School nurse advocates disappointed that the House didn't fund a nurse for every school, but say they will lobby the Senate for it

By Melissa Patrick
Kentucky Health News

Representatives of the Kentucky Nurses Association's School Nurse Task Force were disappointed that the state budget that passed the House Jan. 20 did not include their requested funding for a full-time nurse in every Kentucky school every day, but said they would take their request to the next step.

"We definitely will carry the fight into the Senate, as we think that the time has never been better to make this investment in students’ health – physical and mental – and in school safety," Sheila Schuster, KNA policy consultant and a longtime mental-health advocate, told Kentucky Health News.

The House budget is in a committee substitute for House Bill 1, which passed out of committee and the full House on the same day, and went to the Senate on an 85-8 vote.

Nurse Vicki Williams worked at a school
in Calloway County in this 2017 photo.

The House left more than $1 billion unappropriated, and even more in the budget reserve or "rainy day" fund. Legislators are planning a tax-reform package that would reduce revenue during the biennium that starts July 1.

Schuster and Eva Stone, a nurse practitioner who is the health services manager for Jefferson County Public Schools, had asked a House budget subcommittee Jan. 18 for $18 million over the next two years to ensure that every Kentucky school building has a full-time nurse in it – all day, every day. 

This amount was based on a survey of school-nurse salaries in bordering states and other Southern states, said Schuster. The total salary and benefits, for each full-time school nurse would be $56,598. 

Schuster said the advocates hope that the benefits of placing a nurse in every Kentucky school would be researched by the University of Kentucky College of Nursing.

Stone pointed out that Kentucky is in the bottom 10 states for multiple health conditions in children, including mental health, diabetes, asthma, obesity and oral health, and that having a full-time nurse in the building would help to address these conditions.

“With all these negative health indicators we have in the state of Kentucky, having some systems in place to try and address these things early on can have a big impact for children, both educationally and for their long-term health," she said. 

Stone added that research shows that schools with nurses have improved attendance rates with lower absenteeism, higher high-school graduation rates, decreased use of local emergency department services, reduced transmission of infectious diseases, earlier diagnosis and treatment of physical, mental and academic problems, better management of chronic health conditions and better mental physical and mental health screening. 

"A child's ability to learn is directly related to health status," she said, adding that more than 120,000 of the 638,236 children in Kentucky's public schools have a chronic health condition. 

Stone said 29 of the state's 171 school districts have no school nurses, and many more have part-time nurses or nurses who are shared among several schools. 

Schuster said that having a part-time nurse is better than no nurse, but is not optimal: "The ability of the students to really relate to and get to know the nurse, and for the nurse to get to know those students, when she's spread across several buildings on campus is just not the most effective."

Stone said the school secretary often ends up taking care of nursing issues when a school does not have a full-time nurse, and is more likely to send a student home than a nurse would. 

Rep. Tina Bojanowski, D-Louisville, a teacher, said she wasn't sure how we got to a place where we don't have a full-time nurse in every building.

“Let me just explain to you what happens when you don't have a school nurse,” she said. “All of the 'Band-Aid and boo-boo' issues are brought to the school secretary. . . . but all of those other areas that would really help our students become more healthy and to be more in the position where they can be learning won’t be happening.”

Schuster said that in the many years the task force has been working to get a nurse in every school, they haven't heard from a lawmaker who doesn't support the idea, but they also haven't been able to put money in the budget to make it happen – but now is the time. 

"Covid has brought out all of these issues and exacerbated them and shown the inequities, and shown the mental health and its effect on academics and physical health," she said. "We plead with you to really strongly consider putting this money in the budget."

National Health Center Week salutes federally qualified health centers, primary-care providers for one in eight Kentuckians

Map (click on it to enlarge) shows Kentucky Primary Care Association members, their health centers and counties where they have school-based clinics. Shading of counties shows congressional districts.

Aug. 8-15 is National Health Center Week, promoted by the National Association of Community Health Centers, the common name for federally qualified health centers, which get federal funds to provide affordable primary care in areas with a shortage of health-care providers.

Such clinics "are the primary health-care providers for one in eight Kentucky residents, which is more than 550,000 people," the Kentucky Primary Care Association says in a news release.

“We have 32 federally-qualified-health-center members providing primary care and other services with clinic operations across the state,” said David Bolt, the CEO of KPCA. “The health centers are located in medically underserved communities and treat patients regardless of the patients’ ability to pay, their race, or their ethnicity. CHCs improve healthcare access and outcomes.”

"Many CHCs operate school-based clinics," KPCA notes. "The clinics are located in elementary, middle and high schools around the state," with the largest group operated by Cumberland Family Medical Center in 16 counties, from Anderson in Central Kentucky to Barren, Monroe, Cumberland, Clinton and McCreary in Southern Kentucky.

"CHCs employee a large number of physicians, nurses, other medical professionals, and administrative staff," the release says. "Estimates indicate they generate more than $740 million each year for local economies in communities throughout the commonwealth.

To find a clinic near you go to: https://www.kpca.net/, click on the directory tab and choose the FQHC category.

School Nurse Task Force says every Ky. school needs a full-time nurse; asks lawmakers for $3 million to conduct a pilot program

By Melissa Patrick

Kentucky Health News

"Every school needs a nurse every day, all day."

So says the Kentucky Nurses Association School Nurse Task Force, which has worked for this goal for more than five years. It says only 43% of Kentucky schools meet the National Association of School Nurses recommendation for a minimum of one nurse for every 750 students

On Oct. 20, the task force made its case to the legislature's Interim Joint Committee on Education, saying there is no more important time than now for it, in the middle of the coronavirus pandemic, when a coordinated school health approach is most needed.

"We know that when students are healthy, they succeed academically," task-force spokesperson Gannon Tagher told the committee. She is a pediatric nurse practitioner and the associate dean for academic affairs on Northern Kentucky University's College of Health and Human Services. 

National Association of School Nurses chart

Tagher ticked off a long list of well-documented reasons why every Kentucky school needs a nurse every day, all day. She said, among other things, that schools with nurses have improved attendance rates, higher high-school graduation rates, reduced transmission of infectious diseases, and positive outcomes related to covid-19.

She also spoke to the major health and socioeconomic challenges facing Kentucky's children, noting that they rank in the bottom 10 states for physical and mental health, diabetes, asthma, obesity, oral health and substance abuse. She said 16% live in high-poverty areas, and the share of Kentucky children without health insurance increased 29% from 2016 to 2019. 

