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Reduce the risk of falling with strength and mobility

Natalie Fick (guest):

If you’ve known people that have had injuries, you’ve had loved ones that have had a very adverse outcome from a fall, we know that on the positive side that falls are very multifactorial. That it’s a lot of things that you can do to prevent falls and to reduce your risk. And I think it’s something kind of empowering for a lot of people to know that they can kind of take charge of that and they can do a lot to prevent those falls and overall keep them strong and moving well. And that’s, I think, something that once they understand where those resources are, whether it’s with their provider, whether it’s with their therapist or any of like the community exercise programs and things going on too, that they can take those positive steps to keep them moving well and aging in place and maintaining their strength and their mobility too.

Cassie Alvine (announcer):

This is the “Health and Wellness” podcast brought to you by Sanford Health. The conversation today is about understanding falls and fall prevention. Our guest is Natalie Fick, Sanford Health physical therapist. Our host is Alan Helgeson with Sanford Health News.

Alan Helgeson (host):

Thank you, Natalie, for taking time to spend with us today to talk about this topic.

Natalie Fick:

Glad to be here.

Alan Helgeson:

Alright, well we’re going to talk about falls prevention and let’s get started here. I guess the big open question we want to start with: why is falls prevention an important topic for older adults?

Natalie Fick:

I think it’s something that any older adult, no matter age, where they live, it’s always a concern at some point. And it’s a really critical topic for them too because it’s such a leading cause of severe injuries and can overall kind of affect their mobility and their independence, which I think is a common concern for people as they age, you know.

Falls, they can increase your risk of hospitalizations, lead to a decline in overall health and function and mobility, which a lot of people, they want to age in place. They don’t want to have to go to a nursing home, feel like they’re more dependent. And unfortunately we know the adverse issues from falls, whether injuries or other things too can usually lead to more of like a dependent type lifestyle if they aren’t able to recover well. So that is a big factor.

And then also we know just by working on preventing falls, we can just help to hopefully maintain people’s physical health and mobility, allow them to age in place like a lot of people want to do, reduce health care costs, which is another huge worry for a lot of people. And support their overall emotional well-being. So kind of reducing rates of depression, anxiety and just kind of helping them feel more confident and safe with their day-to-day activities.

Alan Helgeson:

You talked about that costing, that’s a biggie. Boy, we hadn’t even really thought about that, but you talked about also, you know, all these different things. What really puts them at risks for falls?

Natalie Fick:

So we think of falls as actually a very multifactorial thing. It’s not just one cause causes the falls like, oh, just a trip and they fell and had an injury. There’s a lot of factors that go into it, you know, starting (with) a very common thing with any aging adult is just lower extremity weakness or overall weakness in their body that we know just puts them at a higher risk of falling.

We know that just in general, if they’re having more difficulty with their balance and walking, whether or not they’re using an assisted device or if they need it can put them at a higher risk.

Sometimes even medications that they’re taking can greatly increase their risk of falling because of either side effects or interactions between medications. And people don’t always realize that. So that’s where it’s a great conversation to have with your provider or your pharmacist to see if you are at a higher risk with that too.

We see a lot of people with even just poor footwear. So wearing good supportive shoes so that you’re not tripping over your shoe, just have overall good stability can be a big factor. Vision problems – I don’t know when everybody’s maybe had the last time they’ve had their eyes checked, but other eye conditions too, whether like glaucoma or even just not having an updated prescription can greatly affect your ability just to see your environment and potentially identify or limit your ability to identify trip hazards or things in front of you and around you too.

And then another common one that I actually work with people a lot on is even like low blood pressure so that when they get up from either laying down or from sitting, they might get dizzy or they might feel really woozy and that potentially can cause a fall and an injury too.

Alan Helgeson:

So many different things you don’t even think about.

Natalie Fick:

Right. Exactly. And the nice part in a way about this too is we know there’s so many factors we can potentially control and we can minimize that risk by identifying where am I at risk and knowing that hey, I can get better footwear. I can talk to my doctor about medications. Or I can go get my eyes checked. Doing things like that greatly, greatly reduces your risk so that you’re safer overall.

Alan Helgeson:

So I was just going to tell you here a couple of things while you’re talking about that I’m going through the footwear thing in my mind of the different things I have and I’m going to admit I’ve got some things, they’re not the greatest, you know. I’ve got some junky flip flops. I’ve got some slippers that my wife would say, you need to get rid of those, you know, we all have those.

Natalie Fick:

Exactly.

Alan Helgeson:

I had no idea about certain medications that could put you at risk for things like that. And then what about if you don’t have vision issues strong enough or bad enough where you have prescription glasses but you’ve got readers everywhere and maybe you walk around the house with your readers down? They could be issues for tripping, right?

Natalie Fick:

Correct. So I mean it can potentially skew your vision just enough where you normally used to like a flooring transition or a small step. And you can misjudge that, or I’ve even had people that have had that discussion where they just got bifocals and all of a sudden they’re having issues or trying to figure out the curbs.

So we see it in a lot of places, thankfully, where people are being more aware out in the community where they might highlight those transitions with like yellow paint or some extra grip on certain steps too to try and help minimize that risk. But they’re still there. They can still happen. The sidewalk will heave in certain spots you might catch your toe. So we always have to be able to hopefully see those and be aware of that too.

Alan Helgeson:

Natalie, I want to go back here and the reason we have you here is that you’re kind of special here with some special training in talking about falls. So let’s talk about where do you work, what clinic are you part of and let’s talk about the reason you’re able to talk about this today.

Natalie Fick:

Yeah, so I work at Sanford here in the outpatient physical therapy department at the Madison Veterans Parkway Clinic. And so, I mean that’s just part of my job is we have been trained in being able to help evaluate and assess people in their fall risk, overall strength and mobility concerns, and helping to improve those so that they are safer in the home.

I’ve also had the privilege over the last five years of working with some amazing people here to help implement some evidence-based fall prevention classes in the Sioux Falls area and the region. And so I am a master trainer with the Matter of Balance class. And then I provide kind of the health care professional viewpoint as well with these classes.

And then I’ve been able to work with this group too as they’ve implemented other classes including SAIL (Stay Active & Independent for Life) and Bingocize (combining bingo and exercise) in the community to again help to reduce this large issue that we have not only in the Sioux Falls region, but in the state as a whole too.

Alan Helgeson:

You’ve got some deep training to not only as a physical therapist, but you have a doctorate in physical therapy, correct? What does that mean, having a doctorate in physical therapy? Can you talk a little bit about that?

Natalie Fick:

So in order to get our doctorate, so in order to even just to get into grad school, you have to get your bachelor’s degree. So I’ve had four years for that in kinesiology. And then I had a psychology and coaching BA minor too and then got into grad school. And so additional three years of training extensively, not only on the body mechanics, how the body function and works, but we when you get your doctorate level, they’ve expanded that training and that knowledge too to be able to better understand how all the systems work together. Not only just the musculoskeletal and the getting stronger too, but how the cardiovascular system affects things too. How the pulmonary system, you know, where we can identify some of those yellow, red flags, how can we work with our providers to help keep everybody as safe as we can.

Alan Helgeson:

So good to have expertise like yours and talking about this today. So let’s keep moving on here because there are a lot more questions here to ask you and talking about falls prevention. Next question for you. What are some of those complications for older adults when falling?

Natalie Fick:

So I think one of the, the biggest ones that we hear a lot is, you know, the broken hip. So it’s a very, very common place for people to have those fractures when they sustain the fall. But you know, we also see those broken wrists and shoulders or arms. I’ve even seen some people too that have had like compression fractures in their backs from the falls too.

Obviously broken bones are not good. They take time to heal. And especially as we age, healing takes longer. Mobility is usually greatly limited because of that for a period of time while things heal.

Other things that sometimes we kind of gloss over but actually can be very significant too are even just the head trauma and the head injuries from these falls where you can potentially get even just a concussion or a traumatic brain injury from that too.

Or we touch on a lot in our classes that we teach, especially if you’re on blood thinners, just the risk of a potential stroke or some type of injury like that as well. And unfortunately those take a long time to heal too or potentially have some very adverse outcomes too, where sometimes we see some people that they have that head injury and they end up passing away too from that fall.

The other things that can happen you know, some people, they just all of a sudden whether they have a fall or a close call start to have a great fear of falling too. And that is a huge, huge precursor actually. And a huge risk factor of falls is the fear because we know when people are fearful of falling, they might avoid activity. They might avoid what they’re doing.

I don’t want to move or I don’t want to do this because I’m going to fall. And in turn, because we’re not as active, we see people actually tend to get weaker. And then unfortunately because of that you’re at a higher risk of falling and then you actually might have more of a fall too. So it’s this terrible cycle to get caught into. And so by addressing sometimes even that fear and that concern showing people, you know, how realistic is this? How can we work through this again? We can kind of decrease their risk too.

Other complications people have, and I know this is a big factor or a big thing for a lot of people is just the increased dependency is people don’t want to depend on others. They don’t want to have to have their children help them with things that they can do on their own.

They don’t want to have to even consider leaving their home and going to assisted living or a nursing home or a long stint in rehab to recover. They want to be able to be independent and unfortunately if they have falls and have injuries or limited mobility, sometimes they have to have that assistance and it’s hard to accept it or hard to ask for it too.

And then even again, just like the psychological effects that we see in a lot of people too, a lot of anxiety, a lot of fear and sometimes even that depression and that social isolation that can happen because if people are worried I can’t leave my house, I can’t navigate those stairs, or I want to go to a show at like the pavilion, but I can’t navigate the curbs and stairs, you know, that depression, that isolation of not being able to even just be out with your friends really sinks in too and can be a big struggle.

Alan Helgeson:

Well I’ll tell you, living in this part of the country also, when you have some tough winters and springs that can add even more fear and danger for people that might suffer from that. Right?

Natalie Fick:

Exactly, and we have a lot of discussions with people, not only in the classes I teach, but also in the therapy world. Like we enter unfortunately the winter seasons that are coming too, the ice, the snow, understandably. We don’t like to go out there if it’s icy and snowy no matter the age you are because of the risk of slips and falls. But we know there can be a higher risk of adverse outcomes too as you age, especially if you’re having more issues with your balance and overall mobility too.

Alan Helgeson:

Well let’s switch now. Let’s talk about some ways to maybe get over some of that stuff. There’s such a thing as falls prevention screenings. Let’s talk about that and how these can help older adults and maybe identifying their risk. And this falls prevention education.

Natalie Fick:

So fall prevention screenings are things that we usually incorporate a lot in therapy if that’s a concern for individuals. But also throughout Sanford we do that as a whole too. And we really just sit down and we talk to people too and just assess their risk factors and then, you know, potentially give them some recommendations as to how they can reduce their risk too.

So with the screenings, there’s a lot of standardized tools that we use from a therapist whether we look at maybe their walking general balance assessments too, just to get us an idea of where they’re at, how they’re overall moving and able to maybe even recover their balance.

And then we talk to them too about if they’ve had past falls and injuries. If those individuals, they’re feeling unsteady and when they’re standing or they’re walking, I mean overall again too, if they’re having worries about falling because that’s a huge factor as well with these screenings too, we even just assess modifiable risk factors.

So what are things that we can change to, again, to help make them safer? And that may be in their home environment, whether it’s grab bars things, or rugs if they potentially even need an assistive device, which isn’t always everybody’s favorite thing to talk about, but sometimes depending on how their balance is overall mobility or if they’ve had past injuries or surgeries, sometimes we may need to start considering the use of a cane or a walker or something to help keep them a lot more stable and steady when they’re out and walking.

We talk to them again about the vision side of things. So again, how can they see or have they had their vision checked? Good footwear, you know, we always are encouraging that so that they’re not tripping on their shoes, let alone on the surface as they’re walking over if needed.

You know, we intervene to reduce that fall risk with different strategies. Like sometimes we recommend just chatting with their provider again, especially if there’s concerns of medication of maybe some dizziness or some blood pressure issues. Even if we talk about neuropathy where it can have a decrease in sensation, which can be very common for people, especially if they have diabetes in their feet where they can’t really feel where their feet are, what they’re walking onto, which, you know, greatly increases their risk of a fall because they’re just not sure where their foot is. If they’re stepping on something that could cause a loss of balance.

And then the other awesome thing that we can do too is we can give referrals for different classes that we’re having in the community if we know that that would benefit them based on their current ability level. Or sometimes we recommend having that discussion with their provider too, if some physical or some occupational therapy would be warranted to help overall improve things.

Alan Helgeson:

Natalie, if somebody’s listening to this today and they heard this thing about the screenings and that Sanford offers these, where would they maybe start? Would it be with their local provider in their community and ask about these screenings?

Natalie Fick:

So that would be a great first step too. I know their primary care providers, they can offer you sometimes just a very basic initial screening. Or even just having a chat with their provider too and say, here’s my concerns, whether I’m having maybe some trouble with some balance, or I notice I’m dizzy with some transitions or certain movements so that we can kind of assess and again, then refer appropriately, if there’s again little adjustments and things that their provider can do, or if therapy needs to get involved.

Or we can try to encourage and let a lot of the providers and people in the region know too of what classes might be available for these individuals. Whether it’s like the A Matter of Balance classes, our SAIL classes, our Bingocize, our tai chi, different things like that just to help keep them moving and keep them strong.

Alan Helgeson:

Some really great things and some offerings for people. And again, if you’re listening too, and you may have older parents, family members that might benefit from these, do some research and maybe ask your provider about these, beyond the obvious things, that are great about this stuff. Maybe share a little bit about how or why patients see these classes as beneficial in terms of giving them some of these tools and ways to prevent these falls from happening.

Natalie Fick:

I think a big thing that when I talk to people in these classes too is they feel like they can finally do something to help themselves too. Because sometimes it’s a very helpless feeling when they’re having issues and struggles but they just don’t know where to start or who to turn to. And so whether the classes or utilizing therapy just to get them going and kind of empower them to show that they can help take charge and they can make some improvements.

Just like anything, the more you practice, the better you get at it too. So when we do that it helps to just get them going there and then they can also just have a better idea and they can see for themselves the different risk factors they may have and how they can potentially modify those too.

We hope and encourage them that by doing some exercises or different things too that they can just improve their overall strength and flexibility, which in turn makes them feel better. When you’re active and you’re moving, your body feels better and wants to do that too. And then again decreases their fall risk.

But the other benefit too, sometimes when they go to different classes or they go to the gym or they do some of these things with some friends working together is just that social interaction and aspect too, which is huge. Especially like we talked earlier too, coming into these colder months where it’s hard to really get through these days when they’re dark all the time. You just don’t really feel like you want to be out and about. But when you have that kind of social pull of, I know my friends are going to be there too, you know, we can chat, we maybe have some coffee, we’re going to do the exercises. I think that’s always a huge draw and an extra benefit too.

Alan Helgeson:

Moving on as somebody that may have parents that we may be visiting during a holiday period, you know, as we, we transition to colder months or we might be seeing parents sometime soon. We go into their homes and we see that they might have some of these things, these fall risks. As a child or a caregiver, how can we look and fall-proof our parents’ or older family members’ homes?

Natalie Fick:

So one of the first things that I have people do, whether your own home or in a family member’s home too is looking at just clearing the waste. So are there trip hazards that are around that we can potentially just get rid of? Whether it’s some cords, it could be rugs, just general clutter, whether we have maybe some boxes or things kind of sitting around too just to see. Can we have clear walking paths that we don’t have to worry about tripping over things?

The rugs can be always a hot topic for some people because they don’t always want to get rid of them, which I understand, but can we look at if there’s even some safer alternatives? So some non-slip rugs that maybe have that rubber backing so they’re not sliding. They make some tape or different adhesive type things now too that you can utilize on them just so that they’re not sliding around or they’re keeping the edges down decreases your tripping risk there too.

So things to look at in your environment, but also even then looking at moving furniture if needed. So sometimes our environments, we have a lot of pieces of furniture or how the layout is can make it very tough to navigate. And so can we shift things a little bit so that I don’t have to be kind of scooting sideways to get past this chair or to get in and out of bed? Can I have a better space?

The next thing we always talk about too is how is the lighting in your environment and do you have a good source of light by your stairs, in your bedroom or your bathroom as you’re navigating around so that again, you can see where you’re going? Replacing light bulbs if you need to or looking, is there ways that I can potentially add lighting on these low-light areas so that I can see better and reduce your tripping risk?

When you talk about like your bedrooms too, even just is there a chair? So if you need to be able just to sit down and put your shoes on or to get dressed, depending on where you’re doing that, like your shoes too throughout the house, do I have a surface that I could sit? And it could be as easy as bringing a chair into your bedroom or making sure you have a nice sturdy bench in your porch to put your shoes on too. But just to have that as an option so that you don’t feel like you have to try and just stand on one foot and balance or very precarious with that securing or adding support.

So especially like in your bathrooms, do you have adequate grab bars that you can utilize? And ideally we want them installed well so you know, screwed into a stud, something sturdy that’s not going to pull out of the wall. And I know that another option that we have as an a temporary option if you can’t do the ones that are manually fastened to is sometimes the really strong suction cup ones can be a nice temporary benefit too, that you have something sturdy to grab onto instead of can I just try and grab the shower curtain rod or kind of some of these different things that are around that really weren’t meant to be a grab bar.

Alan Helgeson:

And one of these things too that I would go out to say here too, Natalie, is that working with a trusted and medical equipment facility like Sanford Equip too because they’re skilled at finding the right pieces for the right job that you’re looking for. Because oftentimes you find some of these that are less quality and all it takes is one time for this stuff to bust loose or to break or to not adhere in the right way and that’s when a fall can happen. Correct?

Natalie Fick:

Correct. They have, you know, like toilet risers or shower chairs, things like that too, that if you need it, they have that as something that you can go look at. You can try it out and see if it works in your space and can be a great solution to again, help keep you safe with those areas.

And then the last thing I always like to have people look at too, especially in your kitchens, but just throughout your house too, is just where do you store your most commonly used things too? So are the things that you use a lot, are they really up high in your cabinets or are they down low tucked away where you are either going to have to potentially use a step stool or do some unsafe reaching? Can you potentially shift things so that it’s maybe stored between your waist and your shoulder height so that that’s easily accessible and that you don’t have to constantly be putting it up and down or using the step stool? Especially if that’s not something that’s either safe for you or comfortable for you to use too. And that’s where I know sometimes people prefer like a clutter-free counter, but sometimes we maybe leave that mixing bowl that we use all the time just on the counter so it’s easily accessible instead of lifting in and out of the cabinet all the time too.

Alan Helgeson:

That sure is hard though for people, right?

Natalie Fick:

It is.

Alan Helgeson:

Getting used to it though.

Natalie Fick:

<Laugh>. It is <laugh>.

Alan Helgeson:

Alright, well, let’s move from the physical things. Let’s talk about some of those situational signs though as we may be visiting older adults and see some of those things. We’ve talked about those physical things, but some of those situational things.

Natalie Fick:

Yeah. Sometimes just to keep an eye on your loved ones too and just see, sometimes you can quickly see better than they can if there’s areas that they’re just maybe struggling a little bit more with. So watching like how they navigate stairs into and out of the house, if they’re really having to pull themselves up or really rely on those railings or somebody else to kind of assist them up. Making sure, do they have good railings or is there another option that they could potentially have for added support or safety navigating there?

Looking at just when they’re kind of going around the home too. Do you notice if they’re making quick turns, if they’re losing their balance or kind of stumbling? Or sometimes you’ll see them too where they’re really relying on furniture and the walls to walk and maintain their stability too. That could just be an indication that either, again, they’re not feeling very steady on their feet. Or do we need to potentially entertain the idea of an assistive device just to help to maintain their stability as they’re navigating their home environment or when they’re out in the community too?

Alan Helgeson:

Well, Natalie, let’s switch gears a little bit here. I want to go back to – we mentioned this just briefly as we were talking about fall risk way at the beginning of the episode – but let’s talk about bone health and osteoporosis and the role that that might play in fall risk, like healing broken bones, brittle bones. Is that sex specific? Does it play even more role in certain sexes? But you know, kind of pick and choose where you want to go with that.

Natalie Fick:

Yeah, so when we hear osteoporosis, I think most often you think of women that this is a concern for too because any woman over the age of 50, usually one in two will have issues with osteoporosis in their lifetime. But I never say rule the guys out with that too, because in that same age bracket, so over 50, one in four men potentially have some osteoporosis too, or osteopenia, which is just kind of that precursor. And showing that there’s some weakening of bones as well.

Just even to assess your risk factor of this, again, your providers usually are recommending getting a DEXA scan right around that age 50 just to look and see where that bone health is too.

And from there, if we’re identifying that osteoporosis is something that is of concern for you, they might recommend either some medications or something that is actually very beneficial too is exercise.

So we adding the, the strength training, the resistance, because we know by challenging our bones, by providing some impact safely can actually help to strengthen our bones too. So trying not to shy away from that. And that’s where either therapy or some exercise classes can be very beneficial on finding a way to start with that too and keep you safe and decrease your fracture risk too because we know when osteoporosis is around you are at a higher likelihood of sustaining a fracture. And sometimes then too it may take a lot longer for that fracture to heal.

Alan Helgeson:

Really good information you’ve been talking about here today, Natalie, but let’s go back to your education here as a physical therapist now. Let’s talk about as a physical therapist, discuss how therapy can come in and play a role in helping people preventing falls and in that recovery should a fall have happened in the injury.

Natalie Fick:

With fall prevention and physical therapy, we love to even work with people proactively. So they might have had a fall or they might have had some instances where they’re noticing that they’re a lot more unsteady and this is something that we can gladly jump in and help people out with before we’re even starting with some just general balance and coordination training. So providing them with some exercises and things that they can do at home and in the clinic with us just to improve that overall balance and stability. Just making sure that they feel more confident with their coordination, to be able to react to those different perturbations and challenges out in the community or at home where your balance might be challenged, and knowing that you can hopefully take the steps or adjust to be able to maintain your upright posture so that you’re not ending up on the ground.

