COMING UP, ALMOST TWO YEARS IN THE COVID PANDEMIC, CASES ARE CLIMBING ONCE BEGIN.

NOW MANY HEALTHCARE WORKERS ARE LEAVING THEIR JOBS EXHAUSTED AFTER WAVES OF DISEASE.

AS WINTER APPROACHES, IS OUR MEDICAL SYSTEM STRETCHED TOO THIN?

AND WHAT MORE CAN BE DONE TO PREVENT THE NEXT SURGE?

WE'LL TAKE UP THOSE QUESTIONS NEXT ON CONNECT NEW YORK.

WELCOME TO CONNECT NEW YORK.

I'M DAVID CHANATRY FROM UTICA COLLEGE.

IN MUCH OF THE NATION AND HERE IN NEW YORK, COVID CASES ARE AGAIN ON THE RISE.

WITH THE HOLIDAYS APPROACHING, CONCERN IS ON THE RISE, TOO.

THAT ANOTHER WAVE COULD BE ON THE WAY.

IT IS DIFFERENT THIS TIME.

68% OF NEW YORKERS ARE NOW FULLY VACCINATED BUT THE HEALTHCARE SYSTEM HAS TO CARE FOR LARGE NUMBERS OF SEVERELY ILL PATIENTS AND THAT SYSTEM ITSELF IS UNDER STRESS.

THOUSANDS OF HEALTHCARE WORKERS, DOCK DOCTORS, NURSES AND OTHERS HAVE QUIT THEIR JOBS, BURNED OUT BY THE NEVER ENDING PANDEMIC.

IS THE HEALTH SYSTEM READY FOR ANOTHER SURGE?

IS THE STATE VACCINE MANDATE DOING MORE HARM THAN GOOD?

HOW COME HOSPITALS AND HOME HEALTHCARE PROVIDERS FACE SEVERE STAFFING SHORTAGES EVEN BEFORE COVID HIT?

WE'LL CONSIDER THOSE QUESTIONS AND MORE WITH OUR GUESTS, Dr. PHILLIP FALCONE, CHIEF MEDICAL OFFICER FOR ST. JOSEPH'S HEALTH IN SYRACUSE, MELODIE KOLMETZ, CENTRAL NEW YORK DISTRICT DIRECTOR OF NEW YORK STATE SOCIETY OF PHYSICIANS ASSISTANTS, BRYAN O'MALLEY EXECUTIVE DIRECTOR OF CONSUMER DIRECTED PERSONAL ASSISTANCE ASSOCIATION OF NEW YORK STATE AND ADAM SETH LITWIN ASSOCIATE PROFESSOR AT CORNELL UNIVERSITY SCHOOL OF INDUSTRIAL AND LABOR RELATIONS.

IT HAS BEEN A WHILE SINCE WE'VE HEARD OF COVID.

AND THE UNCERTAIN FIRST FEW MONTHS, THE BIG SPIKE LAST WINTER.

WE THOUGHT WE WERE OVER IT AND LEARNED THE HARD WAY WE WEREN'T.

SO WHAT ARE WE SEEING NOW?

CAN YOU GIVE US THE BIG PICTURE LAY OF THE LAND IN TERMS OF CASES, HOW MANY DO YOU HAVE AT ST. JOE'S AND HOW MANY AROUND THE STATE RIGHT NOW?

>> HERE IN CENTRAL NEW YORK ONONDAGA COUNTY, WE HAVE SEEN ABOUT 1300 OR MORE HOSPITAL ADMISSIONS, WHICH IS 13% HIGHER OVER THIS PAST WEEK THAN WHAT WE EXPERIENCED PREVIOUSLY.

AT ST. JOE'S WE ARE RUNNING ABOUT 45 PATIENTS CURRENTLY IN-HOUSE THAT HAVE COVID AND I THINK THE CENTRAL NEW YORK POSITIVITY RATE IS RUNNING ABOVE 6%.

SO WE ARE STILL SEEING AN INCREASE AND DEFINITELY IN THE LAST FEW WEEKS, THE PERCENT POSITIVITY RATE HAS INCREASED FROM 4% UP TO OVER 6% NOW.

>> SO ARE YOU CONCERNED ABOUT THE WINTER?

WE GO BACKIN' DOORS?

IS THIS TROUBLING?

>> I AM CONCERNED.

WE ARE GOING TO BE OR DEALING WITH TWO THINGS.

NOT JUST COVID BUT WE ARE OR DEALING WITH THE FLU AND THIS YEAR COULD POTENTIALLY BE MORE OF AN ISSUE.

THE FACT THAT WE WERE ALL VERY CAREFUL LAST YEAR WITH MASKING AND HANDWASHING AND BEING VERY CLOSE, AVOIDING BEING CLOSE TO EACH OTHER, I THINK THAT REDUCE REDUCED THE NUMBER OF FLU CASES.

WE SAW FEW IF ANY FLU CASES.

THIS YEAR WE ARE RUNNING INTO A POTENTIAL SITUATION WHERE IT COULD BE A PROBLEM IN COMBINATION WITH THIS NEXT SURGE OF COVID CASES.

>> ARE PEOPLE NEGLECTING TO GET THEIR FLU SHOTS BECAUSE THERE IS SO MANY EMPHASIS ON COVID.

>> I THINK SOME PEOPLE ARE RELUCTANT OR HAVE BEEN RELUCTANT.

WE HAVE DONE EVERYTHING WE CAN TO GET THE MESSAGE OUT THAT YOU SHOULD GET VACCINATED, PARTICULARLY THIS YEAR MORE SO THAN EVEN YEARS IN THE PAST AND I THINK IT'S IMPORTANT FOR PEOPLE TO KNOW THAT THEY CAN GET BOTH.

IF THEY WANT TO GET VACCINATED FOR COVID, THEY CAN GET THE FLU VACCINE AT THE SAME TIME.

HOPEFULLY PEOPLE WILL TAKE THAT INTO CONVERSATION AND UNDERSTAND THIS IS A PARTICULARLY IMPORTANT TIME TO HAVE IT DONE.

>> AND IN TERMS OF COVID, UNLIKE LAST YEAR, THIS YEAR, THERE ARE THINGS YOU CAN DO.

I MEAN THERE ARE TREATMENTS AVAILABLE NOW COMING ONLINE?

>> CERTAINLY VACCINATION IS THE NUMBER ONE THING I ADVISE FOR EVERYBODY TO CONSIDER DOING BECAUSE IT GIVES YOU THE MOST PROTECTION.

BOOSTERS FOR THOSE WHO ARE REQUIRING IT OR NEED IT, I THINK ARE ALSO IMPORTANT AT THIS POINT BECAUSE WE KNOW THAT OVER THE SIX MONTHS OR SO FOLLOWING THE FINAL DOSE OF YOUR INITIAL VACCINE, THAT YOUR IMMUNITY DOES WANE SO GETTING A BOOSTER, PARTICULARLY THOSE ELDERLY OR IMMUNE OWE COMPROMISED SHOULD DO THAT AND THOSE OF US IN HEALTHCARE SHOULD CONSIDER DOING IT.

I THINK THERE ARE THINGS THAT WE CAN DO.

NOW THERE ARE NEW MEDICATIONS COMING OUT, ORAL MEDICATIONS THAT COULD HELP REDUCE THE RISK OF SOMEBODY BEING ADMITTED TO THE HOSPITAL.

>> AND IF THEY ARE ADMITTED, THERE IS SOMETHING ELSE YOU CAN STILL GIVE THEM.

>> CORRECT.

>> MELODIE KOLMETZ, YOU WORK WITH PHYSICIANS ASSISTANTS SO THEY'RE RIGHT ON THE FRONT LINE OF ALL OF THIS AND AFTER OAFERG THAT HAS TRANSPIRED OVER THE PAST 20 MONTHS, HOW ARE THEY FEELING WITH HAVING TO DEAL WITH THIS AGAIN?

>> LOTS OF FRUSTRATION.

BUT LOTS OF HOPE.

THE PROFESSION HAS BEEN GROWING SINCE THE LATE 1960s WHEN IT FIRST DEVELOPED AFTER THE VIETNAM WAR AND ONE OF THE STRENGTHS OF THE PA PROCESSION IF FOR EXAMPLES IS THAT WEARIED INDICATED IN THE MEDICAL MODEL.

WE ARE GENERALISTS.

AS A RESULT OF THE COVID PANDEMIC, MANY OF US WERE CALLED UPON TO FLEX AND USE SOME OF THE SKILLS AT THAT TIME WE LEARNED YEARS AGO.

MANY OF US DID JUST IN TIME TRAINING AND MOVED TO OTHER AREAS OF CLINICAL PRACTICE.

AND AS A RESULT, SOME PEOPLE FOUND A LOVE FOR SOME AREAS OF MEDICINE THAT THEY HAVEN'T HAD AN OPPORTUNITY TO EXPERIENCE BEFORE.

SO THERE ARE SOME POSITIVITY OUT OF THAT.

>> THAT IS FINDING THE SILVER LINE EXPWHRG ABSOLUTELY.

>> BUT THE FIRST THING YOU SAID IS THERE IS SOME FRUSTRATION.

>> SURE.

>> FRUSTRATION WITH WHAT.

>> I THINK FRUSTRATION WITH ITSELF THE SIS TECHNOLOGIES IN GENERAL THAT WERE ALREADY STRESSED BEFORE THE COVID PANDEMIC.

FRUSTRATION BECAUSE PAs ARE CARING FOR PATIENTS ON THE FRONT LINES BUT THEY'RE ALSO RESPONSIBLE, AS ARE THE REST OF US WHO WORK IN HEALTHCARE, FOR LOOKING OUT FOR THEIR FRIENDS AND THEIR FAMILIES AND THEIR NEIGHBORS AND TRYING TO GIVE GOOD REPUTABLE EVIDENCE-BASED INFORMATION WHEN THEY'RE ASKED.

THEY FEEL LIKE THEY'RE EDUCATING ALL THE TIME AND THAT IS TIRING AFTER A WHILE YOU.

