More than 10 percent of students in Maine Public Schools have "chronic health conditions," such as asthma, type-1 diabetes and seizure disorders. Some local school officials say they believe the numbers of students with serious health needsis growing. This can lead to a particularly difficult problem in small, rural school districts, which may not have a full-time school nurse.
In the middle of her kitchen in Farmington, a woman we'll call Betsy pulls out a blood sugar monitor, a syringe and a vial of insulin for her 6-year-old son Bryce. Betsy asked that we not use her last name due to privacy concerns. Bryce cringes when he sees the needle, but over the past few months, he's become well-acquainted with it.
“So I'll give him insulin now and then the school will give it in three hours,” Betsy says. “Plus snacks. Okay, Ready?”
This is a routine that Bryce goes through several times a day, after having been diagnosed with Type 1 Diabetes last October. The disease requires constant maintenance in the forms of blood checks and injections from early in the morning until late at night.
Betsy says the diagnosis changed everything for Bryce and the whole family. Both Betsy and her husband work in the medical field, and she says it was hard at first to just send Bryce to school.
"We know that insulin can save his life. And it can also end his life, if given too much or too little," she says. "So, therefore, the first few weeks after going back to school, my husband and I took time out of our own schedule and went in and assisted the school nurse and teachers, did some education and training with injections, recognizing high and low blood glucoses."
The family's situation was complicated by the fact that the local Mallett Elementary School doesn't have a full-time school nurse. The nurse is out, at other schools, one-and-a-half days per week. In some cases, MaineCare can help pay for a private-duty nurse for students, but that wasn't the case in this situation. Betsy says she considered going in to school to take care of Bryce herself.
“Or hire a private nurse, which we don't have the means to take care of? It left me, for five weeks, wondering if I'd have to leave my own position,” she says.
RSU 9 Superintendent Tina Meserve sees the nursing limitations in the context of a larger issue facing schools, particularly in rural Maine: a growing number of students with serious health conditions.
A recent report from the the Maine Department of Education finds that more than 10 percent of students across the state have “chronic conditions" such as diabetes, seizure disorders or life-threatening allergies.
"That's my big right challenge now. We have a lot of kids with mental, health needs. Students with a lot of physical health needs that are serious," Meserve says. "We want to be able to provide for them. And we also want to make sure that when they're unexpected, and there's high cost, there are some resources available for schools to be able cover that".
But in some cases, those resources just aren't there. Kelley Strout, a professor of nursing at the University of Maine says that, in general, according to her research, more affluent school districts in Maine tend to provide more nurses per child, than do some poorer districts, like those in Washington County.
“What we see is that those schools are strapped more for resources,” says Strout. “And they don't get the health resources that the affluent schools have, that are doing well.”
The state's education funding formula provides one nurse for every 800 students in larger districts, and one for every 720 students in smaller ones. Those are numbers that many local officials say are inadequate and far too broad — and that don't take into the account the precise needs of students within each school.
Janis Hogan, a school nurse at Camden Hills Regional High School, says adequate nursing can improve everything from nutrition to student attendance, but that's often not so when a nurse is stretched thin.
“Prior to working here, I had five schools, I had 850 students, five administrators, five sets of parents, staff, had to train anybody on different issues. So it was really just putting out fires, putting out fires, putting out fires,” Hogan says.
And even when there is enough money to pay for nursing staff, smaller districts can have a hard time finding people to fill the positions. Jill Adams is the executive director of MADSEC, the organization that represents Maine special education administrators. She says the toughest positions to fill are often special education teachers, speech therapists and nurses.
"I'm sure that many of the places up North, over west, even in the southern part of the state, they have difficulty sometimes finding these services," Adams says.
To solve the problem, schools have limited options.
Atlee Reilly, a managing attorney with Disability Rights Maine, says schools must provide care when a doctor finds it necessary.
"If a child needs a nurse to access education, or access to a nurse, it has to be provided," Reilly says.
Occasionally, students can be sent to another school with more medical resources, though that can lead to transportation issues. Administrators say that for some services, such as speech therapy, schools have used video to connect with providers in other states.
Eric Herlan, an attorney who specializes in special education law, says a common strategy for schools is to is to consult with doctors to determine which services truly require a nurse, and then designate trained staffers for other needs.
"And to get the doctor to think hard about what the particular functions actually are that have to be done for this medically fragile child," Herlan says.
Back in Farmington, the district has found a temporary solution for Betsy and her son, Bryce. It's brought in a substitute nurse to Bryce's school on certain days.
But superintendent Tina Meserve says with severe medical needs for students across the district, officials are still working on a permanent solution that will provide enough care for every student. Meserve wants to see more assistance from the state to help with serious medical needs.
"The ideal would be for there to be funding to cover the additional need so you don't have to pull resources from other sites who already have, maybe two-and-a-half-days, or partial coverage, to begin with," Meserve says.
For Betsy, the current fix has brought some relief to the family during the school day.
"Whether she needs to go get him on a playground or give him a snack before gym class, so he can participate in as many normal activities as possible,” Betsy says.
But Betsy says she expects that as her son grows up, she'll need to keep working to ensure that he gets the care he needs.
Originally published 5:36 p.m. Jan. 25, 2019