We also work with people too and just overall with some strengthening. Because we know that by strengthening those major muscle groups, especially in your legs, that increases your overall stability and reduces your fall risk, and shows that it’s easier to get up out of a chair, do some of those things that also can be very challenging as we age.

And we want to make sure that again, we can age in place, we can maintain that mobility that we want to and not have to struggle with just those daily functions as well. And then we also can work with people too just with assessing their gait, their walking, seeing if there’s that need for an assistive device or if there’s little adjustments and things that we can help recommend just to keep them safer when they’re navigating certain challenges.

Alan Helgeson:

So much good information. Any last thoughts that you want to share today and maybe that takeaway nugget here about falls prevention, Natalie?

Natalie Fick:

We know that falls is a huge concern for the aging population, and it doesn’t necessarily mean that you’ve had to have a major fall in the past. That fear can kind of creep in even if you’ve known people that have had injuries, you’ve had loved ones that have had a very adverse outcome from a fall.

And so we know that on the positive side that falls are very multifactorial, that it’s a lot of things that you can do to prevent falls and to reduce your risk. And I think it’s something kind of empowering for a lot of people to know that they can kind of take charge of that and they can do a lot to prevent those falls and overall keep them strong and moving well.

And that’s I think something that once they understand where those resources are, whether it’s with their provider, whether it’s with their therapist or any of the community exercise programs and things going on too, that they can take those positive steps to keep them moving well and aging in place and maintaining their strength and their mobility too.

Alan Helgeson:

Natalie Fick, thank you for being our guest today. It’s been a pleasure having you here.

Natalie Fick:

Yeah, thanks for having me.

Cassie Alvine:

This episode is part of the “Health and Wellness” series by Sanford Health. For additional podcast series by Sanford Health, listen on Apple, Spotify and news.sanfordhealth.org.

Get more episodes in this series

Mammography vs. thermography for detecting breast cancer

Dr. Christina Tello-Skjerseth:

I think some people just feel better with getting some kind of exam that is pain-free and doesn’t have radiation. And that’s fine for some people, but you need to know that it’s not actually detecting cancer. And just because you get a negative thermogram does not mean you don’t have cancer. And you really should be using modality like mammography, which has all the data behind it and that’s federally regulated so that things are done consistently and accurately.

Courtney Collen (host):

This is “One in Eight,” a podcast series by Sanford Health. I’m your host, Courtney Collen, with Sanford Health News. One in eight women will be diagnosed with breast cancer during her lifetime, so we want these conversations to shed light on awareness, featuring expertise from our Sanford Health providers that could save your life or the life of someone you love. We’re so glad you’re here.

This conversation breaks down the difference between mammograms and thermograms. To help us do that, I want to welcome Dr. Christina Tello-Skjerseth. She is the chief of radiology at Sanford Health in Bismarck, North Dakota, and chief of staff at the medical center, and specializes in diagnostic imaging as a radiologist. Dr. Tello, welcome.

Dr. Christina Tello-Skjerseth (guest):

Thank you so much for having me again. I’m looking forward to this talk.

Courtney Collen:

Me too. So happy to have you here. I’m not familiar with thermography in this space, especially when it comes to screening for breast cancer. Can we start by having you break down the differences between mammography and thermography?

Dr. Christina Tello-Skjerseth:

Sure. So mammography is essentially obtaining a specialized X-ray of the breast where you can see the different kinds of tissues in the breast. And the purpose of that is to find breast cancers when they’re smaller and, you know, earlier and better to treat.

Thermography is a different type of exam. It’s actually like a heat sensing camera that can take the temperature of the skin surface and then make like a different pictorial representation of that. So it doesn’t actually show anything inside the breast. It doesn’t really show you any detailed anatomy, and it’s FDA approved because of its safety profile. It’s a safe technology, but it’s not approved because of its efficacy.

So we actually don’t use thermography to detect breast cancer. It’s really just sensing temperature on your skin. And, you know, the theory behind that is that breast cancers are hypermetabolic, meaning they essentially take up more blood flow because the cancer is making more vessels, and it essentially eats more, if you want to think of it that way. So the thought process is that more vessels, more metabolism, makes that area hotter. It gives off more heat, and then you can see that on your skin surface.

Now, the research behind thermography, most of the data out there is from the ‘70s and ‘80s. There’s really no recent information about it showing that it can actually detect breast cancer. And the FDA actually will put out warnings to facilities that that advertise thermography as a breast cancer detection tool. That’s really not what it’s used for. It’s approved to be used in addition to another type of screening or a diagnostic test, not a stand-alone tool.

Mammography is extremely regulated by the government, by the FDA and MQSA, which is Mammography Quality and Standards Act, since 1992. So there are a lot of guidelines, rules, and certifications we have to stick with and follow every three years to make sure that our equipment is appropriate. Our technologists are up to date, and the radiologists, and how we interpret exams, even the language we use in the reports, it’s all standardized and very regulated. So everyone across the U.S. should be doing it the same if they’re certified in mammography. Thermography really has nothing like that.

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Courtney Collen:

What kind of misinformation are you hearing or reading about specifically when it comes to thermography as some might compare it to mammography? Can you help clear the air there?

Dr. Christina Tello-Skjerseth:

Let me start with the main benefit of mammography. It’s the only tool we have, the only screening tool we have that has shown – from decades and decades and decades of research – to decrease mortality from breast cancer, meaning your chance of dying from breast cancer. And studies have shown that there’s a 40% reduction in breast cancer mortality using screening mammography.

Some of the harms of mammography, and I say “harms” in quotes, the main one is radiation. So yes, we’re taking X-rays of the breast and that makes radiation. So your body is getting radiation from the machine. And most of our data regarding the harms of radiation in general come from atomic bomb survivors in the ‘40s and other different atomic disasters we’ve had. And it’s all extrapolated data showing what the potential risks are for having certain doses of radiation.

Now, mammography has a very, very low dose of radiation. It’s about equivalent to maybe getting three to five chest X-rays. And to us living here on Earth, we get cosmic radiation every day that comes down from the sun, space, everything outside the Earth. And so there’s a certain dosage that we get every year. And getting a mammogram is about equivalent to just living on Earth for two months. It’s about that same dose of radiation. So it’s a very low dose.

Our equipment is very technologically advanced. It’s very modernized. So we’re able to calibrate very well and get the dose as low as reasonably possible. It’s very safe, and there’s been no data out there showing that mammography causes cancer. And that’s really the main I’ll say advertisement that people use for thermography is that there’s no radiation. There’s not an increased chance of getting cancer from that tool.

Thermography is also reported as painless because there’s not any compression of the breast. That’s another one of the, I’ll say, harms or downsides of getting mammography is that you are in a compression paddle. So some people are really sensitive to that and it can hurt for the most part, you know, having them myself, I would just say it’s just uncomfortable, but it’s just for a couple of seconds. There’s no long-term damage for that.

So I guess to kind of summarize that the main issues with mammography are the radiation, the pain.

Another one is the callback rate, meaning if you have a screening mammogram and then we find something and bring you back for more imaging, people get very anxious and concerned about that. But what people need to realize is that there’s really only a 10% callback rate. So for every thousand mammograms that we read, we’re only really calling back 10 people, I’m sorry, a hundred people to get further imaging. And the vast majority of those people will just get sent back to screening or have like a short term follow-up. The biopsy rate is quite small. The actual rate of cancer is quite small. It’s about five to eight people per a thousand mammograms will actually get diagnosed with cancer. So it does cause a lot of anxiety.

Thermography really doesn’t have any of that related to it, so to speak. But one thing I want to highlight is if you do get a thermogram and they find something “abnormal,” the next thing to do is to get a mammogram. So you’re really not preventing getting further imaging. And they’ll actually send you to your doctor and they’ll do a full workup of the breast. So it’s not like you’re completely cutting out mammography or radiation as a whole. But I think the bottom line is that the radiation profile of mammography is very safe and it has not been shown to cause cancer.

Courtney Collen:

And the mammogram is still the recommended tool in prevention and detecting breast cancer early. Correct?

Dr. Christina Tello-Skjerseth:

Absolutely. Yep.

Courtney Collen:

What question should I be asking my provider regarding a mammogram or a thermogram?

Dr. Christina Tello-Skjerseth:

Well, I think now in 2024 we’re really getting more towards a sense of individualized medicine, and having those conversations with your provider as far as your risk profile. There’s a lot of genetics that go into your risk for breast cancer, but there’s a lot of environmental things as well: the age at which you had a child, the age at which you started your menstruation, drinking, smoking, there’s all kinds of different environmental things out there that can increase your risk, if you had biopsies before, if you have certain medical conditions. So it’s important to have those conversations with your doctor early.

We actually recommend having some kind of risk assessment by the age of 25 just to see if you would fall into those average risk guidelines for mammography versus high-risk guidelines. And those do change. If you’re average risk, the recommendation from all of the major societies that we follow in this country are to start annual screening, mammograms at age 40, so you get those every year. If you’re higher risk, we may start you as early as 30. If you’ve had a relative – a first year relative, like your mother or sister had it in their 30s – maybe you’d start 10 years earlier. So even in your 20s. So we are actually screening some women in their 20s.

Additionally, you may add on a breast MRI if you’re high risk. So there’s really a lot of options we have. So again, it’s really important to have that risk conversation with your primary care provider to decide what schedule you should be on.

Courtney Collen:

What role, if any, does thermography play in breast cancer screening?

Dr. Christina Tello-Skjerseth:

You know, to be honest, it really doesn’t play a role in screening. I think some people just feel better with getting some kind of exam that is pain-free and doesn’t have radiation. And that’s fine for some people, but you need to know that it’s not actually detecting cancer. And just because you get a negative thermogram does not mean you don’t have cancer. And you really should be using modality like mammography, which has all the data behind it and that’s federally regulated so that things are done consistently and accurately.

I will also say that the FDA does a really good job at watching some of these facilities that offer thermography, and mostly they’re going to be like medical spas or naturopathic, homeopathic type places, chiropractic care, that offer thermography. The FDA watches these facilities pretty closely. And if they advertise thermography as a screening tool and advertising it as having the ability to detect breast cancer, the FDA will send those facilities a letter, essentially telling them to cease and desist and to not give out that misinformation to the community.

We have one here locally that advertises it, but they advertise it appropriately and saying that this tool does not detect breast cancer. It’s to be used as an adjunct tool. So they’re at least advertising it correctly. But again, thermography really doesn’t have any data behind it showing that it can detect breast cancer and that it’s a good stand-alone tool and it’s not approved to be a breast cancer screening modality on its own.

Courtney Collen:

Sure. And like you said, if they were to detect anything, then a mammogram in most cases is the next step.

Dr. Christina Tello-Skjerseth:

Exactly. And when you really think about it, again, it’s a camera that’s detecting the temperature of your skin. So anything that’s increasing your temperature in that area could cause a positive thermogram. I could touch my breast and just put a little pressure on it. That’ll increase the heat there. Being outside will increase the heat. I mean, there’s lots of things, any type of inflammation will increase that heat. So it’s not specific for cancer.

Courtney Collen:

1. And to recap, schedule your first mammogram starting at age 40 every year. And then if you’re high risk, sometimes as early as 30, and some women are even screened in their 20s in some cases.

Dr. Christina Tello-Skjerseth:

Yep. And then adding on some kind of supplemental screening if you’re high risk such as a breast MRI. That’s really the number one tool that we use in addition to mammography.

Courtney Collen:

Such valuable information. Thank you so much, Dr. Tello. What else do you want us to take away from this conversation?

Dr. Christina Tello-Skjerseth:

I guess I would just say if you do have any questions, please talk to your provider. I’m hoping you know that a lot of people now have good information about thermography so that they can have those conversations with their patients. And if the providers ever have questions, they can always call the radiology department. There’ll be a breast imager there that can answer any of their questions before they talk to those patients.

But I think just as a whole, it’s good to have good information, ask questions out there, whether you’re a medical provider or a patient, just to kind of know what the options are and what’s appropriate. And again, please know that mammograms are completely safe and very federally regulated so that things are being done safely and effectively. And again, it’s the only modality we have that can decrease your chances of dying from breast cancer, and that’s from decades and decades of research.

Courtney Collen:

Dr. Tello, thank you so much for your time and for all that you do.

Dr. Christina Tello-Skjerseth:

Thanks for having me. I appreciate it.

Courtney Collen:

This was “One in Eight,” a podcast series by Sanford Health. Find more of these podcast conversations featuring our Sanford Health medical experts on Apple, Spotify, or news.sanfordhealth.org. For Sanford Health News, I’m Courtney Collen.

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How to become nationally recognized for quality care

Alan Helgeson (announcer):

“Reimagining Rural Health,” a podcast series brought to you by Sanford Health. In this series, we explore the challenges facing health care systems across the country from improving access to equitable care, building a sustainable workforce, and discovering innovative ways to deliver high-quality, low-cost services in rural and underserved populations. Each episode examines how Sanford Health and other health systems are advancing care for the unique communities they serve.

In this episode, Matt Holsen with Sanford Health News talks with Marie Walker, director of nursing, and Kelsey Moulzolf, administrator at Good Samaritan Society – Woodland in Brainerd, Minnesota, on how to become nationally recognized for quality care.

Matt Holsen (host):

I have with me the leadership team from the nationally recognized Good Samaritan Society – Woodland location in Brainerd, Minnesota. Marie Walker is the director of nursing, and Kelsey Moulzolf is the location administrator. Thanks for being here today.

Kelsey Moulzolf (guest):

Thank you for having us.

Marie Walker (guest):

Yes, thank you.

Matt Holsen:

Let’s start with this. How does the Good Samaritan Society in Woodland become nationally recognized for providing quality care to older adults?

Kelsey Moulzolf:

Well, we have always strived at Woodland to provide high quality care for our residents in both the nursing home and assisted living. And by holding ourselves accountable, we have really been able to reach those goals and we were able to apply for this health award.

Matt Holsen:

It’s an awesome recognition to have. Are there some key steps along the way?

Marie Walker:

You know, I just think wonderful teamwork is the way we achieve things. It’s okay for us to call each other out and say, “oh, let’s maybe do it different next time.” And our whole leadership team is vested in the best interests of the residents.

Matt Holsen:

For the general public, when they hear quality, they might not know exactly what we’re talking about. So, what are some of the quality indicators the industry is looking for?

Marie Walker:

At Woodland, some things that we really watch for is we look at our quality measures and determine where are we at between state and national average? We always are striving to do better. So, every month we review those, and we look at them and say, “OK, currently we have a high incidence of falls. What are we going to do to fix this issue?” And we just work on it as a team. We review at our quality meeting. If things don’t go well at the quality meeting and we can’t come up with a solution, then we move on to a PIP (performance improvement plan) committee and we just dig into it deeper.

Matt Holsen:

What are some of the indicators you’re looking at? How is it measured?

Kelsey Moulzolf:

It’s measured to other nursing homes in the U.S. and just in Minnesota. And some of those measures are pulled from CMS (Centers for Medicare and Medicaid Services) Five Star, some are MDH (Minnesota Department of Health), some are resident and family quality-of-life surveys. And then, of course, we also look at our Peakon, our employee surveys.

Matt Holsen:

When it comes to your team, where does the drive to be there for residents like this come from? Is it because there is a resident at the end of every decision, or how would you describe that?

Kelsey Moulzolf:

Absolutely. Yeah. And I think a lot of our staff, not only managers, are very passionate to work in long-term care. I mean, it takes our whole facility, not only managers to get us where we are.

Matt Holsen:

What challenges do you run into trying to achieve quality, and how do you overcome them?

Kelsey Moulzolf:

A lot of the data that we use is not accurate. Some of it can be a year to a year-and-a-half old. So we really kind of take our current resident population and try to compare it to that old data and improve from where we can.

Marie Walker:

Some of the other challenges that we’ve encountered is staff buy-in. So, to get staff to buy into the changes that we need to make as leaders, we’re out there rounding with them, we’re listening to them, we’re praising them for their ideas. If you get them to buy in, you’re on the road to success.

Matt Holsen:

You talk about staff buy in. Where do the residents and their families come into this?

Marie Walker:

Yeah, absolutely. So, residents and families obviously are also involved, and we let them know what’s going on at the center level, at our resident council, our family council, and we also take ideas from them on how can we improve the care. Because if they’re not happy, no one is going to be going down the right road.

Matt Holsen:

How does the community play a role?

Kelsey Moulzolf:

The community is very important. We have very close partnerships with the local hospital clinics, hospice agencies, and honestly, just by having that communication back and forth has really helped with resident cares and quality.

Matt Holsen:

Being a nationally recognized location, do you get a lot of your peers coming to you asking what worked? What are you guys doing there and what do you say to them?

Marie Walker:

I guess as a director of nursing, when I get questions or people call and they’re like, “Oh, what are we going to do in this situation?” You just be upfront and honest, and you listen to what do they have going on in their center? If you have the opportunity to go to those centers, that’s pretty awesome actually, to go to the other Good Sam locations and see what are you doing? And how can we learn from you and you learn from us? And just being able to be there for them, so they can vent and talk about their struggles, I guess is the biggest thing.

Kelsey Moulzolf:

And I think just being honest too. I mean, we’re still learning. I mean currently we’re applying for gold. We just started it a few weeks ago, but it’s a long process. It’s really great to learn about your building and then just hear about other people’s buildings to get better.

Matt Holsen:

When you say you’re applying for gold, what do you mean?

Kelsey Moulzolf:

So, we have the quality award in silver and we’re applying for gold now.

Matt Holsen:

Very good. Well, I hope you get it.

Kelsey Moulzolf:

Us too.

Matt Holsen:

What’s the process when it comes to that?

Kelsey Moulzolf:

Gold is a very long process, so we started two weeks ago, and the application gets submitted in January. It’s meetings, a couple meetings a week with gold. They also do a facility survey, so if you don’t pass a facility survey, you won’t get the award.

Matt Holsen:

Do you find when families and residents are looking for a place to make their next home that this matters to them?

Kelsey Moulzolf:

I think so. When we received silver, we had residents on Facebook I saw that were reposting our silver award and they made the cutest comments like, “This is why I live here.” It was really great to see that.

Marie Walker:

Nice bragging rights for the families when they have families from out of town. That’s one thing that struck me is, I was getting stopped in the hall and, “Marie, this is my son from Texas.” And just they were explaining that we were a silver facility and what wonderful care we give, and that was just nice that they were able to brag to their families as well.

Matt Holsen:

Good Samaritan Society locations are part of the community too. So, I’m guessing the community takes pride in having such a great care facility. My last question for you both would be, what steps should families take when they’re looking for a nursing home for a loved one?

Marie Walker:

Yeah, so I would recommend that they go out and look at Nursing Home (Care) Compare. There you can compare yourself to other nursing homes in the area. You can look at their five-star rating. You can look at their survey results. And then, I also highly recommend just pop in and see us. We are open to visits. We love to have people come in, tour the campus. We like to brag. We like to show you what we’ve got going on.

Kelsey Moulzolf:

I would agree with what Marie said. You know, if you look at nursing home compare and you’re still not sure, I would go into the building. You get a real good feeling of how it is when you actually are walking in the building.

Matt Holsen:

Great advice. Congrats again on your national recognition and thanks for being here with us today.

Kelsey Moulzolf:

Thank you.

Marie Walker:

Thank you.

Alan Helgeson:

You’ve been listening to “Reimagining Rural Health,” a podcast series brought to you by Sanford Health. Hear more episodes in this series or other Sanford Health series on Apple, Spotify and news.sanfordhealth.org.

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Fertility nurse inspires change after own miscarriages

Alli Harrison (guest):

I remember just crying in my office for like a good 10 minutes and then fanning my eyes, being like, “OK, we’ve got to go back to work.”

Courtney Collen (host):

Alli Harrison, a nurse practitioner, had just checked her hormone levels.

Alli Harrison:

I saw the level. I knew that this was going to be a miscarriage. Like I’m working at a fertility clinic every day seeing all these pregnant people. And so that was hard in itself. And then when I got pregnant the first time and had that early loss, it’s shocking. I prepared myself for it. But when you’re actually the patient and the person going through it, it’s just a whole different scenario.

Cassie Alvine (announcer):

This is “Family Portraits,” a new podcast series by Sanford Health.

Courtney Collen:

In this series, we focus a lot on family, but the word family can bring varying emotions. Families come in all colors, shapes and sizes. Family units are dynamic, never perfect, but always evolving.

Growing a family is easier for some than it is for others. Couples who dream of bringing new life into the world spend years of their life struggling to do so.

That brings us to infertility, which can be really hard to talk about. One in six people around the world have a hard time getting pregnant after trying to conceive and grow their family. Unfortunately, so many of them experience miscarriage. It’s a heartbreaking reality. And for some, that painful feeling of loss never goes away.

Alli Harrison:

Well, we know that infertility is definitely increasing.

Courtney Collen:

That’s Alli. Like I mentioned before, she’s a nurse practitioner in Fargo, North Dakota, specializing in reproductive medicine at Sanford Women’s.

I sat down with her in early 2021 as she spoke broadly to that awareness around infertility and the emotional toll it can take on expecting parents.

Alli Harrison:

I think what happens is people usually keep this information to their self. It’s kind of personal. They have people around them that want to support them, but maybe don’t know what they’re going through. And it can be mentally taxing for people. If you think about every month that someone tries to get pregnant and they don’t, that’s just like a monthly reminder that it’s another month that it didn’t work. And so we do see a lot of anxiety and depression with our patients.

Courtney Collen:

When I talked to her as part of that podcast a few years ago, I asked her this: What do you enjoy most about the work that you do?