>> NEVER GET A MOMENT TO LET THE GUARD DOWN BECAUSE SOMEONE IS ALWAYS SAYING WHAT IS THIS AND THERE IS SO MUCH MISINFORMATION FLOATING AROUND.

>> ABSOLUTELY.

>> SO THEY HAVE TO DEAL WITH THAT AS WITH EL.

>> 100%.

>> PROFESSOR ADAM SETH LITWIN, YOU STUDY HEALTHCARE STAFFING, AS I UNDERSTAND IT.

>> I DO.

>> AND HOW BIG A PROBLEM WOULD YOU SAY THIS IS AROUND THE STATE IN TERMS OF SHORTAGES-- WELSHING I GUESS THERE IS THE PRE-COVID AND POST-COVID DISTINCTION.

LET'S STICK WITH THE POST-COVID FOR A MINUTE.

ARE YOU SEEING THAT PEOPLE ARE LEAVING THE PROFESSION?

>> WE ARE.

MY COLLEAGUES AT THE I.L.R.

SCHOOL HAVE BEEN STUDYING THE HEALTHCARE WORKFORCE ACROSS THE STATE VERY CLOSELY FOR FOR A LONG TIME.

AND I THINK MOST IMPORTANT POINT TO BRING ACROSS IS THAT THIS IS REALLY NOT ABOUT THE VACCINATION MANDATE OR, IN SOME WAYS NOT EVEN ABOUT COVID.

THIS IS A REALLY STRUCTURAL ISSUE THAT HAS EXISTED FOR A VERY LONG TIME BECAUSE FRONT LINE HEALTHCARE WORKERS ARE JUST BURNED OUT.

THAT WAS TRUE BEFORE COVID BUT WE KNOW THE BUREAU OF LABOR STATISTICS TELLS US THAT WE HAVE LOST ABOUT HALF A MILLION HEALTHCARE WORKERS SINCE THE START OF THE PEB FEBRUARY 2020.

ONE IN FIVE HAVE ACTUALLY LEFT MEDICINE ALL TOGETHER AND SO JUST IN TERMS OF NUMBERS, WE KNOW THERE IS A REAL PROBLEM.

THAT SAID, THERE ARE ISSUES BOTH PSYCHOLOGICAL AND ECONOMIC AND I THINK THEY FEED INTO ONE ANOTHER.

PSYCHOLOGICAL, AS I SAID, FRONT LINE HEALTHCARE WORKERS ARE REALLY LEAVING IT ALL ON THE FIELD.

THEY'RE GIVING ALL OF THEIR EMOTION AND ENERGY TO THEIR PATIENTS AND THEIR PATIENTS FAMILIES AND EMPLOYERS DURING THE DAY AND THEN THEY GO HOME AT NIGHT LOOKING FOR A RESPITE AND END UP ARGUING WITH THEIR FRIENDS OR RELATIVES ABOUT WHETHER OR NOT THE PANDEMIC IS ANY WORSE THAN THE SEASONAL FLU OR WORSE THAN THAT, WHETHER OR NOT THE PANDEMIC IS A HOAX.

I THINK IN GENERAL THEY'RE JUST RUNNING OUT OF ENERGY, RIGHT?

AND THEN THEY GO BACK TO WORK.

THEY THINK THEY'RE GETTING PAST THE HUMP AND THEN THEY'RE OR DEALING WITH THE DELTA VARIANT, PREMATURE LIFTING OF MASK MANDATES AND ARMY OF ANTI-VACCSERS.

IT IS GETTING DIFFICULT TO THEM PSYCHOLOGICALLY.

IN MOST LABOR MARKETS IF THEY HAVE A HIGH QUALITY JOB THEY HOLD ON TO IT.

IN THIS LABOR MARKET, THEY'RE SAYING WE DON'T REALLY HAVE TO.

THIS IS WHERE THE ECONOMIC PIECE OF IT BEGINS TO COME INTO PLAY.

>> YOU ARE SUGGESTING BECAUSE THERE IS A LABOR SHORTAGE IN OTHER FIELDS AS WELL THAT THEY CAN FIND ANOTHER JOB AND JUST SAY I DON'T HAVE TO WORRY ABOUT THIS?

>> ABSOLUTELY AND WE CAN SEE THAT IN THE BLS NUMBERS.

PEOPLE ARE LEAVING HEALTHCARE.

ON TOP OF THAT I THINK THAT EMPLOYERS DIDN'T RESPOND SUPER WELL TO THIS.

INITIALLY THEY CUT SALARIES, REDUCED BENEFITS, VERY SLOW TO PROVIDE THE PPE THE WORKERS NEEDED AND THIS ADDS UP THAT THEIR EMPLOYER DOESN'T PARTICULARLY CARE ABOUT THEM AND ONCE THAT HAPPENS AND THE PSYCHOLOGICAL AND ECONOMICS START REINFORCING ONE ANOTHER, IT IS VERY EASY FOR PEOPLE TO JUSTIFY LEAVING THEIR POSITION.

BY THE WAY, RNs IF THEY LEAVE THEIR POSITION, THEY CAN WORK FOR MORE MONEY, RIGHT?

THEY CAN WORK AS TRAVEL NURSES.

MANY OF THEM END UP AT THEIR OLD JOBS MAKING SUBSTANTIALLY MORE THAN THEY WERE BEFORE.

>> I WAS GOING TO ASK ABOUT THE TRAVEL NURSES.

WE.

WE ARE GOING TO GET TO YOU BRYAN.

BUT THE ISSUE WITH TRAVELING NURSES, SO THAT MUST CREATE A LITTLE FRIX I WOULD IMAGINE ON ANY SETTING WHERE YOU HAVE PEOPLE WORKING SIDE BY SIDE AND ONE GROUP MAKING SIGNIFICANTLY MORE THAN ANOTHER, ESPECIALLY AS YOU POINT OUT, IF THEY JUST HAD THAT JOB AND, YOU KNOW, LEFT AND CAME BACK IT'S A HUGE ISSUE.

PEOPLE ARE FINDING THEMSELVES WORKING MORE AND MORE BECAUSE THE SHORTAGE IS GETTING WORSE AND WORSE AND WHEN MANAGEMENT DOES TRY TO RESPOND TO THE SHORTAGE, THEY'RE THEN PAYING PEOPLE SUBSTANTIALLY MORE TO WORK IN THE SAME SPACE AS THESE OTHER WORKERS.

YOU COULD EASILY BE WORKING NEXT TO SOMEBODY MAKING SUBSTANTIALLY MORE THAN YOU WERE.

AND REMEMBER YOU ARE BURNED OUT AND ANGRY AND ON THE CUSP BEFORE THAT.

YOU CAN SEE THIS CREATES A VICIOUS CIRCLE OF BURNOUT AND DISSPIRITTEDNESS THAT REALLY IS JUST GOING TO GET WORSE AND WORSE UNTIL WE FIGURE OUT A WAY TO ADDRESS THIS.

>> YOU MENTIONED IN YOUR COMMENTS, PREMATURE LIFTING OF MASK MANDATES.

I NOTICED I THINK IT WAS IN WASHINGTON D.C. WHERE ALL OF A SUDDEN THEY'RE GOING TO LIFT THEIR MANDATE AND THERE HAVE BEEN OTHER CASES WHERE THAT HAS HAPPENED.

SO YOU ARE SUGGESTING WE SHOULDN'T BE GOING THERE JUST YET?

>> SO I'M NOT THE PUBLIC HEALTH EXPERT.

BUT WHAT I CAN SAY IS THAT FRONT LINE HEALTHCARE WORKERS ARE USED TO FEELING LIKE THEY'RE WORKING WITH EVERYBODY, ALL OF THEIR CO-WORKERS AND WITH THEIR PATIENTS AND THEIR PATIENTS FAMILIES TO FIGHT A SHARED ENEMY, RIGHT?

THEY'RE FIGHTING A WAR BUT THEY'RE ALL ON THE SAME SIDE AND I THINK WITH THE LIFTING OF MASK MANDATES BEGINS TO SHOW IS THAT THIS ISN'T TYPICAL FOR HEALTHCARE WORKERS.

THEY, IN MANY WAYS, FEEL LIKE THEY'RE WORKING AGAINST POLICY MAKERS.

THEY FEEL LIKE THEY'RE WORKING AGAINST THEIR PATIENTS AND PATIENTS FAMILIES AND PATIENTS ARE GETTING ANGRY.

THEY'RE DEMANDINGIVE MECHANIC TIN AND HYDROXYCLOROQUINE AND OTHER TREATMENTS THAT ARE NOT PROVEN AND WHEN THE FRONT LINE WORKERS DON'T WANT TO DELIVER THOSE, PATIENTS GET UPSET.

>> IT STRIKES ME THAT HEALTHCARE WORKERS, PEOPLE GO INTO THE FIELD WITH AN ALTRUISTIC INSTINCT AND YOU HAVE TO WONDER IF THAT WELL OF COMPASSION BEGINS TO RUN DRY IF YOU ARE RUNNING INTO THE SORT OF THINGS YOU ARE DISCUSSING.

I WANT TO BRING IN BRYAN O'MALLEY.

THE EXECUTIVE DIRECTOR OF THE CONSUMER DIRECTED PERSONAL ASSISTANTS.

YOU REPRESENT HOME HEALTHCARE WORKERS.

DEFINE IT.

WHO ARE WE TALKING ABOUT?

SEEMS LIKE A PRETTY BIG FIELD.

>> AND WE ARE A SEGMENT OF THE OVERALL HOME HEALTHCARE POPULATION.

WHEN PEOPLE THINK OF HEALTHCARE, YOU THINK OF AN AGENCY THAT IS GOING TO SEND SOMEONE TO THE HOUSE.