"The ability to learn is affected by health," she said. "If children are hungry, if they're tired, if they haven't had a home to sleep in, if their chronic conditions such as diabetes and asthma are poorly controlled -- then learning falls to the bottom of the hierarchy. They just don't have the ability to learn." 

Tagher said that in addition to addressing the health needs of students, school nurses also regularly address the "social determinants of health," which include very practical things such as housing and transportation.  

School nurses are an integral part of a school's trauma-informed care team, she said, and are often the first to recognize factors like bullying and mental-health issues that increase the risk of a student becoming a perpetrator or a victim of school violence.

She also stressed that school safety is more than just preventing violence: "When we have children with food allergies and children with asthma, children with diabetes in our schools, they have the potential to face life threatening emergencies during the school day, and a nurse can prevent these life threatening emergencies from happening."

During the 2018-19 school year, according to Tahger's slides, 21,074 Kentucky students had food allergies, 47,805 had asthma, and 1,507 had Type I diabetes.

Patricia Burkhart, co-chair of the task force said in an e-mail, "Legislators need to prioritize school nurses just as they did school safety. We would argue that health and safety go hand-in-hand."

Tagher said funding is often the reason given for a district's inability to have a full-time nurse in every school. With an annual salary for a full time nurse, including benefits, estimated at $52,406 a year, it would cost about $65 million for every school to have a full time nurse, according to task-force calculations.

To fund a full-time nurses in every school, the task force offered three solutions, including:

• New rules that allow Kentucky schools to bill Medicaid for "medically necessary" care for students who qualify for the program; 
• Partnerships with community agencies, like local health departments, federally qualified health centers or local health systems, who can share the cost of full-time nurses in each school; or
• Kentucky's share of funds from the Every Student Succeeds Act, the main source of federal money for elementary and secondary education.

The task force has talked about funding sources since it started asking for a full-time nurse in every school, but this year for the first time it is asking legislators to fund a $3 million pilot program that would allow it to place 56 school nurses in schools with the greatest need and measure the impact.

"A nurse in every school all day every day is an integral part of ensuring the health of our children and the future of our state," said Tagher. "We cannot afford to not fund school nurses right now."

There was no public reaction from legislators at the meeting because time ran out as Tagher concluded her presentation. 

Nurses call for a school nurse in every school, 'every day, all day'

By Patricia V. Burkhart, Lois Davis and Carol Komara

Special to the Lexington Herald-Leader

Connecting the dots for health, education and safety is paramount if schools across the commonwealth are going to re-open. It would be negligent for the governor, the public-health commissioner, the legislature, and the Kentucky Board of Education to recommend schools re-open without school nurses present in all schools, every day, all day. The lieutenant governor’s task force for the re-opening of schools should regard school health as a core component of public health.

We applaud school districts and their board members and superintendents who have advocated for school nurses. However, in Kentucky, there is great disparity among children who have access to a school nurse and those who do not. Data from the Kentucky Department of Education indicate approximately one third of Kentucky school districts do not have school nurses.

The Kentucky Nurses Association School Task Force has emphasized the need for more school nurses since 2014, but funding has always been a barrier. This is not a partisan issue, and with the pandemic at our doorstep, the health of students and faculty should be a priority for funding. When funds were made available for Senate Bill 1, school counselors at a ratio of one counselor for every 250 students were funded, but pathetically, school nurses were not included in that bill. Designated funds should be allocated to support the need for school health and safety to support a school nurse as a member of the school-based community team. The American Academy of Pediatrics recommends one nurse for every 750 students; however, in many Kentucky school districts, the ratio is one nurse for more than 8,000 students.

We were most appreciative that both the governor and lieutenant governor included the need for hiring more school nurses in their campaign platform, even before we faced this pandemic crisis. Now is a critical time to start focusing on the total health and well-being of students.

The governor has been talking about inequalities in the state’s health care system. A comprehensive health approach would ensure that all children have daily access to a school nurse who can identify conditions early, communicate with their families, and connect them with appropriate resources. During a pandemic, there is an even greater imperative for a nurse in every school, working with at-risk children and their families.

Our schools need to be re-opened for students. There are too many unintended consequences for students if they don’t. Sending children and staff into schools without a nurse is irresponsible, especially during a health crisis. It is unthinkable and inexcusable not to have nurses in every school across this state, especially now.

We urge parents and grandparents to contact their local superintendent’s office or school board members and ask how many nurses are in the district and what the plan is to increase the number so that there is a nurse in every school, every day, all day! If determined that a school district lacks school nurses, then we encourage you to call your state senator, representative, and the governor. We need you to be the voice for our children!

Patricia V. Burkhart, PhD, RN, FAAN; Lois Davis, MSN, RN; and Carol Komara, MSN, RN, are members of the Kentucky Nurses Association's Task Force on School Nurses.

Health departments and their employees making tough choices now that the General Assembly has passed Bevin's pension bill

Bevin at bill signing (Lexington Herald-Leader photo by Alex Slitz)

Kentucky's health departments and their employees face some difficult decisions in the wake of the pension legislation passed in the recent special session of the General Assembly.

The law written and signed by Gov. Matt Bevin freezes the pension costs of health departments for another year, at 49 percent of payroll, avoiding an increase to 83 percent, which would have forced layoffs and program cuts, and could have put some of them out of business.

But now the health departments must choose whether to stay in the Kentucky Retirement System "at full cost, leave the retirement system by paying a lump sum equal to future projected benefits payments, or buy their way out in installment payments over 30 years," writes David Zoeller of The Paducah Sun.

Marshall County (Wikipedia map)

Zoeller notes that the Marshall County Health Department "has already been making tough decisions," such as ending its school-nurse program and cutting its staff by almost 30 percent.

John Cheves of the Lexington Herald-Leader notes, "Public employers that quit KRS will be encouraged through financial incentives to freeze their employees’ pensions so they accrue no further benefits. Instead of a pension, employees will be transferred into a riskier defined-contribution retirement plan, such as a 401(k), with a balance that rises and falls with the stock market, and that retirees can outlive if their money runs dry. . . . Some could lose hundreds of thousands of dollars in anticipated retirement benefits if their pensions are frozen."

Cheves's object example is the Garrard County Health Department, which has seven employees, some of whom are less than 10 years from retirement. "Under the state pension formula, the final decade on the job is crucial to maximizing their monthly retirement checks," he notes, and gives a specific example:

"Cathy Stapleton, a nurse at the health department, is 55 with plans to retire at 62. She doesn’t want her pension to be frozen and replaced with a 401(k) account that would have seven years — not the usual 30 to 40 — to build wealth through compound interest. One ill-timed market crash could sink her." She told Cheves, "It means a lot when you come into a pension. It means you have a retirement where you can count on having that income every month." Getting a new 401(k) plan at age 55 "would be a lot different."

