Discussing the Future of Health Care

As COVID-19 roots itself as a fixture in everyday life, its impact on the health care landscape is still evolving. But on the East End, that isn’t the only factor affecting the future of the medicine.

The Express News Group posed a number of questions to four leaders in East End health care, asking them to reflect on the past three years and consider what lies ahead — from areas of innovation and needed improvements, to mental health, the opioid crisis and the pandemic itself — as well as issues plaguing the region, such as the affordable housing crisis, shortages of primary care physicians, and more.

Participants included Paul J. Connor, chief administrative officer at Stony Brook Eastern Long Island Hospital; Carol A. Gomes, chief executive officer at Stony Brook University Hospital; Marc Adler, senior vice president and chief of hospital operations at Long Island Community Hospital; and Mary Crosby, president and chief executive officer of East End Hospice.

This is what they had to say.

It has been about three and a half years since the COVID-19 pandemic hit New York. This fall, we have already seen COVID cases surge, along with reports of RSV and flu cases also on the rise. How can health care providers continue to spread the message about the importance of vaccination and the new reality of needing to get a COVID-19 booster annually, as well as a flu shot? What have we learned in terms of best practices over the years?

Paul Connor: We are well-equipped to deal with any COVID-19 outbreak. Our staff is fully educated and prepared for any situation. Our supplies are always fully stocked and have policies and procedures in place.

Carol Gomes: The best approach to sharing lessons learned is to refer to evidence-based literature, which provides scientific facts associated with the benefits of vaccinations for influenza and COVID-19. In addition, the key to supporting these activities is access to vaccines.

Marc Adler: Respiratory viruses are best controlled by limiting their transmission. Throughout the COVID-19 pandemic, we learned that the basics — immunizations, frequent handwashing, limiting exposure to sick contacts and precautions for the most vulnerable, including infants, elderly, and those with weakened immune systems — is the optimal strategy.

What is the actual forecast for COVID-19 this winter? Do you feel like your hospitals are equipped if there is a surge in infection rates?

Adler: We are always concerned for a rise in respiratory illnesses in the colder months. COVID-19 brings an additional layer of preparedness, both for patient placement in hospitals and for staff illnesses that strain our workforce. Care for our caregivers is particularly important now. Because of this, we have stepped up our contingency planning in the event of an uptick in hospitalizations and ensured an ample supply of masks and gowns and review protocols we developed during the pandemic.

Is there an area of medical treatment that has advanced significantly over the last two years?

Connor: Artificial intelligence and its application to the medical field has made leaps and bounds in recent years. For example, in our radiology department, when reading a mammography, there have been studies that show there is significant efficacy in applying these AI programs to imaging, especially mammography.

What areas of innovation are you most excited about? Where are we seeing breakthroughs?

Adler: As the population ages, providing care in hospitals is creating a greater challenge for the traditional care delivery model of brick-and-mortar care. Hospital at Home programs, using remote monitoring and mobile providers, effectively extends the reach of acute care to patients who can receive care in the comfort of their own homes. The industry is nascent and destined to grow as remote monitoring technologies improve.

The sharing of medical information, including through home monitoring and implants, as well as smartwatches, has been on the rise over the last decade, enabling people to share information with health care officials about their health during an average day. How have these technologies aided health care? Are there drawbacks?

Gomes: New technology is part of the ever-changing health care landscape. Medical information sharing and home monitoring are extremely pertinent to ensure continued capability to address the needs of patients when intervention is needed. From monitoring blood pressure, heart rate and pulse to monitoring weight and fluids to address patient needs diagnosed with congestive heart failure, the ability for continuous monitoring demonstrates a proactive approach to providing necessary interventions to optimize outcomes.

Adler: Remote monitoring has been tremendously effective at identifying issues that need immediate attention like heart rhythm abnormalities and blood sugar changes for diabetics. People can self-monitor, or some devices send information directly to their providers.

What are the technologies coming down the road that will potentially help doctors and nurses diagnose, treat and potentially cure some cancers, or other potentially fatal diseases?

Connor: The application of AI to the health care field is going to revolutionize health care. This will account for, basically, a larger number of individuals who can be subject to using this type of technology and being diagnosed quicker, with a plan of care made available earlier so the patient is treated faster.

