AUSTIN, Texas – There are more than 300 medically under-served communities in Texas that some groups say could be better served by a change in regulations.
Advanced Practice Registered Nurses, known as APRNs, are fully trained to treat and diagnose acute and chronic illnesses, and practice full primary care. But rules in Texas restrict them from providing care to the full extent of their education and training.
Elizabeth Ellis is a doctorate-level nurse practitioner who owns and operates the B.I.S. Community Clinic in Bedias. She explains a supervisory rule limits the scope of practice of APRNs because it requires them to have a contract with a collaborating physician.
"Texas is a large state with very large health care needs, and rural health needs,” says Ellis. “We need to get with the future and provide independent practice to our highly qualified and highly trained nurse practitioners that have experience. "
Texas ranks 46th among states for the number of physicians practicing in rural areas. AARP, the Texas Association of Business and the Texas Public Policy Foundation are among the groups that support expanding nurse practitioners' scope of practice.
Research from the Journal of Nurse Practitioners shows that health outcomes for patients cared for by nurse practitioners is the same or better of that of a physician. And Ellis argues costly supervisory contracts can hamper patient care.
"We're having to pay them and in my case divert funds away from my clinic that could be utilized towards providing additional equipment or services in my clinic so that I can pay for a physician to be my collaborating provider,” says Ellis.
Some physicians organizations argue that doctors have more extensive training and experience in patient care, and say rules are needed to ensure safety. But Ellis counters changing the regulations would not end collaboration between medical professionals.
"We all have our certain limitations and scope so if you're a good practitioner you know where your limitations are and you're always going to reach out to your colleague and to ensure the appropriate treatment plan for your patient when you need to,” says Ellis.
More than 20 other states allow nurse practitioners to work to the full scope of their training without a supervisory contract, and the Department of Veterans Affairs also extended full practice authority.
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A health care workforce shortage in New Hampshire is leaving Alzheimer's patients and their families with few options for treatment.
Patients facing a possible diagnosis are having to wait more than six-months to see a neurologist and are often forced to travel long distances.
Melissa Grenier, regional manager for the Alzheimer's Association of New Hampshire, said while patients wait, the disease progresses and families feel the financial and emotional strain.
"We want people to have the earliest and the most accurate diagnosis possible so that they can implement the best treatments," Grenier urged. "They can plan for the future."
New Hampshire has the most job openings in health care per capita and will need a more than 100% increase in geriatricians to meet demand by 2050.
Grenier pointed out 26,000 people in the state live with Alzheimer's disease and the number will grow to 32,000 next year.
State lawmakers are considering a bill to help build the pipeline of health care workers needed for what has been dubbed the "silver tsunami" of Alzheimer's and dementia patients. Senate Bill 403 would create a rural residency program, expand student loan repayments for medical workers and help expose more students to health care careers.
For now, Grenier noted the state has just 10 respite care facilities for people with Alzheimer's and demand is growing.
"I do not think that New Hampshire has the infrastructure to support our aging population and our growing population of people with memory impairment," Grenier asserted. "And subsequently, the number of people caring for those folks."
Grenier emphasized respite centers offer families a more affordable option compared to home health services, but those living in the state's lakes region or north country have even fewer options. She added people often call the Alzheimer's Association 24-hour hotline looking for advice on the difficult health care decisions they face each day.
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Summer will be here before you know it, and experts say now is the time to get prepared for Arizona's scorching and life-threatening temperatures.
Some 645 heat-associated deaths were confirmed by Maricopa County's Department of Public Health in 2023, breaking the previous year's record by more than 50%.
Dr. Rebecca Sunenshine, the health department's medical director, said the 2023 Heat Related Deaths Report demonstrates this is a significant public health concern for Arizona's most populous county.
"This is really a call to action," she said, "to make sure that we all come together across the county - community-based organizations, cities, the county government - to prevent these deaths almost all of which are preventable."
In 2023, an average of 13 heat related deaths per day occurred during July, with people who were unhoused making up the largest proportion. With hotter months on the way, Sunenshine encouraged Arizonans to check on neighbors and seniors who may live alone, make sure air conditioning systems are working and follow the county's "10 tips" to stay safe in the heat.
In addition to tracking heat-related deaths, the Department of Public Health also conducted an evaluation of cooling and respite centers that were part of Maricopa County's Heat Relief Network last year. Sunenshine said they learned valuable details - including that two-thirds of respondents didn't have a stable home, and that many people found the cooling centers only through roadside signs advertising them.
"Some of the biggest barriers to accessing cooling centers are not knowing they exist, not knowing where they're located and not having transportation," she said, "and we based all our actions this upcoming summer on the results of this cooling center evaluation."
She said they were able to establish a call center, operated by bilingual community health workers, to help connect people not only to heat-relief resources but to energy and security-assistance programs.
Arizonans can call 211 to help find transportation to the nearest heat-relief location, when they open again on May 1.
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This week, an Alabama group is drawing attention to the need for Medicaid expansion.
Currently, approximately 300,000 people are stuck in a health care coverage gap, earning too much for Medicaid but not enough for private insurance.
Debbie Smith, Cover Alabama campaign director for Alabama Arise, said they are reaching out to legislators statewide and sharing information about the stakes involved.
"About 19 of our rural hospitals are at risk of immediate closure," Smith reported. "That means they are at risk of closing in the next year. And having patients that come in that don't have health insurance coverage is not good for their bottom lines."
The Cover Alabama Coalition is engaging lawmakers through meetings in their districts and encouraging residents to share their experiences and thoughts on Medicaid expansion via social media. Although 19 rural hospitals are due for immediate closure, a report on rural hospitals from advisory firm Chartis highlighted more could be at risk in the long run. The report revealed nearly 74% of Alabama's rural hospitals are operating at a loss.
Smith sees Medicaid expansion as a life-or-death matter, which can greatly enhance the quality of life for many residents. She noted it would provide access to preventive care and vital medications, and can help people enter or remain in the workforce. She pointed out the current Medicaid threshold creates barriers for families in need.
"Let's say a single mom with two kids, she can't make more than $4,656 a year and still qualify for Medicaid unless she has a disability or is pregnant," Smith observed. "And at the other end of the perspective, they have to make at least around $25,000 to qualify for the health insurance marketplace."
She added the expansion could also benefit around 5,000 veterans who lack coverage. Currently, 41 states including District of Columbia, have already expanded Medicaid. Mississippi has also recently passed legislation in its House, it is now waiting for a Senate vote.
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