Garrard County (Wikipedia map)

Department Director J Smith told Cheves he will recommend to the Garrard County Board of Health that it stick with KRS and pay the 83 percent. "Telling middle-aged people who devoted their lives to public service that they’re suddenly going to risk financial insecurity in their senior years is not a viable choice, he said," Cheves reports, quoting him directly: “We’re not going to opt out. If we opt out, to me, we’re screwing our employees here. Some of my people have got just a few years left. We expect to get what we were promised. We were promised a pension.”

The department has already eliminated family-planning services, cut health education, "laid off its emergency-preparedness coordinator and a front-desk clerk, and officially eliminated a third position, Smith’s old job, which he still does in addition to being director," Cheves reports. "That means he splits his time between inspecting schools, businesses, septic tanks and the like for safety and cleanliness, and managing the department."

“I’ll admit, our response time is slower now because of it,” Smith told Cheves. “When people used to call in for a site evaluation, we usually could get out there the same day. Now it might take us a week. It’s just — I’m sorry, we don’t have the people we used to. . . . I told our Board of Health that if we want to keep the services we have left, we’re going to have to have a tax increase.”

Kentucky River District Health Department
service area: Wolfe, Lee, Owsley, Leslie,
Perry, Knott and Letcher counties (KRDHD map)

Using local tax dollars to fund public health would result in huge inequities, said Scott Lockard, director of the Kentucky River District Health Department, which covers some of the state's poorest and unhealthiest counties. "Communities that need public-health services the most, that have the highest poverty rate, that have the poorest health outcomes, also have the least ability to raise local revenue," Lockard told Kentucky Health News in June.

As pensions threaten school-nurse programs, schools can get new Medicaid money for both physical and behavioral health

By Melissa Patrick
Kentucky Health News

Many of Kentucky's school districts have long struggled to pay for school nurses, let alone professionals in behavioral health care. And now some health departments may no longer be able to provide nurses because they will have to pay more into their employees' pension system.

But schools are about to get some help with their students' health needs, under state officials' plan to allow schools to use Medicaid funding to cover both physical- and behavioral-health services. More than two in five of the state's children are covered by Medicaid.

Deputy Secretary Kristi Putnam

Kristi Putnam, deputy secretary of the Kentucky Cabinet for Health and Family Services, who has spearheaded this effort, said that by the start of the next school year, schools will be able to use Medicaid to serve all students enrolled in the program.

"I'm a former school teacher and I know how valuable it is to have health services and behavioral health services for kids right there at your school," Putnam said. Research shows that children who don't get needed care can suffer academically.

What's it all about?

Until December 2014, schools could only bill Medicaid for students who were disabled or met other limited criteria. That's when the Centers for Medicare and Medicaid Services changed the guidelines to allow states to provide services to any student who is enrolled in Medicaid, and get federal reimbursement for those services.

Only now has Kentucky decided to seek the money, a decision that seems largely driven by an increase of behavioral-health issues in schools.

Gaining access to these funds varies by state. In Kentucky, it requires an amendment to the Medicaid state plan and putting an appropriate billing process in place. Putnam said the amendment and fiscal analysis will be submitted May 1, with a request for an Aug. 1 start date and that they are still working on the billing aspect of the requirements.

She said the administration is working on the assumption that the funding will be approved and will start informing schools about it on May 1, because participation is optional.

States must provide matching money to get federal Medicaid dollars, 30% in Kentucky's case. Putnam said existing school-based Medicaid expenditures can count toward the match.

"The state and local funding that is being used right now for any health and behavioral-health service can be used as the match to draw down additional federal funds," she said. "So there is no increased costs to the state or to the school district."

Putnam said the amendment will be broadly written, so the new money can cover both physical- and mental-health care, along with provisions for telehealth.

"You have to have both," she said. "It's just exciting because there has been limited funding for behavioral-health services . . . but this will allow us to expand both, and we need to expand both."

Kentucky adults are strongly supportive of schools taking a more active role in helping families get health care services for their children, with 84% saying in the latest Kentucky Health Issues Poll that they favor such action.

So far, 14 states, including Kentucky, are either considering, actively pursuing or have already taken advantage of this additional Medicaid funding in their schools, according to a policy brief penned by three non-profits dedicated to health: Community Catalyst, Healthy Schools Campaign and Trust for America's Health.

Why does it matter?

For years, Kentucky schools have struggled to find funding for health care in schools. And while Putnam has pointed to the need for more behavioral health funding, school nurses have been on the chopping block for years as school and health-department budgets have decreased.

Kentucky Department of Education photo

These cuts have forced schools to find creative ways to provide health care to students. Some have moved to school-based health centers, which provide care to students through a public-private partnership; others have used fewer nurses to cover more students. Others have relied on health departments, but cuts in federal and state funding have forced the departments to ask for more money from schools to fulfill this role.

That said, health departments' school-nurse programs could be at further risk because of the state's pension crisis, which on July 1 will require health departments to increase their pension obligation from 49.47% to 83.43% of payroll -- unless a special session of the state legislature changes that.

In the regular session, Gov. Matt Bevin vetoed a bill that would have offered some temporary relief to the health departments and has said he will call a special session to deal with the state's pension system early this summer.

The Marshall County Health Department decided last week to end its school-nurse program, in order to help pay for its possible extra pension obligation of $566,200 a year. In a news release, local health officials called it an "agonizing decision."

"The Marshall County Health Department school health program has been in our schools for over 25 years," they said. "Our school nurses have truly made a positive difference in the lives of our children, their families, the school system, and our community. Discontinuing this program is a tremendous loss for all of us."

Meanwhile, the need for health services in Kentucky schools is greater than ever, with students showing up at school with a long list of chronic physical-health and behavioral-health conditions, an electronic-cigarette epidemic that no one saw coming, as well as schools having to deal with issues around bullying, suicide, the drug epidemic and gun violence.

Mahak Kalra, the health policy director at Kentucky Youth Advocates, who has worked with the cabinet on this project, pointed to research that shows students with health problems, whether they be physical or behavioral, struggle to do well in school.

"So, providing those health services in the school setting can address their immediate health-care needs and can connect them to the services they need and really keep them learning," Kalra said.

She added that it will also reduce many of the barriers parents have to get their children health care, like transportation, non-flexible work schedules or simply finding a provider who will accept Medicaid.

