Robert's Story

It was a love affair that lasted over 25 years.  Robert’s first love was heroin.  The only problem was, typical of a destructive relationships, she didn’t love him back.  The deceptive nature of her seduction could lure, entice and ensnare.  Under her skillful spell she could work her magic with her crafty hands.  She could deliver anyone that followed her down a road to euphoria.  Then, without notice, she could plummet them into the pit of despair.  She was filled with empty promises.  

Since 1972, Robert did anything and everything he could to please his “love”, leading him into a life not unfamiliar to an addict.  The cycle of theft, drug dealing and jail became a common practice.  He became a skillful business man in his world.  Running his “boosting” practice earned him the reputation in the neighborhoods as the guy who could deliver the highest quality shoplifted retail goods.  Clothing, shoes, household items, personal hygiene products merited him the infamous name “Boscov’s Bob”.

As the years went on, Robert’s path became littered with broken relationships and a criminal record over 6 pages long.  Behind him he left two broken marriages and shattered relationships with his children.  Heroin was in control of everything.  

As darkness settled in on a night in the mid 1990’s, so did Robert and heroin’s relationship.  Heroin was a temperamental, unpredictable and infuriating lover.  She pulsated through his veins and his heart beat through his chest that night.  As he awoke from the overdose his eyes followed a pin-stripe up the pant leg to a burly police officer standing over him.  From the captivating clutches of heroin’s fuzzy haze, he could hear the words from the officer’s booming voice, “Just another junkie, let him die.”  

Between the years 1977-2000, Robert had spent time in over 7 Pennsylvania County jails and with each conviction, discharge and parole he learned to network and became a more skillful criminal.  The cycle of crime continued so that he could feed his lover’s unquenchable thirst.  Like most addicts, Robert thought this was normal.

In 1998, after being caught at his last shoplifting incident and facing a state sentence, he had enough.  Robert finally broke up with heroin.  Predictably, she didn’t take it lightly.  Within the confining chambers of a concrete jail cell, the wretched nature of drug withdrawal ran its course- vomiting, diarrhea, sweats and shakes.  Robert freed himself from the grasp of this evil temptress.

After serving out his 1 ½ year state sentence, Robert turned to the Lebanon Rescue Mission for a program for convicted criminals.  As a disabled veteran, he qualified for a full scholarship to work on a degree program at Alvernia College.  He majored in addiction and now works as an addiction counselor and community drug and alcohol educator.  Each day he helps others break free from the cycle of addiction.

Robert’s story is not an unusual one.  Drug addiction takes hold and destroys the lives of millions of people and their families.  However, the question we are left with is this: what do we do as a society to combat this issue that is ruining lives, families and filling our prison system?  Before we build more prisons in order to deal with common criminals like Robert, we need to step back and look at the facts.  According to a study done by the Center for Substance Abuse Treatment, it costs $25,900 a year to incarcerate one person, whereas, it costs $1,800 a year for outpatient drug treatment and $6,800 for long-term residential care.  Similar studies have shown that for every $1 dollar in drug treatment yields a $7 reduction in crime-related costs.  Furthermore, this ratio raises 1:12 when healthcare costs are included.  One year of drug treatment has been conclusive with a reduction in drug selling, illegal activity, sex trading, homelessness and an increase in employment.

When the Patient Protection and Affordable Care Act was passed in March 2010, part of the essential benefits included a provision for mental health and substance abuse treatment.  It is now part of the law that insurance companies include and pay for drug rehabilitation services similar to the ones that Robert now provides.

¹ for Substance Center Abuse Treatment, 1997 National Treatment Improvement Evaluation Study (NTIES) (Rockville, MD:  CSAT, 1997); Federal Bureau of Prisons.

² National Institute on Drug Abuse (NIDA)  Teaching Packet No. 3:  “Understanding Substance Abuse and Addiction:  What Science Says” http://www.nida.nih.gov/pubs/teaching/Teaching3/Teaching5.html

³ Office on National Drug Control Policy, “ONDCP Drug Facts February 2002” Presentation.

Guest Blogger: Barb Bloomfield

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Today is a guest Blogger:  Barb Bloomfield

Barb Bloomfield worked as a union organizer for hospital workers, and later as an a geologist involved in investigation and cleanup of contaminated groundwater.  Just before she retired, she got a bad case of arthritis in one of her knees.  While she was getting physical therapy, which was paid for by Medicare, she thought about all of the people who had to pay out of pocket or couldn’t afford treatment at all and decided to get involved in the campaign to make health care available to everyone.  Since her retirement, she has been volunteering with the Pennsylvania Health Access Network in the campaign for access to quality and affordable health care.  

