The Nurse Is In: A Solution for Healthcare in Rural Ohio

The Situation. In just a few years, one in four Ohioans will be age 60 and older. Adding to this dynamic is the reality that the oldest members of the millennial generation have already begun turning 40. We know from repeated surveys at AARP that most older adults want and intend to age in their current home or community.

Safe, convenient, and affordable access to healthcare providers in their own communities or within a reasonable driving range is crucial to ensuring Ohio’s aging population thrives. However, there is one threat to this success: health professional shortage areas.

As defined by the Health Resources & Service Administration, health professional shortage areas are geographic areas, populations, or facilities that lack an acceptable amount of health providers or services. HPSAs are also referred to as “health deserts.”

A total of 1,770,848 people live in an Ohio primary care HPSA according to data released in March. Eighty-one of 88 counties in Ohio have at least one designated primary care shortage area, meaning they lack access to primary care services in their community.

The Disparity. There is a significant disparity between rural areas and non-rural areas (including urban areas) with primary care professionals. Rural areas are more than twice as likely to be designated as HPSAs than urban areas. Access to physicians is simply easier in urban areas, compared to the long distances that may be driven in rural areas. According to a 2014 report by the National Center for Health Statistics, there are only 39.8 primary care physicians per 100,000 people in rural areas, compared to 53.3 in urban areas.A 2020 report by the University of Minnesota’s Rural Health Research Center examines health outcomes and the social determinants of health for older adults. The results show that rural older adults face a different set of challenges. Compared to urban counterparts, rural older adults:

• Are more likely to suffer heart attacks and stroke
• Are less likely to have seen their regular doctors within the past year
• Are more likely to have disabilities

Health deserts remain a pervasive problem for all regions of Ohio, but especially its rural areas as demonstrated in 2018 data compiled by County Health Rankings. In Ohio, Delaware County has a ratio of 1 primary care physician for every 690 people. In Cuyahoga County, this ratio is 1:890. However, in Morgan County, there is only 1 reported primary care physician to serve the population of 14,600 people. Even in Cuyahoga County, there are 16 primary care HPSAs.

The Red Tape. Outdated policies are hampering solutions to cure these health disparities. Research suggests that by allowing advanced practice registered nurses (APRNs) and nurse practitioners (NPs) to fill vacancies in health deserts are vital to filling these health services gaps.  The Future of Nursing: Leading Change, Advancing Health, published in 2011, provides an elaborate examination of the nation’s changing landscape of healthcare, and how reform and nurses are necessary to meet it. The National Center for Biotechnology Information summarizes, “although APRNs are highly trained and able to provide a variety of services, they are prevented from doing so because of barriers, including state laws, federal policies, outdated insurance reimbursement models, and institutional practices and culture (IOM, 2011).”Ohio is currently a reduced practice state, which the American Association of Nurse Practitioners explains, “State practice and licensure laws reduce the ability of NPs to engage in at least one element of NP practice. State law requires a career-long regulated collaborative agreement with another health provider in order for the NP to provide patient care, or it limits the setting of one or more elements of NP practice.” Ohio law defines a standard care agreement, which requires practicing NPs to work with a physician.

According to the American Association of Nurse Practitioners, states restricting advanced nurses from practicing primary care without doctors are more associated with geographic disparities, more chronic disease, and primary care shortages. Moreover, these restrictions are associated with higher costs of care and lower national health rankings. Depriving Ohio of the benefits is both immoral and unnecessary.

A Solution. AARP Ohio has backed Ohio House Bill 221, Enact Better Access, Better Care Act, which would end anti-competitive standard care agreements statewide and allow APRNs and NPs to open up primary care practices in much-needed regions.

States that already grant advanced nurses full authority, they are more likely to work in rural and underserved communities while maintaining the highest standards and keeping care affordable by removing anti-competitive licensing.

A Virtual Event: The Nurse Is In: A Solution for Healthcare in Rural Ohio. AARP Ohio hosted The Nurse Is In: A Solution for Healthcare in Rural Ohio on Monday, July 26. The panel discussion addressed primary care shortages and health challenges impacting older Ohio residents’ quality of life. AARP Ohio State Director Holly Holtzen stated:

It's critical to address primary care shortages in Ohio to take care of older Ohioans and support the state’s 1.5 M family caregivers. These health deserts are a serious problem especially in rural Ohio. Rural residents have greater transportation difficulties reaching health care providers, often traveling great distances to reach a doctor or hospital. When you factor in the needs of older Ohioans, many who rely on family caregivers for their transportation, you can quickly see how this is a tremendous barrier to quality health care.

AARP Ohio hosted the panel discussion, which examined the intersections between primary care shortages in 81 of 88 Ohio counties, the outdated restrictions facing advanced practice nurse practitioners in Ohio and the promising solution introduced in Ohio House Bill 221 that could alleviate the state’s primary care shortages. The bill was introduced by Ohio State Representatives Jennifer Gross and Thomas Brinkman and Brinkman was also a panel member. Charlie Katebi, health policy analyst for Americans for Prosperity and panelist remarked:

The past year combating Covid-19 shows Ohio faces a shortage of health care providers, making it harder for people to access the care they need. However, we have qualified health professionals who are already trained to deliver critical care services to Ohioans, but are unable to practice the full extent of their medical expertise due to unnecessary bureaucratic red tape.

AARP Ohio thanks Rep. Brinkman for sponsoring this bill that gives Ohioans more health care options and looks forward to how the discussion can help expand and improve health care for the communities that need it the most.

Joining Katebi and Brinkman, were panelists Dr. Edward Timmons, expert on occupational licensing and Professor of Economics and Director of the Knee Center for the Study of Occupational Regulation at Saint Francis University and Samantha Cater, DNP, ARPN, NP-C from the Ohio Association of Advanced Practice Nurses and a family nurse practitioner in New Concord.