Kalra and Putnam both noted that this additional funding will help support the School Safety and Resiliency Act, or Senate Bill 1, that among other things calls for one trained school resource officer in every school and one guidance counselor for every 250 students by July 1, 2021 or as funds and qualified personnel become available. School-based mental health service providers fall under a subsection of the guidance counselor requirements and are listed as optional.The bill has no funding attached to it.

"This is one way to have those school-based mental health providers provide those services," Kalra said.

Eva Stone, district health coordinator for the Jefferson County Public Schools, pointed out that Medicaid will only pay for licensed mental-health providers, not guidance counselors -- unless they have a special certification, which most of them don't.

Stone, who is also an advanced practice registered nurse, added that amending the state plan to define what this additional Medicaid funding will cover provides a great opportunity for Kentucky to meet all of the needs of the state's children, whether they be physical, mental or social -- like whether a child is homeless or has access to food or is being abused at home.

Stone has long said that school nurses are the best situated to coordinate all of these efforts because "that's what nurses are educated to do." Further, she said, making coordination of care reimbursable in the state health plan would allow for that coordination to happen.

"We have the opportunity to craft this in Kentucky in a way that would make all those players work together," she said.

The state says Kentucky has 1,688 students for each school psychologist; the national standard recommends 500 to 700.

The 2018 School Health Profiles Report shows that 41% of all middle and high schools in Kentucky have a part-time registered nurse and 58% have a full-time registered nurse. The Kentucky Health Issues Poll found that 92% of Kentucky adults would support a law to require a nurse in every school.

Ky. nursing leaders call for a full-time nurse in every school to keep students safe and healthy, and therefore able to learn

Kentucky's nursing leaders are calling on state lawmakers to recognize the vital role school nurses can play "to support student learning in a safe and healthful environment," and are urging them to find "innovative funding" to put a nurse in every school.

"The school nurse is in a prime position to lead this effort but must be present in every school," lead author Kathy K. Hager,  president of the Kentucky Nurses Association, writes in an op-ed for the Lexington Herald-Leader. Only 54 percent of Kentucky's secondary schools have a full-time registered nurse, she notes.

Hager says that nationwide, an estimated 27 percent of students have a chronic health condition and 17 percent experience a mental-health issue each year. In addition, she notes that students are struggling with bulllying, drug-use and gun violence issues.

"In this climate of school violence, along with children’s increasing struggles with physical, behavioral and mental health challenges, much is being debated regarding strategies and resources to support student learning in a safe and healthful environment," Hager writes. She argues that a nurse in every school is the best way to address these needs.

Hager notes that daily access to a full-time nurse as part of the strategy to improve health and safety in schools is supported by the American Academy of Nursing and the American Academy of Pediatrics; the World Health Organization has also identified school health services as an important strategy toward this end.

A recent Academy of Nursing brief on this issue said, “School nurses deliver skilled health care to students, provide referrals to other providers, and assist families in gaining access to specialized care. Yet, despite these undisputed benefits, many schools do not have daily access to a full-time school nurse due to inadequate funding and lack of integration of school health services to the broader health-care system.”

Kentucky adults are overwhelmingly supportive of a law to require a nurse in every school, with 92 percent of them in the latest Kentucky Health Issues Poll saying they supported such a measure.

"We are fully aware of the current budget constraints in Kentucky; however, for the health and welfare of our Kentucky children, we must find innovative funding sources to place a nurse in every school as part of a comprehensive health and education system," she writes. "Contact your local school board and legislators and be the voice your children need. For the health, safety and welfare of our children, every Kentucky school needs a nurse and a comprehensive school health-care plan. Kentucky children are counting on you."

Patricia V. Burkhart, Carol Komara and Lois Davis, who represent the nurses association’s Kentucky School Nurse Committee, also contributed to the the op-ed.

54% of Ky. high schools have full-time nurse; poll finds strong support for one in every school, more active role for schools

Barely half of Kentucky's high schools have a full-time registered nurse, according to the School Health Profiles compiled by the federal Centers for Disease Control and Prevention. The CDC says 45 percent of Kentucky high schools had a part-time registered nurse, while 29 percent had a school-based health center.

The latest Kentucky Health Issues Poll found that Kentucky adults "overwhelmingly favor a state law requiring schools to have a nurse in each school building, with 92 percent in support," says a news release from the Foundation for a Healthy Kentucky, which co-sponsors the poll.

"Children spend a considerable amount of time at school," said Ben Chandler, president and CEO of the foundation. "School nurses and resource staff are as likely to see evidence of health issues as parents in the home. Healthy students are more successful academically, and strong partnership between schools and families can help improve both student and health performance."

Many Kentucky school districts have struggled to maintain nurse coverage, mainly due to financial problems of county and district health departments that have contracted with the schools.

Three Central Kentucky school districts could have to look elsewhere for school nurses after the Lincoln Trail District Health Department voted not to renew its school health contracts in Marion, LaRue and Hardin counties, reports Stevie Lowery of The Lebanon Enterprise. Marion County School Supt. Taylora Schlosser said if the schools don’t have nurses, front-office staff will have to be trained to give medicine. He is trying to get the health department to reconsider.

Poll finds support for more active health role for schools

The CDC reported that about half of Kentucky's high schools provided health-care referrals to students with chronic conditions.

"School nurses play a vital role in keeping students healthy and ready to learn. They can treat children with minor health issues at school to prevent lost instructional time," said Paula Little, assistant superintendent and supervisor of instruction in Clinton County and a member of the foundation board. "They can also spot major health issues that might otherwise go undetected and have an overwhelmingly positive impact on a school's learning environment."

The poll also found that 61 percent of Kentucky adults strongly favor schools taking a more active role in helping families get health care for children. The support for schools' role in health was significantly higher in 2017 than in 2009, the last time the poll asked the question.

However, it showed a partisan divide that the other question did not, with strong support at 74 percent among Democrats, 58 percent among independents and 52 percent among Republicans. But 26 percent of Republicans said they "somewhat" favored a more active role for schools, making overall GOP support 78 percent. The total Democratic support was 92 percent.

There was also a difference among income lines, with strong support from 70 percent of adults with incomes below 200 percent of the federal poverty level, and 58 percent from those above that level.

Oldham County aims to have a nurse in every public school

Most public schools in Kentucky don't have a full-time nurse to serve students, and school districts have struggled recently with the issue.

In Oldham County, though, the school board voted Aug. 28 to add seven more nurses, which would put one at 17 of the county's 19 public schools, Travis Ragsdale reports for Louisville's WDRB. Supt. Carolyn Wosoba "said the plan is to hire the other two during the 2018-19 school year."