A SMALL WINDOW INTO THE BRITISH NATIONAL HEALTH SERVICE

In August 2011, my partner Rich and I went to England.  We decided to go to Cornwall, the southwestern corner of the country, where, I am told, half of England spends its vacations.  We went because I love high cliffs with crashing ocean, I wanted to see a moor, and because Tintagel, the legendary birthplace of King Arthur, is there.  

 One day, we were having lunch at a cafe at Crackington Haven, a deep, horseshoe-shaped cove carved into the high cliffs by the local river and the ocean.  The beautiful beach was made of coarse sand and ocean-smoothed pebbles and cobbles.  We sat outside on the patio to enjoy the pleasant weather and dramatic view, but we and a young lady at another table were being attacked by yellow-jacket bees, so after trying to help each other swat them away, we went inside.

 Our new young friend was wearing a T-shirt that had something to do with health care, which I asked her about. She told us the most amazing story:

She was in the middle of a 630 mile solo walk around Cornwall's coastal path, which follows the edge of the land just as it drops to the ocean hundreds of feet below.  The Cornwall peninsula is a rugged plateau with steep narrow valleys carved by rivers on their way to the sea.

Shelly was walking to raise money to buy a physical therapy machine for a hospital - the Bristol Royal Infirmary -  where she had been treated for a congenital deformity in her legs - extreme knock-knees - and was facing a lifetime in a wheelchair.  She had had four surgeries, and then spent 20 hours a day in a machine which continuously moved her legs to strengthen her muscles.  Now she could walk like any healthy young person does without even thinking.  What a wonderful way to celebrate her full recovery, and what a story!

But, I asked who had paid for her surgery?  The British National Health Service had paid for everything.  Then why did she have to raise money?   She said she was grateful for the medical care that had enabled her to live a normal life and decided a good way to "give back" would be to use her walk to raise money for another machine to help other patients get the treatment they needed.

Twice in the summer of 2011, I had seen people in the U.S. who appear to be living with this uncorrected deformity.  Once was in July at the Butler County fair, where a beautiful young woman was walking painfully but gamely, and another time, in Philadelphia where at a downtown intersection a young man was struggling to get across the street before the light changed.  

What if they had had the protection of the ACA and its basic patient protections such as insurance companies no longer being able to discriminate against people with preexisting conditions?  Would they be able to access the amazing treatment Shelly received?  What if doctors and care-givers didn’t have to make decisions about necessary health treatment based on a patient’s health insurance?  Will these people be better off in 2014 when the uninsured can now access health insurance from an affordable new insurance marketplace called the exchange?  

Shelly finished her walk on October 1, 2011.  I am hopeful.

The Bagel Shop

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As of March 2011, certain fast food establishments began posting calorie information on their menus



Pennsylvania has terrible bagels.  While the Keystone State has many redeeming qualities, its bagels are not one of them.  About a year ago I was visiting upstate New York and made my regular stop in one of my favorite bagel shops.  It was a chain establishment, not quite like the “mom and pop” ones in New York City, but still one of my favorites.  The menu however had changed since my last visit.  Next to all the menu items there were numbers for the calories in each item.  As a health educator that has spent a lot of my career working with adolescents conducting personal diet analysis, I was fascinated and intrigued by this new phenomenon in New York. 

I was so used to working with students and clients that were not aware of calorie content in the food they eat, particularly what they drink, that I must have been speaking out loud to myself at seeing the 430 calorie coffee drink right there in black and white.  At that moment, the shop owner engaged in a conversation with me regarding this recent New York State menu regulation.  He explained to me that within a few months, many restaurants were going to be required to reveal the calorie content on their menus.  I nodded with interest and continued to listen.  He summarized his explanation with, “Now the government has to tell us what to do.  As if we can’t make our own choices!”

