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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

Luna’s Story: How one health center cares for the transgender community

By Liz Seegert

March 16, 2017


The American Health Care Act, the proposed Republican health plan, would deal a major blow to Medicaid funding for the states. The Congressional Budget Office projects that if it passes, Medicaid cuts will total about $800 billion over the next decade, and leave 24 million more people uninsured—including many in the LGBT community.


Under the ACA, health plans cannot refuse coverage based on pre-existing conditions, such as HIV, substance abuse, or a transgender medical history. There are non-discrimination protections based on sex, which  include gender identity and sex stereotypes, in any health program receiving federal funds (including Medicaid and in state marketplaces). This also includes sexual orientation.


The Center for American Progress found that among lower income LGBT individuals (making between $15,000 and $22,000 annually), the uninsured rate dropped 18 points since the ACA’s Medicaid expansion.


Luna Hernandez is among those benefitting from enhanced Medicaid coverage. She is a transgender woman who receives care through Community Health Center, Inc. in Middletown, Conn. Thanks to the Center’s Project ECHO program, an education program for safety-net providers, Luna’s care team is knows more about prevalent health issues among the transgender community and understands how to best interact with their patients.


On this week’s HealthCetera, Luna discusses her struggles and triumphs, her focus on staying healthy and the importance of the care CHC provides. I also speak with Wanda Montalvo, PhD, an advance practice nurse at the Weitzman Institute the policy arm of CHC that oversees Project ECHO, about what the real-world ramifications of Medicaid funding cuts mean to vulnerable populations.


This segment airs on HealthCetera on Thursday, March 16 at 1:00 PM to 2:00 PM on WBAI 99.5 FM, New York, and is streamed live at


You can also listen to the interview here, or on on iTunes.


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. 

Repeal, replace, or repair – what’s at stake for Medicare

By Liz Seegert

February 9, 2017

As Republicans in Congress move forward with plans to repeal, replace — or maybe just “repair”  the Affordable Care Act, there’s a tremendous amount at stake — not just for the 20 million individuals who could lose health insurance, but also for 57 million Medicare beneficiaries. But, Democratic party leaders vow to fight any changes that will affect millions older Americans who rely on this program.


credit: Edward Brown, AcademyHealth

During her keynote address at the Academy Health Policy Conference in Washington, DC, on January 30, House minority leader Nancy Pelosi of California reminded the audience that the ACA has helped to extend the solvency of Medicare. “We took savings and used it to prolong Medicare’s solvency and added benefits, like free checkups and the rest and reduced the cost of Rx drugs by moving to close the donut hole,” she said.


House Speaker Paul Ryan’s budget, however, would take that same $800 B in Medicare and use it to give a tax break to the wealthiest people in America. “They want to voucherize Medicare, that’s their budget, they want to block grant Medicaid, which would be very harmful,” Pelosi said.


She also pointed out that half of all nursing home residents rely on Medicaid, the social safety-net for those with low income.  “These are middle class seniors who have paid down their assets. What would their families do if Medicaid was not helping to cover them in nursing homes.?”


credit: Ulrich Joho

Republicans have long supported privatizing Medicare, primarily through a voucher system.  Economist Paul Krugman wrote about the pitfalls of this approach back in 2012. Despite what many see as a disaster for the middle class, the approach has long been supported by Speaker Ryan. Contrary to analyses by the Congressional Budget Office, Ryan claims Medicare is going broke and Obamacare is to blame. HHS Secretary-designee Tom Price confirmed that major changes to Medicare are likely on the horizon.


However, according to the Kaiser Family Foundation,  Medicare is not “broke.” Part A, the part that pays for hospitalization, will remain solvent through 2028. Without any changes to funding, it will then cover 87 percent of Part A costs through payroll taxes, but it’s not going bankrupt or disappearing any time soon.


What’s really affecting the program is the aging of the population and a need to cover more people. As KFF points out, “repealing the ACA in its entirely would add $802 billion to Medicare spending over 10 years.” Higher spending will result from elimination of provisions which lowered payments to providers  and Medicare Advantage plans. That will likely mean higher premiums for beneficiaries, higher deductibles, and greater cost-sharing. It would also speed up Medicare’s projected insolvency date.


Senate minority leader Charles Schumer, (D-NY) tried to reassure anxious constituents and rally them to action in a “town hall” phone call with AARP-NY members last week.  He said that Medicare was a promise made for future generations, and vowed that he “will do everything I can as Senate minority leader to ensure Medicare remains in place.”


Schumer cautioned listeners that apathy is the enemy. “We’re in more danger than we’ve been in for a long time.” He warned that privatization could lead to the end of Medicare as we’ve known it. That means seniors will be at the mercy of  health providers, hospitals, insurance companies and drug companies. ACA provisions save every senior $2,100 in prescription drug costs, by helping to close the donut hole, according to Schumer. “If repealed, millions of seniors would pay a lot more for prescription drugs.”


It’s not just Medicare changes that older adults need to be concerned about. Schumer echoed Pelosi’s warning that Medicaid changes will create chaos for those who rely on the program live in nursing homes or assisted living. That’s because block grants—lump sum payments to states regardless of number of people enrolled—coupled with an increasingly older population, will reduce total available funds to pay for long term care. That will likely put older adults and their families on the hook to make up additional costs, or they might find themselves in a position of being unable to find appropriate and affordable long term services.


So who really benefits from ACA repeal and ensuing changes to Medicare? According to the non-partisan Center on Budget  and Policy Priorities, the highest income households will see the biggest tax breaks. Top earners could reap $2.8 billion in tax cuts while about 7 million low- and moderate-income families will lose their credits and subsidies — averaging $4,800 each this year.


It’s not yet clear what repeal, replace or repair will ultimately look like. House Speaker Paul Ryan’s plan for revamping Medicare ironically looks a lot like Obamacare, reported NPR.  At least a few Republicans are acutely aware of the potential volatility of tampering with the program, writes Bruce Jaspin in Forbes. Several GOP Senators who introduced their own alternatives to the Affordable Care Act don’t touch Medicare’s popular reforms.


Candidate Donald Trump promised not to touch Medicare, President Trump is now drawn into the ideological battle. The question is, will he keep that promise or will he go along with an aggressive GOP agenda that can only hurt vulnerable older adults?



You can hear an excerpt from Leader Pelosi’s remarks here:


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.