Eye on Nursing

AARP

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Published May 18, 2010

/ Updated August 14, 2013

AARP believes that every American deserves a highly skilled nurse when and where nursing skills are needed. A richly skilled, effectively integrated nursing workforce — with enough professionals to meet the need — is essential to delivering high-quality health care.

For more information on nursing issues and how they impact your health care, visit the Center to Champion Nursing in America, an initiative of AARP, the AARP Foundation and the Robert Wood Johnson Foundation.

NURSING WATCHDOG

AARP members are watching for policy solutions and legislation that would fully realize nurses' potential contribution to a patient-centered, transformed health care system in the following areas:

Removing Barriers to Practice and Care: Modernize outdated policies (public and private) and change state and federal laws and regulations to allow nurses to practice to the full extent of their education and training.

Patient-Centered Transformed Health Care System: Advances and contributions to the research, advocacy and communications strategies through the national network of professional and health care related stakeholders.

Advancing Nursing Education: Federal and state policies to increase the educational level of nurses through an improved education system that promotes seamless academic progression.

Nurses Leading Change and Advancing Health: Federal and state policy making bodies include nurses on advisory committees, commissions, and boards.

AARP & Nurses Join Forces to Support Caregivers With the Care Act

The Coalition of Geriatric Nursing Organizations (CGNO), whose membership includes over 28,700 nurses in long term care, joins AARP in support of the Caregiver Advise, Record and Enable (CARE) Act. The CARE Act codifies state law to assure each hospitalized patient has an opportunity to designate a caregiver in the hospital record, which action research has shown improves care transitions back into the community. The CARE Act was passed by the OK state legislature in May, 2014 with the support of the Oklahoma Nurses Association. Follow all of the action on this campaign on twitter with Elaine Ryan, AARP Vice President of State Government Affairs. Her handle is @Roamthedomes.

In 2012, Susan C. Reinhard authored a study with colleagues at the United Hospital Fund that showed the expanding role of family caregivers now includes performing medical/nursing tasks of the kind and complexity once only provided in hospitals. The study, Home Alone: Family Caregivers Providing Complex Chronic Care, found that almost half (46 percent) of family caregivers performed medical/nursing tasks for care recipients with multiple chronic physical and cognitive conditions. Of those family caregivers, 78 percent were managing medications, including administering intravenous fluids and injections.

AARP also conducted research with the Hartford Institute for Geriatric Nursing’s program Nurses Improving Care for Healthsystem Elders (NICHE) which has embedded geriatric models of care in over 470 hospitals across the country. They found that support of the caregiver improved both the caregiver and patient hospital experience. The key elements of the CARE Act include, designation of a caregiver in the hospital record, notification of the caregiver in a reasonable time prior to discharge, review of the discharge plan and demonstration by the caregiver that the care can be provided.

While the CARE Act applies to all hospitalized patients, frail elders with multiple chronic needs account for the vast majority of unnecessary rehospitalizations which cost Medicare $ 17 billion last year. Most post hospital care will continue to be provided by unpaid family or friend caregivers. They, and their family members they serve, need much support to maintain their quality of life and prevent bad outcomes. Implementing the CARE Act in each state will provide a system for enhancing caregiver support.

Read the CGNO press release here.
Read more about nurses and the CARE Act here.

Providing the Nurses We Need

Nurses are central to consumers’ good health, especially within a changing health care system. They are positioned across the health care system to provide high quality health care, increase access to health care services, and keep costs down. Yet, as our population ages and requires more complex health care, we’re facing a shortage of nurses – 260,000 over the next 15 years.

To ensure Americans have a nurse, with the right skills, when and where they need one, Congress should: 1) modernize Medicare nursing education payments to help produce more advanced practice nurses; 2) establish a reliable, dedicated source of funding for nursing education capacity; and 3) remove federal legislative and regulatory barriers that prevent advanced practice registered nurses from fully using their skills to provide services within Federal health programs.