A conversation about ideology seemed rather fruitless because swirling through my mind was the reality.  We are now looking at an American public where 2/3 are considered overweight or obese.  The health and economic costs to this reality has been devastating.  While obesity is associated with an increased risk of heart disease, diabetes, stroke, some cancers, hypertension, high cholesterol and sleep disorders, it has had a detrimental impact on our healthcare costs.  In 2008, an obese person cost our medical system $1429 more per person than someone of normal weight.  Overall, this adds up to a systemic cost of $147 billion a year to our public and private insurance pools.[i]  In a study done by the USDA, Americans spend 42% of their food budget away from home.[ii]  An extra 134 calories a week from one additional meal away from home amounts to an extra 2 pounds of body weight each year.[iii]

As of March 2011, nutrition labeling in chain restaurants came to Pennsylvania as well as the rest of the country.  A provision in the Patient Protection and Affordable Care Act now states that there must be clear nutrition labeling on the menu at all chain restaurants with 20 or more establishments.  Additionally, vending machines must also contain nutrition information.  Establishments in which their primary role is not to sell food, such as movie theaters and bowling alleys are exempt from this provision.  


I simply replied to the store owner, “because of your new menu labels, now I can make my OWN informed choice.”

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[i] Finkelstein, EA, Trogdon, JG, Cohen, JW, and Dietz, W. Annual medical spending attributable to obesity: Payer- and service-specific estimates. Health Affairs 2009; 28(5): w822-w831.

[ii] Todd, J., Mancino, L., Lin, B., The Impact of Food Away from Home on Adult Diet Quality.  USDA Economic Research Report #90.  February 2010.

[iii] Ibid.

The Health/Wealth Gap: Stacey's Story part II

This is the conclusion Stacey's story, which is a part of a three-part series called "The Health/Wealth Gap".

Stacey in Philadelphia

Stacy can hear the distant gun shots as she sits in the living room of her home in the Philadelphia neighborhood she grew up in.  The police sirens echo in the dark night.  As a single mom, she keeps her 2 boys close.  Cleats and sports paraphernalia are in the hall.  They are the only luxury in the budget for the boys.  The free sports programs keep them off the street.  Nursing textbooks for Stacy’s bachelor’s degree program are strewn about the floor of this home she now owns.  She is prideful of being the first homeowner in her family, but she is determined that life can offer better. 

Each day Stacy goes to her job caring for a terminally ill child.  Changing G-tubes, Oxygen, trachea care, and vents are a part of her daily routine.   It’s October, usually her patient gets sick and ends up in the hospital.  Fortunately for him and Stacy this year he is able to be managed at home.  Stacy wouldn’t get paid if he wasn’t.  Stacy makes $33,000 a year as an in-home Registered Nurse in Philadelphia.  She is paid hourly with no steady schedule.  She does not have sick time or personal days.  To get any personal days she has to work 2000 hours (almost 1 year).  Stacy, an educated Registered Nurse who cares for terminally ill children also does not have health insurance.

While she is offered health insurance by her employer, they do not contribute and she simply cannot afford the $650 a month for the family, or 30% of her income.  After the mortgage, electric, water and groceries it is financially impossible.  Under the shadow of this financial reality, Stacy rubs her sore joints.  She has Lupus, an autoimmune condition like her mother.   

The cycle never broke.  The demons that haunted Stacy in childhood hover.  They torment and crawl into every crevice of her being and refuse to leave.  Why won’t they go away?  Like her parents before her, she did what she was supposed to do, but the demons of poverty refuse to leave.

The reality that lack of health insurance is synonymous with poverty is evident.  However, what is the possibility that children can break out of the cycle of poverty?  A report from the Congressional Budget Office states that between 1979-2004, roughly the timeline of Stacy’s story, the poorest one-fifth of Americans saw their income rise 9%, the wealthiest one-fifth saw their income rise 69% and the top 1% saw their income rise 176%.  As economic inequality has grown, so has the inability for intergenerational social mobility.[1]  According to a 2010 OECD report, social mobility between generations is dramatically lower in the United States compared to other developed countries.[2]

While the Patient Protection and Affordable Care Act gives hope to the working poor because they can now access healthcare on the individual exchanges with premium tax credits, we are still left with the question about prosperity.  Are we really the land of opportunity?  Do we really live in a society that rewards its citizens for their efforts and values them for their contributions?  Does the American Dream really exist?

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[1] Sawhill, I., Morton, J., “Economic Mobility:  Is the American Dream Live and Well?”  Economic Mobility Project.

[2] Economic Policy Reforms:  Going for Growth.  A family Affair:  Intergenerational Social Mobility Across OECD Countries.  2010

The Health/Wealth Gap: Stacey's Story Part I

This is the second of a three part series called "The Health/Wealth" Gap and features Stacey from Philadelphia.