Alli Harrison:

This area is challenging. It’s challenging for patients. It’s challenging for providers because we’re working really hard to help someone make a family. And so the most challenging part is that obviously heartbreak when you’re not able to achieve a pregnancy. But the best part about it is really supporting them along the way and then hopefully being with them as they navigate that first part of a healthy pregnancy.

Courtney Collen:

Beyond the clinic, family is everything.

Alli Harrison:

My husband Shaun and I have been married for 10 years now, and we have two little boys. Our son Rhett is three and he’s going on 13. And our son Tripp is going to be four months old. In our spare time, we love to go to the lakes. We love to do outdoor activities. Our sons both love the water, so we spend a lot of time swimming and doing all types of sports. We like to spend a lot of time just with family.

Courtney Collen:

But as Alli explains growing her family wasn’t an easy journey.

Alli Harrison:

Prior to the birth of our son, Rhett, we did have one miscarriage. And after Rhett, while trying to get pregnant again, we did have two additional miscarriages. The most recent one, we found out we were pregnant in December of 2021, and because we had had two prior losses, we decided that we should monitor the pregnancy closer in the early parts. And so we had frequent blood work and we had early ultrasounds. And that first ultrasound that we had, they saw that the baby was there and was growing, had a heartbeat, but the heartbeat was low. And so there was a little bit of concern with that.

So we repeated the ultrasound a week later and we saw that the baby had stopped growing, but that there was still a heartbeat. And so that was a little bit different than what we had experienced in the past where that miscarriage happened spontaneously. With this experience, we were basically told, you’re going to miscarry. We just don’t know when it’s going to happen, and therefore you have to keep doing these ultrasounds until the heartbeat stopped.

And so that was a lot to kind of mentally grasp. You know, it’s your baby, so you want it to keep growing, you want it to be healthy. But at the same time, we knew it wasn’t going to be a healthy pregnancy.

Courtney Collen:

She remembers the day she experienced her first miscarriage that same day she was in the clinic caring for patients.

Alli Harrison:

I do specifically remember that day because I was working in the women’s department, so working with a lot of people that were already pregnant, I was like, “I think I’m starting to miscarry.” And so I had asked one of my doctors that I work with, I was like, “Can you put in a blood pregnancy test? I just want to see where that level is.” And so I did, and I actually got that result back while I was at my desk getting ready to go in with my next patient. And I saw that it had dropped.

I will never forget that moment because I was just like, oh my gosh, how am I going to do this? Right? and so I saw the level. I knew that this was going to be a miscarriage. I remember just crying in my office for like a good 10 minutes and then fanning my eyes, being like, “OK, we’ve got to go back to work.”

So I did end up just going in with that next patient just a little bit late feeling like a little fragile. I could feel like my pulse was racing the rest of the day. And, you know, I just felt like, well, this is what I have to do. I have a full schedule of patients and I’ll navigate these feelings when I get home. It was kind of like a quick message to my husband saying like, you know, I think I’m miscarrying and I’ll talk to you as soon as I can. But I, yeah, I did continue the day. But I just, I will never forget that feeling of like, just my heart was dropping when I saw that.

Courtney Collen:

When we recorded that podcast talking about infertility, I had no idea that she was struggling with her own infertility. So I sat down with Alli again to talk about her journey. I wanted to know what it was like to work as a fertility nurse while she was experiencing infertility and loss. How did she do her job? How did she navigate her emotions, yet maintain that professionalism of care?

Alli Harrison:

The doctor that put that level in for me and had me go get my blood drawn was messaging me is like, I’m really sorry. Like, what do you need? And in that moment I was like, “It’s OK. It’s OK.” You know, like I kind of just built up that wall immediately and was like, OK, we can do this. We’ll get through the day.

I do remember thinking like, “Wow, this is what it feels like for those patients that have that loss in the clinic.” And, and thinking right away, like, “Wow, this is way different than I expected it to feel.” You know, until you experience that loss on your own, it’s hard to really put yourself in those shoes completely. And so I kept thinking to myself like, well, the work has to keep going. We have to keep going, and there’s people here that are here because they need to be here. And so I just, yeah, I just put it aside. And then navigated that when we got home.

Courtney Collen:

Alli said her approach to how she cares for patients changed that day.

Alli Harrison:

I felt I had a good approach to people that, you know, I’m sitting in front of and telling them like, you know, your baby’s heartbeat has stopped. Or this will not be a good pregnancy. It has not progressed. But I think having that experience myself definitely changed a few things on how I talked about that with patients. I think the biggest thing that I did change is just kind of like sitting in that moment with them. So, you know, telling them like, your baby’s heartbeat has stopped. I’m so sorry. And then just sitting. And that’s a really uncomfortable space, whether it’s, you know, that quiet with your friend as they’re telling you something or a patient. But it’s important to not move forward immediately and start talking about other things, right? So it’s more of a, you know, that this pregnancy is not going to continue and I’m really, really sorry, and I know this is really, really painful. And then just sitting there, and usually if you give them that time, it’s like, OK, there’s tears, there’s shock involved.

And then it’s a discussion of what do you feel like you want to talk about? Do you want to talk about next steps or do you want to go home? Right? Like sometimes that shock of getting that news, you can’t comprehend anything at that point. Your brain instantly is saying like, there’s no more due date. Like, our family’s not growing. Like, what am I going to tell my husband if he’s not there? Or how am I going to tell my kids? Right? Like, what if you had already told them and you’d showed them ultrasound pictures?

And so there’s so many things that they’re going through in their head about what they’re going to do in their personal lives that it’s hard to jump into things and say, OK, how do you want to manage this now? Right? Like, we know that this miscarriage is going to happen. And so I think just giving them that extra time, like clinic runs behind sometimes, and when you go in with that next patient and you’re late and you say, I had a patient that needed more time today. And that’s the truth. I mean, they just need that time and it’s not a quick in and out visit.

And so I think that’s a big change that I did is just really taking it slower and asking them what they want to hear in that moment. Because if they’re not processing, you know, do I want surgery? Am I going to have this happen at home on my own? They’re not going to be able to receive that information and understand it in a way that needs to be there.

Courtney Collen:

Another component to her care is checking in with the partner.

Alli Harrison:

We always have our eyes on the mom, talking to them about how this is going to go. And a lot of times their partner is really feeling it too, right? And so, just because they’re not carrying the pregnancy doesn’t mean that they don’t feel those same feelings of pain. They’re running through, how am I going to support her? How am I going to get her through this? They maybe were having relationship troubles from the start because they’re going through tons of fertility treatments. And so there’s just so many things that are going on in that initial five minutes of hearing this information that I try to just take a step back and just sit there and just be there for them in that moment.

Courtney Collen:

In Alli’s three miscarriages, her first two were naturally progressing miscarriages. In other words, the bleeding and loss happened naturally. Her third was further along, but there were concerns with baby’s heartbeat and baby’s growth.

Alli Harrison:

So it’s like, OK, what do we do now? And it is a matter of you just need to wait it out, but you are going to miscarry. So that was just such a weird scenario to go back to work and be like, OK, I know this is going to happen. I don’t really know when it’s going to happen. And you also have to keep doing ultrasounds to get to that point where the heartbeat has stopped before you can do any type of management of the miscarriage. So that was like, well, how do I do this? I’m going into this ultrasound, these ultrasound techs are thinking like, oh, this doesn’t look good. And I kept having to tell them, I’m expecting this, right? Like, I’m almost at the point where I can’t do this anymore. I can’t keep seeing this positive heartbeat and things like that. I am actually hoping for it to stop, which is such a weird thing to navigate as a mom because you’re like, I would give anything for this pregnancy to continue, but this isn’t going to be OK. And so once I finally did get that ultrasound and the pregnancy had stopped and the heartbeat had stopped, then it was that discussion of, OK, how do we want to manage this?

Courtney Collen:

After this third miscarriage, Alli wished to undergo genetic testing.

Alli Harrison:

And it was actually coming home from surgery that I get home and I’m … resting and I get a message reminding me to put in that PTO or, you know, allowed time away.

Courtney Collen:

Through this recovery, Alli had to go back to work.

Alli Harrison:

I responded, is there a bereavement code you can put in for this? And that’s when I found out that Sanford did not have bereavement leave for the loss of a pregnancy at any point in pregnancy, which is just was wild to think about. I’m like, here I am at 11 weeks. What is someone else gonna do at 24 weeks? Right? Obviously I was upset by that. And, the craziest part of it all is that my husband had two days of bereavement leave for a miscarriage for a partner.

Courtney Collen:

This was early 2022.

Alli Harrison:

That was part of the reason that I was a little bit driven to pursue this topic further. I was shocked to find out that with women having miscarriages or pregnancy losses, that no matter where they were at in the pregnancy, they wouldn’t have any days off to recover. Whether that be an early miscarriage or the loss of a pregnancy later on, I knew that miscarriage happened often. I know it happens to one in four women – in our case three different times. And I also knew that it’s physically and emotionally stressful on a patient or a woman or her partner to navigate those feelings after.

So with knowing that I had had surgery and had to physically recover, I also knew that there’s the mental side of that, which is, you know, going through that grieving process and acknowledging what happened. I also thought about the families that have to explain that loss to their children. So they maybe had told their children that they’re pregnant and maybe aren’t going to bring home that baby.

And so knowing that we have to navigate those topics that emotionally can take some time, and not having a day or two or five off to go through that is stressful for people. The other side of that is, you know, I see patients every day that go through this, and I know that when you get that positive pregnancy test that you instantly think about the future. You know, what’s our family going to look like? What’s delivery day going to look like? And it’s a time of planning. And so when that shock comes that you’ve lost that pregnancy it takes time to go through all that.

Courtney Collen:

Alli did her research, and she was determined to get answers. So she emailed Sanford President and CEO Bill Gassen.

Alli Harrison:

I knew that if I was gonna write this letter to Bill that I’m going to have to have some support behind it. I’m going to have to have some statistics, some facts, some reasoning as to why this needs to change.

Courtney Collen:

She first connected with friends outside of the organization to learn about their policies.

Alli Harrison:

I listed all those organizations. I listed what their bereavement leave was, and shockingly, we were pretty much the only one that didn’t have it. And so I think showing him that evidence and giving him that, I knew that that would help. I still didn’t think it was going to change, right? You just feel like this small little voice amongst this huge organization. And so I was still skeptical of it, but I did include in that message to him, I just said, you know, this is how this goes.

Courtney Collen:

Bill got that email.

Bill Gassen:

Allison sent me a personal, heart wrenching email telling me all about her miscarriage, and then asking me why Sanford Health didn’t have a leave policy in place for employees who were experiencing a pregnancy loss. To be honest with you, I did not have a good answer for her.

Courtney Collen:

In April of 2024, he shared Alli’s story and some of his own in his opening remarks to a room full of corporate leaders during their annual meeting.

Bill Gassen:

And I couldn’t stop thinking about her story, especially because I’m sure, as some of you can relate, I was drawn to my own personal experience and remembered when my wife Jill and I went through a very similar experience.

Before we were blessed with our five children today, Jill also experienced a miscarriage, and she experienced that actually while she was at work in surgery. And I’ll never forget the phone call that I received that day, nor the pain that we felt in the days and the weeks that followed.

And for anyone who’s gone through a miscarriage, you know how painful that loss is and how with all loss, how important it is to be able to grieve and to be able to take time to process that.

Courtney Collen:

Alli’s email and courage marked the beginning of something new.

Bill Gassen:

By having the courage to speak up, Allison led important change at Sanford Health. Allison’s story led to Sanford Health adding compassionate leave for pregnancy loss as part of our employee benefits starting this last year.

And I can only imagine the courage that it took for Allison to first just share that story with me, someone who she didn’t know personally. And then at that same time, to be able to advocate not only for herself, but importantly for the entire Sanford family. And for that, for that courage, I will always be thankful to Allison.

Alli Harrison:

I didn’t think this would change. I didn’t think that I had the ability to create a change. It’s hard to picture big-picture Sanford, which is huge, amongst many, many states. And to think that like that impacts all those people was pretty crazy. It did give me that motivation to really think about the things that are important and things that I’m passionate about and things that other people might be passionate about, and really encourage them to try to make that change.

Tripp is our rainbow baby. And he’s just the best. We feel very, very blessed to have two healthy boys now. We picked his name because, oh gosh. We picked Tripp’s name because it means the third boy and the pregnancy that we lost in January was a boy.

And so, not only do we love the name, but it also has a little bit of meaning to us that he’s our third boy, and although our other boy isn’t with us, we can think of him when we’re hanging out and using Tripp’s name.

We didn’t know how big brother Rhett was going to adjust to a baby at home, but he just loves him so much and he’s just obsessed with him and has been a really great transition becoming that family of four. And I think our family’s complete, so I don’t think that that compassionate leave will ever apply to us, but I am glad that it’s there for the people that do need it.

I fully recognize with the work that I do that we’re lucky to have two boys at home, and not everybody gets to create a family like that. And so this whole experience has really driven that home for us. We’ve lost three pregnancies, but we’re very, very thankful to have our two healthy boys at home with us.

Courtney Collen:

Allie’s perspective from this journey has given her an entirely new sense of gratitude she takes into the clinic every day.

Alli Harrison:

It’s amazing. And I don’t take it for granted, like the fact that I work in an infertility clinic where these families would give anything to have a baby. You know, you tend to feel a little bit guilty about having your own two healthy kids.

I always think there is no stronger pull that a female can feel that if they want to be a mom, they are going to do anything they can to get to that point. And that heartstring pull is really, really strong. I mean, women go through losses and years and years of treatments and medications and all that, all for that ultimate goal. And I just hope that people know that, you know, whether this journey ends the way you want it to or not, like just, I just want you to, to keep going.

Courtney Collen:

Through this change, Alli and her family honor the three little ones who aren’t here on earth.

Alli Harrison:

We don’t forget them. People often say, I wish I could talk about it more. And remember that and remember them. It is a way to say we didn’t forget about you. We’re working towards ways to make this better for people that go through this and that don’t get to see their babies earthside and don’t get to meet them until later. And so yeah, it absolutely is a way to acknowledge that this happens and acknowledge the pregnancies that didn’t make it and really be somewhat of a support for the people going through it.

Courtney Collen:

Alli ended up talking about her journey, including sending that email to Sanford, CEO, Bill Gassen in a video that Sanford produced for their internal series called “Blue Chair.” Alli never could have anticipated the impact of sharing her own losses on others.

Alli Harrison:

Obviously makes me emotional, but I mean, I’m talking like 50 to 100 people emailing me saying like, “I just saw your Blue Chair Story and this is so cool.” I ended up posting the video actually on social media. I had this one lady message me, and she’s like, I’m an old mom now, and you’re a young mom, but us old moms are cheering for you because they didn’t talk about this stuff. They didn’t take time for themselves. They didn’t have any support.

I think the part that makes me emotional is these are unforgettable, real moments for people. This is not like, oh, I had a fender bender and I moved on and I don’t really remember when that happened. These are things that are real-life scenarios that could impact your physical, mental health for the rest of your life.

These are really real, real painful things for people. And so to have the ability to speak out about that and have people share their stories, which maybe was sharing for the first time, I feel really honored to have them send me those things. And it just really comes full circle. I got an email saying, “I now know how to support my daughter better,” right? Like, I had miscarriages, I never told her, and now she’s had one. And she said to me, “I wish you would’ve told me. I wish I could have reached out to you and knew that you knew what I was going through right now, and you’ve felt this pain.”

It’s opening conversations for people. It’s opening that conversation about benefits for employees. It’s pretty, pretty awesome to see.

Courtney Collen:

The influence of Alli’s story began to move beyond Sanford Health to other companies.

Alli Harrison:

People were messaging me, saying, “I just checked with my company and we don’t have that either. How did you enact this change?” And I think there was maybe five now that have messaged me back almost a year later saying, “I changed it for my company.” So to think that it’s not just Sanford is so cool. To think that all these other places are kind of listening, and listening to their employees and really focusing in on how can we keep these employees and how can they be the best that they can be?

Courtney Collen:

A caregiver by day making a difference in the name of family and motherhood.

Alli Harrison:

Moms, ugh. They just – they carry the world. Being a mom to these boys is amazing. And if people ask me about them, I’ll share. But I always say, I am here doing this job because I want you to feel what it’s like to be a mom.

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Preventing leader burnout in long-term care, senior living

Alan Helgeson (announcer):

“Reimagining Rural Health,” a podcast series brought to you by Sanford Health. In this series, we explore the challenges facing health care systems across the country from improving access to equitable care, building a sustainable workforce, and discovering innovative ways to deliver high-quality, low-cost services in rural and underserved populations. Each episode examines how Sanford Health and other health systems are advancing care for the unique communities they serve.

In this episode, Matt Holsen with Sanford Health News talks with Fred Pitzl, administrator in Olathe, Kansas, and Angela Prevo, director of nursing in Ottumwa, Iowa, on the topic of preventing leader burnout.

Matt Holsen (host):

I have Fred Pitzl, administrator for the Good Samaritan Society in Olathe, Kansas, and Angela Prevo, a nursing director for the Society in Ottumwa, Iowa. We’re talking about leader burnout. Do each of you have personal experiences with burnout?

Fred Pitzl (guest):

Matt, I can truly say that I have not. I’ve been very thankful for the role I’ve been able to play within the Society, really seeing the mission that we have and that, I think, that’s really has kept me from that whole area of burnout. So I’m very thankful for that. That sense of purpose has really helped out.

Matt Holsen:

Angela, have you had any experiences? How did you deal with it?

Angela Prevo (guest):

Yes, unfortunately I have experienced burnout being in the manager position for 22 years. Emotionally, physically I’ve experienced burnout.

Matt Holsen:

What are some of the common signs you look for when it comes to burnout?

Angela Prevo:

I think sometimes when I’ve experienced burnout, I might get mood changes. I might lose sleep.

Matt Holsen:

How does that affect you in your day-to-day?

Angela Prevo:

It makes my attitude not as good as it should be. I like to maintain a positive attitude and when I start feeling myself go down that negative road, I have to find ways to cope.

Matt Holsen:

Are there common signs you look for with your team, Fred?

Fred Pitzl:

Absolutely. Something we’re always looking out for is we want people to be engaged at work. So some of the things you’re going to see is people just not having the energy for the job. Maybe not having the same passion that they once did, not taking pride in their work. That’s something that we would look for, becoming cynical. That’s something I try to catch myself too. That could be a step towards burnout. Then maybe you’re just exhausted as we were talking about, exhausted emotionally, you’re spent at the end of the day. Those are things that we would see.

Matt Holsen:

Are there specific resources you and your team have in place to help people avoid or recover from burnout?

Fred Pitzl:

I would say the most important thing is to use your PTO. We are afforded a lot of time that we can use. Because sometimes people either fill us or they drain us. And when they start to drain you more than they fill you, I think it’s time for us to take a break. We need a break from them. They need a break from us. I think that’s very important that we do that.

Also, within Sanford/Good Sam, we have our volunteer time off as well. We could use that. That’s eight hours as given to us as employees. And that’s a great time to focus on others when we’re doing that.

Matt Holsen:

Explain that a little bit. What is volunteer time off?

Fred Pitzl:

Volunteer time off is a new initiative started a couple years ago. So, if you’re a full-time employee, you get eight hours to volunteer at whatever organization of your choice and you can serve there. You’re representing the Society, you’re representing Sanford. If you’re a part-time employee, I believe it’s four hours that you’re allowed to give (while being paid).

Matt Holsen:

It’s a great program. Angela, let’s go back to the resources available. You’re in charge of a number of nurses. What is there for them if they’re struggling? What can be done?

Angela Prevo:

I always encourage them to talk to their manager. Of course, that’s why I need to stay 100% all the time. But I also encourage them to reach out to peers that they can trust. Find a friend at work, somebody that they can safely vent their feelings to.

Matt Holsen:

When it comes to recovering, maybe avoiding too, do you kind of align with Fred there too? Use your PTO, take a break.

Angela Prevo:

Work-life balance is extremely important, and I think as leaders that we sometimes forget that because our nature is to just work, work, work. And we have to remind ourselves that that is important.

Matt Holsen:

It’s a different interest industry because there’s a resident at the end there and you want to be there for the resident. Is that kind of why people are pushing themselves so hard?

Fred Pitzl:

I think people truly care and when they care so much, they don’t take it, take time away, that can impede with what they’re doing. So, I think we just have to give people permission to take time off and to step away. That’s going to help them in the long run.

In our industry, we have so many regulations that we’re under, there’s a myriad of them and we just have to make sure that we are doing what’s right by the residents. We’re also wanting to make sure we’re taking care of our employees. That they get the time away so they can better care for the residents that we’re called to serve.

Matt Holsen:

Is that stressful to have all of that hanging over your head?

Fred Pitzl:

Yes, that’s very stressful but that’s why you need a team. You can’t take it all on yourself. You have to really spread out what we’re doing. We’ve got a very, very important mission now. We’re called to share God’s love through the work of health, healing and comfort. It takes all of us in the building to make that happen. And I always align people’s work to the mission. If you’re a cook, if you’re a person who’s hanging pictures, if you’re a person cleaning a room, you are helping us live out that mission.

Matt Holsen:

Angela, are there changes in the industry you’d like to see to better support leaders and reduce burnout?

Angela Prevo:

I guess the changes I would like to see are maybe tools that we can give our staff to be mindful and aware of the signs of burnout and what to do about it.

Fred Pitzl:

The advocacy that’s going on with Good Samaritan Society in Washington, D.C., is amazing. Because there’s so many different regulations that are trying to come down upon us right now. There’s a staffing mandate. So, I think just continuing to have that advocacy out there is so important for us. Those are things we’d like to see happen so we can care for our residents, care for our staff so they can care for our residents.

Matt Holsen:

Angela, you were putting your hand up again. Do you have something to add?