IN THE REALM OF CONSUMER DIRECTED, THE AGENCY IS THERE TO SUPPORT BUT THE CONSUMER THEMSELVES ARE THE ONES WHO ARE HIRING FOLKS SO THEY HIRE, THEY TRAIN, THEY SUPERVISE AND OVER THE PAST FEW YEARS, AS THE STAFFING SHORTAGES AND TRADITIONAL HOME CARE SECTOR HAVE GOTTEN WORSE, THE STATE HAS LEANED MORE AND MORE ON THIS PROGRAM AND THAT'S NOT TO SAY THAT INDIVIDUALS HAVE AN EASIER TIME FINDING FOLKS.

IN FACT THE OPPOSITE.

THEY HAVE A HARDER TIME BECAUSE THEY DON'T HAVE THE INSTITUTIONAL ASPECTS THAT GO INTO THAT BUT IT IS A WAY TO GET SOME LEVEL OF CARE AND TAKE THE ONUS OFF OF AGENCIES AND MANAGED CARE PLANS TO DELIVER THOSE SERVICES IN PEOPLE'S HOMES WHICH, OVER THE COURSE OF THE PANDEMIC HAS PROVEN CRITICAL.

IF PEOPLE CAN'T GET TO THE HOSPITALS BECAUSE THE HOSPITALS ARE PACKED, CERTAINLY HAVE BEEN AT CERTAIN POINTS, AND OF COURSE IN NEW YORK CITY WHEN THIS ALL STARTED, THERE WASN'T MUCH ROOM THERE.

SO ARE YOU SEEING NOW A CHANGE IN THE STAFFING LEVEL WITHIN THE PEOPLE YOU WORK WITH?

>> I THINK WE ARE JUST SEEING A CONTINUED EXACERBATION OF A PROBLEM THAT WAS AT EPIDEMIC PROPORTIONS ALREADY.

>> THAT WE WERE JUST HEARING FROM PROFESSOR LITWIN.

>> EXACTLY.

I TOOK NOTE WHEN ME SAID, YOU KNOW, TRADITIONALLY IF YOU HAVE A WORKFORCE THAT FEELS RESPECTED AND LIKE THEY'RE IN A HIGH QUALITY JOB, THEY WILL STAY, AND THE PROBLEM IS IN HOME CARE THE WORKERS HAVEN'T FELT RESPECTED TO BEGIN WITH.

ABOUT 90% OR SO OF HOME CARE IS PAID FOR BY THE STATE'S MEDICAID PROGRAM.

TWO DAYS BEFORE THE STATE SHUT DOWN FOR COVID, THEY DRAGGED MYSELF AND A WHOLE BUNCH OF OTHER PEOPLE TO MIDTOWN MANHATTAN, GROUND ZERO NATIONWIDE TO CUT HOME CARE.

HOME CARE WORKERS WHEN THEY SHUT DOWN THE STATE, EXCEPT FOR ESSENTIAL WORKERS, AGENCIES LIKE US WERE FORCED TO BE THE ONES TO HELL HOME CARE WORKERS THAT THEY COUNTED AS ESSENTIAL WORKERS.

THEY WERE BEING PULLED OVER BY THE POLICE WITH NO RESOURCE TO DEMONSTRATE THAT THEY HAD A RIGHT TO BE ON THE STREET.

AND THEY ARE IN MANY INSTANCES, THEY'RE EARNING CURRENTLY $2.50 LESS THAN PEOPLE EARN AT McDONALD'S OR BURGER KING BY LAW.

2.50 LESS THAN TARGET OR WAL-MART OR AMAZON WAREHOUSE.

>> SO YOU SAID IT EXACERBATES THE ISSUE WE HAD BEFORE AND I'M THINKING OF THAT NUMBER FROM THE BUREAU OF LABOR STATISTICS PROFESSOR, YOU SAID ALMOST HALF A MILLION PEOPLE.

AND I BELIEVE THAT'S 94,000 OF THEM WERE NURSES SO THE REST OF THEM, I'M GUESSING, ARE PEOPLE LIKE BRYAN WORKS WITH AND IF THAT MANY PEOPLE ARE LEAVING, WHAT DOES THAT DO TO THE PEOPLE IN THE HOME?

ARE THEY NOT ABLE TO GET CARE.

>> THEY'RE NOT ABLE TO GET CARE THAT IS WHAT IS HAPPENING AND AT A CERTAIN POINT THE SPTIONS BECOME I CAN'T GET CARE SO I GO TO A NURSING HOME.

THE NURSING HOME BEDS STOP EXISTING AND SO FOLKS JUST GO WITHOUT SERVICES AND THEN THEY WIND UP IN ST. JOSEPH HOSPITAL AND THEY'RE CAN'TING TO THE OVERCROWDING OF THE HOSPITALS AT A TIME WHEN WE ARE TRYING TO A: KEEP PEOPLE OUT BECAUSE OF COVID AND B: LOWER THE OVERALL HEALTHCARE EXPENSES BY KEEPING PEOPLE OUT OF THE HOSPITAL.

AND SO REALISTICALLY, IT'S A SNOWBALL EFFECT THAT LEAD TO PEOPLE DETERIORATING HEALTHCARE.

>> I WOULD IMAGINE THAT FOR THE PATIENTS, PEOPLE IN THE HOME WHO ARE GETTING SERVICES, IF THEIR PROVIDER LEAVES BECAUSE MANY PEOPLE ARE DROPPING OUT OF THE WORKFORCE, I MEAN YOU HAVE THE SAME PERSON COMING TO YOUR HOME.

THERE MUST BE A TRUST LEVEL THAT BUILDS UP AND THEN BOOM IT'S GONE.

THAT'S GOT TO BE-- >> IT'S DEVASTATING.

IT IS A RELATIONSHIP THAT IN SOME INSTANCES CAN BUILD UP OVER THE COURSE OF A DECADE OR MORE.

WITH PEOPLE USE HOME CARE, WHEN PEOPLE USE THESE SERVICES SUCCESSFULLY, IT ALLOWS THEM TO TAKE CHRONIC HEALTH CONDITIONS THAT DON'T MAKE YOU ILL BUT MIGHT MAKE YOU DISABLED AND THE DIFFERENCE IN THAT IS I'M SITTING BEFORE YOU DISABLED, I HAVE EPILEPSY, THAT'S A DISABILITY BUT I'M NOT ILL.

SO AS LONG AS I HAVE MY MEDICATION AND ANY OTHER SUPPORTS, I CAN STAY IN THE COMMUNITY HEALTHY AND CONTRIBUTING.

IF YOU TAKE AWAY THOSE SUPPORTS, THEN I LOSE MY ABILITY TO BE IN THE COMMUNITY AND IT IS REMOVING THAT, WERE WHETHER IT IS FOR YOUNGER FOLKS OR OLDER FOLKS TO LIVE AT HOME TO BE PART OF THEIR COMMUNITY AND, YOU KNOW, WE ARE BREAKING UP COMMUNITIES, BREAKING UP FOLKS ABILITY TO STAY AT HOME.

>> Dr. FALCONE WHAT ABOUT ST. JOSEPH.

HOW HAS.

MORALE ALWAYS A QUESTION.

EVERYBODY FEELS IT.

WE HAVE LOST A SIGNIFICANT NUMBER OF OUR NURSING STAFF, OUR SUPPORT STAFF.

AND A LOT OF IT HAS TO DO WITH PEOPLE BEING BURNED OUT, NOT BEING WILLING TO PUT UP WITH WHAT THEY'RE FACING EVERY DAY AT WORK SO IT IS A BIG CHALLENGE AND THERE ARE BOTTLE NECKS, AS YOU DESCRIBED, YOU KNOW, WHEN WE CAN'T GET SOMEONE OUT OF THE HOSPITAL BECAUSE THERE IS NOWHERE TO SEND THEM.

THE NURSING HOMES ARE UNABLE TO CARE FOR THEM.

WE CAN'T GET THE APPROPRIATE HOME CARE THEY NEED.

IT ENDS UP MAKING IT HARDER FOR US TO HAVE OPEN BEDS AVAILABLE TO TREAT THOSE PATIENTS WHO REALLY NEED TO BE TAKEN CARE OF AT HOSPITAL.

WE ARE FACING THAT.

AND I THINK EVERY HEALTHCARE AGENCY ACROSS THE ENTIRE STATE, PROBABLY ACROSS THE ENTIRE COUNTRY IS FACING THE SAME ISSUES WITH STAFFING.

AND I THINK THE TRAVELING NURSE ISSUE IS CERTAINLY BECOMING A PROBLEM FOR US AS WELL WE ARE SEEING THAT WHERE SOME OF OUR NURSES ARE GOING TO WORK FOR SIGNIFICANT MORE MONEY WITH A TRAVELING AGENCY, WHEN IN FACT THEY'RE ACTUALLY WORKING NEARBY AND IT'S A VERY DEVASTATING EFFECT ON OUR STAFF AND MORALE BECAUSE IT JUST TAKES EVERYTHING OUT OF PEOPLE WHEN THEY SEE THAT HAPPENING AND IT'S A REAL TOUGH CIRCUMSTANCE.

>> I SEE.

YOU SAID YOU HAD CONSIDERING RETIRING BUT WERE NOT YET THERE AND NOW THEY ARE SO THEY HAVE TAKEN THIS AS AN OPPORTUNITY TO LEAVE AND THOSE ARE THE STAFF WHO HAVE THE MOST EXPERIENCE AND THE ONES WE WOULD HAVE HOPED TO GUIDE THE NEWER NURSES COMING ON.

WE ARE FORTUNATE AT ST. JOSEPH, WE HAVE A COLLEGE OF NURSING SO WE HAVE A SUPPLY OF NURSING GRADUATES WHO ARE INTERESTED IN COMING TO WORK AND YET WE ARE GOING TO BE SOMETIMES FACED WITH SITUATIONS WHERE WE DON'T HAVE AS MANY PEOPLE AS WE WOULD LIKE TO HAVE TO TRAIN THE NURSES UP TO WHERE THEY NEED TO BE.

SO IT'S GOING TO BE PERPETUATING PROBLEM THAT WE SEE OVER THE NEXT FEW YEARS.