October 2011:  Stacey in Philadelphia

Stacey's mother, Susan, rubbed her child’s cheek.  With each stroke she prayed that it would take away the pain or at best, sleep would rescue her baby from the suffering.  Susan was recently widowed and with no dental or health insurance, the gentle touch of a mother’s hand was the best she could offer her child.  Its the mid 1970's, Stacey is age one, the youngest of the three children her widowed mother had to care for in this working class neighborhood of Philadelphia.  Stacey's father died at 38.   After almost 20 years of service to the steel mill, the family couldn’t prove that the years left him with the cancer that took his life. They were certain however, that the years of service did leave the family without any health insurance.  Stacey's father died 10 months shy of the family being able to collect his pension.  

It wasn’t supposed to be like this.  When Stacey's parents got married in the early 1970's, they were prepared to fulfill the roles expected of them at the time.  Stacey's father had a reliable union job in the steel mill while her mom became a stay-at-home mom of 3 children.  They had staked their claim in a home in the Philadelphia neighborhood.  They had captured the “American Dream”.  At least they thought they had.    

Stacey's father's untimely death wasn’t part of the plan.  Either was the rheumatoid arthritis that soon set in to her mother's hands.  Rheumatoid arthritis, an autoimmune disease, is a condition where the body attacks itself.  Like the condition that slowly began to cripple Susan's hands and the rest of her body, life seemed to be doing the same for Stacey's parent's “American Dream.”

As the years went on, Stacey's mother raised the 3 children on the SSI left to them by their father.  It was the 1980’s, economic prosperity seemed to loom about the nation.  Those were not the memories of Stacy’s childhood.  Her mother didn’t qualify for Medicaid because she ‘made too much money’ from the children’s SSI.  It was only because of the goodwill of a neighborhood doctor that her mother received free medical oversight.  However, kindness and goodwill from one caring doctor didn’t pay for expensive procedures, equipment and medications.

As Stacey grew up, she was determined to break the cycle of poverty she witnessed as a child.  Like many Americans, she believed that with hard work she could pull out of poverty.  Education was the way to go.  She received her LPN and eventually her associate’s degree in nursing (RN).  Her first patient was her mother.  By this point Susan was considered clinically disabled and qualified for Medicaid.  With each changing administration, policy and budget change however, Stacey fought to keep her mother insured.  As unpaid bills and cancellation notices came in, Stacey fought.  Susan died at the age of 63, 2 years shy of being eligible for Medicare.  

Please return next week for Part II of "Stacey's Story".

*names have been changed to protect the identity of the subjects.

The Health/Wealth Gap: Stacey's Story

This is the first of a three part series entitled the "Health/Wealth Gap".

Stacey in Philadelphia

In reflection of President Obama’s State of the Union last week, the issue of fairness was a prevailing theme.   This theme has often been painted with slogans such as “class warfare” or “redistributing the wealth”, but when we dig deeper behind the meaning of fairness, we can see that it really is about access to opportunity.

It is a common statement in the field of public health that the “less you have, the more you have”.  In other words, those from lower economic means have a greater prevalence of disease and disability.  The poor have a tendency to live in crowded or environmentally toxic living conditions with substandard housing and are less likely to have access to healthy food.  In fact, the poor disproportionately live in areas we dub “food deserts”, regions in which affordable healthy food and transportation to them is lacking.  It also shouldn’t be a surprise that the working poor are also disproportionately represented among the pool of the uninsured, therefore exponentially increasing their prevalence of disease and disability.  Finally, the poor live in areas with a low tax base resulting in substandard education that leads to lack of awareness concerning health issues and opportunities to rise beyond their current social status.   

My travels across Pennsylvania have certainly shown many things about our healthcare crisis.  Our changing global economy with its evolution from manufacturing jobs to service sector jobs has taken its toll on the working class.  Between 1980-2007, the number of Americans with access to employer provided healthcare has drastically declined.[1]  The need for cheap labor has meant increase in low wage jobs with little or no benefits.  In other words, there has been a lack of opportunity for the working class to achieve economic social mobility which guarantees protections and security in the area of health.

In the Fall of 2011 I became intrigued by what I saw emerging in the national landscape and ongoing dialogue about economic inequality as the “Occupy Wallstreet” movement unraveled across the country.  Being aware of what I have come to call the “Health/Wealth gap”, I was certain that this national dialogue about economic inequality had to encompass those that have been shut out of access to healthcare. 