"Oldham County nurses are split amongst different school campuses but cover multiple schools," Ragsdale notes. "According to the Kentucky School Nurses Association, only 44 percent of public schools in the commonwealth retain a full-time nurse for students."

Ragsdale reports, "Oldham County has 1,679 students with chronic health conditions including but not limited to asthma, seizures, and tracheostomy."

Nurses and their allies seek a mandate for a nurse in every school, which they say would improve learning outcomes

Kari Hall, CMA, with a Madison County student

By Melissa Patrick
Kentucky Health News

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, who 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.

Nurses could be front-line fighters of big-ticket health items, they say

Stone, who worked as a school nurse for 16 years, passionately argues that school nurses could and should be part of a long-term plan to improve Kentucky's dismal health outcomes by improving the health of its children. But she said she also knows the best way to get educators to pay for a full-time school nurse is to "speak the language of education."

"We can talk about health care if we want, and all of the health care people will agree with what we need to do, but the educators don't have buy in in Kentucky and that is because they don't see the value," with some exceptions, she said.

“I want to be clear in saying that I'm not a proponent of just sticking a body in the building. I want a nurse in every school, and I'm going to fight for that, but I think we have to be intentional about what we are asking for and what we are doing,” Stone said.

For example, she said she would like to see a comprehensive school health system in Kentucky that allows school nurses to be care coordinators for all students' health needs, which would put them "on the front line of every health problem that is a big ticket item for Kentucky."

“We could have a very different outcome for children in our state," she said. Later saying, "But of course that means you have to look at school nurses differently than just putting band-aids on boo boos and checking kids for head lice."

Kentucky ranks in the bottom 10 states in the nation for multiple health indicators in children, such as poor physical and mental health, diabetes, asthma, obesity, poor oral health and substance abuse.

Donna Mazyck, executive director of the National Association of School Nurses, also linked school nurses to education, saying they "provide a critical link between students, health and learning." She said the latest federal education law clearly recognizes the intersection between health and education.

"In the law there is a phrase called 'well rounded education,' -- and what does that mean? That means health education, physical education, as well as all the other core courses," she said. "We believe that students need access to a school nurse every day."

Stone also mentioned the importance of the law, noting that one of its goals is to tackle chronic absenteeism, which school nurses can improve. "If they aren't in school, then they don't learn," she said, adding that students who are chronically absent are often the ones in the achievement gaps.

Nurses can boost attendance, which boosts school revenue

Kentucky's school districts want to keep students in school partly because attendance is part of the formula that determines how much money schools get.

Jenny Sexton, RN, works on attendance with
Jennifer Allen, Madison Southern asst. principal

Jennifer "Jenny" Sexton, the school nurse at Madison Southern High School, went from being a part-time nurse at the high school to full-time this year. She and others are actively working to improve attendance through diligent monitoring and positive outreach to chronically absent students and their parents.

Early results have already shown improvements. Madison Southern improved attendance to 94.32 percent in December 2016 from 93.65 percent last year, which means that 41 more students have been attending school this year, on average. Sexton said the improvements will be greater in the next analysis, because she said daily attendance has been running around 95 or 96 percent.

Michelle Malicote, Sexton's school-health-clinic services manager, said, "We are actually seeing that Ms. Jenny, so-called, generated roughly $7,000 in one month, because she kept so many students sitting in their seats for so many more days."

There are several funding models for school nurses. Most of those Stone mentioned involve some funding from Medicaid, or funding somehow connected to Medicaid. For example, several school districts have contracted with health clinics to provide school nurses and in-school access to clinical care that can be billed to the students' health insurance, which is often Medicaid.

Asked if this initiative needs to be put aside until the Trump administration repeals and replaces Obamacare, she said, "Well, we really ought to wait and see," but said another solution would be for Kentucky to lead a demonstration project "to show what we could do with an intentional school health program -- and then you couldn't argue with the outcomes."

Brooks said, “We are going to have to wait and see, to some degree, how health care shakes down at the federal level. I think federal decisions will have a real impact on whether a door is opened for Kentucky to pursue school-based health, and if that door opens, I hope we walk right through it.”

However, Brooks said he is hearing support from lawmakers and school officials for the idea of putting a nurse in every school, and is optimistic about the likely changes to Medicaid that will give states more autonomy.

"I actually am more optimistic about this as an idea whose time has come than I've ever been," Brooks said. "I believe that the concept has been accepted and I think that the flexibility that we may be getting from the feds would actually enhance rather than be a detriment to this."

Mazyck said community involvement is often needed to secure funding for school nurses. “Creative solutions require communities to rise up and say, 'This is what we need,' and that they value it,” she said. “I don't hear people saying they don't want them. I hear them saying, 'How can we afford them? How can this be sustainable?'"

Brooks said, "I don’t think this is some abstract, theoretical, pie-in-the-sky idea. I think if we as a commonwealth said we are really going to go about the business of making a commitment to school based health, I think there are ways we could figure out flexible, creative, win-win ways to fund that proposition. I cannot imagine a single principal in Kentucky not welcoming a school nurse if funding was available."

This article was produced as part of the Health Care Workforce Media Fellowship of the Center for Health, Media & Policy, New York, N.Y. The fellowship is supported by a grant from the Johnson & Johnson Foundation. Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Media at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Kentucky Health News reporter gets fellowship to report on rural health workforce issues, with a focus on nurses

Melissa Patrick

Melissa Patrick, reporter for Kentucky Health News, has been named 2016-2017 Nursing and Health Care Workforce Media Fellow for the Center for Health, Media & Policy.

Patrick, a former nurse, will focus on rural health issues that affect nurses and other health care providers within the evolving health care delivery system during her eight-month fellowship.

“We’re thrilled to welcome Melissa as this year’s media fellow. She is strongly committed to raising awareness about the role of nurses and other health care workers in the current and future health care system” Diana Mason, co-founder of CHMP, said in a news release.“This fellowship provides an opportunity to work with some of the top health journalists and nursing workforce experts, hone reporting and production skills, engage in cross-platform reporting, and contribute to the national conversation about health care delivery challenges in the years ahead.”

Patrick's main project will take a multi-part look into a shortage of school nurses throughout the state, a shortage of nurses to serve rural areas, the role of advance practice nurses in meeting some of Kentucky’s health needs and state policy issues impacting nurses.

The fellowship is supported by a grant from the Johnson & Johnson Foundation.

Clinton County coalition works to change the health lifestyle of its children, in an effort to change the local health culture

By Melissa Patrick

Kentucky Health News

Public officials and local leaders in a small, rural county in Southern Kentucky that ranks near the bottom of in the County Health Rankings for the state have formed a coalition to improve the health of its community, with a focus on its children.