NURSING AND HEALTH CARE UPDATES

Home Health Care Planning Improvement Act

On August 6, 2013, AARP sent a letter to Senators Collins and Schumer, and Representatives Walden and Schwartz endorsing the Home Health Care Planning Improvement Act. The bill would authorize nurse practitioners, clinical nurse specialists, certified nurse-midwives and physician assistants as eligible health care professionals who can order home health services under Medicare.

Read the letter.

News in Nevada

Nevada Gov. Brian Sandoval signed into law last month a bill that will help increase consumer access to primary care and prescription medication in the state. Enacting the law was a key priority of the Nevada Action Coalition, the Nevada Advanced Practice Nurses Association, AARP Nevada, and other stakeholders.

"It's a huge win," said Debra A. Toney, PhD, RN, FAAN, chair of the Nevada Action Coalition's executive committee and former president of the National Black Nurses Association. The law frees advanced practice registered nurses (APRNs) from binding practice restrictions that required them to work under the supervision of physicians. The removal of that requirement, Toney said, will help increase consumer access to care and medication in a state that desperately needs it.

The new law "will help close the primary care shortage gap for the state," Toney wrote in response to a recent blog post. "This opens up opportunities for nurse-led clinics to provide greatly needed services in these communities."

Signed into law in June, the bill gives APRNs full practice authority-a key goal of the IOM report on the Future of Nursing. Nevada is the 17th state, along with Washington, D.C., to allow APRNs to practice to the full extent of their education and training. Read more here.

Loosen Unneeded Nurse Practitioner Limits, See Results

As legislative liaison for the Nevada Advanced Practice Nurses Association, Susan S. VanBeuge is one of the top people who made Nevada's new law possible. See how she makes a forceful argument for the law in this op-ed, and use that when making the case for removing barriers in your state! Read the op-ed here.

VA Nursing Academy

The Senate Appropriations Committee commends the U.S. Department of Veteran Affairs for addressing the nursing shortage through the Veterans Affairs Nursing Academy. This pilot program established partnerships with competitively selected nursing schools to expand the number of teaching faculty in VA facilities and affiliated nursing schools in order to increase student enrollment in baccalaureate nursing programs.

The Committee notes the VA’s realization of a net-positive value for the pilot overall and urges the VA to continue its collaboration with the Department of Defense through the Uniformed Services University of the Health Services by providing nurse faculty and nursing students in the graduate nursing education programs through the external evaluation period.

House Nursing Caucus Welcomes New Co-Chair in January 2013

Freshman Congressman Dave Joyce announced on January 16 that he will co-chair the bipartisan House of Representatives Nursing Caucus. Rep. Joyce, an Ohio Republican, will join California Democrat Rep. Lois Capps in leading the caucus, which meets regularly to discuss issues related to the nursing profession. Read the rest of his announcement here.

News in Tennessee

Recently, the Tennessee Action Coalition had success at the end of 2012 and in January 2013 getting the word out about nursing scope of practice through several publications including an OpEd in the Nashville Tennessean January 2013 titled: "Tennessee Voices: Let Skilled nurses ease health burdens". Other items inlcude an article on scope of practice in The Tennessee Nurse showcasing its work resulting from a survey used to guage progress on the Future of Nursing: Campaign for Action within their state. Read more about the survey and other relevant articles on nursing scope of practice within the state here.

News in Virginia

AARP Virginia sent a letter to the Virginia Board of Nursing, commenting on proposed regulations concerning continuing professional competence for nurses seeking to renew their licenses. To ensure a highly-skilled, qualified health care workforce, AARP Virginia encouraged the Board of Nursing to require competence standards beyond the continuing education requirements currently in place.

News at the Center to Champion Nursing in America, DC

The Center to Champion Nursing in America contributed to a comment letter AARP submitted to the Centers for Medicare and Medicaid Services (CMS) on payment policies under the Medicare Physician Fee Schedule and other proposed revisions to Medicare Part B. The letter expressed support for pain management services provided by certified registered nurse anesthetists and voiced concerns about consumer access to durable medical equipment. The proposed requirement that physicians sign off on an extensive list of items including commonly prescribed items, such as blood glucose monitors and standard wheelchairs may create a barrier for consumers, many of whom routinely receive this needed equipment ordered by nurse practitioners and other advanced practice registered nurses as well as physician assistants. This proposed policy change runs contrary to current Medicare reimbursement practice.