Gomes: The use of artificial intelligence to utilize key data points for predictive analyses can certainly work toward helping doctors to diagnose and treat disease. Genomics and genetic mapping can assist to pinpoint patient-specific needs that can also optimize treatments for individual patients.

What preventative care do you recommend to avoid medical issues like heart attack and stroke?

Gomes: A healthy nutritional outlook, regular exercise and optimal sleep habits can all contribute toward a healthy lifestyle. For those who may be genetically predisposed to these conditions, it is important to seek medical attention from a professional to obtain the necessary guidance and approach for proactive steps toward optimizing healthy outcomes.

Adler: A balanced diet, ample sleep and regular exercise have always been staples. Finding happiness and daily purpose can be fulfilling and reduce adrenaline surges and stress, which can be associated with heart attacks and strokes.

What is the status with telehealth? Are people still using it in a robust way? Is it being used too much? What are the pros and cons?

Connor: At Stony Brook Eastern Long Island Hospital, we have five applications of telehealth: TeleNeurology, TelePalliative Care, TeleEndocrinology, TeleBehavorial Health and, coming soon, TeleNephrology. We believe that this allows access to improved health care and better outcomes overall.

Gomes: The pandemic served as a burning platform relating to health care delivery models. As a result, the full implementation of telehealth was hastened in order to provide direct access to health care providers to address health care needs on a timely basis. Telehealth continues to be used robustly and is growing in terms of the types of services being provided. Besides the opportunity to improve access, it is also an efficient use of time for both the provider and the patient.

Adler: We saw a significant surge in telehealth during COVID-19. It’s likely that this modality was coming, and the pandemic accelerated its adoption. Now, providers and patients are more comfortable with telehealth. While some medical issues are best addressed in person, remote options clearly have value and will likely continue, especially in reaching patients who have difficulty getting to providers readily and for home health options like hospital at home.

Mary Crosby: Our therapists at our Zinberg Family Bereavement Center are still offering virtual sessions, which can be such an important tool for reaching clients who are homebound or have difficulty traveling to appointments. For individual therapy sessions especially, telehealth can sometimes be the difference between getting the support clients need and having no access to care.

Patients often report delays of several weeks or even months to get a doctor’s appointment. How are they making scheduling more efficient and making appointments to see specialists more readily available?

Connor: One of the central components of the Stony Brook Medicine strategic plan is access. In the plan, access to care is a large piece of it and developing a frictionless process that will allow the patient to immediately contact a provider at Stony Brook. Our aim is to have our patients be able to make an appointment within a reasonable period of time to get the care they need.

Adler: The NYU Mychart app puts scheduling right in patients’ hands. It’s a seamless connection that enables scheduling initial and follow-up visits. Test results are made available on the app and communication with providers is an option. This technology has transformed the way patients can access care.

On the East End, many quality-of-life issues lead back to a lack of affordable housing, as businesses struggle to retain staff because of the housing crisis. What is the status of staffing at local hospitals and other health care facilities? Is it still a challenge to hire people, keep nurses and staff health care centers — particularly in the wake of COVID burnout? Or have staffing levels rebounded in the last year?

Connor: We have a limited number of affordable apartments for the use of itinerant employees. Our community needs affordable/workforce housing. There are significant impediments to establishing workforce housing and getting over these obstacles will be challenging. Due to the pandemic, hospitals across the county have seen health care professionals leave the field. Recruitment of high-quality employees has and continues to be a top priority to SBELIH. Consistent hiring allows us to adequately address staffing needs and continue providing exceptional care to our patients. Stony Brook Medicine’s talent acquisition department has provided a significant amount of resources to increase awareness for our open positions.

Gomes: Workforce challenges in the health care sector are occurring throughout the United States. As many health care workers have since retired or left the workforce during and after the pandemic, there is a concerted effort to focus on pipelines to create interest and enthusiasm to encourage students in elementary, middle and high schools to learn about health care careers for future consideration. Federal and state governmental agencies are offering grants to directly address workforce challenges, particularly in the area of nursing, to ensure a steady stream of qualified health care professionals. At Stony Brook, we are fortunate to benefit from university graduates who enter the workforce every year in medicine, nursing, ancillary services — such as laboratory technologists, radiology technologists, respiratory technologists, physical and occupational therapists — nurse practitioners, physician assistants, and myriad additional health care professionals.