With this in mind, in mid-October I hit the road and headed to Philladelphia to join an “Occupy Philly” rally to see what I could find.  I had no idea what to expect and the day I went I only had enough change to plug my parking meter for 2 hours.  It only took 10 minutes before I met Stacey, a full-time employed nurse and mother of two.  I spent those 2 hours talking to Stacey and documented her story.  For the next 2 weeks I will tell her story that goes back 2 generations, beginning with her parents.

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[1] Cohen RA, Mukuc DM, Bernstein AB, Billheimer LT, Powell-Griner E. Health Insurance coverage trends, 1959-2007: Estimates from the National Health Interview Survey. National halth statistics reports; no 17. Hyattsville, MD:  national Center for Health Sttistics. 2009.

Has the "Silly Season" begun already?

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Mitt Romney on the campaign trail during the Republican Primary

The term “Silly Season” has been popping into my mind a lot lately.   “Silly Season” is typically described as the time in late summer into early fall of an election year where candidates engage in political posturing for media attention.  This will usually results in ridiculous claims.  My question then is, has the “silly season” already begun?

 After the recent primary caucuses and elections, presidential hopeful, Mitt Romney claimed that if he became president he would tackle the deficit by repealing the health care bill (Patient Protection and Affordable Care Act).  He continued to claim that repealing the bill would save $95 billion a year.  Not only is the latter statement completely false according to politicafact.com, but it is quite the opposite of the reality.  Over the next 10 years, the PPACA is projected to lower the deficit by $143 billion[1].  This will be done through a variety of means including a medicare payroll tax to those earning over $200,000 being the primary method.  Others include some fees on the medical industry, the tanning industry, and a $2000 fine to large employers that do not offer insurance and their employees who therefore utilize the individual exchanges (marketplace).  Finally,  there are measures to cut down on waste, fraud and abuse, end overpayments to medicare advantage, an excise tax on high end plans, stronger restrictions for Health Savings Accounts (HSA) and of course the highly debated fine for not adhering to the mandate.

While I have come to expect our politicians to flat out lie for political pandering, what has come to disturb me most is the statement concerning a commitment to repeal the bill and the political weight the argument is carrying.  I often wonder if those that support the rally cry have stepped back and asked themselves exactly what this would mean.  As I have explored this issue around the state of Pennsylvania, I have often become frozen in dismay regarding the lack of information and belief in misinformation many people possess.  They know little about the details that lie behind the political rhetoric.  Sadly, our politicians take advantage of this ignorance.

Therefore, I challenge those that support Mr. Romney’s rally cry to repeal the healthcare law by asking them to consider some of the following hypothetical situations: 

·         Should we now tell 2.5 million young adults (and their parents), like Eric, that they are no longer able to access affordable care?  As of January 2011, the PPACA has allowed young adults under the age of 26 to stay on their parent’s health insurance until they obtain a policy of their own.

·         Should we tell small business owners like Susan, and Laura/Michael that they will no longer have access to small business tax credits and the small businessexchange (marketplace) in order to purchase affordable healthcare?  Do they have to instead continue spending over 30% of their take home pay on health insurance?

·         Do we now have to tell every single insured American that health insurance companies can continue the same consumer abuses they have done for decades?  In other words, are you going to explain to the American people that when the Medical Loss Ratio is repealed, insurance companies can spend unrestrained amounts of patient premium dollars on advertising, CEO bonuses and lobbying instead of on their health care?

·         Do you also intend to tell every single American that health insurance companies can continue arbitrarily raising your premium rates year to year because you support repealing rate review?

·         Are you going to explain to Gary that when his company laid him off and moved to Venezuela or Brianna, whose company refuses to offer her healthcare that they will no longer be able to access affordable healthcare from the individual exchange (marketplace) ?

·         Finally, try explaining to me that because I have a pre-existing stroke condition that if I someday change insurance plans I can be denied coverage, subjecting myself to financial peril.

As the silly season seems to be upon us a bit early this election season, I leave those that support repeal with one final statement:   Be careful what you wish for….you just might get it.