>> THE AMERICAN JOURNAL OF NURSING LED AN ARTICLE BURNOUT AT THE BED SIDE.

YOU MENTIONED BURNOUT, IN TERMS OF MENTAL HEALTH, NOT JUST THE FRUSTRATION OF OR DEALING WITH THE JOB BUT THE MENTAL HEALTH THE PEOPLE THAT ALL OF YOU ARE DEALING WITH.

I MEAN WHAT ARE YOU HEARING IS THAT MORE THAN JUST FRUSTRATION?

>> I THINK IT'S VERY CHALLENGING.

NURSING STAFF HAVE BEEN VERY RESILIENT AND ADAPTABLE BUT IT HAS TAKEN ITS TOLL AND DIFFICULT.

WE HAVE AN ENTIRE DEPARTMENT DEVOTED TO COLLEAGUE HEALTH AND WELL-BEING.

AND THEY'RE OUT THERE EVERY DAY TRYING TO TALK TO PEOPLE, PROVIDING EMOTIONAL SUPPORT THINGS THAT PEOPLE NEED, BREAK ROOMS WHERE THEY CAN TAKE A QUIET PEACEFUL TIME AWAY FROM THE STRESSES OF THEIR JOB.

WE HAVE HAD PET THERAPY DOGS, WHICH ARE A BIG HIT.

PEOPLE LOVE PETS AND WHEN THEY SEE THEM ON THE FLOOR, IT MAKES THEM FEEL VERY GOOD.

WE ARE DOING EVERYTHING WE CAN TO HELP SUPPORT OUR STAFF BUT IT IS A CHALLENGE AND THE LESS RESOURCES YOU HAVE, THE MORE DIFFICULT THE JOB BECOMES EVERY DAY.

>> AND I IMAGINE IN ANY HEALTHCARE SETTING, SOME PEOPLE DON'T MAKE IT, RIGHT?

SO IF YOU ARE THE NURSE DEALING WITH SOMEONE IN THE CLOSE SITUATION AND REPEATEDLY SEE PEOPLE WHO DIE, THAT'S GOT TO BE-- >> IT'S VERY DISTRESSING.

>> AND WHAT ABOUT IN THE PA WORLD?

ARE YOU SEEING THE SAME MENTAL HEALTH ISSUE COME?

>> ME PERSONALLY, I WAS FORTUNATE TO BE TRAINED AS A FIRST AID FELLOW THROUGH THE PA FOUNDATION SO EVEN PRE-COVID I WAS FORTUNATE ENOUGH TO GO AROUND AND WORK WITH VARIOUS HEALTHCARE WORKERS ALL ACROSS FROM E.M.T.S AND PARAMEDICS TO HOME CARE TO NURSING HOME STAFF TO FOLKS IN HIGHER EDUCATION PROGRAMS THAT ARE WORK WITH THE HEALTH FORCE TRAINING THEM IN MENTAL HEALTH FIRST AID, THAT, TOO IS A PROBLEM THAT HAS BEEN EXISTING FOR A LONG TIME AND THE PANDEMIC HAS EXACERBATED IT.

WHAT I WILL SAY I'M HEARING FROM MANY OF MY COLLEAGUES THAT THEY FEEL BETTER SUITED AND MORE SUPPORTED NOW THAN THEY DID BEFORE WE WERE CHATTING ABOUT OF WE CAME ON ABOUT HOW IT IS SAFE TO TALK ABOUT MENTAL HEALTH STRESSES AND STRAINS AND THAT PEOPLE ARE ENCOURAGING EACH OTHER TO SEEK HEALTH AND LOOK FOR THE RESOURCES AND TAKE TIME FOR YOURSELF.

DO SOME MEDICATION,-- MEDITATION, FOCUS YOUR OWN WELLNESS BECAUSE OF THE STRESSORS PEOPLE ARE FINDING AT WORK AND AT HOME.

>> AND I GUESS THAT AT HOME PART IS PRETTY IMPORTANT AND PROFESSOR LITWIN REFERENCED THAT EARLIER WHEN PEOPLE WORK AND THEN IT DOESN'T NECESSARILY GET EASIER WHEN YOU GO HOME.

>> NO, I REALLY APPRECIATED THE FACT THAT HE PICKED UP AND COMMENTED ON THAT AS WELL BECAUSE YOU ARE IN HEALTHCARE BECAUSE YOU ARE A CAREGIVER.

YOU ARE CARE GIVING AT WORK AND YOU ARE CARE GIVING AT HOME WITH YOUR FAMILY, FRIENDS AND NEIGHBORS.

FOR A LOT OF US, IT'S INHERENTLY WHO WE ARE.

>> YOU HINTED EARLIER THAT THERE IS A VERY DEEP WELL OF ALTRUISM IN FRONT LINE HEALTHCARE WORKERS, NURSES IN PARTICULAR AND I THINK THAT SPEAKS ABOUT HOW BAD THE PROBLEM HAS GOTTEN.

ANY OF US WHO HAVE KNOWN A NURSE OR CARED FOR BY ONE, WE KNOW IT TAKES AN AWFUL LOT FOR A NURSE TO WANT TO GIVE UP AND THE FACT THAT SOME OF THEM ARE NOW IN MEASURABLE NUMBERS AND WE CAN'T BLAME THEM.

I THINK IT REALLY SAYS SOMETHING ABOUT THE SITUATION WE ARE FACING ALONG THOSE LINE ARE WHAT THE IMPLICATION AS LONG THE ROAD.

WHAT DOES THAT MEAN FOR DOWN THE ROAD?

AND I MEAN FIVE YEARS DOWN THE ROAD, NOT NECESSARILY MARCH.

>> FIVE YEARS DOWN THE ROAD WE MIGHT BE OKAY.

ENROLLMENTS FOR NURSING STUDENTS ARE NOT DOWN.

THE PROBLEM WITH ENROLLMENTS AS A MEASURE OF LABOR MARKET HEALTH THAT HAS THERE IS A BIG DELAY IN ENROLLMENT AND PEOPLE ENTERING THE LABOR MARKET SO THAT DOES NOTHING TO SOLVE OUR PROBLEM THAT WE ARE FACING RIGHT NOW BUT IT DOES SUGGEST IN THE MEDIUM AND LONG-TERM WE STILL MIGHT BE OKAY.

THE BIGGER ISSUE WE FACE NOW IS ONE YOU AND Dr. FAL KOBE TOUCHED UPON THAT MOST OF THE NURSES LEAVING NOW TBDZ TO BE THE MOST EXPERIENCE EXPERIENCED AND WITH INSTITUTIONAL KNOWLEDGE.

WHEN THEY LEAVE IT IS ESPECIALLY DIFFICULT FOR THE REMAINING NURSES NO MATTER HOW WELL TRAINED THEY ARE AND WHAT THEY THINK TO THE JOB, IT IS DIFFICULT TO KNOW HOW EVERY CASE CAN BE DEALT WITH IN THAT HOSPITAL.

IT WOULD BE ONE THING IF THERE WERE A RANDOM EXODUS OF FRONT LINE HEALTHCARE WORKERS OR EVEN THE NEWEST ONES LEAVING BUT AS YOU SAID, IT TEND NOT TO BE.

IT TENDS TO BE SOME OF THE MOST VALUABLE TO SORT OF TRAINING AND MAINTAINING STANDARD IN THE HOSPITAL.

>> AND THAT BABY BOOM BULGE, WHICH IS AFFECTING ALL INDUSTRIES, MUST CAN AFFECTING THIS, TOO.

SO MORE PEOPLE ARE LEAVING JUST AT THE TIME AND AS THE POPULATION AGES AND NEED MORE CARE, ASIDE FROM COVID.

>> ASIDE FROM-- YEAH, ASIDE FROM COVID, WE SEE STRUCTURAL INCREASES IN THE DEMAND FOR HEALTHCARE AS FAR AS THE EYE CAN SEE.

NOW INTERESTINGLY, THAT DOESN'T NECESSARILY TRANSLATE INTO PAY INCREASES FOR FRONT LINE HEALTHCARE WORKERS WHICH IS ANOTHER ISSUE WORTH THINKING ABOUT BUT IT'S REALLY IMPORTANT TO GET ACROSS THAT WHILE COVID HAS SHINED A SPOTLIGHT ON THESE ISSUES, REALLY THEY EXISTED LONG BEFORE THAT.

IF THERE IS A SILVER LINING TO THIS, PEOPLE ARE PAYING MORE ATTENTION TO THAT.

>> GOVERNOR HOCHUL JUST ANNOUNCED YESTERDAY, I BELIEVE, A NEW PROGRAM TO PAY TUITION FOR A THOUSAND NURSES.

THAT HAS TO HELP BUT IS THAT GOING TO BE ANYWHERE NEAR ENOUGH?

>> PROBABLY NOT ENOUGH BUT IT'S A START.

WE ARE DOING THE SAME TYPE OF PROGRAM AT ST. JOSEPH'S TO TRY TO ENTICE OUR NURSING STAFF TO STAY WITH US FOR THE LONG-TERM AND TO GO INTO NURSING IN THE FIRST PLACE.

I THINK IT IS GOING TO HELP US BUT THERE IS A TIME LAG FROM STARTING NURSING SCHOOL AND BEING A FULLY TRAINED CAPABLE NURSE IS A FAIRLY LONG PERIOD OF TIME.

IT'S A GOOD START BUT I THINK WE WILL NEED TO CONTINUE DOING THAT FOR THE NEXT FIVE TO 10 YEARS.

>> AND THERE ARE THE OPPORTUNITIES, LIKE I KNOW YOU HAVE A PROGRAM AT ST. JOE'S AND UTICA COLLEGE HAS A SIMILAR PROGRAM FOR SECOND DEGREE SO PEOPLE WHO HAVE A DEGREE ALREADY AND SAY AFTER FIVE YEARS OF DOING THIS OTHER JOB OR 10 YEARS, I THINK I WILL BE A NURSE.

THAT'S NOT SO LONG, RIGHT?