Angela Prevo:

Yes, just teaching also healthy ways to take care of yourself by getting enough rest, promoting exercise, eating right. Because I feel like sometimes as health care workers, we don’t take good care of ourselves, and we end up showing up to work tired or things like that.

Fred Pitzl:

And there’s a lot of resources with our own company here with wellness, with well-being that we have the opportunity to take advantage of. And those are things I encourage anyone who’s a Good Sam/Sanford employee to look at what’s available within Sanford.

Also, look at The Sanford Leader (internal tool). There’s opportunities for you to become a better leader, which I think is going to help you avoid burnout if you are focusing on the right things with our residents. There’s a lot of different opportunities for us out there as leaders.

Matt Holsen:

Rely on that support. I think that’s great advice. Thank you two for joining us here on this important topic.

Fred and Angela:

Thank You, Matt.

Alan Helgeson:

You’ve been listening to “Reimagining Rural Health,” a podcast series brought to you by Sanford Health. Hear more episodes in this series or other Sanford Health series on Apple, Spotify and news.sanfordhealth.org.

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Leaders share keys to retaining the senior care workforce

Alan Helgeson (announcer):

“Reimagining Rural Health,” a podcast series brought to you by Sanford Health. In this series, we explore the challenges facing health care systems across the country from improving access to equitable care, building a sustainable workforce, and discovering innovative ways to deliver high-quality, low-cost services in rural and underserved populations. Each episode examines how Sanford Health and other health systems are advancing care for the unique communities they serve.

In this episode, Matt Holsen with Sanford Health News talks with Tammi Lehto, administrator, and Allyson Tator, administrator home health, at Good Samaritan Society – Loveland Village in Colorado on the topic of retaining the senior caregiving workforce.

Matt Holsen (host):

I’m chatting with two administrators from the Good Samaritan Society in Loveland, Colorado. Tammi Lehto leads a very large campus with a variety of services, and Allyson Tator directs the home health team. Thanks for being here.

Tammi Lehto (guest):

Thank you for having us.

Allyson Tator (guest):

Thank you.

Matt Holsen:

We’re talking about retaining caregivers, the senior caregiving workforce. What are some of the biggest challenges you face when doing that, Tammi?

Tammi Lehto:

I think we’re still seeing a little bit of the aftereffects of the COVID-19 pandemic with some occupational burnout and, you know, just trying to work with our staff. Just engaging a little bit more and trying to recognize that stressor in their life.

We also have competitive wages with other competitors in the area. There’s a strong desire for more enhanced work-life balance with our staff, and just patient safety overall of our residents, and the overall workload I think are probably some of the biggest factors that we are kind of still seeing.

Matt Holsen:

And for people who don’t know, Loveland is a big facility. How many employees do you have?

Tammi Lehto:

Oh gosh. Well, we are a continuing-care campus. So, we have independent living, assisted living, and then our skilled nursing, which we call “health care.” And I’m the administrator for the health care side of Loveland Village. We probably have anywhere from maybe close to 275 employees overall on our campus.

Matt Holsen:

Allyson, what are some of the challenges your team faces?

Allyson Tator:

I think for me, just having all of my staff at different campuses, not only at Loveland but also in the community, is the communication. I think that’s a huge barrier to just making sure that everybody is informed and feels like empowered and recognized. I mean, it’s obviously something that you have to have a heart for and a lot of the staff that I do retain have been with me 12 years, five years-plus. I think that’s the hardest part is finding that staff member that can do it and encouraging them and knowing that it’s hard taking care of somebody. And sometimes they can be grumpy and don’t take it personal and but also support them.

Matt Holsen:

What are some of the other roles that fill out your team?

Allyson Tator:

There’s the caregiver. I have business office coordinators in the office. Then I have nursing and therapy.

Matt Holsen:

So what strategies are you using to try to address this issue that are proven to be successful, do you think?

Allyson Tator:

For me, it’s like I always have an open door. They also, if my door is closed, they know they can text me if I’m in a meeting. I think that they all know that. And that’s kind of when I came over to Services at Home side in 2016, that’s kind of been mine, where I try to send cards. I try to send texts. I recognize them. When they start orientation, I ask what their favorite soda is or just little things because I think that goes a long way when you just notice them for those little things. Birthdays, anniversaries, kids’ birthdays, husbands’ birthdays.

Matt Holsen:

The little things mean everything to many people. Tammi, what’s working for your team?

Tammi Lehto:

When we do have a new hire, we do what’s called bubble wrapping the employee, and we highly try to protect them in that first 90 days of employment. We have a scoreboard posted at our facility, and we do have scoreboard rallies to celebrate when they reach their 30 days, 60 days, and 90 days. There’s dancing, there’s music, it’s just a great time overall.

But part of that is also our current employees and trying to invest with them at the same time. So, we connect them – our new employees – with mentors. And so we celebrate those mentors with mentor bonus checks. Like big checks, like you’re on the “Price Is Right” on our scoreboards.

We also do employee referral bonuses. We started a new program called “pick up points” about a year ago as well. So, when staff do pick up shifts, they earn points and they can cash them in on a catalog that we have. And so, we award those at our scoreboard rallies when somebody does cash in for pick up points. And so that’s like allowed us to now be totally agency free for over a year now. So, that in and of itself is a great celebration.

And then one of the things, as Allyson was alluding to, finding that perfect caregiver, whether it’s a CNA or nurse, especially with my director of nursing, it’s becoming more, our interviews are more intentional. More behavioral-based questions, engaging other staff as part of the interview process or taking that prospective new employee on a tour so you’re just trying to find the right fit for success for the new employee and then also for the organization.

Matt Holsen:

That’s incredible. So, you’re obviously not sitting back and you’re being active in this and trying to recruit and retain. How do you gather and act on feedback from your caregiving staff?

Tammi Lehto:

We do huddles throughout the day. Some of them might be like intentional touch points and just rounding, seeing how the staff is doing that day. What their challenges are? Is there anything we can do as far as assisting with supplies or answering questions? So those are throughout the day. And then we also obviously just completed our Peakon engagement survey. So, we’ll be finishing up a review of all of our comments, putting our action plan together.

And just for example, I have a meeting scheduled with my staff next week just to kind of share the results from our side of the building and just try to engage them and OK, what are some things we can work on? You know, like what are your specific challenges? Because if you’re trying to put an action plan together, you really need to involve your staff in that, otherwise your action plan could go in a totally different direction that isn’t going to address what their concerns are.

Matt Holsen

Allyson, what would you add to that?

Allyson Tator:

I would say that it’s a complete blessing to be at Loveland’s campus and I think for my staff there, they feel that, and it does, it’s a family. It’s a happy environment. I know when there are tours, when there’s anything that’s going on or at when I am taking a new hire around, they’re like, “Is it really this happy?” It is. It’s not me. I mean, people, the residents are happy. The staff is happy, you know, they’re there.

And so, yeah, I would just probably say along that it’s knowing your staff, just really being there for them and having them know that they’re a part of it and that you’re trying to communicate all of the changes that happen with our company, let alone at a location level. So, they feel like they’re not being blindsided. That they know what’s going on.

Matt Holsen:

How do you see your roles evolving to better support caregiver retention, Allyson?

Allyson Tator:

I would say to continue to be positive. I know I have a board in my office that says, “I get to, instead of I have to.” I get to go to work. I get to make a difference. I also have it at home, but I think that is something to make sure that I stay positive even when there’s days you close your door for a minute and you’re taking a deep breath yourself.

But I think that positivity and then just reassuring people that it’s the right fit. That it’s a great place and all the other benefits our company has.

Tammi Lehto:

And for myself, I’ve been in this industry for over 30-plus years now and it’s always been highly recognized that for the resident and their quality of life, the biggest factor for that is the CNA that is assigned to them. So, you can’t utilize techniques that you might’ve used like when I first started. You have to evolve with all the changes that are happening yourself.

In our workforce now, they want to be engaged and they want to be involved in the decision making. So, I feel like the more transparent you can be with everything, the better. And as Allyson has said, we’re a fun campus and we enjoy having fun and you should have fun at work. So, we go dancing down the halls, you know. There’s just all kinds of fun themed events that happen on our campus. And so, the more that you can do all that, I think is for success in the long run.

Matt Holsen:

I’ve been there a few times. It really is a fun community like you describe. I want to thank you both for joining me here in this discussion about this important topic, retaining the senior caregiving workforce. Have a great day. Thanks.

Allyson and Tammi:

Thank you. You too.

Alan Helgeson:

You’ve been listening to “Reimagining Rural Health,” a podcast series brought to you by Sanford Health. Hear more episodes in this series or other Sanford Health series on Apple, Spotify and news.sanfordhealth.org.

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Vaccinations help older adults stay stronger for longer

Alan Helgeson (announcer):
This is the “Health and Wellness” podcast brought to you by Sanford Health. The conversation today is about the importance of vaccination for older adults. Our guests are Amanda Petrik, director of nursing, Good Samaritan Society – Canton, South Dakota, and Courtney Vroman, director of nursing, Good Samaritan Society – Battle Lake, Minnesota. Our host is Matt Holsen with Sanford Health News.

Matt Holsen (host): 
I’m joined by two nursing directors. Amanda Petrik serves the Good Samaritan Society in Canton, South Dakota. And Courtney Vroman is a nursing leader in Battle Lake, Minnesota. Welcome. Thanks for being here.

We’re talking about vaccinations, and let me start with you, Courtney. Why should older adults be getting vaccinations and which ones are the most common in your setting?

Courtney Vroman (guest):
Well, older adults, we really want to see them get vaccinations as they get older. Their immune system really declines. It doesn’t respond as well in its ability to fight off infections and diseases, so they really become susceptible.

Matt Holsen:
What are some of the specific vaccinations that you’re giving to folks?

Amanda Petrik (guest):
Typically during the year? Flu, COVID, RSV and pneumonia are the big ones we hit in our facilities.

Matt Holsen:
And how is that managed in a long-term care setting?

Amanda Petrik:
I have a wonderful infection preventionist and I’ve also went through the training. So we kind of work well together but we do set up with Lewis long-term care and we do have a plan. The first year we gave all the vaccinations at once and it was kind of hard on our elders. So now last year we spread it out more so that we have good protection through that fall season.

We started with our flu in September, RSV in October, and then we did our COVID in November. So they had that great protection through the holiday.

Matt Holsen:
Courtney, what is the process like at your location?

Courtney Vroman:
At our location, it’s really a team effort. We too have an infection preventionist, but we’re really looking at resident vaccines prior to them coming to the nursing home. As soon as they come to us, we have the infection preventionist and the case managers interviewing the residents, reviewing records, interviewing families, so that we can really bring all of that information together. We have a flu vaccine clinic every fall, COVID vaccine clinic every fall and as well when booster time comes up. So we’re really looking at all of those things.

Matt Holsen:
Would you describe this as easy to access? I mean, it’s very convenient for residents, or how would you describe that?

Amanda Petrik:
I would say it’s very convenient when you have a good team that works together. Like she said, with admission, you get that baseline of what’s going on and you update and educate. It’s a lot of education that goes into it with families because some families are hesitant. You just really have to speak to what the recommendations are by the CDC (Centers for Disease Control and Prevention).

Matt Holsen:
That actually leads me right into my next question. Do you encounter a lot of vaccine hesitation at your location?

Courtney Vroman:
At our location, it’s not unusual to encounter that. We probably encounter it more with new admissions. Usually when new admissions are coming, they’re coming to us after a hospital stay, an illness. So their focus is on something other than vaccines.

So again, it’s really about educating them, the importance on the vaccines, the risks and the benefits, and at the same time you’re trying to develop a trust relationship with them. They’re oftentimes unfamiliar with our caregivers and they don’t have their usual providers around them. So it’s really many things coming into play there.

Matt Holsen:
Amanda, what do you do when you encounter vaccine hesitation?

Amanda Petrik:
A lot of education. I really do emphasize the communal setting and how infections do spread quite a bit faster than if you were at home. So it’s really important for that primary prevention in nursing to start with your vaccinations when coming into the setting.

Matt Holsen:
What are the risks when you do avoid getting vaccinated? What happens?

Courtney Vroman:
Well, there’s risk for increased illnesses, disease, spreading amongst not just your resident population, but also over to your workforce population. Increased hospitalizations.

Amanda Petrik:
I would say that too.

Matt Holsen:
From what I remember, you guys both have high vaccination rates at your location. Can you tell us a little bit about that?

Courtney Vroman:
Yeah, we’re really excited about that. We achieve high vaccine rates. Right now we’re in the 97th percentile for vaccine compliance rates through the Good Samaritan/Sanford platform.

Matt Holsen:
When we talk about vaccination rates and having rates that high, what does that do for a community? What are the benefits?

Amanda Petrik:
The benefits are, I’m going to tell you and I should knock on wood somewhere, but we did not have any positive cases of influenzas this year. Our COVID outbreak that we did have in January was a minimum of, I think we had five that tested positive, none of which had any symptoms. It was just kind of a fluke. The one got tested and I had to test the whole building. So we really know that the vaccinations work because we’re not seeing people passing away from COVID per se.

Matt Holsen:
Courtney, what would you add to that?

Courtney Vroman:
So I can also add that usually we end up seeing a healthier community. They’re developing herd immunity when they’re getting those vaccines. If they do get the illness, oftentimes what we’ve seen, especially in the last year, is that they’ve had just a decreased level of acuity as far as the illness goes. So the vaccines are beneficial even if they do get COVID or influenza. The illness just hasn’t been quite as strong.

Matt Holsen:
And we talked a lot about residents during this, but this goes for staff too, right? I mean you’re chatting with staff, encouraging staff?

Courtney Vroman:
Yes, absolutely. Because of course if your staff gets sick, then you have other issues that you’re dealing with in long-term care all while you have to continue providing cares to the residents.

Matt Holsen:
Anything you’d like to add to that?

Amanda Petrik:
We just really encourage if they’re not going to do their vaccination, that they wear a mask, obviously. And then making sure we’re doing great hand hygiene and all the infection prevention precautions that we do.

Matt Holsen:
Thank you for joining us on this important topic.

Alan Helgeson:
This podcast is part of the “Health and Wellness” series by Sanford Health. For additional podcast series by Sanford Health, find us on Apple, Spotify, and news.sanfordhealth.org.

Get more episodes in this series

Growing the Gill family comes with help from Sanford Health

Nikki Gill (guest):

You feel just this sense of desperation and panic because it’s like, is this all that you can do? I don’t think I’ve ever prayed more in my entire life. Just like out of just pure desperation of just, “I’ll do anything. Just like save my baby,” you know?

Cassie Alvine (announcer):

This is Family Portraits, a new podcast series by Sanford Health.

Alan Helgeson (host):

So what is a family? Google says it’s one or more parents and their children living together as a unit. Another definition is all descendants of a common ancestor. Likely my family is different than your family. We celebrate this. It’s what makes us unique and develops the chapters of our own stories.

In this new series, with each unique story of family, we’ll sew these stories together with a common thread. That thread is one of compassionate care and expertise. And while these stories intersect with the caregivers from all across the many rural communities that Sanford Health serves, the stories belong to the wonderful people that trust us with that care each and every day.

In this episode, our family portrait begins with the story of Nikki and Polly Gill and of all places, on the volleyball court.

Polly Gill (guest):

So Nikki and I met at Dakota Wesleyan and we both played volleyball together, and that’s the first time we met. And then yeah, we were just roommates.

Nikki Gill (guest):

So Polly was like a really big volleyball star in high school. And when I was in high school, my team actually played against hers, and her senior year, she’s from Pierre and they were undefeated all season. And she was a senior and I was a junior. And from our high school in Rapid City at Stevens High School, we ended up beating them in the state championship. So that was like the first encounter and to this day she does not get to live that down. And so yeah, we played volleyball in college together and then like she said, we were roommates and then became more than roommates and fell in love and got married and had a baby. <laugh>

Alan Helgeson (host):

Polly Gill. She keeps track of their time together.

Polly Gill (guest):

I think we dated about seven years before we got married. And then now we’ve been married for, it’s gonna be seven years. It’s been the best 14 years of my life. Yeah.

Nikki Gill (guest):

Yep. Good answer. <Laugh>

Alan Helgeson (host):

When you’re together, at some point the conversation is likely to come up. You know, kids. For Nikki, the answer was easy.

Nikki Gill (guest):

I’ve always known that I wanted to have kids.

Alan Helgeson (host):

For Polly Gill, not so much at first.

Polly Gill (guest):

I actually didn’t want to have kids. When I met Nikki, that’s just something we talked about. I just knew she was gonna be amazing and that’s like all I wanted at the end of the day is a family with her. So that’s kind of when I changed my mind and, that’s what I wanted.

Alan Helgeson (host):

Starting a family is filled with so many challenges, but for Polly and Nikki agreeing on having kids was only the beginning.

Nikki Gill (guest):

I was with boys my whole life before I had fallen in love with Polly. And so I had imagined having babies in the traditional sense. And so when Polly and I fell in love, we had to look at how we wanted our family to work. And initially, I remember having a conversation with Polly at one point saying like, I don’t know how we would … that was like a deal breaker for us at one point.

Polly Gill (guest):

We almost didn’t make it because of that.

Nikki Gill (guest):

I was like “I want to have babies. I want to  have a family. I don’t know that this is going to work.” So yeah, I just, I hope that people can listen to this. Or there’s at least somebody out there who can listen to this and think, “Oh gosh, like that’s awesome that I can marry who I want to marry, or love who I want to love and have a family.” Like you can have all of that.

Polly Gill (guest):

Right? And then going into Sanford too, not once did they look at us like we were a same-sex couple. They looked at us like every other couple and didn’t even bat eye at us being same-sex.

Nikki Gill (guest):

Can’t say enough good things about those doctors.

Polly Gill (guest):

Yep. They just acted like we were just a heterosexual couple. And they just made us feel loved and like it wasn’t anything different. And we really appreciated that.

Alan Helgeson (host):

Nikki on how they started on that journey to having a baby.

Nikki Gill (guest):

We wanted both of us to be involved with having our child. So what we actually did with Theo was we had Polly get her eggs ready. So we kind of like split the IVF process together. So Polly had her eggs retrieved for the IVF process and then those eggs were created, like the embryos were created with her eggs and the sperm donor. And then those were put into me. So like, Theo would not have been able to exist without either of us put together, which is like what we were really hoping for in a perfect world.

Alan Helgeson (host):

The Gills found it took a good deal of patience.

Nikki Gill (guest):

I also have PCOS, so I have polycystic ovary syndrome.

Alan Helgeson (host):

And more patience.

Polly Gill (guest):

He has always been the last chance of everything during this whole pregnancy. And the last chance we were going to quit, that’s when we tried something different.

Nikki Gill (guest):

It took about three to four years for the whole process.

Alan Helgeson (host):

Things started turning the corner when the Gills visited with the team at Sanford Fertility and Reproductive Medicine Clinic.

Polly Gill (guest):

We started at Sanford Health because I believe that they’re the only fertility clinic in the whole state of South Dakota. So we’re very, very blessed that they’re nearby. And we couldn’t ask for the better doctors. I think we started off with Dr. Hansen. From the very start we just worked as a team and they said, “We’re going to get you guys through this and we’re going to do everything we can to get you guys pregnant.” And they give us a lot of hope. And they pushed through until we, until we got there.

I was super excited. But how many times we had negative after negative after negative. It was like, “There’s no way we can be pregnant. This is just not going to happen.” And we just didn’t want to celebrate yet. Man, but when we found out, when those were two solid blue lines and the pregnancy (test) said positive, we just bawled. And we just said, you know, we’ve been working on this for four years, trying to have our family and it was the best moment of my life.

Nikki Gill (guest):

Polly is much better at being in the moment and being just really present and really grateful and really happy. And my personality is more like analytical and it’s just like, “OK, what’s the next step? What’s the next step?” So when I saw those positive lines, for me it was like, “We’re not out of the woods yet. We don’t have a baby. I could still have a miscarriage. We’re in the first trimester.” So I wasn’t ever able to really stop, take a breath and enjoy things because in my head it was like very factual, medical, “What do we have to do next?” And also I will say I felt a ton of pressure, like emotional pressure, to be perfect all of the time when I was pregnant. Because it’s like, if I do anything wrong, I’m going to ruin this pregnancy. So like every emotion that comes along with it.

Polly Gill (guest):

Yeah, there’s a lot of pressure on comes with it — women who get pregnant — and I think that’s for every pregnant woman. There’s a lot of pressure onto, it’s like, they feel like it’s your job to make their family. Everything’s on you. You have to do everything perfectly.

Nikki Gill (guest):

And when you’ve never been pregnant before.

Polly Gill (guest):

Yeah, it’s scary.

Nikki Gill (guest):

It’s like, is this normal? Is this not normal?

Polly Gill (guest):

Right. It’s scary.

Alan Helgeson (host):

The Gills found that when it came to starting their family, they experienced a whole new family at Sanford Health.

Nikki Gill (guest):

We have gone through a lot of doctors at Sanford for this whole journey. So we started with our fertility doctors, Dr. Hansen, and let us add their amazing team of PAs. And then as soon as I got pregnant and we graduated from the fertility doctors. Then we went to Dr. Kemper.

Polly Gill (guest):

Oh and man is she, she’s awesome!

Nikki Gill (guest):

So then really after you graduate from the fertility doctors, it’s like a normal pregnancy, right? So then you just have like a normal baby doctor, which is so weird because you have these fertility doctors who are checking you and ultrasounds all the time to going to just like a regular baby doctor.

Polly Gill (guest):

Dr. Kemper would look at the ultrasound and say, “You guys are good.”

Nikki Gill (guest):

Because it was IVF, that’s what labeled us as a high-risk pregnancy. But yeah, we just had like a normal experience from that, at that point. And then at my 20-week scan, we found that my cervix was shortening and funneling, which is a sign of labor.