Clinton County (Wikipedia map)

Clinton County ranked 102nd out of 120 Kentucky counties in the 2016 County Health Rankings. “We recognize that. We saw that in our kids,” Lora Brewington, chief compliance officer of Cumberland Family Medical Center Inc., told Kentucky Educational Television in a report to be aired soon about the coalition.“And if we don’t change something now, we’re going to be going to the funeral home for kids a lot younger.”

So, with the help of the Foundation for a Healthy Kentucky, they formed the Clinton County Healthy Hometown Coalition to implement a multi-faceted public health program for the community's citizens, that focuses on its children.

“The coalition came together [according to] Aristotle’s thinking, that the whole is greater than the sum of its parts,” Brewington told KET. “We have a lot of great groups, that do a lot of great things, but if everyone is going for the same goal, and the resources are not combined, you’re not going to accomplish anything. And once we get everybody together and on the same page, by combining resources, we’ve been able to do some great things.”

Paula Little, assistant superintendent and supervisor of instruction for Clinton County schools, told KET that the coalition recognized most of the county's health issues stemmed from obesity, and decided to focus their efforts on the children in the community to change their culture.

"So we feel like if we can start young and start with our children and teach them healthy habits and healthy lifestyles that when they grow up they won't be faced with obesity and all of those chronic diseases that go with it," Little said.

Many of the coalition’s activities are school-based. Teachers have incorporated physical activity into the school day as well as during their morning routines and after-school day-care programs.

The coalition has worked with the schools to improve nutrition. Fruits and vegetables are now served every day with every meal. The schools also began offering supper to students during the school year and has since served over 6,400 meals. The program began last October.

Recognizing that an estimated 38 percent of Clinton County's children live in low-income families, the coalition launched a summer food program that delivers breakfast and lunch in a retrofitted school bus called the Bus Stop Café to areas in the county with high student populations.

The Healthy Hometown Coalition has also implemented school-based health clinics, which provides for the healthcare needs of students through a public-private partnership while they are at school. The clinics are run by the Cumberland Family Medical Center. In addition to providing clinical care, the clinics provide body mass index assessments and provide nutrition and obesity counseling.

“It’s about accessibility,” Brewington said. “It’s about the kid who has a cough and needs to see a doctor, but the parent can’t take off from work. ...It's about having healthcare right there where the child is the majority of the time."

Not mentioned in the KET report is that Clinton County schools implemented a comprehensive smoke-free policy last year that will go into effect in July. The policy will ban smoking on school property both during school hours and during school sponsored events, and also includes electronic cigarettes and all vapor products.

The coalition is working to change the culture of its community so that a healthy lifestyle becomes the norm, and not the exception.

“When you’re attempting to change a culture, and change the way people live, that’s a very long process,” Little said. “And it has to be something that’s consistent, that’s ongoing, and it has to be a message that children hear everywhere they go in the community.”

A full-time coordinator, April Speck, manages the various coalition programs and writes a weekly health column in the Clinton County News that often celebrates individual success stories. The coalition also sponsors community events, and has built a new playground.

“What makes me feel good about it is that I know there’s a real need here,” Speck told KET. “There’s a lot of kids who have childhood obesity... And just seeing them start to make changes in what they are doing, how much they are eating, their water intake, I know that we’re making an improvement.”

Pediatricians' national group calls for at least one nurse in every school; Ky.'s schools have a long way to go to meet that goal

By Melissa Patrick
Kentucky Health News

Kentucky's high schools fall far short of new recommendations by the American Academy of Pediatrics that call for every school in the United States to have at least one nurse on site.

Only 42.2 percent of Kentucky's high schools have a full-time nurse, 37.4 percent have a part-time nurse and 20.4 percent do not have one at all, according to research led by Teena Darnell, assistant professor of nursing at Bellarmine University.

"School nurses improve school attendance and decrease the dropout rate which leads to better academic outcomes. . . . Most importantly, they help keep the nearly 680,000 children attending public school in Kentucky safe, healthy and ready to learn," Eva Stone and Mary Burch said in an e-mail to Kentucky Health News.

Stone, an advanced-practice registered nurse, is the director of student support services for Lincoln County Schools. Burch is the health coordinator for Erlanger-Elsmere Schools.

The pediatrics academy's policy statement, published in its journal Pediatrics, replaces a previous recommendation that districts have one nurse for every 750 healthy students, and one for every 225 students who need daily professional nursing assistance.

"The use of a ratio for workload determination in school nursing is inadequate to fill the increasingly complex health needs of students," says the policy statement.

School nurses today monitor more children with special needs, help with medical management in areas such as attention-deficit/hyperactivity disorder, diabetes, life-threatening allergies, asthma and seizures and also provide immunizations, work on obesity prevention efforts and provide substance abuse assessments, among other things, says the statement.

As school nurses have been eliminated from school budgets, school-based health centers, which provide health care to students through a public-private partnership, have become popular. This model allows schools to bill private insurance or Medicaid for services to offset some of the costs.

Most recently, the Carter County Board of Education unanimously approved a one-year contract with Kings Daughters Medical Center of Ashland to provide its school health services, Joe Lewis reports for the Grayson Journal Times. The hospital will provide a nurse practitioner who will rotate throughout the district's schools.

That doesn't comply with the new guidelines to have one nurse in every school, but the program plans to use telemedicine to keep the nurse practitioner connected to the schools throughout the day.

"Unfortunately, Kentucky has no requirement to have a registered nurse in every school," Stone and Burch write. "Every school needs a nurse. What we see in the schools is a reflection of the health of the community. Kentucky is missing an incredible opportunity to not only keep children safe at school but also to implement a system of improving long term health in the commonwealth."

In-school health clinics in two Paducah-area high schools provide both physical and mental health care for students

Paducah Tilghman and McCracken County high schools now have in-house health clinics that provide both behavioral and physical care for their students, and it's a "natural fit," Genevieve Postlethwait reports for The Paducah Sun.

Services for the in-house clinics are provided by Baptist Health Paducah and Four Rivers Behavioral Health.

"I'm really surprised nobody did it before now, because it makes so much sense," Stephanie Sandberg, a Four Rivers counselor stationed at Tilghman, told the Sun. " It's been cool to get a multidisciplinary approach and be able to hook these kids up with services that they may not get otherwise."

Previously, Four Rivers provided a traveling counselor to the high schools, but now there is a counselor stationed at each of the high schools everyday.

