Nursing at Hunter-Bellevue School of Nursing, and a health policy expert and leader. Diana tweets @djmasonrn.