Adler: COVID-19 created challenges to staff, but there is a renewed interest in health care opportunities. While the profession is very demanding, it is also one of the most noble and rewarding and offers an opportunity for dedicated, caring individuals to devote themselves to careers helping others. We are focusing on educating and developing passionate people for the future.

Crosby: Hospices have been an outlier when it comes to the health care staffing crisis. At EEH, we’ve seen increased interest in hospice from nurses who are looking beyond hospitals and other health care settings. Hospice care is a unique and intimate part of health care. Our nurses, social workers, hospice aides, staff and volunteers have great autonomy in their work. They develop strong partnerships with patients, caregivers and families. There’s a lot of pride among our staff for the work we do.

That said, we’re still impacted by the lack of affordable housing and high cost of living here on the East End. We’re also very affected by traffic congestion. The majority of our patient care happens in people’s homes. Our staff are driving from one appointment to the next. They get stuck in the trade parade and have to navigate back roads. This can be one of the biggest challenges when we’re recruiting. People just aren’t ready or willing to spend big parts of their day in their cars, so we divide the East End into districts and help our staff manage their travel as efficiently as possible, but it’s a challenge.

There has been a renewed focus in mental health care and wellness, particularly for teens and children, in recent years. How are your health care agencies working to provide increased mental health services for children and teens?

Crosby: Statistics show that one in 12 children in the United States will experience the death of a parent or sibling by age 18, and that number doubles by age 25. East End Hospice has been the East End’s principal resource for grief and bereavement therapy for more than 20 years. Our Zinberg Family Bereavement Center offers year-round programming led by full-time, licensed therapists who are experts in grief and bereavement.

We offer individual and group therapy, in-person and virtually, although virtual sessions are less in demand than recent years and tend to be used by adults more than children. We hosted the 26th session of Camp Good Grief this past summer and planning is well underway for our 2024 season. We enroll between 150 and 170 campers, age 4 to 17, each summer. We partner with many East End school districts. We’re often called in to respond to sudden or tragic loss. We prep educators and school employees so they feel ready to talk about death and offer on-site counseling for students.

Demand for mental health care and wellness have become buzzwords, which is great for awareness, but we also need to build capacity so we can meet the need. All of our bereavement programming is free to anyone in the community in need of our services. Funding comes from charitable donations and greater investments are needed to adequately support our community, especially children and teens and, importantly the 18 to 25 population who are often overlooked.

The elderly population continues to grow on the East End. Are health care providers, regionally, equipped to treat this population? Where are we seeing advances and where can we do a better job?

Connor: SBELIH is optimally equipped to care for the aging population. A large portion of our patient population is in the over 60 demographic. Most of our patients are healthy, active and want minimal interruptions to their life from health care events. We help them get back to work and back to enjoying their lives without sacrificing any quality of care. Our nurses, physicians and ancillary services are knowledgeable about the population and comfortable with the unique care some of these patients need. They are skillful in managing patients with limited mobility, complex medication regimens and understand potential need for additional home and skilled nursing needs from the moment the patient enters our doors. For our hospital and surgical services, we are actively working to attain a geriatric surgery verification from the American College of Surgeons to more formally shine a light on the care we already provide.

Gomes: Very specific competencies are required to care for the elderly patient population. At Stony Brook University Hospital, we earned a geriatric emergency department accreditation, which fulfills key areas of focus for this patient population. From providing a safe environment to developing specific policies and protocols for elderly patients, it is extremely important to pinpoint key processes to optimize the care for this growing patient population. In addition, being exposed to proactive wellness programs is also extremely important as we age. Stony Brook Medicine and Stony Brook University launched the Center for Healthy Aging, which provides a holistic view on health care, education and research associated with serving an elderly patient population. The goal of the CHA is to promote healthy aging and extend both physical and mental well-being through innovative research solutions, and transform the care of the aging population in Suffolk County and beyond.