The Center to Champion Nursing in America contributed to a comment letter AARP submitted to the Centers for Medicare and Medicaid Services (CMS) on proposed updates to the Home Health Prospective Payment System (HH PPS) rates and addresses other home health changes, including hospice quality reporting. AARP encourages CMS to allow advanced practice registered nurses such as nurse practitioners to order home health services, which could prevent possible delays in accessing needed care. Read more here.

The Center to Champion Nursing in America contributed to a letter AARP sent to Senator Conrad (D-ND) endorsing his legislation entitled the "Craig Thomas Rural Hospital and Provider Equity Act of 2011" (S. 1680). Senator Conrad’s bill would also add certified nurse-midwives and clinical nurse specialists to the list of eligible health care providers who can conduct face-to-face encounters with patients to determine eligibility for Medicare home health services. More importantly, the legislation would allow nurse practitioners, certified nurse-midwives, clinical nurse specialists, and physician assistants to certify for home health services for Medicare beneficiaries. Allowing these advanced practice registered nurses to certify home health services could decrease costs, expedite treatment by eliminating the need for physician sign-off, and allow patient-centered health care teams to practice more efficiently. (July 23, 2012)

The Center to Champion Nursing in America contributed to a comment letter AARP submitted to the Centers for Medicare and Medicaid Services (CMS) regarding increased Medicaid payment rates for primary care providers. The letter encouraged CMS to include advanced practice registered nurses and physician assistants, who currently provide primary care services across the country, as providers eligible for these increased payments. (June 11, 2012)

News in Connecticut

AARP Connecticut submitted testimony in support of Senate Bill 414, which allows Advanced Practice Registered Nurses (APRNs) to sign forms to authorize needed health care services. This bill would increase consumers’ access to support services by allowing APRNs to sign, certify or give an authorization where a physician is allowed or required to do so.

News in Louisiana

AARP Louisiana offered support for House Bill 951, which proposed to remove a mandatory collaborative practice agreement between physicians and nurse practitioners who practice in medically underserved areas, thereby increasing consumers’ access to health care.

AARP Missouri submitted testimony in support of Senate Bill 679, which proposes to increase consumers’ access to health care by removing the mandated collaborative agreement between physicians and advanced practice registered nurses and instead would allow a written protocol or a standing order.

AARP and members of the Nursing Community sent a letter to the Federal Trade Commission expressing support of their efforts to promote competition, access, and choice in health care through opinions on proposed regulations and legislation affecting Advanced Practice Registered Nurses’ scope of practice.

AARP Virginia submitted a letter in support of a Virginia Department of Health Professions’ study regarding scope of practice for nurse practitioners, the elimination of barriers to practice, and health care access for consumers.

AARP submitted a letter to Members of Congress expressing serious concerns with the House Reconciliation proposal pursuant to the Fiscal Year 2013, including provisions affecting state health insurance exchanges, Medicaid and CHIP provisions, and the repeal of the prevention and public health fund.

Along with partnering national nursing organizations, AARP sent a letter thanking CMS Acting Administrator Marilyn Tavenner for her leadership on the recently-released Graduate Nurse Education (GNE) Demonstration solicitation. The letter also requested a 30-day extension of the proposal deadline to allow additional time for questions and clarification.

AARP applauds Medicare Graduate Nurse Education Demonstration. In a statement released earlier this week, AARP applauded the CMS Innovations Center's recent release a request for proposals to implement an initiative to produce more advanced practice nurses (APRNs). The Medicare Graduate Nurse Education demonstration program, established by the Affordable Care Act (ACA), will provide $200 million over four years to create partnerships between hospitals, schools of nursing and community-based providers such as community health centers, and will help to incentivize the production of more highly skilled nurses.