"I've always been of the opinion, if we knew what some of these kids go through between 3 o'clock in the afternoon and when they come back to school the next morning, we probably wouldn't wonder why they didn't study for that history test," Janice Schofield, one of the two Four Rivers counselors stationed at McCracken, told the Sun. "If somebody is having significant emotional problems, they can't concentrate in school. They can't focus. They can't study. I think the need has been there for a long time, and slowly schools are getting on board with it. I've been very welcomed out here."

Most of the behavioral health cases in both high schools come by way of referral, either through the Baptist Health Clinic at Tilghman or through the school counselors or principal at McCracken, and are free if they are made through referral, Postlethwait reports. Sandberg has a caseload of 16 students she sees regularly, and Schofield has 20 and both see a handful of "emergency" cases each week.

Sandberg and Schofield told the Sun that they've seen kids facing a wide spectrum of behavioral and mental health issues, mostly depression and anxiety, but also substance abuse, suicidal thoughts and "even psychosis."

Postlethwait writes, "The addition of the mental health component to the school clinics signifies more than just an expansion of services, it suggests a change in culture. Slowly but surely, Sandberg said she's feeling the shift." (This story is behind the Sun's paywall.)

School health units expand in Southern Ky.; treatment and prevention should pay off in longer, healthier lives for students

By Melissa Patrick
Kentucky Health News

School-based health centers are a new approach to providing student health care through a public-private partnership, whose model of care has the potential to improve the lives of some students forever.

The units were created as a way to keep nurses in schools, during a time when school-nurse budgets and health department budgets are being slashed, as done recently in Lincoln County.

Kentucky has 15 such clinics, six of them operated by the Burkesville-based Cumberland Family Medical Center.

The CFMC Healthy Kids Clinics provide a wide range of care to its students, including acute care visits, well-care visits, school and sports physicals, flu clinics and immunizations, all during school hours.

"For those cases where typically the child would have to go home, like an earache, stomach bug, strep throat or flu, now those kids can be seen at school by the nurse practitioner or physician assistant," Clarissa “Moochie” Hart, CFMC's director of school-based services, said in an interview.

This model of easily accessible health care that focuses on prevention for all of these students has the potential to influence their health when they become adults. A recent study found that teens with unmet health care needs have poor health outcomes when they become adults, notes Stephen Feller of United Press International.

The study, published in the Journal of the American Academy of Pediatrics, analyzed data from the National Longitudinal Study of Adolescent to Adult Health and found that teens were 13 to 52 percent more likely to have "adverse adult health outcomes" if they had had unmet health care needs in adolescence, compared to those with no unmet need. This was found to be true regardless of the reason given for the unmet health care need.

"These findings reinforce the importance of early intervention and investment to improve adult health," said the report.

How do the Healthy Kids Clinics work?

This year, CFMC expanded its Healthy Kids Clinics to Adair, Casey, Clinton, Cumberland, and Wayne counties after a successful pilot in Russell County last year. Now they serve almost 15,000 students in 26 Southern Kentucky schools.

Each school will continue to have a school nurse, paid for by the school district and CFMC, Hart said. The new feature is that four of the districts will have their own nurse practitioner and two of the smaller districts, Clinton and Cumberland, will share a physician assistant, all overseen by a physician.

This additional personnel, including a nurse assigned to help each of the nurse practitioners and the physician assistant, is paid for entirely by CFMC. It is able to sustain the program because it can bill the family's private insurer, or the recently expanded federal-state Medicaid program for the poor, if the child is seen by a physician's assistant or nurse practitioner.

If a school nurse decides a student needs that higher level of care, she calls the parent or legal guardian to get permission. "This is just an option," Hart said. "The parents have the option of picking their kids up and taking them to their current medical provider."

While students must have a signed consent form to be seen by any health-care provider in school, no care is to be given without the permission of the parent or guardian, who will be called every time care is recommended, Hart said.

If the student sees the nurse practitioner or the physician assistant, CFMC then bills that student's insurance or Medicaid, which pays CFMC more than most providers because it is a Federally Qualified Health Center.

"We are not going to turn anybody away regardless of their ability to pay," Hart stressed. "We are not in this to make money. This is a great service that keeps our kids healthy and hopefully changes the way that young people look at getting health care. We want to stress the importance of preventive care."

Hart also noted that school-based health centers decrease student absences and helps parents avoid missing work.

Lincoln County set to lose four school nurses if alternate funding or new partnerships are not found

UPDATE, Aug. 11: The school board made up part of the health department's budget cut, allowing it to keep seven nurses, "but not before a lengthy discussion which included talk of salary cuts and new pay scales for nurses," The Interior Journal reports.

The Lincoln County School District joins the ranks of Kentucky schools that are at a loss regarding how to pay for its school nurses as school budgets and health department budgets dwindle, so much so in Lincoln that it may lose four registered nurses for the upcoming school year, Abigail Whitehouse reports for The Interior Journal.

Many school districts have relied on local health departments to help pay for its school nurses, but cuts in federal and state funding, as well as a reduction in Medicaid reimbursements have forced health departments to ask for more money from schools to fulfill this role.

That is the case for the Lincoln County Health Department, which had to cut $150,000 in local funding toward the school nurse program, Health Department Director Diane Miller told Whitehouse.

“We're not able to fund them at the level (we were) but we are still going to go ahead and provide services to the Medicaid population and we will continue to bill those services for them,” Miller said.

The Lincoln County Board of Education held a special meeting July 14 to discuss the lack of funding for its school nurse program and the potential reduction of RNs at each school, Whitehouse reports.

Director of Student Support Services Eva Stone painted a picture with numbers that conveyed how vitally important school nurses are. "Of the nearly 4,000 students in the district, there were 1,755 health conditions reported during the 2014-15 school year and 905 alerts were reported, which she said typically means there might need to be some medical intervention done at school," Whitehouse writes.

Stone spoke to the value of nurses as a means of keeping kids at school. "Of the 13,280 total visits to the school nurse last year (through the middle of May) 93 percent of those students were sent back to class," Whitehouse writes. Stanford Elementary School Principal Brandi Hon concurred and told the board that because school nurses keep kids in school, this helps maintain funding because of fewer student absences.

Stone is searching for a solution and told the board that she will have a meeting with Danville-based Ephraim McDowell Health, Whitehouse reports. The school board gave her until its next meeting on Aug. 6 to find a new partnership or alternate funding.

But the bottom line is that if the district can't come up with $150,000, four nurses will be cut, leaving five nurses to cover ten schools, Whitehouse reports.

Superintendent Karen Hatter told Whitehouse that district funding for the school nurse program has been about $250,000 a year and paid for from a contingency fund, or money left over after the district expenses are budgeted. But a school-bus wreck and a central-office fire in 2014 have caused insurance rates and deductibles to increase, which will draw down the fund.