Alan Helgeson (host):

This really wasn’t part of the plan, right? Nikki’s doctor knew what to do,

Nikki Gill (guest):

So they had to put in a cervical stitch to like stitch up my cervix to stop it from opening in hopes that that could keep the baby in long enough to get to viability. So I remember at that 20-week appointment, they were like, “You could have a baby within the next couple of weeks.” And we were like,”Um, that can’t happen!” So we had Dr. Rodel do my cervical stitch and she is just amazing.

Polly Gill (guest):

She’s amazing too.

Nikki Gill (guest):

Yeah.

Alan Helgeson (host):

While Polly and Nikki hoped that this would help keep the baby in Nikki for a while longer, things didn’t quite work out that way. At 24 weeks and five days, things changed.

Nikki Gill (guest):

Ugh. You think you would be able to like get through it? After telling the story so many times. OK, so the night before the emergency C-section happened, I had felt pressure in my vagina and they came and did a pelvic exam and they said everything looks good. Theo was reading normal on the fetal monitor. There was like, I had the cervical stitch in. So they said if he were dilating at all, there would be blood. Everything looked good. So they had just said like, “No concerns at this point.” So we said, “OK.” So I woke up that next morning and I went to the bathroom and it felt like my vagina was falling out of me. And I had called Polly into the bathroom and I said, “This is not normal.” And something was coming out of me.

And so we called the nurse in and she’s like, “Let’s get you into bed.” And I said, “What is this?” And it was his umbilical cord that was falling out of me. And it was like, they say, when you’re waiting and you’re in bed rest, they talk to you and they say, “I hope that you never have to experience an emergency C-section, but if you do, it’s like a beautiful symphony.” It’s like everybody comes in and they all have their roles and it’s just like a flawless, beautiful symphony and there’s really no other way to describe it.

So they wheeled me out and I had a nurse by my side who I had on Day One, and I just grabbed her hand and I said, “Is he going to live? Is he going to be OK?” And she said, “We’re going to get him out of there. You have to stay calm right now and not give yourself anxiety with everything else that’s happening.” And it was really urgent to get him out of me because with his umbilical cord falling through, that’s cutting off oxygen to him. So we go into the emergency room and they put me on the bed and one person’s at my head and she’s saying, “Do you give consent to be put out?” And I said, “Yes, just save my baby!” And there’s a person like down below, and she’s just like sticking a catheter in and the surgeon comes in. They have to time the procedure perfectly because they’re putting me under general (anesthesia). Like they’re knocking me out completely. Normally with a C-section, they can give you like, an epidural kind of and like numb you.

Polly Gill (guest):

Paralytic. Yeah.

Nikki Gill (guest):

And they couldn’t, they needed to just put me out completely. There was no time. And so they’re like scrubbing my stomach up and the person by my head is saying, “Are you ready for her to be put out?” And the surgeon’s saying, “Nope, not quite ready yet. Not quite ready yet.” And then I have somebody holding my hand and they’re looking for the heartbeat. And I said, “Is there a heartbeat? Is he alive?” And they couldn’t find one. And so they’re getting ready to like put this mask on my face. And I said, “Stop. Is there a heartbeat?” And they said, “Yes, yes, we have a heartbeat.” I said, “OK, put me under.”

Polly Gill (guest):

So when her cord fell out, all the doctors ran in and everybody left. And I was by myself. And I like, had a little moment with God where I dropped to my knees and I just said, you know, I pray that, because she could have had an infection and if the umbilical cord wouldn’t have come out, she could have died and so could have he. I had a rush of peace over my heart, and then from that moment I knew that everything was going to be OK. And then I went and saw him for the first time and it was the most beautiful thing I’ve ever seen. And he was kicking and he was sassy. And we actually got to have a delayed cord clamping because he was such a fighter. And ever since then, he’s been a fighter.

Alan Helgeson (host):

Baby Theo is born one pound, eight ounces and now begins a new chapter for the Gill family. A 120-day stay at the neonatal intensive care unit at Sanford USD Medical Center in Sioux Falls. And new doctors to care for this growing family.

Nikki Gill (guest):

From our fertility doctors to our OB/GYN to our maternal-fetal medicine doctor, Dr. Rodel, we then had Theo and then we had a new team of doctors, all of our NICU doctors. They’ve got like a rotation, and so we had talked about how every week that doctor was exactly what we needed at that time.

Polly Gill (guest):

They had different ideas.

Nikki Gill (guest):

And they all like bounce ideas off of each other. And every step along the way, it was exactly perfect for what Theo needed.

Polly Gill (guest):

And we can’t even get started on the NICU nurses. I mean, they’re a family.

Nikki Gill (guest):

Just the whole team.

Polly Gill (guest):

We still think about ’em and yeah, they’re just amazing.

Alan Helgeson (host):

During this whole journey to starting a family, the Gills encountered things they never expected in each step along the way. Four months in the NICU took its toll.

Nikki Gill (guest):

He was going to have to go to the NICU regardless. We knew that that was going to happen. We just didn’t know how sick he was going to be when he was in the NICU. His first week, they say that like, the baby is going off of the hormones that I had provided for him when he was inside of me, and it’s like a honeymoon stage. So the first week he was great, and then after my hormones like kind of leave his body and it’s up to his little body to be like, “Whoa, like I gotta do this on my own,” that’s when reality sets in.

The first week was a breeze compared to everything else. And then it got like more complicated. You feel just this sense of desperation and panic because it’s like, “Is this all that you can do?” And I don’t think I’ve ever prayed more in my entire life just like out of just pure desperation of like just, “I’ll do anything.”

Polly Gill (guest):

Just pleading.

Nikki Gill (guest):

It’s just like, “Save my baby,” you know? And they can’t promise you that he’s going to live, right? Like I kept asking the nurses, I would be like, “He’s going to live, right?” And they would say like, “We’ve got really good doctors.” And they would say like, “We’ve got a really good team.” And they would say like, “He’s just doing what preemie babies do.” But nobody could ever tell me like, “Yes, he’s going to live.” Because you can’t promise that to families. And you just so desperately want somebody to just say “He’s going to make it. He’s going to be OK.” But you can’t. So you just have to like, hold onto your faith that everything is going to make it.

Polly Gill (guest):

And just seeing your little guy hooked up to that many things is just the hardest thing to look at.

Nikki Gill (guest):

Those nurses deserve all of the good in the world. They are not only medically taking care of your child, but then they’re like counselors to you.

Polly Gill (guest):

They become like your family.

Nikki Gill (guest):

Yeah. And they’re like therapists.

Polly Gill (guest):

They were like our angels.

Nikki Gill (guest):

Yeah. They wear so many hats throughout the day just to, they’re just phenomenal.

Alan Helgeson (host):

In the months that have passed for Polly and Nikki, some of the challenges they faced were the things that could have had the power to transform or the power to tear them apart. For the Gill family, Polly, Nikki and Baby Theo, it forged a strength like none other.

Polly Gill (guest):

So the hardest part about it in the NICU was the roller coaster that we had to go through. We made progress. You know, two steps forward and then you’d digress five steps back. And so you’d think he was doing good, we’d be OK, we’d be happy, we’d be like, “Yes, he’s got this.” And then we’d get bad news and his lungs weren’t functioning the way we wanted to. He’d make a little more progress and then he’d fall back.

So I think that was the biggest roller coaster of emotions, was really hard to maintain. And I mean, it gets to you. We had a lot of times where Nikki and I broke down thinking he was going to die. So many times. And it is just an emotional roller coaster that I was not ready for. But at the end of the day, it’s made us stronger and a stronger family.

Nikki Gill (guest):

They say the hardest part about being in there is the beginning and then right at the end. Because at the end he looks like a baby, he’s doing so good, but like, you can’t go home yet. And then he’s like big enough where he just wants to be held. And like, when he’s really little, he’s just on a machine and he’s sedated. When he is big enough, he’s crying out and you want to see him, and you want to love him, and you want to hold him, and you can’t take him home. And you’re at work, right? Like you can’t just be in the NICU 24/7.

Alan Helgeson (host):

Where the Gill family has been, they know that others will be too. As a couple that has experienced a journey filled with challenges and opportunities, some words of encouragement.

Polly Gill (guest):

During the whole NICU stay too, we had our neighbor who went through the exact same thing as us. We had that person to talk to, and finding people who understand you was helpful for me anyways. Our neighbor was kind of going through the same thing, and talking to that mom really helped. And so I think finding your community is helpful.

Nikki Gill (guest):

Our NICU neighbor.

Polly Gill (guest):

Our NICU neighbor. Yes. And then talking to her, her child right next to us has gone through the same thing Theo has been. It’s helpful to find your community and also like, things might be really, really dark at the time and really, really tough. But like, things are going to get better. It’s going to get better. It just takes time.

And you might be in the darkest place of your life, but Sanford’s there to help you. The nurses are, the doctors are, your family is, but it does get better. And there were all those moments where we couldn’t hold him because he was in an isolette. We could only put our hands through a hole and touch him. And Nikki goes, “He is sleeping in our bed until he’s in college.” <Laugh>. I’m sure he’d love that.

Alan Helgeson (host):

Theo is a growing boy and the Gill family story is just beginning.

Polly Gill (guest):

He’s just the best boy and he’s so happy and he is laughing and we finally get to see him actually acting like a baby, which we were waiting for for so long. And we just love him so incredibly much.

Nikki Gill (guest):

I would do all of that over a million times if this was like the result of it. It was like so worth it.

Polly Gill (guest):

I agree.

Nikki Gill (guest):

Yeah.

Alan Helgeson (host):

Remember when we began this episode and Polly said they had been together for 14 years.

Polly Gill (guest):

So Nikki and I were still together when marriage wasn’t even legal and we were together when marriage was legalized for same-sex couples.

Nikki Gill (guest):

Nationwide.

Polly Gill (guest):

Nationwide. And so that’s how long we’ve been together and it’s like, we’ve been through all of that. And so knowing that we’ve worked through that together as a couple and then now we can work as a family, as a same-sex couple to get pregnant. It’s something that’s very realistic, even for other couples of same sex. It’s a very realistic opportunity for them and it’s possible.

Alan Helgeson (host):

And for their part, Polly and Nikki are grateful for the medical team who helped them along the way as they begin this new chapter in their life together.

Polly Gill (guest):

They are the story. They are our beginning, our middle, and our end, and our family at the end of the day, even when we’re home. So they are our complete story and they saved his life and they helped us have a baby and her family. They just didn’t do it for their jobs. They truly loved us and loved Theo. Been an awesome journey with Sanford and our family.

Nikki Gill (guest):

Yeah. We’re forever, forever, forever, forever grateful for all of the people who have helped us along the way.

Polly Gill (guest):

And of course couldn’t get through this without God too. So a lot of praying and a lot of good team is what made it made this happen, possible.

Alan Helgeson (host):

Well, we couldn’t really finish this episode without Nikki and Polly telling us the best part of this whole experience.

Polly Gill (guest):

Theo. That’s just it.

Polly Gill (guest):

He is like, he’s just our whole world. So in my happiness with him.

Nikki Gill (guest):

I would say that too. Yeah. I mean, just having him and looking into his eyes and just seeing him smiling at you. A close second though would be watching Polly be a mom. It’s like the most beautiful thing ever from somebody who didn’t even want to have kids, to now seeing her love him is amazing, and it’s like she’s just blossomed into this version of perfection that I’ve never seen before. So watching her be a mom is a very close second.

Polly Gill (guest):

You’re making me cry. <Laugh>.

Learn more

• Explore different types of pregnancy care options
• Preconception planning for high-risk pregnancy
• Midwives are part of pregnancy care spectrum

Creating healthy communities at work is an ongoing process

Alan Helgeson (announcer):

“Reimagining Rural Health,” a podcast series brought to you by Sanford Health. In this series, we explore the challenges facing health care systems across the country from improving access to equitable care, building a sustainable workforce, and discovering innovative ways to deliver high-quality, low-cost services in rural and underserved populations. Each episode examines how Sanford Health and other health systems are advancing care for the unique communities they serve.

In this episode, Courtney Collen with Sanford Health News talks with “future of work” expert and bestselling author Eric Termuende and Ashley Wenger-Slaba, Sanford Health senior vice president of employee experience, education and workforce relations. The conversation is on workplace culture and the future of work.

Courtney Collen (host):

Thank you both so much for your time.

Eric and Ashley (guests): Thanks for having me.

Courtney Collen:

Eric, what are the top three opportunities you see when it comes to building a resilient and thriving workforce?

Eric Termuende:

Yeah, so first of all, let’s get a better understanding of resilient. To me, resilient is able to navigate change, able to bounce back from uncertainty, able to navigate whatever the future of work is for sure going to promise us. So given that that’s an understanding of what resilience is, a foundation of trust on the team is imperative.

We have to make sure that people feel seen, heard, and understood. You know, a sense of belonging, I think is a better way of saying that. And there has to be an opportunity or a forum to do things different than the way we’ve always done it. Because, in the work that we did, what we found is that the actual root of happiness is a sense of contribution. And when we’re able to contribute, try new things, feel seen, heard, and understood, built on a foundation of trust, resilience is present, and the future of work is not something we have to shy away from.

Courtney Collen:

Where have we made progress when it comes to workplace culture? Where does work remain? How will this shape strategy and policy moving forward?

Ashley Wenger-Slaba:

Courtney, when I think about the progress we’ve made over the last several years, one of the things I’m most proud of is how we have really grown our listening culture at Sanford. We’ve built out a number of different strategies where we are actively listening to our employees in a number of different ways, trying to really stay in tune day-to-day with the employee sentiment across the organization. Whether that be our employee survey work, our SAFE rounding, our employee connection process – just a number of different ways that we are getting real-time feedback from our employees and utilizing the information to pivot our strategies and offerings as an employer.

Eric Termuende:

I think we’ve identified that culture is an important thing. And we’ve also identified that it’s very nuanced. So something that might work at Sanford Health might not necessarily work at the media company downtown or for the sports team, and that’s totally fine.

We recognize that culture is important, but it’s not necessarily universally the same. I mean, even if we were to just look at the best places to work in the country according to Fortune magazine, one of them, well, let’s say Sanford Health, of course, we’ve got that one there. But, but another one is like Cisco, out of San Francisco, internet infrastructure. And another one is the Hilton hotel chain. And I guess the point that I’m trying to make is that yes, three great places to work, but that doesn’t mean that somebody who’s a valet at a Hilton wants to work at Cisco in a server room, or somebody who’s making a bed at a Hilton wants to work at a hospital and that’s fine. We’ve got three great cultures, but not necessarily great for each other.

So where’s there progress that needs to be made? We have to understand that culture is not static. You know, we heard this throughout the pandemic so often: How do we preserve, how do we maintain the culture we have? I think the answer is you don’t. With every new hire, with every person that retires, with every new patient, with every new customer, culture changes and is supposed to recognize that it’s a moving target that we’re always looking to move forward. And I think we’ll get there eventually and continue to get to wherever we need to be.

Courtney Collen:

Fascinating, great insight. Thank you. You talk about one-degree shifts that build communities at work. In other words, small changes can have a big impact on workplace culture. Eric, can you share some examples of that?

Eric Termuende:

Yeah, let’s make it a little easier and make it more on a personal level. Let’s just say I wanted to lose 10 pounds or gain 10 pounds. Instead of just setting that goal of losing 10 pounds, which of course we need to do, what are the little shifts that I can make right now that will eliminate excuse, eliminate distraction and eliminate any reason for me to not ultimately get that done?

So maybe I’m putting my shoes beside the door so that they’re there. Maybe I’m blocking a spot in my calendar because my calendar’s been busy and I haven’t been able to make time. And the excuse that I tell myself is that I’m too busy – relatable. Maybe I just have that, you know, clothes that are folded at the base of my bed. Maybe if I’m looking to lose 10 pounds, I might say, well, I’m not just going to go on an all salad and juice diet. Maybe I’ll just take the sugar out of my coffee this morning. You know, which might be a bigger than a one-degree shift change for some people. But instead of saying, how do I cut everything? What’s the small change that I can make? And I found that in the workplace, the same thing happens.

We often have our big strategic initiatives, our five-year plans, and they can be overwhelming. They’re huge. Right? They’re daunting. They’re exhausting. Instead, set that goal, but then say, what’s the one small shift we can make to get a little bit closer to that goal today? And I found that that often lies in how we communicate and connect with each other.

So the best tip that I’ve got is, ask that one extra question that you’ve told yourself you didn’t have time for. My favorite question when we’re trying to build camaraderie is what are you most excited about? It’s just such an easy way to find out what people are looking forward to, what they’re passionate about, and what they’re excited about.

Courtney Collen:

Well, that segues nicely into our last question, Eric, because I’d love to know what excites you most about the future of work.

Eric Termuende:

Sure. The pandemic obviously has hopefully long, long passed us. But we had this rhetoric around going back to like a new normal. And I think based on how fast the world around us is changing, there is, and there never will be a new normal, which again, can be daunting and anxiety inducing. Sure.

At the same time, it can be very optimistic. It can be very exciting. What I’m most excited about for the future of work is that it might be a turbulent time right now. But as we settle into change being constant, as we settle into a new way of doing things, what I think is going to happen is that the workplace will reconfigure itself a little bit. We’ll see short-term turbulence, but in the long-term, we’ll see people landing exactly where they need to be, working in places they love to work, doing work they love to do with people they love to do it with. And ultimately on Monday morning, not dragging their feet to work and on Friday afternoon, not necessarily skipping out of the office. I see the future of work is very positive, very optimistic, and very human centered.

Ashley Wenger-Slaba:

What I think excites me the most about the future of work at Sanford is that I think we have just this incredible group of people with such a diversity of talents. And as we build upon that listening culture, as we increase trust and that psychological safety in the workplace, we’re really able to just better leverage and pull out those diverse talents, those diverse lived experiences, and we really truly are stronger, too – better and better together because we’re able to do that.

Courtney Collen:

Yeah. I love to know, Ashley, what do you love most about what you do?

Ashley Wenger-Slaba:

I’m a lawyer by background. And so I started my career trying to mitigate risk in the employment law world. Stop bad things from happening in the workplace. And now I’m able to do preventative, proactive things to make the workplace better and try to avoid ever having to be in those situations, and that’s just a really rewarding and engaging shift for me professionally.

Courtney Collen:

Well, we appreciate all that you do. Thank you both so much for your time.

Ashley Wenger-Slaba:

Thanks, Courtney.

Eric Termuende:

I’m grateful to be here.

Alan Helgeson:

You’ve been listening to “Reimagining Rural Health,” a podcast series brought to you by Sanford Health. Hear more episodes in this series or other Sanford Health Series on Apple, Spotify, and news.sanfordhealth.org.

Get more episodes in this series

How to begin the talk about assisted living

Karis Gust:

Probably 80% of the residents that I talk to who are currently in assisted living, when they move in, they say, boy, I should have done this a long time ago. And that’s OK. It’s sometimes hard to hear because, you know, maybe they could have stayed in assisted living longer, or maybe they could have, I guess, I don’t know what it could have been.

But they realize the benefits of being in assisted living. They’re getting more support. They’re having opportunities to socialize with other people. And that’s something that they realize once they get there that had been severely lacking in their lives.

Cassie Alvine (announcer):

This is the “Health and Wellness” podcast brought to you by Sanford Health. The conversation today is about caregiver burnout and recognizing when it might be time to consider assisted living. Our guest is Karis Gust with the Good Samaritan Society. Our host is Alan Helgeson with Sanford Health News.

Alan Helgeson (host):

Welcome to our podcast today, and our topic is tips to avoid caregiver burnout and really recognizing when it might be time to consider assisted living. And joining us is Karis Gust, and Karis is with Good Samaritan Society. Karis, thank you for joining us.

Karis Gust (guest):

Thank you for having me.

Alan Helgeson:

Well, can you tell us what your title is with Good Samaritan Society?

Karis Gust:

Yes, I am a nursing and clinical services consultant. I cover assisted living specifically. So this topic is right in my bailiwick or whatever you want to call it.

Alan Helgeson:

OK.

Karis Gust:

My backyard.

Alan Helgeson:

So every day you’re dealing with folks that are going, alright, here’s where I’m at. This is all new. Help me sort all this stuff out. Right?

Karis Gust:

Absolutely. Every day. Yep.

Alan Helgeson:

Because people are always moving into this topic because, you know, we’re growing up and there’s always some amazing statistic about the graying of America. And the Baby Boomers are getting older and needing more health services, right?

Karis Gust:

Yep. They absolutely are. We’re, you know, the gray tsunami. I mean, we’re not really seeing that as much yet. But what we are seeing is that certainly people have needs and people want to stay in their homes as long as possible. And I’ll be one of those people too, I’m sure. My parents are.

But the bottom line is none of us are getting any younger. And so we’re all going to eventually get to a point in our lives where we probably need some assistance. Alright. And so, you know, that’s where assisted living can come in, and home health, and there’s lots of resources that can come in and be helpful.

Alan Helgeson:

So let’s start right away here, Karis. Let’s talk about who might be benefiting from what we’re going to be talking about. So those different groups – the caregiver relationships or those family members who might benefit from what we’re going to be talking about.

Karis Gust:

Honestly, just about everybody. If you’re young, if you’re in your teens, if you’re, maybe not in your teens, but if you’re an adult and you’ve got parents who are aging maybe you’ve got grandparents who are aging, you know, maybe you have a spouse. Maybe you yourself are older and you have an older spouse or an older loved one, or somebody, an aunt.

There’s all kinds of people who have family members or friends who are going through various transitions in their lives. Of course, assisted living targets, our audience is mostly elderly people. I mean, certainly 55 and over. I think this information can be helpful for anyone with a person in their life, regardless of the relationship, who is at a point where they might need some more assistance.