THAT'S A FASTER PROGRAM?

>> IT STILL TAKES TIME.

IF YOU GET OUT OF MEDICAL SCHOOL, YOU HAVE TO GO A RESIDENCY, THE SAME IS TRUE FOR NURSING.

THEY CAN GET OUT OF NURSING SCHOOL BUT THEY NEED TIME AND THE INSTITUTIONAL CAPACITY TO KNOW HOW TO HANDLE PATIENTS IS NOT THERE UNTIL YOU HAVE BEEN IN THE SITUATION LONG ENOUGH.

IT WILL TAKE TIME TO TRAIN PEOPLE UP TO A STANDARD THAT WE ARE HAPPY WITH.

>> HAVE YOU TO SEE SOME THINGS FIRST.

>> YOU HAVE TO LIVE IT BEFORE YOU CAN DO IT LET'S CONSIDER THE AFFECT OF THE VACCINE MANDATE.

THE SAME RESISTANCE IS PRESENT IN THE MEDICAL COMMUNITY THERE ARE SO MANY DIFFERENT MANDATES OUT THERE THERE WAS A FEDERAL AND MEDICARE ONE AND THE STATES AND THE COURTS ARE WEIGHING IN.

CAN YOU CLARIFY WHERE WE ARE WITH MANDATES AND THEN WHAT THEY HAVE MEANT FOR STAFFING?

>> AS YOU SAID, THERE ARE A NUMBER OF PLACES RIGHT NOW AND THE COURTS KEEP MAKING DECISIONS SO THINGS COULD CHANGE BETWEEN NOW AND WHEN THIS ACTUALLY AIRS BUT FOR THE MOST PART, I THINK WHAT WE ARE SEEING IS A BIG FOCUS ON A RELATIVELY SMALL NUMBER OF FRONT LINE HEALTHCARE WORKERS THAT ARE REFUSING TO BE VACCINATED.

AND SO I ACTUALLY DON'T THINK THAT IT REALLY IS AS MUCH OF A PROBLEM AS MANY PEOPLE SAY.

THAT SAID, WHEN YOU ARE ALREADY SO SHORT STAFFED, JUST LOSING ANOTHER FEW IS A REAL PROBLEM AND I KNOW CERTAINLY IN MY COMMUNITY HERE, THERE ARE GOOD HANDFUL OF NURSES IN PARTICULAR IN TOMPKINS COUNTY, WHO HAVE DECIDED THAT THEY WOULD ACTUALLY RATHER GIVE UP THEIR JOBS THAN GET A VACCINE.

THAT'S QUITE A DECISION FOR SOMEONE TO MAKE.

BUT IN TERMS OF ACTUAL NUMBERS ACROSS THE STATE, I DON'T HAVE THEM.

AND I HAVEN'T SEEN THEM.

>> HAVE PEOPLE STARTED TO GET VACCINATED BECAUSE OF THE MANDATE?

HAVE WE SEEN THAT?

I KNOW IT'S HAPPENED IN THE CORPORATE WORLD.

>> WE HAVE SEEN THAT.

WE HAVE HAVE A MANDATE IN PLACE SINCE JULY WE WERE ONE OF THE FIRST IN THE AREA TO REQUIRE THAT OF OUR EMPLOYEES IT'S A CORE VALUE.

IF WE HAVE PUT THAT OUT THERE.

WE HAVE SEEN PUSH BACK.

PEOPLE HAVE LEFT AS A RESULT OF THAT REQUIREMENT BUT IN THE END THE PEOPLE WHO HAVE STAYED HAVE GOTTEN VACCINATED AND I THINK WE ARE MORE PROTECTED AND IN BETTER SHAPE TO TAKE CARE OF OUR PATIENTS.

>> DID THAT SURPRISE YOU THE LEVEL OF RESISTANCE?

>> IT DID A LITTLE.

I MEAN WE ARE ALL IN HEALTHCARE BECAUSE WE ARE SCIENTIFICALLY BASED PEOPLE BUT THERE WERE CONCERNS.

JUST LIKE THE GENERAL POPULATION PEOPLE WILL RELUCTANT TO TRUST SOMETHING DEVELOPED QUICKLY.

THEY DIDN'T SEE AS MUCH DATA AS THEY WANTED TO SEE.

AT THIS POINT A YEAR IN THE VACCINATION CYCLE WITH MILLIONS AND MILLIONS OF DOSES AND VERY FEW IF ANY SIGNIFICANT SIDE EFFECTS, I THINK PEOPLE ARE BEGINNING TO REALIZE IT'S A SAFE AND EFFECTIVE METEDDED ON OF PREVENTING SERIOUS ILLNESS AND DEATH AND THAT'S WHAT A VACCINE SHOULD DO, PROTECT THE BULK OF THE POPULATION FROM SUFFERING SEVERE PROBLEMS AND IF WE CAN ACHIEVE THAT, I THINK WE WILL BE SO MUCH BETTER I SAW ANOTHER HEADLINES THIS MORNING ANOTHER NUMBER OF YOUNG CHILDREN WHO HAVE BEEN VACCINATED, WHICH WAS SURPRISINGLY HIGH I THINK THAT'S TELLING US SOMETHING, TOO.

>> IT IS.

THE LAST POOL OF PEOPLE NOT ELIGIBLE, NOW THAT THEY'RE ELIGIBLE, I THINK WE WILL SEE LESS AND LESS CASES BECAUSE IF A CHILD GETS SICK AND INFECTS SOMEONE ELSE, IT BECOMES A PROBLEM.

IF WE CAN GET ALL OF THE GENERAL POPULATION INVOLVED, I THINK THAT WILL BE SAFER.

>> I DIDN'T EVEN HAVE IS TO SAY A WORD AND AS SOON AS THAT VACCINE WAS APPROVED FOR 12 AND OLDER MINE WAS KNOCKING ON THE DOOR.

WHEN CAN WE GO?

>> ISN'T THAT INTERESTING?

>> AMAZINGLY SO.

>> WHAT WAS THE REASON?

WHY SO EGOER?

>> HE HAS ASTHMA SO HE KNEW THAT HE WAS AT GREATER RISK BECAUSE OF HIS LUNG DISEASE AND JUST BY HIM PUTTING THE PIECES AND PARTS TOGETHER, HE ASKED.

AND WAS VERY, VERY PLEASED BECAUSE I FELT LIKE EVEN AT AGE 12, HE COULD WEIGH OUT THE RISKS VERSUS THE BENEFITS.

THE RISKS TO ME, IF I GET THIS ILLNESS IS GREATER THAN EVEN MY COMPATRIOTS BECAUSE I HAVE UNDERLYING ASTHMA.

THE POTENTIAL BENEFIT, THE BENEFIT WE SEE AS HEALTHCARE PROVIDERS DIFFERENT THAN A 12-YEAR-OLD BUT CAN I STILL GO TO SCHOOL.

I CAN PARTICIPATE IN BOY SCOUTS.

CAN I PARTICIPATE IN THE ATHLETIC ACTIVITIES THAT I ENJOY SO THOSE WERE BIG BENEFITS FOR HIM.

>> AND HOW DID HIS CLASSMATES.

>> IT HAS BEEN ENJOYABLE TO WATCH THE RIPPLE EFFECT.

YOU DROP THE PEBBLE IN THE POND AND YOU WATCH IT SPREAD OUT AND EVEN WATCHING THE KIDS TALK ABOUT IT IS REALLY INTERESTING AND HOW THEY EDUCATE EACH OTHER AND TALK TO THEIR PARENTS AND GRAND PARENTS SO I DO THINK THAT IT HAS BEEN A LITTLE BIT OF MAYBE POSITIVE PEER PRESSURE.

>> BRYAN, WHAT ABOUT WITH YOUR GROUP HOW HAS THE IMPACT-- HOW HAS THE THE MANDATE IMPACTED?

>> WITHIN THE HOME SECTOR OVERALL, THE CONSUMER SECTOR IN PARTICULAR HAS BEEN EXEMPTED FROM THE STATEWIDE MANDATE PERFORM CARE AT THE SFD LEVEL WAS EXEMPTED FROM THE CMS MANDATE AS Dr. LITWIN INDICATED, OSHA MANDATE IS TIED UP IN THE COURTS.

HOME CARE OVERALL, I THINK THE NUMBERS ARE 5 TO 7% OF THOSE WHO OPTED TO LEAVE THEIR JOB.

WHICH IS A LOWER NUMBER THAN WE EXPECTED AND WHAT WE FOUND OUT IS A LOT OF HOME CARE WORKERS WERE ACTUALLY VACCINATED AND WE JUST DIDN'T KNOW IT AND THEN A LOT OF OTHERS WERE, WHEN PUSH CAME TO SHOVE, THEY MADE THE CHOICE TO BECOME VACCINATED.

THE PROBLEM WHEN WE ARE LOOKING AT SUCH A LOW-- IT'S A LOW PERCENTAGE, BUT WHEN WE ARE LOOKING AT A WORKFORCE OF 150 TO 200,000 PEOPLE, THAT'S A LARGE NUMBER, PARTICULARLY WHEN MERCER CONSULTING SAYS WE ARE DOWN 23,000 HOME CARE WORKERS IN THE STATE.

AND SO, YOU KNOW, THAT IS A REAL NUMBER.

AND TO ADD THAT 5% ON TO THAT, DOES PRESENT REAL PROBLEMS FOR GETTING PEOPLE SERVICES.

>> AND WHAT DOES THAT DO FOR CARE THEN?

YOU SAY PROVIDES GETTING THEM SERVICES BUT A CERTAIN PERCENTAGE OF PEOPLE, 23,000-- >> 23,000 WERE ALREADY GOING WITHOUT THE AMOUNT OF SERVICES OR ANY SERVICES THAT THEY NEEDED.