"Hatter said she values the program and understands the concerns but she is also in charge of keeping the school district budget solvent," Whitehouse reports.

In-school health clinics not only meet the health-care needs of students and staff, but also their families

School-based health clinics in Kentucky could become a trend,  especially as the state searches for solutions to meet the health care needs of schools as budgets for school nurses continue to be slashed.

Southern Kentucky has Cumberland Family Medical, based in Burkesville, which has clinics at the five schools in Russell County and a deal to do likewise with the four in adjoining Adair County.

Western Kentucky has three such clinics, with two more likely to open next year, Genevieve Postlethwait reports for The Paducah Sun. 

The clinics are at McCracken County's Reidland Middle School, Lone Oak Elementary School, and Paducah's Morgan Elementary. Next school year a full-time clinic will open in McCracken County High School, hopefully followed by a clinic at McNabb Elementary.

These clinics exist as a partnership between Mercy Medical Associates and the local public school districts; the school districts supply the space, Mercy supplies and staff and the Lourdes Foundation helps with funding, Postlethwait reports.

An advanced practice registered nurse with Mercy Medical, Julie Higdon, said she has seen well over 30 patients at the Lone Oak clinic since it opened in mid-April. "That's not busy by ER standards," she said, "but that's busy for a little clinic that's just softly opened."

The clinics serve the entire "school family," from the students and their parents and siblings to the districts' teachers, staff and administrators, regardless of their ability to pay. "Their goal is to give the community the preventive, acute and critical health care it needs while reducing students' and teachers' time away from school, and parents' time away from work," Postlethwait writes.

"It's a big deal when you start talking about dollars and cents, too," Tennille Rushing, director of clinical operations for Mercy, told Postlethwait.  "Not only in the impact for the schools to have kids staying in the classroom and helping with attendance numbers, but for parents. If you only have a limited number of days that you can take off, and you have to take off half a day to go sit in a lobby somewhere with your child, you've missed a half day of pay."

These clinics will also help those without a primary-care provider, which are in short supply in the Paducah area. The Lone Oak clinic will remain open by appointment only this summer.

"I feel like these clinics really have the potential to meet a need for the community," Higdon told Postlethwait. "I feel like it has great potential to grow, I really do." (This story is behind a paywall.)

Southern Kentucky physician expands his in-school clinics; already in Russell County, will be in Adair County next year

Dr. Eric Loy
(Columbia Magazine photo)

An entrepreneurial physician in Southern Kentucky has developed a way to deliver school health services that could have a broader impact on communities.

Cumberland Family Medical, based in Burkesville, has clinics at the five schools in Russell County and now has a deal to do likewise with the four in adjoining Adair County.

Dr. Eric Loy, who owns the clinic, "said that the agreement could have an important impact on the community both short term, by helping create a healthier and more focused student body; and long term, by creating a culture where people get acclimated to seeing doctors and nurses for physicals and regular checkups on a consistent basis," Wes Feese reports for The Adair Progress.

“We have a chance to change the culture of health care in Kentucky,” Loy told the Adair County Board of Education, which voted to spend $80,000 next year on the clinics. That is "roughly the same cost the district currently pays for school nurses," Feese reports. "If the trial run next year is successful, both parties will have options to continue the agreement."

"Cumberland Family Medical will pay two-thirds of the nurse expense and will bill the insurance of the patient," Toni Humphress reports for the Adair County Community Voice.

School Supt. Alan Reed complimented the dedication and service of the county’s school nurses but said costs to employ them were “soaring,” Feese reports. Reed said of Loy's plan, “This is kind of a novel approach, and from all we’ve seen, we really like it. It cuts down on time and any barriers for a kid getting health care.”

Loy agreed, saying, “A lot of times that’s the barrier, that it’s hard [for parents] to miss work.”

School principals said sick students may have to sit in an office or lobby all day because working parents are unavailable to come pick the students up and take them to a doctor. "Director of Pupil Personnel Robbie Harmon said that this move could have a bigger long-term impact on the community than any project he’s worked on in his time in the school system."

Loy's in-school clinics are manned by a full-time nurse practitioner who travels between schools, and is overseen by a physician. "Loy said that all forms of insurance would be accepted, and that all children would be seen and treated, regardless of their ability to pay," Feese reports. "He also said that the clinics could help out with insurance enrollment."

Adair County had one of the state's highest percentages of people without health insurance until the federal-state Medicaid program was expanded under federal health reform. The uninsured rate has dropped dramatically, but some families are still without health coverage.

Ten-county Lake Cumberland District Health Department is the latest to ask schools to foot more of the bill for school nurses

The Lake Cumberland District Health Department told school districts in its 10-county area in December that it would no longer be able to pay for nurses for each school, setting off negotiations with the districts.

Somerset Independent Schools Supt. Boyd Randolph said one option would have the schools employ the nurses but contract them back to the health department in order to bill for the full extent of Medicaid services, Chris Harris reports for The Commonwealth-Journal.

Health Department Executive Director Shawn Crabtree told the Somerset newspaper that his agency was "running a deficit" because it wasn't being paid as much for treating Medicaid patients. 

Schools all over Kentucky have been faced with this "unfunded mandate," as Editor Stevie Lowery called it in an article for the The Lebanon Enterprise. If a student requires medical care in order to attend school, state law requires school districts to provide the care, but doesn't necessarily provide a way to pay for it.

The dwindling number of school nurses last year prompted a new law to allow school personnel who aren't licensed health care professionals to administer or help a student self-administer insulin and otherwise treat diabetes symptoms if they take certain training.

Surrounding Somerset, each school in the Pulaski County School District has its own in-house nurse, as does every school in the regional health department's coverage area, with the cost shared by the school system and the health department, Harris reports. Asst. Supt. Sonya Wilds told the Commonwealth Journal last month that the schools pay approximately $20,000 per nurse.

The department has proposed that the schools pay the full cost of employing 12 nurses, which will fall "in the neighborhood" of $750,000, about three times what they pay now, Supt. Steve Butcher told Harris. “Of course, we would receive money back from the health department on Medicaid claims, but . . . it’s hard for me to wrap my head around how much that would be worth to us,” he said.

As school officials consider all of their options, they are also looking at the individual needs of schools, with the understanding that these needs constantly change and are like a "moving target."

“We’ve got some schools that have kids with feeding tubes, and some schools that are heavy on [students with] diabetes,” Butcher told Harris. “It’s not necessarily bigger schools that have more issues, it’s just schools have specific kids that have got needs that we can’t do anything about and need additional help."