So it seems to be a population that defies simple answers It's even hard for policymakers to zero in on how much home care services to pay for.

I've seen that change wildly.

Like, if you look back 10 years, it might've been if we put a kid with a, on a ventilator and a tracheostomy at home, then we're gonna say, "The only way you can go home safely with medical technology is with medical people.

So you need 24 hours a day of nursing, seven days a week." And then that was unsustainable, so we said, "Well, maybe you need 24 hours, five days a week.

Maybe you need eight hours, four days a week." And it continued to shrink, and as it shrunk, the kids did okay, until we get to the tipping point.

[gentle music] And that tipping point isn't that the parents can't learn to be nurses, respiratory therapists, and physical therapists at home.

It's that parents don't get a vacation, don't get a day off.

I wanted to learn from Nancy a bit about what it is that draws clinicians into service for children with medical complexity and what it takes to do the job well.