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[1] Kaiser Family Foundation:  Summary of Health Reform law.  March 2010

Eric's Story

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Eric with his parents at Cabrini College Graduation
May 2011: Radnor, PA

On April 20, 2010, The Deepwater Horizon, BP’s oil rig stationed in the Gulf of Mexico, exploded.  In its aftermath it left suffocating sludge that not only smothered the life out of the plants and wildlife in the region, but the hopes and dreams of the inhabitants that found their livelihoods along the gulf shores.  Like the native egret that gasped for its last breath beneath BP’s mess, the fisherman watched hopelessly as their only ability to support their families floated away in the mucky waters.  Vietnamese Americans composed 1/3-1/2 of all fish vessel workers that navigated the gulf shores on a daily basis. The only skill they were trained to sustain their livelihoods was now gone.  Almost 2 years later, BP is back in business while these fishermen still struggle to survive.  Who is going to look out for the gulf coast families?

In 2010 Eric was a college student at Cabrini College in Radnor, Pennsylvania.  As an optimistic student that interned with Catholic Relief Services he understood the plight of the underrepresented in society.  Soon after graduation in the spring of 2011, he got a job with NETWORK, an agency that advocates for the families impacted by the oil spill along the gulf coast.  On a daily basis, Eric advocates for the fisherman, the small business owners who run hotels and restaurants in this tourist heavy region to make sure BP reimburses them for their loss.

Youth like Eric are a valuable asset to society.  What is protecting them from falling into financial ruin like the victims in the Gulf?  Prior to the passage of the Patient Protection and Affordable Care Act (PPACA), recent graduates would be left uninsured upon graduation.  In fact, in 2009 40% of all the uninsured came from the youth population between the ages of 18-34[1].  With half of all bankruptcies being triggered by a costly illness[2], this left our youth population at a high risk for starting off their lives in financial hardship. 

In 2011, Eric and his peers were the first graduating class to be protected by a provision in the Patient Protection and Affordable Care Act (PPACA) that allows young people under the age of 26 to stay on their parent’s health insurance following college graduation until they found a job.  Eric was able to remain on his parents insurance until he began his employment with NETWORK, where he then received his own insurance.  In July 2012, when his contract with NETWORK ends, he will be able to go back on his parent’s insurance until he finds further employment.

By requiring insurance companies to keep young people on their parent’s health insurance, we have seen a lot of success in filling the gap of the uninsured.  Statistics released around the time of Eric’s graduation by the Center’s for Disease Control  have found an additional 2.5 million people now have access to healthcare that otherwise would not have had it.[3]  Over the past few decades, the rising rates of the uninsured has been one of many contributing factors to rising healthcare costs, this success therefore amounts to a roughly 5% decrease in the gap of the uninsured in the US.

As of this past year, we no longer need to liken our youth population with the egrets and fisherman who continue to struggle along the gulf shores because of corporate irresponsibility and greed.

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[1] KCMU/Urban Institute Analysis of 2009

[2] The Fragile Middle Class: Americans in Debt; by Elizabeth Warren, Harvard Law School and Smith Business Solutions

[3] Cohen RA, Martinez ME. Health insurance coverage: Early release of estimates from the National Health Interview Survey, January–March 2011. National Center for Health Statistics. September 2011

Sheila's Story

With an I-Phone in hand, Sheila e-mails her professor about a recent assignment and texts a coworker as she informs me of next weekend’s ‘on call’ duties.  With a backpack filled with Cheerios and string cheese strung to her back, she also entertains her young child.  The upcoming paper was weighing heavily on her mind and this evening is sure to turn into a late night.  It was mid September, a new academic year was in full swing, and I had at last found an individual who had discovered the knack for striking that delicate balance between professional, personal and student life. 

 Sheila is a Certified Registered Nurse Anesthetist at Lancaster General Hospital and represents one of the many Advanced Practice Nurses we will be relying on in the years to come.  Sheila recently completed a master’s degree program and is currently working towards a doctorate of nursing practice in anesthesia.  The need for these doctorate level nurses will be in great demand.  By 2020, the United States will be looking at an estimated physician shortage of about 91,000, split evenly between primary care and specialty areas, such as anesthesia.[i]  With our aging population and more people being able to access healthcare because of the PPACA this has become a startling reality and has called upon our healthcare industry to make some changes.