Alan Helgeson:

So for those caregivers, and if you are working with somebody that’s needing some different that you’re helping with – folks that have some health issues and you’re taking care of someone in the home, or maybe not in the home, but a family member, somebody – that there might come with some burnout and some stressors that come with doing that. Because life can be challenging when you’re adding on a lot of these things. And you talk to folks like that every day, right, Karis?

Karis Gust:

We do, yes. Every day. Sometimes we have a lot of our people who are caring for their parents, they are also working a full-time job. Maybe they’re trying to pay for their kids at college. They’re moving their kids in and out of college, but they’re also caring for Mom or Dad. You know? So there’s those stressors.

The stress of maybe it’s a spouse and they’re both getting older. One maybe has some health concerns. So, you know, then there’s that dynamic. So there’s all kinds of different ways that people come to a point where they say, boy, I really need some help. And oftentimes it doesn’t happen as soon as it maybe should.

Probably 80% of the residents that I talk to who are currently in assisted living, when they move in, they say, boy, I should have done this a long time ago. And that’s OK. It’s sometimes hard to hear because, you know, maybe they could have stayed in assisted living longer, or maybe they could have, I guess, I don’t know what it could have been.

But they realize the benefits of being in assisted living. They’re getting more support. They’re having opportunities to socialize with other people. And that’s something that they realize once they get there that had been severely lacking in their lives.

Alan Helgeson:

And it’s that 20/20 hindsight. But let’s talk about right now, today. And those caregivers that are feeling, you know, like they’re a little stretched thin, what are some things that you maybe counsel people on? What are some of those ways and some things that we can do right now that maybe we can do to manage stress?

Karis Gust:

So, different signs. I would say, first we need to identify the stress, right? How are we sleeping at night? Are we taking care of ourselves? Do we find that we’re a little bit maybe less patient than we used to be? We’re maybe more short. Maybe our family is saying to us, Mom, boy, you seem edgier. Or you seem, you don’t seem like yourself, and you just don’t feel like yourself and you’re investing time and you’re caring for your loved one. Sort of stepping back and just recognizing those signs is kind of the first thing.

And then the second thing is giving yourself permission to care for yourself. And that is critical. A lot of people who are caregivers, they put the other person first, but that’s the nature of a caregiver, right? We want to care for others. We want to make them better. We want to make their lives better. But we can’t be good caregivers unless we also take care of ourselves.

Alan Helgeson:

We really don’t do that. And I think that’s a pretty common thing you see in the upper Midwest too, right, Karis?

Karis Gust:

Absolutely. Absolutely. Yes. We are horrible at taking care of ourselves. And you know, I started off my medical career as an ambulance person. I was an EMT, and one of the first things they told us is, do not injure yourself. Because if you injure yourself, we just have another patient, right?

And so the first thing was to focus on your own safety, which was counterintuitive because you were there to help, right? And to save and to care. But you also had to preserve your own safety so that you could do those things for the other person, so you could offer assistance and not also be a patient yourself.

So I like to think of it like, that’s almost the same thing that happens in a situation where we have a spouse, a couple, and where the wife or the husband is caring for one or the other. And they can become a patient themselves if they don’t look after themselves. So they don’t care for themselves. So they can provide care to the person who officially needs the care.

Alan Helgeson:

So Karis, what are some things we can do to care for ourselves then as we’re talking about that?

Karis Gust:

Great question. So the first thing we need to make sure we’re caring for ourselves physically, right? We need to get enough sleep, have enough hydration, proper nutrition, exercise, really take care of our bodies.

Second thing, get equipped. If our loved one that we’re caring for has mobility issues, we want to make sure that we have our home set up to facilitate that. The bed can, maybe we get a hospital bed that can go up and down so we don’t have to find ourselves lifting so much. Get the vehicle modified for an easier routine. Make sure that we can easily get Dad or Mom in and out of the car without endangering ourselves or our loved one.

Maintaining other interests. Take some time for yourself, even 15 minutes away can be rejuvenating. Maintain some of your hobbies. Do you like to play cards once a week with your friends? Don’t give that up. Make time for it. Because if you do, and I’ll talk to you moms out there. Remember when our kids were really little, all you mom caregivers, it’s not that much different. We were told you’ve got to take some time for yourself to be a better mom. And it’s the same thing with caregiving.

We really need to carve out that time for ourselves, even 15 minutes, and keeping those special activities and work activities and social activities to just have that sense of self still.

Alan Helgeson:

Let’s switch a little bit now and talk about how to cope when you and your spouse might have different health needs.

Karis Gust:

Sure. So a lot of times we see situations where one spouse maybe has health needs that aren’t quite as intense as another, as their spouse. And so in those situations, it’s difficult. You know, the healthier spouse may feel very obligated or like it’s their duty to really care for their spouse and they love them and they want to be with them, but their spouse needs a lot more care. And so they sort of, and often it happens very gradually and all of a sudden you realize, oh my goodness, like I am practically providing, Mom is practically providing nursing home level care to Dad, and Mom is 95 and frail. And is this really safe for either one of them?

And so that can be kind of a scary conversation. Maybe Dad has dementia and is wandering, and Mom isn’t sleeping because she’s so worried. And so that creates a really intense dynamic and a really hard one, I think, for families to navigate. And I think one of the greatest gifts that a family can give their parents in a situation like that, or any caregiver, is to give them permission to say, it’s OK to ask for help. It’s okay to look at or even visit some memory care or assisted-living locations or something like that. Just giving them permission to ask for help.

Alan Helgeson:

One thing that I noticed too, Karis though, is that when they stop doing things is that if they don’t do those things – those things they’ve always done – that’s a sign that they’re not valued anymore. Or they’ve always taken care of Dad in that way, or they’ve always made supper. You see what you’re saying?

Karis Gust:

Yes. And so that’s where family can come in and say, you know, Mom, you’ve made dinner for Dad for 55 years. It’s time for you to have a break. You deserve a break.

Alan Helgeson:

It’s all in managing the conversation.

Karis Gust:

It’s all in managing the conversation. Keeping it very positive, being very supportive. And, you know, if people are proud, they may insist on doing that, and you know, try to find some middle ground where you can say, let us get you some help. Even if it’s just bringing somebody in once a week to help you give Dad a shower so that it’s safer for both of you.

Alan Helgeson:

We’ve talked about some tools, and how to maybe help managing those. Are there things that you offer and some resources where we can maybe direct people to find more things like this to help them out?

Karis Gust:

Yes, absolutely. So a couple ways to do that. Certainly. I know a lot of us go on the internet and we do some search, and we might talk to our physician, or we might go on to, of course, I’m here from the Good Samaritan Society. We have a great website, good-sam.com.

There’s an 800 number on there that people can call and they can talk to our connection center folks and they will talk to them about different options and different service offerings that we have.

You know, we have a great home health line that can come in. They have people that can come in, help manage medications, they can help provide bathing assistance. They can even do some housekeeping.

You have services at home. There’s a lot of things that can be done that can help sustain and keep you safe in your home for longer.

There’s the temporary, the respite care where maybe Mom wants to go on vacation. Dad has, you know, some health care needs that don’t let him travel. And so he can go have a short stay in one of our assisted living buildings for respite care. Maybe, you know, a weekend, 10 days, something short. And then Mom can go or Dad can go and rejuvenate and rest and relax or maybe even have, I don’t know, a procedure done, what have you, take care of themselves.

And then, you know, Dad’s in, or Mom is in great hands being completely taken care of by staff. And then we come back and we go back to our normal cadence of life without having to make any drastic move out of our house. You know, downsize, anything like that. It’s just a temporary thing.

Alan Helgeson:

So really some great options and a variety of options. And again, where can people find out all these things? I mean, from just reading up on some resources to how to learn about all these options, where do they go again, Karis?

Karis Gust:

So good-sam.com has a lot of great resources for caregivers, for if you’re looking at different options, if you’re thinking about memory care, assisted living, or home health or hospice, we have all kinds of resources on there. There’s knowledge articles, there’s you name it. We have got all kinds of resources on there. That’s one place to look. I know caregiver.org is another good one to go to.

Alan Helgeson:

Now we want to switch the conversation. So we’re talking about caregivers looking after folks right now in their homes or however they’re managing those relationships and looking after their loved ones. Eventually it might come time to have that conversation. When do we ask the questions to consider it might be time to consider assisted living options?

Karis Gust:

I’ll say one thing first, when you’ve been into one assisted living, you’ve been into one assisted living. Every assisted living is a little bit different. And so finding an assisted living that is appropriate for you does require some research. And so we always encourage people to go and visit and look. And a lot of times you can have lunch at the facility. You can even, sometimes there’s a try out stay. Stay one night and see how it goes. You know, there’s all kinds of different options with that.

But how do we identify when it’s time for that? Well, first of all, I would advise don’t wait until you’re like, oh my gosh, Dad had a stroke and now he can’t walk anymore. And now we really have to move into assisted living. Or even go straight to the nursing home. Don’t wait until that point because then it’s a lot harder, you know, to actually choose a place that you want to live. You’re sort of stuck like wherever there’s –

Alan Helgeson:

Forced into a tough situation.

Karis Gust:

Yes. And that is so stressful. And it always happens like on Christmas Eve. Honestly, it’s just, it’s awful. It makes it a horrible transition for the loved one, for the person transitioning. It makes it horrible for the family. So as we age, start having a plan in the back of your head just knowing that if there would be a catastrophic fall, we live in the Midwest, there’s ice and snow and there’s always the potential that something …

Alan Helgeson:

Three seasons of the year (laugh).

Karis Gust:

Exactly. Yes. We have three seasons of winter and a month of summer. And so there’s always a chance that we could have a catastrophic event that would cause that. And so being prepared for that and just sort of having a plan in place ahead of time about, OK, we’ve checked out these places, you know, this is one that we really liked. We think we could be happy here. We don’t have to move in today, but we have a plan. So let’s get on the waiting list. Let’s just have that plan laid out.

When do we know? Well, I’ll give you an example from some of my own experience. The house that my loved one was living in – was getting elderly – had steep stairs to the basement. That’s where the washer and dryer were. Well it was getting, I couldn’t even hardly safely navigate the stairs.

And so, you know, at that point then it’s becoming much more difficult for my loved one to make it up and down the stairs to do laundry, well, right then and there, that is a safety risk. But it’s also going to start impacting that person’s personal hygiene. Maybe they don’t feel safe showering anymore on their own because they’re afraid they’re going to fall. Maybe they are falling and they’re not telling anyone because they’re afraid somebody’s going to make them move.

So really being transparent and open, maybe if we want, you know, are noticing that our loved one is getting thinner and they’re not trying to lose weight. That’s a sign that maybe we’re not taking good care of ourselves. More aches and pains, maybe being more tired all the time. Really paying attention to your loved one.

What’s the state of the house like? Did Mom always used to be a fastidious housekeeper, and now it’s just kind of rack and ruin? Open the fridge. What’s in the fridge? Is there food in the fridge? What’s Mom eating? You know, really thinking about those things and paying attention to what, you know, are we eating healthy? You know, regular meals, are there just pill bottles sitting everywhere? And it makes us wonder, is Mom taking the pills the way her medications as prescribed? Because that alone, we’ve had people move in who aren’t doing very well into assisted living and within a week they’re almost a hundred percent better because they’re eating three meals a day. They’re getting their medications on time. They no longer have to worry about cleaning their house or mowing the yard or doing their own laundry. It’s so freeing. So there’s all kinds of great things that can happen.

So one of the big things to consider, Alan, is the financial considerations.

And certainly that is a huge area of concern for a lot of people thinking about long-term care. It is expensive. There are a lot of different ways that that gets paid for, depending on the state that you live in. If you don’t have funding, many of our assisted living locations in Minnesota take the Elderly Waiver program, which is through the state of Minnesota. South Dakota has similar programs. There are funds available to assist with that. Certainly, you know, you can look at different cost options of, you know, can we make it work, staying in our home, bringing home health in. That might be a more affordable decision. But really looking at all of your options.

And that’s another reason why it’s really important to visit multiple locations because some assisted living providers have what we like to call the chandelier effect.

You walk in and you see the big price tag and it’s all fancy and it’s, everything’s just high end and it looks amazing. And then maybe you walk into an assisted living that isn’t quite as fancy. Maybe it’s not as new, but the staff are really kind, the price tag isn’t quite as high. They have good ratings on their, maybe their Google reviews. So there’s just a lot of different things. So, I guess my point is more is not necessarily more (laugh). So higher expense does not necessarily equate higher level of care. There are a lot of things to really go into it. There really are. And the price tag can be frightening.

But when you think about no longer having to pay insurance on your house, no longer having to pay for the upkeep on your home. So when you pay the flat fee in assisted living, you’re paying for health care, you’re paying for all the meals, you’re paying for all the activities and outings, and you’re paying for also the bricks and mortar around you and the maintenance of the bricks and mortar and the lawn care. I mean, everything. It’s all included in that price. So yes, the price tag does seem high, but you have to remember how much it includes.

Alan Helgeson:

I want to go to this next thing because what you said earlier, Karis, you talk about so many folks wait until it’s too late where you’re forced into something. You got to do it right away. Right away. So if this is apparent, we wait till it’s too late, how do you start that conversation? Because I think so many people are afraid to start this because no one wants to talk about it. How do you start it with a parent?

Karis Gust:

So the best way to go about doing it then, Alan, is to really sit down with your loved one, and sort of have the discussion going in a way and get to a point where it feels like it maybe is their idea to move into an assisted living. You know, Mom, wouldn’t it be great to just be able to walk down the hall or take Dad down and play bingo. A lot of our assisted living locations are putting in pubs, sports bars. I mean, you name it, the spa. There’s a pool. There’s a movie theater. I mean, there’s all kinds of amenities and you don’t have to drive anywhere. It’s right there. Wouldn’t it be nice not to have to cook for yourself anymore?

I remember when my grandma moved into an assisted living. She thought she had moved into the Taj Mahal. I mean, she was like, I have had it made. She was so tired of cooking for one person. Her spouse had died years ago, my grandpa. And she’d been cooking by herself and living in her little tiny house for so long. And when she got into assisted living, they were preparing meals for her. She didn’t have to cook anymore. Her laundry was done for her. Everything was, she thought she had moved into a resort. She was thrilled and it was really a good thing for her at that point.

Unfortunately, we do have situations where people stay in their homes, and they aren’t taking their meds on time. They aren’t eating what they need to be eating. And that accelerates their decline into frailty. And having social isolation can lead to a hastening of the dementia process. So if we have early stage dementia, having more activity and more stimulation can really slow that process down.

Regular meals, regular eating, all of those things are so important to delaying the aging process. And that’s where assisted living can really, those vibrant communities and being part of a vibrant community can sometimes even reverse the aging process. And this is clinically shown when we talk about frailty and early-stage frailty can be reversed.

When we get to severe frailty, though, that cannot be reversed. And that’s when we get to a point where it’s no longer possible to reverse that. So recognizing those early stages of frailty, maybe we’re weaker than we used to be. You know, you get into assisted living, you have a regular exercise program you’re going to, and you don’t have to drive anywhere. It’s right there down the hall. You have physical therapy and occupational therapy right there who can come down and work with you in your apartment.

There’s all kinds of things that can help sustain you and even reverse that aging process. And so not waiting until the point where, honestly, Alan, we have a lot of cases where we assess somebody for assisted living. They need the nursing home. They bypass us completely.

Alan Helgeson:

You know, this rapid decline – this goes back to what you were saying about recognizing those signs, having that conversation earlier rather than when you’re forced to something in a difficult, quick, bad situation.

Karis Gust:

Correct. And so what I always tell people is, could we keep Dad or Mom safe here for now? Yeah. We could. Is it the best place for them? Not really. They’re isolated socially now. They can’t drive anymore, say, or they don’t feel comfortable driving anymore. Maybe they don’t feel comfortable. They’ve got some early dementia. They don’t feel comfortable being in a big crowd anymore. They don’t want to go out to big social gatherings like they used to. Maybe they need smaller group engagement.

And so they progressively become more and more socially isolated. And that leads to depression. It leads to self-neglect. It leads to all kinds of things. And, and especially if we have maybe somebody who’s caregiving, a spouse who has higher care needs, they feel very bound to the home and they can’t really leave or do the things that they used to enjoy.

And so then that contributes to their decline as well, to the point where they’re not able to safely care for Dad. And so it’s a fine balance, and every situation is completely different, but opening up those discussions and not being afraid to have those discussions and giving everyone around the table permission to just say it’s OK to not try and be a superhero and not try and do everything ourselves.

And maybe the best way to show love to Dad or Mom is to help them move into an assisted living where they can have all the support and care that they need. In our assisted livings, especially in Minnesota, we’ve got lots of blended assisted living. So we have couples who move in. Mom is completely independent, or Dad. So one person is receiving assisted living services, the other one is just living in the building as an independent resident. And they can come and go as they please knowing that Mom or Dad is safe in the building, that they’re having a meal, their beds are being passed, they’ve got eyes on the person and they can go and continue doing their activities in the community and that type of thing if they want to.

Alan Helgeson:

Oftentimes here we have adult children that are scattered across the U.S. And we know that with siblings, siblings never agree ever. Usually, you might have one or two that might be closer that are taking care of Mom or Dad, others are off maybe in other parts of the country and the burden may fall on that adult sibling that is here. Right? And when you’re having to have these discussions, it may not go well among these adult siblings.

When it comes time to have these conversations with Mom and Dad, how do you have that discussion among the siblings?

Karis Gust:

You know, Alan, that’s one of the hardest dynamics that we have to deal with, frankly. It really is.

Alan Helgeson:

Are there any tips for that? It is incredibly difficult. And maybe there aren’t.

Karis Gust:

(Laugh) I wish I had some. But what I can say is that it is very frustrating for the family, the children maybe who are close and who are seeing Mom on a daily basis. And so they have seen Mom’s decline. They understand what’s happening. They’re in the house, they smell the urine, they see the home in a state of disarray. They see the changes whereas, you know, the center daughter who’s living far away only talks to <om once a week on the phone and Mom’s lucid during that time or whatever, and they don’t see and they don’t smell. And so it’s difficult, if you haven’t been part of that, to accept, you know. I don’t want to call it denial necessarily, but not fully understanding or grasping the full extent of what’s going on.

And I don’t know how to fix that. Except to encourage that loved one to just come physically if they can, to come and be part of it. Maybe get on a Zoom call or a WebEx. Get on a FaceTime call and really have them show the home or try and get a better sense of the bigger picture. Because when we’re only remembering the way Mom was a year ago when we were here for a visit and now significant changes happened during that time, it’s almost impossible to fully grasp what that’s what’s actually going on. And recognizing that and affirming that that’s OK.

Alan Helgeson:

There are so many people that are going through that, right? So many folks, but there really isn’t a magic recipe for it.

Karis Gust:

There isn’t. And you know, I think some of those children who live far away probably feel guilty too, that they can’t be here more. And there’s so many reasons why they can’t. And so being kind to ourselves and understanding that it’s OK to maybe let go and be supportive. There’s no easy answers and every family dynamic is so different. Those are really tough. And I acknowledge that. And I think that those of us who are trying to help families through those discussions need to acknowledge and just affirm that that makes sense, that people feel that way. And it’s OK to try and be understanding of that.

Alan Helgeson:

Let’s switch topics now and change that whole topic to how do you have this conversation with a spouse on when it might be time to consider assisted living?

Karis Gust:

You know, I think being really honest and open with each other to the extent that you can, given that maybe one of you has dementia and just really opening up the discussion about if you’re still living in your own home and you’ve got steep stairs, you’ve got a yard that needs to be mowed and saying to your spouse, you know what, I don’t want to burden the kids with this.

We’re at a point where we really do need more help doing things. You know, I’m not as strong as I used to be, so trying to help you bathe. You know, I’ve got back issues or whatever it might be. Or it’s just getting harder to go out and get groceries. I don’t feel comfortable driving in the winter. Let’s start looking at a place where maybe we can get more help, where we don’t have to worry about mowing our yard anymore.

We don’t have to worry about cleaning our house anymore or doing our laundry or all the things that are just getting harder for me to do physically. Maybe I have a lot of arthritis in my hands and it’s really difficult for me even to wash dishes anymore. Let’s go and just visit. We don’t have to move in today. Like, let’s just go in and visit and see what services and offerings are out there and let’s look at prices and let’s talk.

It’s just opening up the discussion. You know, neither of us are getting any younger. I’ll speak for myself. When I get to that point, I don’t want to be a burden to my kids. My kids are like, oh, I’ll take care of you, Mom. And I’m like, I don’t want you to do that necessarily. And I know that there’s a lot of cultural dynamics and certainly this discussion gets very different when we have certain cultures where that’s very much the expected practice, and that’s OK too. And so for those situations, that’s maybe a separate discussion than this one, but really trying to bring then services as much as possible into the home as much as we can is probably the way to go.

Alan Helgeson:

And that goes back to the options that you offer too.

Karis Gust:

Yes, and we do have a lot of options. I guess just having an open discussion about, let’s really talk about where we’re at right now, and let’s not wait so long that we have to make a sudden move. Because it would be really nice for us to be able to have time to go through our stuff, to go through our belongings and maybe make sure that our grandkids get things that we really want them to have, that we involve our kids in maybe taking the things that are of value to them. And by the way, when you move into assisted living, you don’t have to get rid of all your stuff. You move in, you’re still going to be surrounded by the things that are important to you. You’ll still bring your family photos. You’ll have your favorite artwork on the wall. I mean, you’re still going to have all of your treasured items with you – probably less of them. But the things that are most important to you certainly can come with you to assisted living. But taking that time to downsize out of your home in a more proactive way than being forced to do it in a really quick way when something horrible happens is something that is best to avoid if possible.

Alan Helgeson:

When you’re having these conversations, talk about a few of those things that you should consider regardless of who you’re talking to, some of those things you want to make sure are part of it, like including empathy. What are some of those other things that are part of that?

