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The shortages are most acute among low-paid nurses' aides who work in nursing homes, and both state legislators and the state attorney general's office have linked the low staffing levels to abuse and neglect of patients.

But the shortages have extended in recent years to many areas of health care. Hospitals complain that there are too few registered nurses, pharmacists and workers who code medical records, and home health care agencies say turnover among aides is at an all-time high.

The staffing problems first began a few years ago in the Hudson Valley, but have spread throughout the state in the last year, striking New York City just recently.

At White Plains Hospital Center, it is now taking six to nine months to fill specialized nursing positions, compared with the three to six months it took just a year ago. Fedcap Home Care Services in New York City now turns away roughly half the patients who request short shifts of nursing care. And nursing home workers who each used to care for about seven residents during the day shift are now regularly compelled to care for 10 or 11 people, and as many as 40 during the night shift, union officials say.

''The work force shortage is one of the most critical issues facing health care in New York State right now,'' said Daniel Sisto, president of the Healthcare Association of New York State, a lobbying group for hospitals and health care systems. ''I think it is affecting care. No health care association wants to admit that, but I think that hospital C.E.O.'s are no longer in a position to guarantee the public that optimum quality of care is being delivered.''

The difficulties in finding and keeping health care workers stem in large part from a booming economy that has created a surplus of higher-paying, less demanding jobs in other fields.

But even more troubling, experts say, are factors that go beyond simply a wealth of job options, and they are forces that will not necessarily be altered by a slowing of the economy, even a recession.

Those factors include a steady decline in nursing school enrollment, and a growing nursing home population that is sicker, and whose more complex medical problems have transformed the job requirements of the people who care for them. In addition, the entire profession suffers from a major public relations problem, with certain jobs in health care often perceived as thankless occupations rather than labors of love.

Similar labor shortages in the health care industry are being felt all over the country. For instance, enrollment in advanced nursing programs has fallen for five consecutive years, according to the American Association of Colleges of Nursing.

But while enrollment in bachelor's degree nursing programs declined nationally by 4.6 percent in 1999, it fell the most -- 7.4 percent -- in schools in the North Atlantic states, including New York. In a recent survey by a trade association, the New York State Association of Health Care Providers, 93 percent of the state's roughly 200 home health care agencies said they could not find enough workers to fill vacancies.

New York's extremely low unemployment rate has made it hard to attract workers, and a decrease in Medicaid and Medicare reimbursements three years ago has kept salaries in many areas of health care low.

For example, recent Congressional projections for the budget period from 1998 to 2003 show an estimated $69 billion drop in spending on Medicare home health programs, a figure more than four times as large as what Congress originally projected. Those reductions end up cutting right into salaries. Most home health aides in New York are paid $5.15 an hour, the federal minimum wage, though some receive as much as $7.

As part of these cuts, many Medicare patients are now entitled to only two hours of home care a day, and the vast majority want nurses' aides in the morning, leaving workers idle in the afternoon and contributing to a shortage of aides for early shifts. As a result, turnover among aides is climbing, executives say, because there is not enough work to go around, and some are leaving the profession altogether, for jobs like retail sales clerk.

''If people are thinking about where they can make the best dollar, they are not going to go into this line of work,'' said Phyllis Wang, president of the New York State Association of Health Care Providers. ''There are more and more opportunities out there, and there has been another full cycle of not giving pay increases while retailers are bidding up. All it takes is 25 cents to lose a worker.''

But there are many other factors, some of them demographic, others just plain quirky, that have contributed to the shortages, and those will not be ameliorated by a weakening economy, industry officials fear.

The average age of those in nursing homes, for instance, has risen sharply in recent years as the population has grown older. Many younger and more robust elderly people have opted for other types of housing, like assisted-living communities, leaving the sickest and most challenging patients to be cared for in nursing homes.

''The kind of residents that come in the nursing homes these days are more demented, more aggressive and more old,'' said Olgarene Oliver, who has worked as a nurses' aide for 26 years. ''It is much harder to take care of them. I have a friend who had to leave because a patient slammed her against a wall and broke her collarbone.''

