FROM DISCOMFORT COMES OPPORTUNITY

The healthcare industry is currently facing unknown territory as the nation recovers from the COVID-19 pandemic. Richelle Gregory, Director of Community Services for Clinton County Mental Health and Addiction Services and Michelle LeBeau, President of the University of Vermont Health Network- Alice Hyde Medical Center and Champlain ValleyPhysicians Hospital (CVPH), recently discussed their vision for the future of healthcare in the North Country and the importance of community partnerships.

“It was eerily quiet,” Gregory said of the COVID-19 pandemic. “It was like a sleeping dragon.” At the beginning of the pandemic, Clinton County Mental Health and Addiction Services was not seeing the traffic it normally did which was unusual considering the isolation many people were experiencing.

“As the world came to a halt because of COVID, we were shifting gears to continue to provide care for the community during the pandemic. Our team was balancing the needs of their families and home lives with immense challenges at work,” offered LeBeau.

Now that infection rates are lower, people are vaccinated and the state is reopened, the demand for services for anxiety and depression has increased. In addition, an increase in alcohol use and overdoses in the area has alarmed professionals. Now healthcare officials are left trying to address the societal trauma created by the pandemic. Gregory believes the recovery community has taken a five-to-ten-year step back due to the pandemic.

LeBeau explained that during the height of COVID, all elective surgeries and procedures were canceled. The number of patient visits in the Emergency Department dropped dramatically. “Today, we are seeing an uptick in patient visits and in the number of surgeries and procedures but we are not at the same level as we were pre-COVID.”

In the North Country, the focus on healthcare post-pandemic is on overall wellness of patients which declined during the past 18 months. Those who were struggling before the pandemic are at higher risk now. Physical, mental and spiritual wellness are all interconnected, as are economic and environmental wellness. As one element of wellness declines, other parts begin to decline as well. Gregory expressed her concern that physical health will eventually follow the same course as behavioral health.

Both Gregory and LeBeau have plans to address the increase in the need for behavioral health and addiction services. Gregory is involved with the Clinton County Law Enforcement Review Committee which made several recommendations for increased training for law enforcement officers about mental health issues. For the review, the committee asked community members to complete a survey. The results indicated a need for better services for those experiencing mental or behavioral health crises. In response to the need, Gregory is working with law enforcement to increase training for personnel and support for the mental wellbeing of the law enforcement officers.

Gregory is also in the process of strengthening the crisis response services in the community that she described as “fractured”. The goal is to identify those who need services for mental and behavioral issues before they reach crisis level. A key to that is communication between local agencies and services. While organizations and community partners frequently know about individuals before they are in crisis, they often do not communicate with each other. That means individuals can fall through the cracks. Part of the Local Services Plan for 2022 is to make sure communication happens so that these individuals will be identified and helped sooner.

A new CVPH adult psychiatry unit will be complete by the end of 2021 and will include a Medical Village–dedicated space on the new unit offering patients the opportunity to prepare for discharge by networking with several community partners. It will also provide a central location for a variety of resources for patients to support a smoother transition to outpatient care. The Medical Village’s goal is to offer patients an in-person, direct connection, whenever possible, to individuals from these agencies who will support their every opportunity for success in the outpatient setting and avoid readmission or return to the Emergency Department.

As the region reopens, CVPH is transitioning once again. “We are just beginning to see the full impact of COVID on healthcare. To continue to do what we do, we are thinking differently and working differently while staying focused on providing the care this community needs,” LeBeau emphasized.

Primary care continues to be an important part of that effort. More than a decade ago, the healthcare community recognized that a deficit in primary care locally was approaching and action was needed. That is when, in partnership with what was then, Fletcher Allen Health Partners (now the University of Vermont Health Network) and the Robert Larner, MD College of Medicine, CVPH established its Family Medicine Residency. Its mission is to train Family Medicine physicians who can practice anywhere with the hope that graduates opt to stay in the North Country to live and work. Since the program started in 2013, six doctors have decided to stay in the region and start their practices. “It’s spectacular,” LeBeau explained, “It’s a huge win for our communities.”

In upstate New York there are about 2,100 vacancies for registered nurses, licensed practical nurses and clinical assistants. here is also a large gap between the number of environmental services aides, cafeteria/food service workers, respiratory therapists and medical technologists.

Workforce recruitment continues to be one of the biggest challenges for healthcare. As people have relocated to rural communities due to the pandemic, LeBeau sees an opportunity to convince young CVPH’s state-of-the-art Vascular professionals to stay in the North Country. Many who have located in our region come from diverse backgrounds which is important for the hospital’s future.

“We are at crisis levels,” Gregory stated. “There are simply not enough professionals in the field to deal with the demands and the pandemic which only made the situation more complicated. One of the major challenges the area is dealing with is co-occurring disorders that involve more than one agency such as Office of People with Developmental Disabilities (OPWDD) and Office of Addiction Services and Support (OASAS). The North Country does not have the workforce or longterm support services available to help these complex cases.

There are currently shortages in both the human services field and the healthcare field that are only going to get worse,” Gregory stated. CVPH is struggling with workforce challenges. LeBeau described a coming shortage of nurses that will impact all areas by 2022.

In upstate New York there are about 2,100 vacancies for registered nurses, licensed practical nurses and clinical assistants. There is also a large gap between the number of environmental services aides, cafeteria/food service workers, respiratory therapists, and medical technologists.

CVPH is working closely with nursing and healthcare programs at Clinton and North Country Community Colleges, Plattsburgh State University and the Champlain Valley Education Services (CVES) New Visions program to address the shortages by introducing students to career options in health care and helping to train professionals. “We experienced similar shortages in the past and found ways to overcome them,” LeBeau explained. “This is the new normal.”

Although the future presents challenges, both Gregory and LeBeau are optimistic. “As a community, we always seem to figure out how to make it work even with limited resources,” Gregory said. “The strength of our communities is our partnerships. We do things for each other because we are so intimately connected and we have to rely on each other to survive. Without a lot of outside resources, we always think outside the box. I will be interested to see what we come up with next.”

LeBeau expressed similar sentiments, “We are going to adapt and change to meet the needs of the community. We embrace taking care of one another. It is one of the best parts of living in a rural community — it’s family. We do this together.”

Gregory concluded “Pulling together is what we do in a crisis. I think we are going to see some great innovation come out of this. Comfortable people don’t grow. Right now, we’re uncomfortable. It will be interesting to see where our discomfort leads us. I believe it will give us the motivation to do things better.”