Crosby: East End residents are choosing to age in place and others are retiring to the area. In addition, 10,000 Americans nationwide turn 65 every day, so the trend toward an older population is only going to continue. People are also living longer and with more complex medical needs. This puts a lot of pressure on our health care system. It also puts tremendous pressure on caregivers — whether they are family members or paid professionals — and, unfortunately, there’s a real shortage of professional caregivers here on the East End, which makes things more difficult. Medical advances of all kinds are improving life spans, but we also want to be promoting quality of life. At East End Hospice, we help our terminally ill patients prioritize quality over quantity of life by managing pain and symptoms. Right now, President Jimmy Carter is shining a real light on the important role of hospice care and the fairly simple ways our care can help patients, their caregivers, families and friends so that we can improve health and reduce the caregiving burden.

Opioid addiction has been an issue that has impacted all communities and demographics across the country. Most recently, we are seeing a growing problem with fentanyl and tranq. How are health care officials responding to this problem? How can health care, local government and law enforcement collaborate to respond to this ongoing crisis?

Connor: In the summer of 2021, the East End was met with great tragedy when six people died due to an overdose of cocaine laced with fentanyl over the course of one week. This tragedy was a brutal reminder of the public health crisis of substance use and addiction that destroys lives. Rich Vandenburgh, a local businessman and community leader, called us the morning after the news broke and immediately asked what we could do. As a response to the senseless deaths, SBELIH has collaborated with Mr. Vandenburgh and Community Action for Social Justice to distribute and install Narcan rescue stations in area businesses. These Narcan rescue stations contain multiple doses of naloxone, which stops an opioid overdose. We will also provide ongoing Narcan training to these establishments and the community. These Narcan rescue stations are a tool to save a life in the event that a life needs saving, like an AED.

The response to the Narcan rescue stations has been overwhelmingly positive and we hope these life-saving emergency kits will help prevent a tragedy like the one the North Fork and Shelter Island faced in 2021. We are presently working with the Town of Southold and CASJ to provide free and confidential in-home Narcan training sessions with licensed Narcan experts. SBELIH is a premier provider of behavioral health care for eastern Long Island and Suffolk County. SBELIH is Suffolk County’s only facility that offers integrated care that encompasses detoxification, rehabilitation and psychiatric services along with medical care with a track record of proven success throughout Suffolk County. Serving adults 18 and over, SBELIH Inpatient Behavioral Health Services provides treatment for mental health and substance use disorders from a medical and psycho-therapeutic approach. Treatment is provided by an interdisciplinary team of physicians, nurses, social workers, recreation therapists and credentialed alcohol and substance abuse counselors. Through individual and group therapy, education, medication management and comprehensive discharge planning, SBELIH provides a nurturing environment that assists each patient to progress and heal within their recovery process.

Gomes: It is important to ensure that the community is aware of the programs available to address lifestyle choices that impact health. More importantly, a proactive approach toward mental health and wellness, including stress reduction activities, health nutrition, regular exercise and adequate sleeping habits, can all contribute to positive health outcomes. Health care professionals can reinforce the availability of information and programs that can benefit patients.

Crosby: We absolutely need a collaborative approach when it comes to addressing opioid addiction. And we need to be thinking not only about those with substance use disorders, but their family and communities, as well. We’ve seen an uptick in people seeking grief and bereavement support for overdose and for losses related to substance use. Oftentimes these clients have been navigating the trauma and stigma of addiction for a long time. Children who experience the death of a parent, sibling or other loved one because of substance abuse disorders can have an especially difficult time and it takes mental health providers, schools, community organizations, and so many others to support them. The old adage of it takes a village to raise a child is especially true when that child has lost someone because of addiction.

How can health care professionals work with the public on ways to address lifestyle choices that impact health? What are some of the lifestyle modifications you recommend to most people in general?

Connor: As part of its ongoing commitment to improving every aspect of health and wellness in the local community, SBELIH provides programs designed to help local residents better understand health risks and improve healthful decision making. Tools and speakers for such educational outreach are enriched through our affiliation with Stony Brook Medicine, as well as through members of the expanding medical staff of SBELIH itself.

Adler: Patients and providers need to be partners in care. Seeking healthy lifestyle choices, sensible diets, adequate exercise and stress reduction all contribute to longevity and quality of life. Health care providers can help tailor these choices to each individual.