AS YOU GET INTO MORE AND MORE RURAL PARTS OF THE STATE, THAT GETS WORSE AND WORSE AND WE JUST ADD TO THAT, RIGHT AND UNFORTUNATELY A LOT OF TIMES THE SAME COMMUNITIESER WITH WE SEE A LOT OF THE VACCINE HESITANCY SO WE ARE JUST PILING ON TOP OF EACH OTHER, WORKFORCE SHORTAGES ARE NOT NECESSARILY TIED TO THE RURAL COMMUNITIES ANYMORE.

IT IS EVERYWHERE MIDTOWN MANHATTAN, THE SAME WAY IT HITS SYRACUSE THE SAME WAY IT HITS PAINTED POST IN ALLEGANY COUNTY.

BUT THE STAFFING SHORTAGES ARE GETTING WORSE AND IT MEANS MORE PEOPLE WIND UP IN Dr. FALCONE'S HOSPITAL.

>> LET ME ASK YOU A QUESTION ABOUT Dr. FALCONE'S HOSPITAL.

YOUR STAFF, WHEN THIS ALL HAPPENED, IN MARCH 2020 AND YOUR STAFF DID HEROIC WORK WHEN COVID IT HIT AND THEN LAST WINTER WE HAD THE BIG SPIKE AND AGAIN PEOPLE NOT ONLY YOUR HOSPITAL BUT HEALTHCARE IN GENERAL, AND WE HAD 3,000 PEOPLE A DAY WERE DYING NATIONWIDE AT ONE POINT.

AND THE STAFF WERE NOT VACCINATED AT THE TIME SO IF THEY COULD WORK UNVACCINATED BEFORE, WHY DO THEY NEED IT NOW TO DO THEIR JOBS?

>> I THINK IT'S JUST A SAFETY ISSUE.

IF YOU ARE VACCINATED YOU ARE MORE PROTECTED THAN YOU WOULD BE IF YOU ARE NOT VACCINATED.

CERTAINLY WHAT WE ARE SEEING WITH OUR PATIENT POPULATIONS RIGHT NOW COMING THROUGH THE DOOR, THE VAST MAJORITY WHO ARE REALLY SICK AND NOT LIKELY TO SURVIVE ARE THOSE THAT ARE UNVACCINATED.

THOSE VACCINATED COMING THROUGH AS PATIENTS ARE MUCH MORE PROTECTED FROM THE SEAR SERIOUS ILLNESS OR DEBTED FROM THE VIRUS.

HAVING OUR STAFF VACCINATED, WE ARE PROVIDING THAT MUCH MORE PROTECTION FOR THE MOST IMPORTANT PARTS OF THE HEALTHCARE SYSTEM, THE PEOPLE TAKING CARE OF OUR PATIENTS.

IF WE ARE NOT VACCINATED, IT IS HARD TO BE AROUND TO TAKE CARE OF THOSE WHO NEED US.

THAT'S PART OF WHY THE VACCINATE MANDATE WAS AN ESSENTIAL PART OF HEALTHCARE AND WHY I THINK IT'S IMPORTANT FOR US TO CONTINUE MAKING THAT CLEAR TO PEOPLE.

>> SO YOU MENTIONED A REALLY INTERESTING POINT, WHICH IS THAT MOST OF THE PEOPLE WHO ARE COMING IN SICK ARE PEOPLE WHO HAVE NOT BEEN VACCINATED.

WE'VE HEARD THE TERM THE PANDEMIC OF THE UN VACCINATED UNVACCINATED, RIGHT.

THINKING OF THE STAFFERS AGAIN, IF THE PEOPLE THAT ARE CAUSING-- WELL, I DON'T WANT TO BE JUDGMENTAL HERE BUT IF YOU HAVE TO DEAL WITH THIS ILLNESS OVER AND OVER AGAIN AND IT'S CAUSING THE FRUSTRATIONS THAT WE HAVE ALL SPOKEN ABOUT AND YOU REALIZE, OKAY, NOW THERE ARE PEOPLE COMING IN SICK ARE NOT VACCINATED AND COULD HAVE BEEN VACCINATED, CHOSE NOT TO, DOES THAT-- I MEAN WE TALK ABOUT THE COMPASSION ISSUE.

I'LL TURN TO PROFESSOR LITWIN ON THIS.

ARE PEOPLE, ARE THEY RESPONDING, REACTING TO THAT.

>> YEAH, WORKERS ARE SAYING SPECIFICALLY THE PATIENTS THEY'RE OR DEALING WITH AT THIS POINT, BY THE TIME THE PATIENT GETS TO THE HOSPITAL, THEY'RE VERY SICK AND WE KNOW MOST OF THE PATIENTS THAT ARE ARRIVING IN HOSPITALS ARE PATIENTS THAT ARE NOT VACCINATED, WHICH IS WHY THEIR CASES ARE SO ACUTE.

SO YOU CAN IMAGINE THEN HOW THAT ADDS TO THE FRUSTRATION, RIGHT THERE IS SOMETHING THE PATIENTS COULD HAVE DONE IT IS NOT ONLY FRUSTRATING BUT IT'S SAD AND DISHEARTENING BECAUSE THEY REALLY WANT TO SAVE THESE PEOPLE AND IT'S INCREDIBLY DIFFICULT ESPECIALLY WHEN THEY BEG FOR THE VACCINE UPON ADMISSION TO THE HOSPITAL AND AT THAT POINT IT'S TOO LATE.

SO WHAT THEY'RE ASKING FOR ARE TREATMENTS THAT AS I MENTIONED BEFORE ARE TOTALLY UNPROVEN AND THAT FRONT LINE CARE PROVIDER CAN'T OFFER.

THAT'S AN AWFUL FEELING FOR A PROVIDER.

AS WE'VE SAID, THEY'RE THERE TO HELP AND THEY'RE CERTAINLY HOPING THE PATIENT HAS DONE EVERYTHING HE OR SHE COULD HAVE TO PREVENT THEMSELVES FROM BEING IN THAT SITUATION AND THAT'S PART WHAT HAVE MAKES COVID VERY DIFFERENT.

>> ARE YOU SEEING THAT IN THE HOSPITAL THAT THIS SORT OF AN TAG NYMPH BETWEEN TO SOME DEGREE THAT IS TRUE.

WE ARE SEEING PATIENTS THAT WE HOPED WOULD HAVE DONE SOMETHING MORE TO PROTECT THEMSELVES AND THEY DIDN'T.

WE ARE STILL TAKING CARE OF THEM OBVIOUSLY.

IT'S JUST A FRUSTRATING SITUATION TO BE IN AND OUR STAFF FEEL IT.

THEY REALIZE THAT THIS IS NOW A SITUATION WHERE WE HAVE METHODS OF PROTECTING OURSELVES AND YET SOME PEOPLE ARE STILL NOT WILLING TO DO IT AND SO FOR THE GREATER GOOD, IT MAKES VERY LITTLE SENSE OF WHY THAT IS STILL HAPPENING.

>> SO THIS IDEA OF PEOPLE COMING IN AND THEN DEMANDING THE VACCINE OR IVERMECTIN OR HYDROXYCLOROQUINE, WE HAVE HEARD THE STORIES AND SOMETIMES I WONDER WHETHER THEY'RE JUST REALLY STORIES.

YOU ARE SAYING THEY'RE NOT REALLY STORIES.

>> THEY'RE STORIES TO SOME DEGREE BUT THEY ARE ALSO TRUE.

PEOPLE ARE ASKING FOR METHODS OF TREATMENT THAT ARE UNPROVEN AND POTENTIALLY UNSAFE AND WE ARE DOING EVERYTHING WE CAN, OUR PHYSICIANS AND NURSING STAFF ARE DOING EVERYTHING WE CAN TO EDUCATE THE POPULATION AND THE PEOPLE WE HAVE IN THE HOSPITAL BUT UNFORTUNATELY THESE FOLKS ARE UP AGAINST A VERY SIGNIFICANT ILLNESS AND THEY'RE GRASPING AT WHATEVER POTENTIAL OPTIONS MIGHT BE THERE FOR THEM.

THE FACT THAT THERE IS AN UNPROVEN TREATMENT DOES NOT MAKE IT BETTER AND WE ARE NOT GOING TO TRY TO DO THAT, WE ARE NOT GOING TO USE SOMETHING NOT PROVEN.

IT'S A SAD SITUATION BUT ALSO SOMETHING THAT COULD HAVE BEEN AVOIDED IF PEOPLE HAD BECOME VACCINATED.

>> LIKE I NOTED BEFORE THE VACCINE MANDATE IS NOT APPLICABLE AND CONSUMER DIRECTED.

WE SEE A DIFFERENT LEVEL OF PUSH-PULL THERE WHEN WE TALK TO THE SENIORS AND THE FOLKS WITH DISABILITIES.

THEY ARE IN A CATCH 22.

THEY VERY MUCH WANT FOLKS TO BE VACCINATED WHEN THEY'RE COMING INTO THEIR HOUSE.

THEY RECOGNIZE THAT THEY'RE VERY MUCH AT RISK POPULATION.

BUT THEY KNOW THAT THEIR CHOICES I CAN DEMAND THAT YOU BE VACCINATED AND YOU LEAVE AND THEN I'M STUCK WITH NO ONE.

I GET NO SERVICES.

I WIND UP IN THE HOSPITAL AND I DIE.

OR I ALLOW TO YOU GO UNVACCINATED, AND MAYBE YOU CATCH COVID AND MAYBE YOU GIVE IT TO ME AND MAYBE I DIE.

THOSE ARE TWO HORRIBLE CHOICES TO BE PRESENTED AND IT'S THE REALITY FOR A LOT OF FOLKS AND IT'S BEING DRIVEN BY THIS STAFFING SHORTAGE, RIGHT?

THEY KNOW THAT THEY'RE NOT GOING TO BE ABLE TO HIRE SOMEONE ELSE IF THIS PERSON LEAVES SO THAT STAFFING SHORTAGE IS DRIVING THE CONSIDERATION WHICH AGAIN, JUST SENDS MORE PEOPLE TO THE HOSPITAL IN YOUR MEDICAL CAREER HAVE YOU ENCOUNTERED ANYTHING LIKE THIS BEFORE?