AARP Comments to Marilyn Tavenner, Acting Administrator for the Centers for Medicare & Medicaid Services, about the proposed rule on “Reform of Hospital and Critical Access Hospital Conditions of Participation.” AARP recommended that the proposed regulation be modified to clearly state that APRNs be eligible for clinical privileges, admitting privileges, and medical staff membership including voting privileges and that hospital policies assure that the process for making these decisions are transparent, objective and timely. (See PPI publication Removing Barriers to APRN Care: Hospital Privileges for more information). (December 21, 2011)

AARP responded to a Request for Information from the Centers for Medicare and Medicaid Services (CMS), and encouraged clear communication, delivery reform, patient engagement, and quality care measures in the development of ACOs. In this letter, AARP also encouraged CMS to adopt the Institute of Medicine’s definition of “primary care” so that practices led by Advanced Practice Registered Nurses (APRNs) and Nurse-Managed Health Centers can participate in ACOs. (December 3, 2011)

AARP New York letter to the Co-chairs, Workforce Flexibility/Change of Scope of Practice Work Group recommending the removal of scope-of-practice barriers for advanced practice registered nurses (APRNs) in New York state. (December 2, 2011)

In a June 2011 comment letter to CMS, AARP expressed concern at the exclusion of Federally-Qualified Health Centers, Rural Health Centers, and nurse-led medical/health homes as eligible providers and suppliers in ACOs, since each of these entities provides primary care, particularly to medically underserved populations. (June 6, 2011)

AARP Comments on the proposed statement of antitrust enforcement policy regarding Accountable Care Organizations participating in the Medicare shared savings program (“Proposed Statement”). (May 31, 2011)

AARP Comments to Don Berwick, CMS Administrator, about the proposed rule regarding the Face-to-Face Requirements for Medicaid Home Health Services.

The law requires that a physician, nurse practitioner, clinical nurse specialist, certified nurse-midwife, or a physician assistant have a face-to-face encounter with the individual before a physician certifies the individual’s need for home health services. AARP pointed out that this is an extra step for patients whose primary care provider is an advanced practice registered nurse (APRN), leading to increased costs and delays in accessing home health care. AARP believes that APRNs should not just conduct the face-to-face encounter, but be able to order (certify) home health services (i.e. sign the forms authorizing services). AARP has consistently supported legislation that would allow APRNs to certify patients for home health services. (September 12, 2011)

A Letter of Endorsement: AARP Supports Home Health Care Planning Improvement Act (H.R. 2267), co-sponsored by Representative Allyson Y. Schwartz (D-PA).

A Letter of Endorsement: AARP Supports Home Health Care Planning Improvement Act (H.R. 2267), co-sponsored by Representative Greg Walden (R-OR).

A Letter of Endorsement: AARP supports Home Health Care Planning Improvement Act of 2011, co-sponsored by Senator Susan M. Collins (R-ME).

A Letter of Endorsement: AARP supports Home Health Care Planning Improvement Act of 2011, co-sponsored by Senator Kent Conrad (D-ND).

Letter to CMS: AARP outlines its priorities related to Accountable Care Organizations, including ensuring that nurse-led practices and nurse-managed health clinics are considered providers within ACOs and ensuring that accurate outcomes data is captured, including for care provided by advanced practice registered nurses.

Statement from Nancy LeaMond: AARP Urges Bi-Partisan Support for Home Health Companion Bills

A Letter of Endorsement: AARP supports Home Health Care Planning Improvement Act of 2010, sponsored by Representative Allyson Y. Schwartz (D-PA 13)

A Letter of Endorsement: AARP supports Home Health Care Planning Improvement Act of 2010, sponsored by Senator Susan M. Collins (R-ME)

Statement from Susan Reinhard: AARP Applauds HHS Investments in Primary Care

Statement from Susan Reinhard: AARP Applauds Medicare Graduate Nursing Education

Nursing

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