This week is both National Hospital Week and National Nurses Week, which happens to be a “happy coincidence.” As I like to say, nurses put the heart in healthcare, and it’s very often our nurses who are the “face” of hospitals and provide the human connection between New Jersey’s hospitals and the 18 million individuals they serve each year.

It’s fitting that I started the week in Washington, D.C., for the American Hospital Association’s Annual Meeting. Much of the meeting was focused on patient-centered care. Among the speakers was Teri Fontinot, the new chair of AHA and CEO of Woman’s Hospital in Baton Rouge, La., who coined a new mantra: “If it’s right for the patient, then it’s right for the hospital.”

One of the freebies I received at the AHA meeting was a blue bracelet commemorating Hospital Week – blue, like those block H signs along our roadways that signal the path to the nearest hospital. We pass them every day, taking them for granted as they blend into the landscape. But in an emergency, those blue signs stand out like a beacon, leading to one of New Jersey’s 73 acute care hospitals that deliver healthcare services 24 hours a day, seven days a week, 365 days a year to everyone, regardless of their ability to pay. It’s reassuring to know they’re there.

I’m asked very often how I like my job. And I can sincerely say I love it because I get to wear the white hat representing a part of society that takes care of people each and every day. But the true heroes are the hospital professionals who take care of our patients – including our nurses, the original “white hats.” So Happy Hospital Week and Happy Nurses Week – and thanks to both for their perfect synergy in taking care of our patients and our communities.

There’s been a lot of buzz this week about a news segment on the NBC program Rock Center about “permanent patients” – that is, patients who in essence become tenants at acute care hospitals because there’s nowhere for them to go once they’re discharged. These patients can stay for months and sometimes years, even if they no longer need an acute level of healthcare services. And because many of these patients lack health insurance, they can rack up overwhelming costs that the hospitals must absorb.

The news team shared stories from hospitals in New York, Illinois, Florida and Arizona, but I've seen it here in New Jersey as well. Very often these patients are uninsured; sometimes they are undocumented immigrants. They arrive at the hospital for needed care. And when they've recovered enough for discharge – but perhaps still need ongoing care in a nursing home or rehabilitation facility – the hospital may not be able to find a facility to accept the patient. Many post-acute facilities provide charity care and otherwise work with patients who are uninsured or underinsured, and I applaud them. But even with their efforts, there remains a systemic lack of access to care for many of these patients.

Rock Center spoke to Ashish Jham, a professor at the Harvard University School of Public Health, who estimated that there are tens of thousands of these patients stuck in the nation's hospitals with no clear place to go.

I don't share this tale to protest hospitals' role as our society's healthcare safety net. It's an intrinsic part of hospitals' mission and they willingly accept the legal and moral obligation. But it is important to understand this problem and the tremendous burden it places on our hospitals. That safety net role requires adequate recognition and financial support from government and other healthcare stakeholders.

Unfortunately, with the continued uncertainty surrounding health coverage in our nation, this problem – like these permanent patients – could be with us for a long, long time.

Guest Blog by Aline Holmes, RN, director of the NJHA Institute for Quality and Patient Safety.

I’ve been fortunate to have served as a nurse for more than 40 years. I’ve witnessed a long list of medical advances over the years – not the least of which is the lifesaving possibilities of organ transplants. I’ve seen patients with just days to live transformed into vibrant, healthy individuals, thanks to the tremendous gift of organ donation.

There currently are about 110,000 men, women and children across the United States awaiting a lifesaving transplant. 5,000 of them are our neighbors right here in New Jersey. A new name is added to the national waiting list every 12 minutes. And sadly, an average of 18 people die in our country every day, still waiting for a transplant.

Despite New Jersey’s rising national reputation in delivering quality healthcare, the Garden State has fallen behind in organ donation. Our state ranks 41st out of the 50 states, with only 31 percent of eligible residents registered as organ and tissue donors. New Jersey is working hard to reach the national goal of 50 percent registered donors, and I applaud the state’s hospitals and our two organ procurement organizations for their efforts to boost organ donation.

But the biggest heroes in organ donation are the selfless individuals who add their names to the organ donor registry. April is the national observance of Donate Life Month. I urge all of you to register as an organ donor. You can join New Jersey’s list of registered organ donors the next time you renew your driver’s license. Or, better yet, act today through the state’s Motor Vehicle Commission, accessible via the Web site www.donatelifeNJ.org.

Day 3 of oral arguments on the Affordable Care Act brought more food analogies, as the justices and attorneys debated whether the rest of the law should stand even if the individual mandate is held to be unconstitutional. Most of the attorneys argued, and Justices Scalia and Roberts seemed to agree, that the law is so large, with so many components, that it should fall in its entirety if the individual mandate is declared unconstitutional.

The justices demonstrated a good working knowledge of how Congress operates, noting that some components like the Cornhusker Kickback were added to get votes. Some justices asked whether or not some of the provisions should be allowed to stand because they are clearly constitutional and at least we’d be left with “half a loaf.” But most seem to agree, as I do, that if the mandate is struck down, we will be left with an empty shell and that the component parts of the law were integral to passage of the entire act.

In day 2 of the Supreme Court arguments on healthcare reform, most legal analysts say the individual mandate in the Affordable Care Act is in trouble based on the oral arguments. The good news is that eight justices were very engaged in asking questions (Justice Thomas apparently hasn’t asked a question in over six years). I just heard a snippet of the arguments where Justice Antonin Scalia questioned whether allowing the government to require individuals to buy health insurance could allow them to mandate other purchases. Like broccoli.

It’s a flawed analogy, and here’s why:

• All people need healthcare at some points in their lives, and if they do not obtain insurance, the cost of their care is shifted onto those with insurance. Not the case with broccoli eaters. For them, broccoli is a choice. And if they don’t buy broccoli, they might instead buy peas, beans or vitamins, or nothing at all (in which case they will need our healthcare system!)
• The government doesn’t mandate that all people, broccoli eaters or not, be able to eat free in America’s restaurants when they are really hungry. And they certainly don’t expect other diners to foot the bill for someone who can’t or won’t pay. But that’s what happens in our country with respect to healthcare. Under the federal EMTALA law, all hospitals must treat and stabilize all people who present in the emergency room, regardless of their ability to pay. In New Jersey, the legal mandate goes even further to include not just the ED but all settings.
• There is no supermarket for the uninsured. Hospitals and federally qualified health centers are their safety nets. Commercial insurers aren’t looking to provide them with free insurance. But broccoli is freely available at any grocery store or produce stand.

I’m proud of Justice Scalia and have a deep respect for him. After all, he’s a Jersey boy who made good. But his broccoli analogy leaves me hungry for some thoughtful analysis.