I DON'T MEAN COVID BUT THE DILEMMA OF PEOPLE COMING IN AND DEMANDING SOMETHING THAT THEY HAVE HEARD ABOUT IN THE NEWS.

>> SORT OF.

PAPE MANAGEMENT AND COMMERCIALS AND DIRECTED COMMERCIAL ADVERTISING.

>> THE WHOLE Dr. GOOGLE EFFECT WHERE PEOPLE CAN GO ONLINE AND RESEARCH A PRODUCT OR DISEASE AND COME UP WITH ALL SORTS OF CURES THAT MAY OR MAY NOT BE PROVEN BUT THEY'RE OUT.

>> WE ARE USED TO PEOPLE COMING IN WITH A MAGAZINE SAYING I SAW THIS ADVERTISEMENT FOR THIS MEDICATION AND SOMETIMES IT'S NOT EVEN A.M. APPLICABLE TO THE MEDICAL CONDITION THEY CARRY.

THEY WILL BRING IT IN AND SAY I WANT THIS.

THIS IS JUST MAGNIFIED IT IS A CHALLENGE AND I THINK IT IS AN EDUCATIONAL THING AND ADDS TO THE WHOLE BURNOUT.

NEED TO THINK ABOUT THIS.

>> AND WITH THIS BURNOUT AND WITH THIS SHORTAGES THAT WE ARE TALKING ABOUT SO YOU ARE RUNNING A HOSPITAL AND I'M NOT SURE HOW MANY PEOPLE WORK AT ST. JOES BUT I KNOW IT'S A LOT.

>> 4,000 PLUS.

>> MORE THAN I THOUGHT.

AND I IMAGINE THAT IF YOU HAVE A SHORTAGE IN A CERTAIN AREA, IT'S NOT LIKE YOU CAN, YOU KNOW, YOU CAN SAY YOU CAN JUST EASILY MOVE PEOPLE AROUND.

IT'S NOT LIKE YOU ARE SAYING DON'T PAINT THAT WALL.

PAINT THIS WALL YOU ARE GOING FROM A SURGICAL UNIT OR WHATEVER.

SO HOW DO YOU ADJUST.

HOW DO YOU MANAGE?

>> IT'S A GREAT CHALLENGE WHAT WE ARE TRYING TO DO IS CREATE SYSTEMS WHERE WE HAVE TEAMS OF HEALTHCARE WORKERS WORK TOGETHER, WE HAVE RNs LPNs PATIENT CARE TECHNICIANS WHO WORK AS A GROUP OR A TEAM TAKING CARE OF A GROUP OF PATIENTS AND THE SKILL SET OF THE TEAM IS GOING TO DICTATE WHERE THEY ARE SO CLEARLY IN AN ICU FEWER PATIENTS TO WORRY ABOUT WHERE YOU MAY HAVE A FEW MORE PATIENTS YOU CAN CARE FOR BECAUSE THEY'RE NOT AS ACUTE.

IT'S AN ADAPTABLE SHIFTING KIND OF CONCEPT THAT WE HAVE MANAGED TO DO.

WE'RE CROSS TRAINING PEOPLE TO DO DIFFERENT THINGS IN OUR OPERATING ROOMS WE HAVE RNs WHO CAN SCRUB IN AS A SURGICAL TECH.

THEY'RE ABLE TO DO MORE THAN ONE JOB WHICH IS A VERY VALUABLE COMMODITY RIGHT NOW IN HEALTHCARE.

WE ARE TRYING EVERYTHING AND DOING EVERYTHING WE CAN TO MAKE EVERYTHING SAFE AND EFFECTIVE FOR THE PATIENTS.

>> WHAT ARE THE CHALLENGES YOU SEE MOVING FORWARD I'LL ADDRESS THIS TO YOU, PROFESSOR LITWIN YOU SAID FIVE YEARS OUT MAY NOT BE SO BAD BUT AS YOU LOOK AT THE STAFFING ISSUES, WHAT STANDS OUT TO YOU?

AND WE CAN EVEN SET ASIDE COVID.

I MEAN WHAT ARE-- LET ME ASK IT THIS WAY.

WHAT WAS DRIVING THE SHORTAGE PRIOR TO COVID.

>> SO I THINK A FEW THINGS.

FIRST AND FOREMOST, WORKERS JUST WANT TO BE TREATED WITH DIGNITY AND RESPECT AND SO IN GENERAL, I THINK MORE AND MORE GIVEN THE BUSINESS REALITIES OF HEALTHCARE, A LOT OF FRONT LINE HEALTHCARE WORKERS FELT LIKE THEY WERE BEING TREATED LIKE NAMELESS FACELESS PRODUCTION INPUTS AND ALL OF A SUDDEN WITH COVID, THESE PEOPLE ARE ESSENTIAL WORKERS AND THEY'RE HEROES AND THAT'S WONDERFUL.

BUT IF YOU WANT TO MAKE A HERO OR ANYBODY ELSE FEEL GOOD, HAVE YOU TO DO MORE THAN GIVE THEM A TRAY OF MUIVES AND A ROUND OF APPLAUSE AT 6:00 P.M. YOU NEED TO TALK TO THEM AND THING THEM AND ASK THEM.

HOW ARE YOU FEELING?

WHAT DO YOU NEED?

I THINK THAT WOULD BE A REALLY GOOD PLACE TO START AND THEN WE CAN ACTUALLY TALK ABOUT THE SIMPLE ECONOMIC THINGS.

ASKING LOIRS TO THROW THESE WORKERS A BONE RIGHT?

GIVE THEM CASH BONUSES FOR RETENTION.

GIVE THEM THE LONG SOUGHT PAY INCREASES AND ACTUALLY OFFER THEM SOME OF THE FLEXIBILITY THEY NEED IN ORDER TO FEEL LIKE THEY'RE BEING TREATED WITH DIGNITY AND RESPECT AND IN ORDER TO FEEL LIKE THEY'RE MANAGING THAT BURNOUT.

AND I THINK OUR TENDENCY IS TO FOCUS ON POLICY MAKERS, WHICH MAKES SOME SENSE BUT I THINK THERE IS A LOT ACTUALLY THAT EMPLOYERS CAN DO IN THE MEANTIME AND ACTUALLY IN SOME SENSE, I FEEL BAD FOR EMPLOYERS BECAUSE I THINK THAT THERE ARE A LOT OF MID LEVEL MANAGERS WHO REALLY WANT TO DO GOOD BY THEIR EMPLOYEES BUT IT'S VERY DIFFICULT BECAUSE THEY HAVE TO ANSWER TO A HOSPITAL BOARD OR POSSIBLY TO SHAREHOLDERS SO THEY EMPTION ARE UNDER A LOT OF PRESSURE AND BELIEVE IT OR NOT I THINK THE SOLUTION COULD BE INCREASED COLLECTIVE BARGAINING BECAUSE IF THE UNION CAN DEMAND SOMETHING, THEN THAT MANAGER ESSENTIALLY HAS TO NEGOTIATE OVER IT AND POSSIBLY PROVIDE IT.

THE WORKERS GET WHAT THEY WANT.

BY ALL INDICATIONS THE RESEARCH SUGGESTS THE PATIENT OUTCOMES ARE JUST AS GOOD IF NOT BETTER AND I THINK IN MANY WAYS, INCREASED COLLECTIVE BARGAINING COULD BE PART OF THE SOLUTION AND BENEFIT MANAGERS AND PATIENTS AS WELL.

>> COLLECTIVE BARGAINING AMONG NURSES, FOR INSTANCE.

>> ABSOLUTELY.

THAT'S RIGHT.

AND WE KNOW NATIONAL GENERALLY HIVE.

>> I'M GUESSING Dr. FALCONE MIGHT HAVE A DIFFERENT VIEW ON THAT.

>> WE MANAGED 150 YEARS WITHOUT COLLECTIVE BARGAINING, I THINK WE ARE DOING OKAY.

OVER THE LAST 20 OR 30 YEARS THERE HAS BEEN CONSOLIDATION IN HEALTHCARE.

LARGE CHAINS OR LARGE HOSPITAL GROUPS AND SMALLER HOSPITALS HAVE CLOSED IN MANY PLACES, RIGHT?

THEY HAVEN'T BEEN ECONOMICALLY SUSTAINABLE HAS THAT BEEN A PART OF THIS ISSUE HERE THAT HAS LED TO SHORTAGES, THE CONSOLIDATION OF HEALTHCARE?

I'LL ASK YOU AGAIN PROFESSOR LITWIN?

>> I THINK IT HAS.

WE ARE SEEING CONSOLIDATION OF MULTIPLE HOSPITALS AND COMMUNITY MEDICAL OFFICES INTO BIG CONGLOMERATES AND I THINK THOSE CONGLOMERATES HAVE A LOT OF MARKET POWER, BOTH IN THE MARKET FOR CARE SO IN PROVIDING CARE IN TERMS OF HOW THEY CAN NEGOTIATE WITH INSURERS BUT ALSO IN TERMS OF THE LABOR MARKET.

IT GIVES THEM A LOT OF POWER WHICH IS ONE REASON THEY HAVE BEEN ABLE TO MAINTAIN STAFFING AT ALL BUT THAT IS BECOMING MUCH MORE DIFFICULT NOW.

>> GO AHEAD BRYAN.