Karis Gust:

Great question. So just really listening and opening it up into an open discussion and really talking about the challenges of, you know, Mom, you’re still living in the family home. You still have to clean and maintain the house and we’re, mowing the yard. We’re happy to continue doing those things, but I’m really concerned and using those, what I call “I messages,” using those concerns.

We’re really concerned that you’re not getting out to have coffee with the ladies like you used to. We’re concerned that you’re not able to go and play Mahjong like you used to and you loved Mahjong and it was your favorite, you looked forward to it. You had pinochle or you had whatever you had game night, used to do all these things with your friends and get out with the ladies and go shopping, do a shopping day. You don’t do those things anymore.

And you know, we understand that you’re really looking after Dad and that’s great. But we want to make it so that you can also still have some things for just you. So let us help you take care of you, is really a good way to put that.

And one way to do that is either bringing additional help into the house which is really the first place to start. Or saying, you know what, Mom, this house, it is not safe for you and Dad to be here anymore. The stairs, if you fell and broke a hip, what would happen to Dad? You could not take care of Dad because you would have to have surgery and then you’d be in a rehab facility to get physical therapy for your hip.

And what would happen with Dad? You’re taking care of him. We all work full-time. We need to make sure that we have resources in place in case something like that happens. So let’s talk about assisted living or let’s talk about what we kind of a plan we can have in place. Let’s go look at a few places just to see. Sort of really having those frank discussions because it’s always an unexpected thing when that happens. You know, Mom, you’re Dad’s sole caregiver. So let’s talk about what happens if something happens to you and let’s also talk about your quality of life.

So really opening up that dialogue and just expressing concern for Mom and your love for Mom or Dad, whoever’s the primary caregiver, and really encouraging them to just consider it. And let’s just visit. You don’t have to move today, but let’s talk about how much stress that would take off your life.

Alan Helgeson:

Karis, thank you for sharing such great information today. As people are considering caregiver burnout and when it might be time to consider assisted living, we talked about those resources and just a bunch of information and how to learn more about this. Can you share with us where to find out more?

Karis Gust:

So I would recommend first going to a place near and dear to my heart, which is good-sam.com. We have great resources on there, lots of knowledge articles, lots of good information that can help point you in that direction. There’s an 800 number (866-528-8240) on our website that will give you the connection center, and we have counselors and consultants on those lines that can help you discuss your care needs and where you’re at or where your loved one is at, and help you understand the different service offerings that we can offer to support you wherever you’re at in your journey.

Alan Helgeson:

Karis Gust, our guest today. Thank you so much for being here.

Karis Gust:

Thank you so much for having me.

Cassie Alvine (announcer):

This episode is part of the “Health and Wellness” series by Sanford Health. For additional podcast series by Sanford Health, listen on Apple, Spotify, and news.sanfordhealth.org.

Get more episodes in this series

An economist takes the pulse of today’s health care economy

Written by Courtney Collen

Alan Helgeson (announcer):

“Reimagining Rural Health,” a podcast series brought to you by Sanford Health. In this series, we explore the challenges facing health care systems across the country from improving access to equitable care, building a sustainable workforce, and discovering innovative ways to deliver high-quality, low-cost services in rural and underserved populations. Each episode examines how Sanford Health and other health systems are advancing care for the unique communities they serve.

In this episode, Courtney Collen with Sanford Health News talks with Ford Koles, a national spokesperson with the Advisory Board for a conversation on the state of today’s health care economy.

Courtney Collen (host):

I have Ford Koles joining me now. Thank you so much for your time. Welcome to Sioux Falls.

Ford Koles (guest):

Thanks, Courtney. Good to be here.

Courtney Collen:

You are a health economist by training. You’re well versed in health care history and the many reform initiatives we have been through over the past few decades. Ford, what do leaders need to know today to shape the future of health care beyond 2024?

Ford Koles:

Courtney, I think the most, I mean the most fundamental truth is that we built a health care system in the United States with the assumption of commercial reimbursement. Right? When I was in econ school and you wanted to understand how much commercial payers paid for a surgery, we would plug in 120% of Medicare, not on the medical side. On the surgical side, that number now according to Rand Corporation is 2.7 times higher. It was 20% higher. Now it’s 2.7 times higher, meaning commercial.

The cross-subsidy model is under immense strain to keep up with growing government payment. So more and more of our future is Medicare and Medicaid, and that’s a fundamental challenge to the cost structure we built in America. We have to change it.

Courtney Collen (host):

What do you see as the industry’s most urgent challenges and greatest opportunities?

Ford Koles:

Wow. So many amazing things going on in this industry. As always, I think that the need to remake costs per my last point – there are three things. We spend most of our money on labor, which was an unholy mess in COVID. And we’re just getting it back, you know, to a place of maybe not sustainability, but calm supplies and purchase services where we were making immense progress before COVID, by the way. You know, unifying the spend under different vendors, getting better, long-term relationships. All of that went out the window with COVID because of the collapse of the supply chain. And lastly, capital spending, which as you know, Courtney is it, and buildings, right? Yep. So we need a lot of progression.

There’s not much on the labor front right now. We’re reinventing the social contract, hopefully using artificial intelligence. So I think there are long-term savings there and good things, but most of the progress we’re making right now has to be in the supply chain.

Courtney Collen:

You talk about an increasingly tough business climate dominated by those increasing costs and prices tightening margins and other headwinds. Ford, how will these disruptive market forces affect decision making and outcomes for patients?

Ford Koles:

We went through a phase. If you look at the patients themselves, and the numbers are bad, the quality numbers held, Courtney – really strong for the first few years of COVID in a way that I think people don’t talk about enough. We held it together in an unbelievably ugly time for health care, and the quality numbers stayed pretty strong in the last year. They’ve really started to drop. And I think what you’re looking at is not some long-term crisis. I think it’s exhaustion, frankly.

It’s like somebody holds it together in a tough situation in their life for a few years, and then when things finally improve, they kind of fall apart. I think that’s sort of what’s happened. So I’m not as worried about it long-term for the health of America. You know, lifespan has stopped improving, but that’s largely, those are COVID deaths, you know? And that’s not the fault of the health care system, right? Americans tend to blame the health care system for things that are largely lifestyle-related issues.

Courtney Collen:

How do these challenges and opportunities play out for nonprofit health care systems in particular?

Ford Koles:

Yeah. I mean, the truth is it’s still, to me a wonderful model. It’s a mission-driven model. Yeah. We need a workforce. This workforce keeps telling us the people coming out of school that they want purpose, and they want motivation. What’s more purposeful and motivating than the mission of most, not-for-profit hospitals and health systems and providers, right? So I think we have some natural advantages there, right? Not-for-profits tend to be far better at physician integration. The for-profits generally don’t do much of that. That’s not their history. That’s not been their business model. That’s not a criticism. It’s just a difference between not-for-profits and for-profits.

But I think so much of what happens in health care is local and has to do with our relationship with the medical staff. I like Sanford as a regional player. I like what they do. They have rural challenges, you know, that are far more aggressive than a lot of the urban systems I work with. But I like the relationship they have with the medical staff.

Courtney Collen:

You spoke here in Sioux Falls, South Dakota, to a number of Sanford’s top leaders. What was your one key takeaway or golden nugget as I like to say, that we can take home?

Ford Koles:

Relatively speaking, American health care is in better shape, way better shape than a year or two ago. Sanford’s in much better shape than most so I guess I’d want them to take the win in that sense. You know, Sanford’s numbers are better than most numbers.

The biggest issues that I hear about at Sanford are largely workforce issues that have to do, not with Sanford, but with South Dakota. They have to do with, you know, population growth or lack of it. They have to do with the cost of living increases that have been huge between Sioux Falls and Omaha. So I think that there are challenges here, but they’re not the challenges I think of a poorly run health care system. Let me put it that way. I like the leaders here impressed me.

Courtney Collen:

Good to hear. What excites you the most about the future of health care?

Ford Koles:

I said it in my talk, which is we are on the cusp of some major advances, both in treating obesity and in treating Alzheimer’s. Both of those things are present in my family. And I would typify them as the two great health care challenges of our lifetimes. And the fact that we’re making significant progress in both of them, to me is miraculous and wonderful and they come with all kinds of reimbursement and spending challenges, but I refuse to look them in the face as something bad. I think we’re seeing amazing progress here.

Courtney Collen:

Ford Koles, I really appreciate your time. Your insight is so valuable, and we thank you for being here and for joining us for this podcast.

Ford Koles:

My pleasure, Courtney. Thank you.

Alan Helgeson:

You’ve been listening to “Reimagining Rural Health,” a podcast series brought to you by Sanford Health. Hear more episodes in this series or other Sanford Health series on Apple, Spotify, and news.sanfordhealth.org.

Get more episodes in this series

Doctors are feeling more valued, less burned out after COVID

Alan Helgeson (announcer):

“Reimagining Rural Health,” a podcast series brought to you by Sanford Health. In this series, we explore the challenges facing health care systems across the country from improving access to equitable care, building a sustainable workforce, and discovering innovative ways to deliver high-quality, low-cost services in rural and underserved populations. Each episode examines how Sanford Health and other health systems are advancing care for the unique communities they serve.

In this episode, Courtney Collen with Sanford Health News talks with Dr. Kevin Hopkins, senior physician advisor with the American Medical Association, and Sanford Health OB/GYN and leader in clinician well-being Dr. Heather Spies on the topic of well-being and resilience.

Courtney Collen (host):

I have Dr. Kevin Hopkins and Dr. Heather Spies joining me now. Thank you both for your time. Welcome.

Dr. Kevin Hopkins (guest):

Sure. Thanks for having us.

Courtney Collen:

What are the top three opportunities that you see when it comes to caring for our caregivers and building a resilient workforce and organization?

Dr. Kevin Hopkins:

I’m going to give you the answer from two different perspectives. I’m going to talk about the short term or short run. And then a little bit about the long run.

So I think from a short-term perspective, there are things that we can choose to do from an operation standpoint that would be impactful pretty quickly. One of those is probably engaging health system leaders in making the business case for caregiver well-being and making sure that our health system leaders understand the value proposition there. The second thing is reducing unnecessary or low-value work that doesn’t really bring value to the care we deliver to our patients or even to our health system. And then the third thing is delegating the valuable work that needs to happen across the capable team. So those are three things that we can choose to do that would have a significant impact right up front.

Thinking about the long game, longer-term things we need to look at, and we know this from research data, survey data: number one is addressing EHR (electronic health record) efficiency just to make it more efficient for users to use and a really valuable tool for patient care delivery. The second thing is addressing staffing, adequacy of staffing, the workforce shortage, obviously, that most health systems are experiencing. And the third is autonomy. Doctors want to be doctors and they want to be respected, and they want to have some degree of autonomy and freedom in things like their schedules and those sorts of things that we haven’t always been able to afford as much as we’d like.

Courtney Collen:

Thank you. Dr. Hopkins.

Dr. Spies, where have we made progress and where does work remain? How will this shape strategy and policy moving forward, would you say?

Dr. Heather Spies (guest):

Yeah. Thank you. I love everything that Dr. Hopkins said because we’ve really partnered with physicians like him who are leading the way in this work in the AMA and other health care organizations across the country, because, like he spoke of, we really need to prioritize the operational things that are affecting our clinicians and the ability they have to care for patients well.

And so the things that we have done is, number one, collaborate. You know, so collaborating with the people that we need to, to move the work forward. So for instance, how do we decrease those administrative burdens? How do we decrease the extra clicks in the EHR? And so not only are we collaborating externally with what our best practices and what ways can we make adjustments, but also internally, you know, from our clinician experience standpoint and our department, we are consistently meeting with Dr. (Roxana) Lupu and our MDIs (medical directors of informatics) to say, what progress have we made? And reducing these burdens, and what do we need to keep pushing for?

We also want to communicate consistently, right? So asking for feedback from our clinicians, what EHR burdens that we have reduced have really been helpful, and which ones are new that are now bothering you, or that haven’t been fixed yet that are building more than we realized. So really that collaborating and the communication piece, I think we’ve made big strides on and we’re making, and we’re seeing some improvement.

But then I think we also have to be sure that we’re communicating back and making people realize the things we have changed. Because sometimes we just have our head to the ground and we’re taking care of our patients, and we think, oh, yeah, I haven’t noticed that BPA alert as much as I did. So I think it’s just, we’re just so busy. We’re so overburdened sometimes that just continuing to cheer each other on and push each other forward with the work. And we’re making great strides, but we’re never going to be happy because we want to keep making sure that we’re taking care of each other and doing the best we can in this.

Courtney Collen:

Can you talk about the national landscape and the AMA’s efforts to support physician well-being?

Dr. Kevin Hopkins:

Sure. Yeah. I’d be glad to. I’ll share just a little bit of what I’m going to share this afternoon in our breakout session, the 2023 AMA organizational biopsy national report that gives sort of a high-level summary of the state of burnout and job stress in physicians across the U.S.

So currently, our report shows that the national burnout rate among physicians is at 48%. It’s significantly improved from a high of 63% back in Q3 of 2021. So all in all, that’s encouraging, but we also have to keep in perspective, it’s still about 30% higher than burnout levels in the normal population that aren’t physicians. So I think we’ve got to take those gains and trends. Within context from 2021 to 2023, overall job stress and burnout levels have declined, and overall job satisfaction has increased steadily. Those two things seem to be inversely proportionate. So as job satisfaction goes up, job stress, at least perceived job stress and symptoms of burnout go down.

The second trend that we’re seeing is a steady increase over the last two years in physicians feeling valued by the organization that they work for. Another inversely proportionate relationship is feeling valued and intent to leave. So as people feel more valued, they’re less likely to leave their current organization within the next two years. And so intent to leave has gone down as feeling valued goes up.

So that’s some of the trends that are happening on a national landscape perspective around burnout and well-being. We still have a lot of work to do. The AMA is, this is our mission. And so certainly there’s a lot that goes on around advocacy for policy change and redevelopment.

But there’s so much content that’s put out by our team in professional satisfaction and practice sustainability from our Steps Forward content, which are tools and modules to help people change the way they deliver care in a more patient-friendly and caregiver-friendly way. Debunking regulatory myths, things that people think are regulatory requirements that really aren’t. Research around EHR use metrics and how we can improve the efficiency of our EHR systems.

And then convening, bringing people together, national and local and regional conferences about how we can deliver care better and take better care of our physicians and other caregivers and health systems. So those are some of the things that the AMA is doing to help encourage the course that we’re on.

Courtney Collen:

Thank you so much for your insight there. Dr. Spies, we’ll wrap up with you here. What excites you the most about the future of well-being and resilience for the health care workforce? And feel free to chime in as well, Dr. Hopkins.

Dr. Heather Spies:

Oh, there’s so many things. I think that you know, over the five years or so that I’ve been really deeply involved in some of this work with clinician well-being is just to see the momentum that we’ve gained when you’re both locally in our regions, in our markets, when you’re at a national conference, to see that it’s actually being lifted to the top of priorities is so great. You know, a few years ago there were small little pockets of people maybe that were trying to push this work, and how can we make sure that the top executive level leaders understand the importance of it? And now, even today, in the beginning of a lot of our meetings, we are talking about it on a daily basis. And so people understand the importance of it.

And now that the momentum is really going, we’re going to start to see huge strides in it. We’re going to start to see changes and unique ideas that we can do to make our clinicians’ lives better. I really am hopeful that over the next few years, we’re going to see people really finding their joy in medicine again, so much more in how they can care for their patients and not feel burnt out day in, day out. And we’re going to just keep making strides. So I’m really excited.

Dr. Kevin Hopkins:

Yeah. I agree. Heather, what we’ve heard from your Sanford leaders, they’re saying the right things. You know, not only is there an awareness of this as a priority, there’s also engagement around it and really making it an organizational and system priority. We know that if we take better care of our people, our people will take better care of patients, we’ll take better care of the organization. And the CEO at my organization talks about treating each other and our patients as family and the organization as our home. But I think if we really do that and do that with consistency, we can’t go wrong.

Courtney Collen:

Dr. Hopkins, Dr. Spies, thank you so much for your time and for all that you do.

Dr. Heather Spies:

Thank you so much.

Dr. Kevin Hopkins:

Thanks.

Alan Helgeson:

You’ve been listening to “Reimagining Rural Health,” a podcast series brought to you by Sanford Health. Hear more episodes in this series or other Sanford Health series on Apple, Spotify, and news.sanfordhealth.org.

Get more episodes in this series

Midwives are part of pregnancy care spectrum

Amanda Sauer:

I did speak a lot about how we do low intervention, low risk. If you want all the things, we do all the things too. So, if you go into pregnancy care and you want to be induced as soon as possible, you want all the medications, you want the epidural, you want all the things – as midwife, we’re there for you to support what you want.

Courtney Collen (Host):

Hello and welcome to “Her Kind of Healthy,” a podcast series brought to you by Sanford Health. I’m your host, Courtney Collen, with Sanford Health News. We are starting new conversations about age-old topics from pregnancy to postpartum, managing stress, healthy living and more. “Her Kind of Healthy” is here to bring you the honest conversations about self-care, happiness, and your overall wellbeing with our Sanford Health experts.

In this episode, we are learning about midwifery and the practice of caring for women in pregnancy, newborns, and also families. If you are a patient exploring provider options and maybe you’re wondering if a midwife would be a good fit, you have come to the right place. Here at Sanford Health, we are so fortunate to have so many wonderful midwives across the region, and Amanda Sauer is one of them in North Dakota. She is a certified nurse-midwife at the Southpointe Clinic in Fargo, and she is here for this conversation. I’m so happy to have her.

Amanda, welcome.

Amanda Sauer:

Thank you.

Courtney Collen (Host):

To start, I’d love to hear about your journey to becoming a midwife, specifically your education and your training, but also what inspired you to pursue this field of health care?

Amanda Sauer:

Initially, I was first a nurse. When I was working as a nurse, I was working at a small hospital, a critical access hospital, that included labor and delivery. Labor and delivery was the area that I loved the most. And we had a certified nurse-midwife that was working there. And I loved being a part of her deliveries. I loved everything about them. As I watched her deliveries, I kind of grew in my desire to want to be able to do more for women. That kind of led me to my path of becoming a nurse-midwife. I took my education further. I went to graduate school, got my master’s and specialized in nurse-midwifery.

Courtney Collen (Host):

What is the difference between an OB/GYN and a midwife?

Amanda Sauer:

So an OB/GYN is a doctor. They went through medical school. They went through that residency. They specialized in OB/GYN. They specialize more in like the high-risk OBs, high-risk pregnancies. They also do surgery, so they can do C-sections, they can do operative deliveries.

As a midwife, we focus more on the fact that pregnancy and labor is a normal thing. We focus more on the low risk, the low intervention pregnancies and labors. Like I said, we view labor and pregnancy as a normal thing. And we’re trained to recognize when things deviate from that normal. And when those deviations happen, that’s when we intervene.

Courtney Collen (Host):

Correct me if I’m wrong, but there are different types of midwives, is that right? And you are a certified nurse-midwife. Can we just talk through briefly the different types of midwives and what makes them all unique?

Amanda Sauer:

Yeah, so there’s three main types of midwives. There’s the certified nurse-midwives (CNM), the certified midwives (CM), and certified practical midwives (CPM). CNMs and CMs are kind of similar in our training. The CNMs are unique as we were nurses first. But both CNMs and CMs go to graduate school. We either have our masters or our doctorates and then we go on and complete a national certifying exam. And we are nationally certified.

CPMs are a little different. They don’t have that formal education. They’re more trained through apprenticeship. So they go with another midwife that’s been a midwife for about three years. They do more out-of-hospital births and home births. They don’t have that formal training and they don’t take that formal certifying exam that the CNMs did and CMs did. But they are certified in their own way. CPMs can only do home births where nurse-midwives and certified midwives can do home births if we want to, but we also do hospital births and birth centers if we want to.

Courtney Collen (Host):

Let’s talk through the prenatal, labor, delivery and postnatal care that you provide as a midwife at Sanford Health.

Amanda Sauer:

So I do all of it. We can do preconception care. We can do the normal routine prenatal care. We manage our own patients in labor and delivery, and then we also do the postpartum care, as well.

Our visits tend to last longer than an OB’s visits would. We like to spend more time with our patients. We like to spend more time doing education, getting to know our patients, doing like anticipatory guidance, letting them know what to expect with what’s coming up in their pregnancy. Kind of preparing them for when they’re in labor and then helping support them through labor and birth as well. At least for the certified nurse-midwives, we were nurses first, so we like to have that patient interaction. We like to do that bedside care. So we like to provide that labor support while they’re in labor and then be there for the end, too.

Courtney Collen (Host):

So you’re really there for the whole process almost, which is really, really cool. What do you, Amanda, love most about providing this type of care at Sanford?

Amanda Sauer:

The part of it that I love the most is the labor support. Here in Fargo we manage the triage and we do the postpartum care, but if I’m not busy in other areas of the hospital, then I really try to be at the bedside with my patients. I like to support them through that labor process and be as present as I can. Studies have shown that having the midwife be there and be present throughout the labor process can decrease the chance of needing interventions.

Courtney Collen (Host):

Yeah, I’m sure they appreciate that too, having you there bedside. If I’m shopping around for a provider and maybe looking to grow my family, how would I know that a midwife is the right care provider for me?

Amanda Sauer:

I think the best way to know if a midwife would be the right care provider for you would be to make an appointment with a midwife. We do a lot of pregnancy care, prenatal care, but we do care outside of pregnancy as well. We do wellness visits, we do preconception visits, we do contraception counseling and things like that, too. So if you’re ever wondering if a midwife would be a good fit for you just make an appointment with us. It could be a preconception counseling, it could be anything, a wellness visit, whatever you need.