More difficult patients, combined with the added paperwork generated by managed care in recent years, has meant that workers are spread more thinly. A report issued last summer by the federal Health Care Financing Administration found that 54 percent of the country's nursing homes provide less than the minimal two hours a day of nurses' aide care for each patient, and New York's experience is consistent with those findings.

Jay Sackman, executive vice president for the nursing home workers unit of 1199/S.E.I.U., New York's largest union of health care employees, said staffing levels were the worst he has seen since 1968.

Nursing homes have been the target of both the State Department of Health and the state attorney general in the last year, and The Daily News last week published a series of articles describing failures in care and supervision at nursing homes in the city.

This year, the Health Department cited 55 of 58 homes that it surveyed, for minor infractions like not getting a patient a yogurt in a reasonable amount of time to far more serious problems involving care. The attorney general's office has investigated 264 cases of patient abuse in nursing homes this year, double the number in 1999.

At a public hearing this month in New York City, Jose Maldonado, a deputy attorney general who heads the state's Medicaid Fraud Control Unit, strongly recommended that the state impose minimum staff-to-patient ratios in nursing homes to better safeguard against patient abuse. There is also a bill in the State Legislature to set such requirements, and it has the support of numerous patient advocacy groups.

A nursing home industry group, the New York Association of Homes and Services for the Aging, has responded coolly to such proposed requirements, arguing that there is no money to pay for more workers.

Wayne Osten, a State Health Department official, said at the hearing that he believed that Medicaid reimbursements to nursing homes were substantial enough to attract more workers. He also said that the Health Department would spend $80 million on a program to attract, train and subsidize poor New Yorkers who agree to work in health care, and that it was seeking proposals to develop the program.

Hospitals, meanwhile, are facing their own labor woes. They have had a difficult time attracting pharmacists in the last two years, largely because of competition from the growing drugstore industry, which has poached many workers and pushed up wages. According to a recent study by the federal Department of Health and Human Services, pharmacy jobs in the retail sector have grown at nearly three times the rate of those in hospitals.

And that hardship for hospitals could worsen, both because of declining enrollment in pharmacy schools and because a recent change by those schools has lengthened the required study to six years from five, delaying the entry of new pharmacists into the market.

Hospitals have also been scrambling to find nurses in recent years, and the situation has worsened considerably in the last six months. The problem is especially stubborn among specialty nurses, like those who work in operating rooms, intensive-care units and labor and delivery units.

The average vacancy rate for registered nurses in hospitals around New York City is 5.5 percent, though as recently as 1998, many nursing school graduates could not get jobs, said Patricia O'Brien, the senior administrator for regulatory and professional affairs at the Greater New York Hospital Association. In some pockets of the city, the rate is closer to 9 percent.

Mr. Sisto, of the Healthcare Association of New York State, said that around New York, some hospitals have been forced to cancel elective surgeries and divert ambulances away from emergency rooms because of the nursing shortage.

What is more, Ms. O'Brien said, the average age of nurses is now above 40, and the ratio of nurses over 50 to those in their 20's is expected to reach four to one in the next few years, leaving fewer nurses to replace those who will be retiring.

Ms. Wang, the official with the New York State Association of Health Care Providers, said, ''We are just not sure the workers are out there.''

Fewer young people are considering careers as nurses and nurses' aides, experts say. Many of the state's vocational programs for licensed practical nurses have been shelved in recent years, and high school guidance counselors are not encouraging careers in nursing and health support services. New York's health care industry itself has done little for recruitment, experts say.

As a result, Ms. Wang's organization, as well as the Healthcare Association of New York and other industry groups, have formed a coalition on staffing. They hope to develop legislative proposals to get more Medicaid money for wages, to recruit retired police officers and firefighters into second careers in health care, and to begin marketing efforts to attract young recruits.

Assemblyman Richard N. Gottfried, chairman of the Assembly Health Committee, is sponsoring a bill that would establish minimum staffing levels in nursing homes. He expects the labor problem to be high on the Legislature's agenda this winter.

''I think staffing in nursing homes, home care and hospitals is going to be a major budget issue,'' Mr. Gottfried said.