>> AS WE TALK ABOUT THE CONSOLIDATION AND THE SHIFT I THINK WE CAN'T IGNORE WHAT PROFESSOR LITWIN MENTIONED OF THE INSURERS ROLE IN THIS DURING THE PAST YEAR, THE NATIONAL PARENT CORPORATION FOR FIDELIS REPORTED $2 BILLION IN REVENUE PROFIT OVER THE YEAR THAT WE WERE ALL SUFFERING AND HEALTHCARE WORKERS WERE SUFFERING AS A RESULT OF COVID SO THE INSURERS WERE DOING JUST FINE THROUGHOUT THIS ENTIRE THING, IN FACT MAKING RECORD PROFITS ENROLLING RECORD NUMBERS OF NEW PEOPLE WHILE DOWNSTREAM PROVIDERS WERE GETTING RATE CUTS FROM THE SAME INSURERS AT THE TIME WE WERE HERALDING OUR HEALTHCARE HEROES SO THERE NEED TO BE RECOGNITION ACROSS THE BOARD AND THE CONSOLIDATION 345EU OR MAY NOT DRIVE CERTAIN BEHAVIORS FROM EMPLOYERS BUT IN MANY AREAS, THE CONSOLIDATION IS NECESSARY BECAUSE THERE IS NO OTHER WAY TO GO UP AGAINST THE LARGE INSURERS WHO REALISTICALLY DRIVE WHAT PEOPLE CAN PAY BECAUSE IF THE INSURERS ARE NOT WILLING TO PAY A RATE, THE EMPLOYERS CANNOT GIVE THAT OUT IN WAGES.

>> I HAVE A FEELING THAT-- >> I COMPLETELY AGREE BUT I THINK THAT WORKERS NOW HAVE BEEN ASKED TO SHARE IN THE PAIN FOR A LONG TIME AND NOW THEY'RE SAYING NO WE'RE DONE SHARING IN THE PAIN.

WE SHOULD BE GETTING A PIECE OF THIS AND INCREASED CONSOLIDATION.

YOU ARE RIGHT, IT IS IMPORTANT TO GO TO BATTLE WITH INSURERS BUT I THINK THAT SETS THE STAGE EVEN MORE SO FOR AN ENVIRONMENT IN WHICH COLLECTIVE BARGAINING COULD BE A REALLY EFFECTIVE WAY TO IMPROVE LABOR MARKET OUTCOMES.

IF ANYTHING, CLARPG IMPROVES PATIENT OUTCOME.

>> GIVEN EVERYTHING WE HAVE DISCUSSED TODAY I'M WONDERING ABOUT THE FUTURE AGAIN, THE FUTURE OF HEALTHCARE.

THAT'S OBVIOUSLY A HUGE TOPIC AND WE COULD DEVOTE MUCH MORE THAN AN HOUR TO THAT.

BUT WE HAVE A DWINDLING WORKFORCE.

WE HAVE EXHAUSTION OF THOSE STILL WORKING.

WE HAVE LOST A LOT OF EXPERT TEASE.

THAT'S ALL NEGATIVE AS I PUT IT THAT WAY.

SHOULD WE BE CONCERNED ABOUT THE FUTURE OF HEALTHCARE?

DOCTOR, I'LL START WITH YOU.

>> I THINK THERE WILL ALWAYS BE PEOPLE WHO ARE INTERESTED IN CARING FOR OTHER PEOPLE AND I THINK THEY WILL ALWAYS BE DRAWN TO THE HEALTHCARE PROFESSIONS BECAUSE OF THAT.

ONE OF THE INMATE PARTS OF BEING HUMAN BEING ABLE TO HELP YOUR FELLOW PERSON SUCCEED, BE SAFE, BE SUCCESSFUL AND BE HEALTHY SO I THINK HAVING THAT FEELING IS STILL THERE I THINK THAT'S NOT GOING TO GO AWAY.

I THINK LIT TAKE TIME FOR PEOPLE TO BECOME ACCUSTOMED TO THE NEW NORMAL BUT I THINK WE ARE GOING TO SEE A REBOUND IN THE SENSE WITH MEDICAL SCHOOLS, WITH NURSING SCHOOLS AND THE HEALTHCARE PROFESSIONS PHYSICIANS ASSISTANTS, TECHNICIANS, PEOPLE ARE GOING TO FEEL I WANT TO CRNT TO MANKIND AND HELP OTHERS.

THE ALTRUISM, I DON'T THINK LIT EVER GO AWAY AND THAT'S SOMETHING THAT WILL TAKE SOME TIME BUT IT WILL COME BACK AND I FEEL DOWN THE ROAD BUT I FEEL WE ARE GOING TO BE BACK TO A POINT WHERE WE ARE IN A MORE NORMAL SITUATION I WOULD AGREE WITH THAT.

I CAN TELL YOU THAT WE ARE STILL SEEING RECORD NUMBERS OF APPLICANTS TO PHYSICIANS ASSISTANTS PROGRAMS ACROSS THE COUNTRY.

U.S. NEWS AND WORLD REPORT'S NUMBER ONE PROFESSION 689.

>> I TOLD MY CHILDREN.

>> WE ARE STILL SEEING PEOPLE DRAWN BY THE ALTRUISTIC NATURE APPLY AND WANT TO CARE FOR OTHERS.

I THINK IT'S AN OPPORTUNITY FOR THE EDUCATIONAL SYSTEM AND HEALTHCARE SYSTEM IN GENERAL TO REEVALUATE AND REALIGN.

IT'S A SYSTEM.

IT'S A PROCESS HAS THE PROCESS ALWAYS WORKED OR COULD WE DO BETTER IN TERMS OF PRODUCING THESE HEALTHCARE PROVIDERS.

I'M POSITIVE, POSITIVE BUT YOU ALWAYS HAVE TO LOOK FOR OPPORTUNITY FOR IMPROVEMENT AND I THINK THAT'S ONE OF THE THINGS WE HAVE TO TAKE AWAY FROM THE PANDEMIC, WHAT WORKED WELL, WHAT IS STILL WORKING WELL.

WHAT NEEDS TO BE REALIGNED AND WHAT DO WE NEED TO START OVER FROM SCRATCH.

>> AND I MAY THROW A WET BLANKET ON THE POSITIVITY, YOU KNOW, AGAIN, I'LL GO BACK TO THE MERCER CONSULTING WHO SAID THAT OUR SHORTAGE NOW OF 23,000 WAS EXPECTED TO BE ABOUT 80,000 HOME CARE WORKERS BY 2025.

THAT'S IN NEW YORK.

WE ARE THE WORST IN THE NATION.

THAT'S BEFORE I HEARD ON THE DRIVE HERE THAT IT IS EXPECT WILLED THAT 30% OF THOSE WHO DEVELOP COVID WILL HAVE LONG HAUL COVID.

WHAT IS THAT GOING TO ACED TO THE NUMBER OF PEOPLE WHO NEED HOME CARE SERVICES.

>> HOW MUCH WILL THAT SHORTAGE GROW BY AND IF WE ARE GOING TO CONTINUE TO PAY 12.50 AN HOUR AND THIS IS GOING TO CONTINUE TO BE A MINIMUM WAGE JOB, WE ARE GOING TO CONTINUE TO BLEED WORKERS.

THIS IS GOING TO GET WORSE AND NOT BETTER.

SENATOR MAY CARRIES A FAIR PAY FOR HOME CARE BILL HERE WHICH WOULD GO A LONG WAY TOWARDS FIX BE IT BECAUSE IT WOULD MOVE THAT WAGE TO 150% OF THE MINIMUM WAGE IN A REGION.

IF YOU MAKE THAT 22.50, UNLIKE NURSING, UNLIKE PAZ, IT IS A WORKFORCE THAT CAN BE DEVELOPED QUICKLY SO YOU CAN MAKE A RAPID TURN AROUND BUT RIGHT NOW IF YOU ARE AT 12.50 AND YOU HAVE A FAMILY OF FOUR, YOU ARE BELOW THE POVERTY LEVEL AND THAT WON'T ATTRACT ANYONE.

>> THERE IS A LOT OF LOW HANGING FRUIT.

A LOT OF OPPORTUNITIES TO REDESIGN THAT WORK, TO ASK MORE OF THE WORKERS TO GIVE THEM MORE TRAINING AND TO PAY THEM MORE.

I MEAN THEY SPEND MORE TIME WITH THE PATIENT OR THE CLIENT THAN ANYBODY ELSE.

THEY SPEND TIME WITH THEM IN THEIR ACTUAL ENVIRONMENT IN THEIR HOMES, THEY COULD BE REAL HUBS, THE PEOPLE WHO COORDINATE ALL OF THE OTHER CARE THAT PATIENTS RECEIVE AT HOME BUT AT THE MOMENT WE DENIGRATE AT THAT TIME WORK, WE PAY THEM NOTHING AND WE DON'T TRAIN THEM.

THAT'S A REAL OPPORTUNITY FOR POLICY MAKERS.

SOMETHING THEY CAN ADDRESS GRECTLY.

>> AND THE BILL THAT YOU MENTIONED FROM SENATOR MAY HERE IN NEW YORK STATE TO POTENTIALLY ADDRESS THAT.

A FEW SECONDS LEFT PROFESSOR LITWIN, I'LL GIVE YOU THE LAST WORD I HAVE BEEN ASKING ABOUT THE FUTURE OF HEALTHCARE AND SHOULD WE BE CONCERNED AND JUST IN A FEW SECONDS, ARE THINGS LOOKING IS IT WET BLANKET OR POSITIVE?

I'LL TRY TO LEAVE WITH YOU SOMETHING POSITIVE.

WHICH IS TO SAY YOU ARE ALL RIGHT.

THERE IS A NATURAL INNATE DESIRE FOR PEOPLE TO WANT TO CARE AND THANK GOD WE HAVE THOSE WORKERS BUT AT THE SAME RATE WE ARE SEEING STRUCTURAL INCREASES IN DEMAND THAT WE ARE NOT GOING TO-- >> THANK YOU VERY MUCH.

HAVE I TO STOP YOU THERE AND THAT WILL DO IT FOR US.

I WANT TO THANK ALL OF OUR PANELISTS FOR JOINING US TONIGHT IF YOU WANT TO WEIGH IN THE ON ON THE PROGRAM, WRITE TO AT DRESS ON YOUR SCREEN, FOLLOW US ON FACEBOOK AND TWITTER AND VISIT OUR WEBSITE AT WCNY.ORG/CONNECTNEW YORK AND ON BEHALF OF OUR TEAM HERE AT WCNY, I'M DAVID CHANATRY AND THANKS FOR WATCHING.