Courtney Collen (Host):

Sure, thank you. How do midwives collaborate with physicians who specialize in obstetrics or OBs? Is there a collaboration for care at Sanford?

Amanda Sauer:

There is. Here we collaborate a lot with the maternal-fetal medicine doctors. But we collaborate with the OBs as well. So like I said before, midwives focus on the low-risk pregnancies. But things happen in pregnancy there. Things can change. Your pregnancy can turn into a high-risk pregnancy. And there are certain conditions that we can’t manage on our own and we would have to collaborate with an OB or maternal-fetal medicine.

And an example would be gestational diabetes. If the pregnancy outside of the gestational diabetes is a healthy pregnancy and the baby’s growing appropriately, it’s completely appropriate for the midwife to continue to do the routine prenatal care. And then having either maternal-fetal medicine or the OBs manage the part that makes the pregnancy a little more high-risk, like the gestational diabetes portion. So they would monitor that aspect of the pregnancy while the midwife manages the rest of it.

Courtney Collen (Host):

One of my first podcasts at Sanford was with Megan Bergers, who is a certified nurse-midwife down here in Sioux Falls. And we talked all about low-intervention birth options at Sanford. And I didn’t know anything about low intervention birth. And that’s one thing that really makes the birthing process unique is being able to kind of choose your own, I don’t know, lack of better words, settings, you know. Can you kind of speak to that and elaborate more on that low-intervention option that I know midwives are really proud to offer at Sanford Health?

Amanda Sauer:

As a midwife, we’re trained to view pregnancy and labor as a normal and natural thing. Going into your own natural labor, it’s a normal process. And we are trained to support that natural physiologic process. If you go into your own spontaneous labor and things are progressing normally there’s no reason for us to intervene. Not everyone needs their water broken. Not everyone needs Pitocin.

Sometimes once you get to the hospital, everyone kind of gets all anxious and thinks that things need to be put on the clock and things need to progress in a timely manner. As long as that labor’s occurring spontaneously and things are progressing, there’s no reason for us to intervene as long as both mom and baby are healthy.

Courtney Collen (Host):

I love the perspective that, you know, birth is a normal and natural thing. I just went through it nine months ago. So I love seeing what our bodies are capable of doing. And then having the care support kind of around you, whether it be midwives or obstetrics or nurses in the room for that support. Amanda, just like shopping around for any health care provider, for example, in pregnancy – what are some questions that we should be asking before we choose a midwife?

Amanda Sauer:

I think before going into your first prenatal appointment, I think it’s important to think about what’s important for you out of your pregnancy care. If you have strong desires or things that are very important to you, I think it’s important to bring up to whoever you’re wanting to see just to make sure that your desires would match up with that specific provider. If you’re going down the midwife route, I think it’s important to have a conversation about “What would happen if my pregnancy does turn high risk? If I have to transfer over to one of the OBs, what would that look like? Would I still get that support from the midwife or would I have to cut ties completely? What would my prenatal care look like?”

Courtney Collen (Host):

Yeah, there’s so much to think about, but I do love that there are so many options at Sanford. Do you feel that way too as a provider, assisting your patients or supporting your patients in that way?

Amanda Sauer:

Yeah, there’s someone here for everybody. I know here in Fargo we have a lot of different OB/GYNs. We’ve got a lot of different midwives. The midwives here, we all kind of share patients. So usually they see each of us at least once throughout their pregnancy. But then on the OB/GYN side, there’s a bunch of them. So even if you start your prenatal care with one provider, and if you feel like you’re not meshing well, you can always switch and meet with another provider too and see if you mesh a little bit better with that other provider.

Courtney Collen (Host):

Sure, thank you.

Amanda Sauer:

If you’re questioning midwifery care or you are unsure about anything, make that appointment with us. I did speak a lot about how we do low intervention, low risk. If you want all the things, we do all the things too. So, if you go into pregnancy care and like you want to be induced as soon as possible, you want all the medications, you want the epidural, you want all the things. As midwife, we’re there for you to support what you want.

So, if you want all the things, as long as it’s safe and reasonable and evidence-based, we’ll allow that as well. So just because we’re midwives and we’re low intervention doesn’t mean that we can’t do all the things if that’s what you want of your pregnancy care.

Courtney Collen (Host):

Amanda, thank you so much.

Amanda Sauer:

Thank you.

Courtney Collen (Host):

To learn more about certified nurse-midwives providing care near you or to book an appointment, visit sanfordhealth.org. This was the “Her Kind of Healthy” podcast by Sanford Health. I’m Courtney Collen. Thanks for being here.

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Stadium announcer loses speech, recovers from stroke

Written by Alan Helgeson

Randy Preston (guest):

On our refrigerator was a little decal, little magnet saying, “BE FAST. The signs of a stroke.” And she in her brain immediately go, well, he’s disoriented. He’s not speaking properly. He can’t feel his left side. These are all signs of a stroke. Randy, you’re having a stroke. Stay where you are. Turn the car off. We’ll come and get you. We’ll find you.

Courtney Collen (announcer):

This is the “Health and Wellness” podcast brought to you by Sanford Health. Welcome.

The conversation today is all about stroke awareness. Our guests are Dr. Abd Elazim, a neurologist with Sanford Brain and Spine Center in Sioux Falls, South Dakota. And joining Dr. Elazim is Randy Preston, a Sanford Health patient here to share his story. Our host is Alan Helgeson with Sanford Health News.

Alan Helgeson (host):

Randy, why don’t you go ahead and say a few things that people might recognize behind the microphone if they were to go to a hockey game here in the Sioux Empire.

Randy Preston:

Ladies and gentlemen, welcome to the ice, your Sioux Falls Stampede!

Alan Helgeson:

And maybe see a baseball game during the summer? They might hear something a little bit different.

Randy Preston:

Ladies and gentlemen, welcome to the Birdcage, home of your Sioux Falls Canaries!

Alan Helgeson:

Now, recently another venue opened up here in Sioux Falls where people could go see collegiate hockey for Augustana.

Randy Preston:

Ladies and gentlemen, welcome to Midco Arena, home of your Augustana Vikings!

Alan Helgeson:

So Randy Preston is not really a stranger to the microphone, so I’m glad you’re here today, but we’re going to talk about something that isn’t something you normally talk about behind that microphone.

Not long ago you came to Sanford Health for a different reason. So let’s go ahead and talk about the day of the stroke and tell us your story of what happened, Randy.

Randy Preston:

Certainly. My wife and I were getting ready to go out on the road. We had some appointments in Fairmont, Minnesota. The entire family was getting ready to leave. So that morning I grabbed the car, filled it with gas, went to the car wash, vacuumed out the car because it was just dirty.

And all of a sudden I started feeling very, very odd. I couldn’t use my left hand, reached up to grab the door handle and it just wouldn’t grab the door handle. Well, this is weird. Well, maybe I, maybe my arm fell asleep while I was vacuuming. Something’s just not quite right. I get in the car, manipulate the car door shut, couldn’t find the seatbelt, tried calling my wife at that point and she didn’t answer the phone. Well, I better get home.

So I backed out of the slot at the car wash, started driving home and on the way home I got lost. And that’s obviously not normal because I drive all the time. Made a left hand turn into a curb instead of turning right onto a street. And at that point I thought, well, OK, this is definitely not normal. I better pull over and try to get ahold of my wife again and find out what’s going on.

Alan Helgeson:

So how much time had passed by this time here, Randy?

Randy Preston:

Less than 10 minutes. This time it was probably five or six minutes and I pulled into a parking lot behind the 18th Amendment in Sioux Falls. It was familiar to me back in the day when I used to drive Lyft and Uber. And that was a good place to stop and get rides. Called my wife and started mumbling through words, telling her, I have no idea where I am. I know where I am, but I can’t, the words won’t come out. And thank goodness for a Life 360 app that we have a locator app. They found me and got me to the – my wife and son both came – my son Trevor grabbed me out of the car, out of the driver’s seat of the car, threw me in the back seat. He got in and basically drove me to the emergency room at Sanford.

I was there within 25 minutes of onset. And at that point I was mumbling through my words. You know, the typical what you hear, the typical stroke thing. I wasn’t able to really communicate very well. Couldn’t feel my left side at all. My left arm, my left leg, none of that was working. My face was drooping. As I go back and look at the dash cam video that I have in my car you can definitely see signs of a stroke, but I didn’t really know what was going on. My wife, when I called her, immediately knew what was happening. And I give all the credit to her for getting me to the hospital as quickly as they did.

Alan Helgeson:

Amazing that they had the quick speed. There were so many things that just aligned to happen right at that time. So how did they know what to do at that time?

Randy Preston:

Well, my wife has been a caretaker for her parents for a number of years. And her dad had a stroke about, oh, I suppose it’s been five or six years ago. And at that point she became involved in a bunch of advocacy groups and some other support groups.

And on our refrigerator was a little decal, little magnet saying, “BE FAST. The signs of a stroke.” And she in her brain immediately go, well, he’s disoriented. He’s not speaking properly. He can’t feel his left side. These are all signs of a stroke. Randy, you’re having a stroke. Stay where you are. Turn the car off. We’ll come and get you. We’ll find you.

And that was ultimately how this, how it all happened.

Alan Helgeson:

Thank goodness that recognizing those signs and symptoms, really one of those big things in the awareness of somebody possibly having a stroke.

I want to turn now to Dr. Abd Elazim, and he was one of the physicians that at the time was part of your care team. And doctor, can we talk about when Randy came to Sanford? Can we talk a little bit about that time and when you may have entered into his care team? Let’s talk about what went on that day.

Dr. Ahmed Abd Elazim:

Certainly. So Randy came to us as a level one stroke alert, and what we mean by level one stroke alert that someone who comes into the hospital, the stroke symptoms or signs very early on in the window for an intervention. And what I mean by intervention is being a candidate for a clot busting medication and an intervention to do a thrombectomy or pulling out a blood clot from the brain.

So he came to us with stroke symptoms and signs in the form of left sided weakness with the left-sided facial droop, left sided upper and lower extremity weakness. And since we lost on the left side, certainly that was very concerning for a stroke.

Alan Helgeson:

So when he came in seeing those signs, now they brought him into the emergency department at Sanford. Is that normally what a person would do if they see something like that?

Dr. Ahmed Abd Elazim:

Correct. So going to the emergency department is the first thing. Anyone with a stroke symptoms and signs should do, calling 911 immediately or going to the ER immediately. Every minute counts.

Alan Helgeson:

I’ve heard a statement, “time is brain.” Can you explain that?

Dr. Ahmed Abd Elazim:

Absolutely. So time is brain in the sense of the sooner an intervention can be done for a stroke patient, the better the outcome is. If you can imagine every minute in a stroke about 1.9 million neurons or brain cells die if we do not do an intervention. So really time is very critical here to improve the outcome by doing an intervention to dissolve the blood clot.

Alan Helgeson:

By that time, his wife and his son getting him here so soon and the ER team knowing that, that’s what really helped him and the positive outcome that he had. Right?

Dr. Ahmed Abd Elazim:

Absolutely.

Alan Helgeson:

So at what point do you come in and do they say, doctor, we want to bring in your expertise as part of the ER care team for a stroke? How does that happen?

Dr. Ahmed Abd Elazim:

So once a stroke patient comes to the ER, a stroke code gets activated and stroke team responds immediately to the ER for an evaluation. The first thing we do is we take quick history, know the exact last known, well, perform a detailed stroke examination and review the brain scans. And based on these results, we’ll take a decision about what to do next.

Alan Helgeson:

Doctor, let’s talk a little bit about you and your team and your expertise and why you are brought in as part of the care team for treating strokes.

Dr. Ahmed Abd Elazim:

We are a stroke team by training. So we are specialized in treating stroke patients. So we do have the capabilities of evaluating the stroke patients and make decisions about giving clot busting medication and doing an intervention to remove a blood clot from the brain and reversing the stroke symptoms on time.

Alan Helgeson:

Let’s talk about those signs and symptoms because we know there are people out there that are maybe not knowing what to look for. So can you share those with us?

Dr. Ahmed Abd Elazim:

Absolutely. So like Mr. Randy said BE FAST. Every letter is specific for certain stroke symptoms or sign. If any of these symptoms or signs happens, we always say, please call 911 or go to the ER immediately.

So B stands for any balance problems that is of a sudden onset.

E for eye, any visual problems like losing one side of the visual field or seeing double or losing vision in one eye.

F for face if there is any facial drooping.

A for arm or leg weakness or numbness.

S for speech, if there is hard time finding words, unable to speak, frustrated because you can’t just find the word that you want to say or if your speech doesn’t make sense, you cannot understand people and people cannot understand you. Or if there is a slurred speech.

T stands for time is brain. If any of these symptoms or signs happen, call 911 or go to the ER immediately. Because we always say time is brain. The sooner you come to the hospital, the more we can offer to reverse the stroke symptoms.

Alan Helgeson:

Now I want to be clear on this too. It’s not that a person has to have all of these symptoms.

Dr. Ahmed Abd Elazim:

Correct. Any of these symptoms.

Alan Helgeson:

Let’s move on to risk factors. We hear with a lot of medical conditions that sometimes things can be more likely to happen if we have certain risk factors. Can you go into some of those?

Dr. Ahmed Abd Elazim:

Certainly. High blood pressure, diabetes, high cholesterol level, smoking, age, also a heart problem called atrial fibrillation. All these are known stroke risk factors.

Alan Helgeson:

Is there anything regarding heredity, history, family history that can bring up some stroke risk factors at all?

Dr. Ahmed Abd Elazim:

So family history of the risk factor we just talked about might be an alarming sign. For example, family history of stroke, previous stroke, family history of high blood pressure, family history of diabetes, all these medical problems that run in family could be an alarming sign for those who have these symptoms or signs.

Alan Helgeson:

Now I wanted to ask you too, now that Randy’s had a stroke and for other people that may have had a stroke, is there more heightened risk of a follow-up stroke or are things just going back to normal if he’s taking care of normal preventive care now?

Dr. Ahmed Abd Elazim:

Whenever we see a stroke, there are really two questions that we try to answer. The first question is, why did that stroke happen? And by understanding this question, we can answer the second question, how can we prevent another stroke from happening in the future? And this is really when the stroke expertise come to play.

So for Mr. Randy, we worked hard to figure out why did the stroke happen in order to place him on the right treatment to prevent another stroke from happening in the future. And by understanding why the stroke happened, we certainly can prevent future strokes from happening again by putting the patient on the right treatment.

Alan Helgeson:

Well, we’re so glad that Randy had such a positive outcome here and that he’s sitting here today and telling his story because I’ve known Randy for a long time. And I know Randy, you’re going to be (laugh) telling everybody, go out and be aware and know these signs and symptoms, right?

Randy Preston:

That’s correct. Be aware, know the signs and symptoms. BE FAST (laugh) and honestly, don’t be scared of asking the questions. You know, don’t be scared of running yourself into the into the ER If you have any symptoms at all. It’s much better to be safe than sorry. I don’t want to say I’m a living proof of that, but you know, my father had a stroke several years ago before he passed away and he was never the same after he – and he didn’t get it treated properly. It took him two and a half hours to get to the ER. So it was a whole different, a whole different outcome.

Alan Helgeson:

Randy was very fortunate living in Sioux Falls, 25 minutes getting to the ER. But for listeners that may live in some of the more rural remote parts, if that happens, what can we share with them and how is Sanford connected to care for those patients in that same way?

Dr. Ahmed Abd Elazim:

So same thing applies, call 911 or go to your local ER immediately. We have the capability of connecting to remote ER and other remote facilities and do what we call a telestroke. So if there is a stroke case in these remote areas, they can connect to the camera, have me on board, look at the patient immediately on the camera, and make decisions also to treat the stroke case.

Alan Helgeson:

That’s fantastic, fantastic. Connected care regardless of where you are.

Dr. Ahmed Abd Elazim:

Exactly.

Alan Helgeson:

So good to know that. And that’s really comforting for people regardless of where you live —

Dr. Ahmed Abd Elazim:

Absolutely.

Alan Helgeson:

— to have that kind of care. What’s that one takeaway you’d like people to take away from this today about stroke?

Dr. Ahmed Abd Elazim:

Time is brain. If you have any stroke symptoms or sign, please remember the BE FAST acronym and go to the ER or call 911 immediately.

Alan Helgeson:

Randy, how about you?

Randy Preston:

I’ll put it in my own personal perspective because I’m the kind of guy that will just suck it up and not bother other people. Don’t worry about it. If you see any signs, get yourself to the ER immediately. Don’t suck it up.

Alan Helgeson:

I want to thank you both for being part of this podcast. Randy Preston, thank you for sharing your story with us today. Dr. Abd Elazim, a neurologist with Sanford Health, we appreciate you taking your time today.

Courtney Collen:

This episode is part of the “Health and Wellness” series by Sanford Health. For more from Sanford Health, find us on Apple, Spotify and news.sanfordhealth.org.

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Patient trust depends on clear information, shared values

Alan Helgeson (announcer):

“Reimagining Rural Health,” a podcast series brought to you by Sanford Health. In this series, we explore the challenges facing health care systems across the country from improving access to equitable care, building a sustainable workforce, and discovering innovative ways to deliver high-quality, low-cost services in rural and underserved populations. Each episode examines how Sanford Health and other health systems are advancing care for the unique communities they serve.

In this episode, Courtney Collen with Sanford Health News talks with Lynn Hanessian, chief health strategist for global communications company Edelman, on the topic of health care trends and the trust barometer.

Courtney Collen (host):

Lynn Hanessian, thank you so much for your time and joining us for this episode.

Lynn Hanessian (guest):

Courtney, delighted to be here. Thank you.

Courtney Collen:

I’ll start with this. What are the top three opportunities you see when it comes to building trust in the business of health care?

Lynn Hanessian:

You know, it’s a great question, and one of the things that we value so much from the trust barometer is it gives us the data and the understanding of our audiences, and then we can make recommendations on how to build trust. And what we see time and time again is that trust comes from not only clear information, but information and dialogue and a shared sense of values.

And so, you know, it is incredibly heartening to see that information can make a profound difference in how well people take care of themselves, but also how empowered they feel to take care of themselves and also their level of trust in the health system where they get their care.

Courtney Collen:

And speaking of trust, Lynn, where have we made progress when it comes to patient trust of health care providers? And where does work remain? How will this shape strategy and policy moving forward?

Lynn Hanessian:

It may be a glass half full solution, Courtney. What worries me is that our trust in so many aspects of the society around us is down, but our trust in our primary care provider has surged this year. It’s both a trust and confidence that I’m in charge of my health, but also together with a primary care provider. And so it’s really balancing those dynamics that are really, really fundamental to getting people engaged, not only empowered, but trusting in their health system. And that makes a big difference.

I worry a lot about health information, but we actually saw some, dare I say, regret in people recognizing that they may have made decisions about their health based on product ads, based on user-generated content, based on friends and family that they regret. So maybe they’re beginning to realize that their ability to access credentialed information through their health care provider should have a higher priority this year.

Courtney Collen:

You talk about the trust barometer revealing a new paradox, Lynn. Rapid innovation offers the promise of a new era of prosperity, but also risks, exacerbating trust issues leading to polarization. How do companies navigate this rocky territory, and how can we use innovation to help build rather than erode trust?

Lynn Hanessian:

So, don’t take for granted the importance of bringing all of your stakeholders along on the innovation journey. It is, of course, incredibly important that we don’t roll out anything that’s not a proven technology, but people are hearing about the impact of AI in so many different aspects of their lives, and they’re worried. So having that dialogue, how helping people to understand what innovation means for Sanford and how you are bringing it to the care that they, that you provide? And also, you know, how do we involve your workforce, your colleagues, in understanding that as well?

There is very clear evidence from what we’ve seen that people expect to be informed. They want to have a dialogue around it, and they also want to understand what the impact is for them. It’s this very generic “AI’s going to take over the world” when in fact, AI may help me manage the care of my family better. So it’s really about bringing everyone along in the journey so that their expectations are informed, and potentially giving them an opportunity to engage in a new way that makes life better for them.

Courtney Collen:

Bringing everyone along, that’s a key takeaway right there. What about the unique role that nonprofit health care systems play in their communities and opportunities to strengthen trust?

Lynn Hanessian:

Yeah, so one thing that’s really, really notable. People want to work someplace where their workforce and their colleagues look like the community that they serve. I would say that nonprofit organizations like Sanford are in and of the community that you serve. And so there’s an important opportunity as you build relationships and trust with your own employees for that to radiate outward into the community. You know, it’s a little, a little bit sort of live and practice what you preach.

Courtney Collen:

What excites you the most about what you call the ultimate challenge, getting the right patients, the right care, resulting in the best possible outcomes? What excites you most?

Lynn Hanessian:

Well, what excites me is there’s new models, new proven models of getting people to their care and the power of virtual care and digital tools in a rural health setting is remarkable and wonderful. That assumes that we have a great trust between our care providers and our patients. And our patients are savvy, they’re smart, they’re not one-size-fits-all. They’re people who are going to be able to determine where they get their flu shots, where they get their specialty care, where they get their primary care, and where they have an ongoing conversation when there may be an urgent care moment.

So I’m really excited that we have a health care ecosystem that’s adapting to the needs of patients and that patients are pretty clear that they have a sense that they can be empowered and when shared the information, shared the control of their own health, a better outcome can happen. It’s one patient at a time, one community at a time. But I’m excited that we’re able to make health care happen in places that are convenient and still quality for patients today.

Courtney Collen:

Yes. Incredible insight. Lynn Hanessian, thank you so much for your time and for all that you do.

Lynn Hanessian:

Courtney, thank you. Have a great day.

Alan Helgeson:

You’ve been listening to “Reimagining Rural Health,” a podcast series brought to you by Sanford Health. Hear more episodes in this series or other Sanford Health series on Apple, Spotify, and news.sanfordhealth.org.

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