The future of our healthcare will be one in which there will be more of an emphasis on collaborative care, where physicians will play a more supervisory role over advanced degree nurses.  Advanced degree nurses hold training that will be relied on for routine care and will play more of a direct role with patients, referring to their physician supervisor when situations have more complex problems and multiple diagnoses.  A substantial body of research has shown that when advanced degree nurses such as Nurse Practioners (NP’s) are utilized in this role, it has resulted in positive clinical outcomes and compares well to those that solely relied on one-on-one physician care.[ii]   According to the Institute of Medicine (IOM), these changes are allowing advanced degree nurses to utilize the full extent of their education and training.   Significant cost savings have also been noted in 26 studies by an increased reliance on NP’s.[iii]  In specialties such as anesthesia, studies have recommended that the industry embrace this model.[iv]

For the first time in over 30 years, the nursing industry will accept major changes in order to keep up with the times.  Promoting a doctorate of nursing practice has been a direct response to the changes in healthcare.  These changes are necessary in order to meet the demands of the greater patient load, keep up with technology and innovation and meet the demand for higher knowledge.  These advanced degrees will come with a higher expectation for continuing competency, more frequent recertification and continuing education.

The Patient Protection and Affordable Care Act (PPACA) includes multiple provisions in order to meet these new demands in the healthcare industry.  Beginning in 2010, funds were available to nursing schools and training facilities in order to increase the number of Nurse Practitioners and Physician Assistants.    $15 million was also made available for Nurse Led Clinics in underserved and rural communities.   The PPACA also invests multiple other resources for workforce development and support for existing nursing infrastructure.

As Sheila works to balance her busy life, she has a positive and hopeful outlook on the future of her profession.  She states, “The changes represent a smarter and better use of resources, a more holistic and well-rounded approach to patient care and it is an exciting time to be in healthcare.”

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[i] Association of American Medical Colleges (AAMC) Center for Workforce Studies, “Physician Shortages to Worsen without Increases in Residency Training,”

[ii] Kaiser Commission on Medicaid and the Uninsured. “Improving Access to Adult Primary Care in Medicaid: Exploring the Potential Role of Nurse Practitioners and Physician Assistants”.  March 2011.

[iii] Roblin D et al, “Use of Midlevel Practitioners to Achieve Labor Cost Savings in the Primary Care Practice of an MCO,” Health Services Research, 2004 June; 39(3): 607-626.

[iv] Brian Dulisse and Jerry Cromwell.  Health Affairs, 29, no.8 (2010):1469-1475

No Harm Found When Nurse Anesthetists Work Without Supervision By Physician

Sue's Story

My travels around the state of Pennsylvania have led me to find healthcare advocates in unusual places.  I first met Sue in my children’s music class.  Each week after the class in which she taught was completed; we found a common bond in the passion each of us shared for access to healthcare.  Through the year, we shared literature, research and exchanged insight into the subject.  It was through her that I learned about Lebanon Family Health Services.  Sue’s guest blog is the conclusion of my five part series on Woman’s Health.

 

Ten years ago I began volunteering for the Lebanon Family Health Services as a board member.  Prior to my time at LFHS, I served on the Girl Scout Council Board of Directors.   For years, I had long been familiar with LFHS, but felt an agency of such value to the community deserved my full attention.

When I became a member of the Board, I realized the breadth of services provided to the community far outreached my previously held perceptions.  It took me about a year to fully understand the range of services and the diversity of clients served by this wonderful agency.  As luck would have it, I became chair of the marketing and Public Relations department, a perfect opportunity to “spread the word”.

To me, Lebanon Family Health Services fills the need of a vastly diverse population of women, children, men and families. Our clients range in age: pre-natal, newborns, toddlers, teens, adults and seniors.  The clients all utilize the OB/GYN, WIC, family planning, job related physical and drug testing, driver license physical and general health services.   These services also include smoking and tobacco cessation programs.

It is an honor to support an agency which provides safe, respectful, clinically sound and above all, affordable opportunities to improve the lives of the members of our community. I feel passionately that families of all backgrounds deserve the best medical care regardless of economics.  LFHS provides a safe environment for teens in need of contraception and counseling with unique teen walk-in clinics.  Another aspect of LFHS that stands out for me is the WIC program (Women-Infants and Children) which not only provides funding for healthy foods, but also includes nutritional counseling, farmers market opportunities and breast feeding support.

I have long believed in the importance of all people acquiring quality healthcare.  The new healthcare law, the Patient Protection and Affordable Care Act (PPACA), will allow the uninsured this dignified access to basic healthcare needs.  The healthier our population, the more productive our community.  LFHS has provided reproductive healthcare opportunities for families of diverse backgrounds, regardless of financial status, with great success. Excellent healthcare is a right, not a privilege.  As a Board Member, I feel it is our duty to promote these opportunities and I am proud to serve this agency and above all, to support our clients.