(The staff at Blue Fish Dental & Ortho work hard to keep their young patients and families smiling | Photo courtesy of Blue Fish Dental & Ortho)
As we all settle into new routines surrounding the COVID pandemic, health-care industry providers have had to pivot the way they do things perhaps more than nearly anyone else. Telehealth, staggered appointment scheduling and a gamut of safety protocols are the new way of life for these hard-working professionals.
We at Cascade Business News checked in with a variety of providers across the health-care industry to see how — and what — they are doing during this unprecedented time. This is but a sampling of the many types of businesses comprising the heath-care world. In today’s pandemic reality, many providers were just too busy to talk. After the mandatory business closures in March, many of them were forced to close their doors for a time, and are still racing the clock to try to catch up. Those who were able to break away for a few minutes and share information provided an overview of how they handled the shutdown, how they have stayed afloat and where they are now in the scheme of things.
Massage Therapy, Nutrition, Wellness
Surviving the Pandemic by Reimagining How to Conduct Business
At Synergy Health & Wellness, Founder RanDee Anshutz says that her team — which comprises licensed massage therapists, registered dietitian nutritionists and diabetes educators — has survived the pandemic by getting “very creative,” and by reimagining how they conduct business.
“In March during the shutdown, we closed all in-person operations. Massage was completely put on hold, and all nutrition and diabetes services took to telehealth,” said Anshutz. “We had not previously been doing that, so we had to figure out how to do it in a week. During the shutdown, I was talking with other providers around the country about what they were doing for COVID precautions, and we rolled out a plan for our clinic accordingly.” Because the staff at Synergy quickly reverted to telehealth, Anshutz said the nutrition and diabetes service lines almost never skipped a beat and have stayed at capacity since the start of the outbreak.
“I’m fortunate, I have worked in health-care for 24 years, so I have used that experience to move us forward,” she said. “We also have a nurse on staff, so she and I were putting our heads together to come up with a plan.” Synergy reopened on June 1 — two weeks later than they were allowed to — in order to make sure the hospitals had the needed PPEs and that they were completely ready. “We waited two weeks because we didn’t want to compete with the hospitals for supplies, and to make sure the staff was trained and ready, that we had all the supplies we needed and that everyone felt comfortable.”
Since reopening, the staff staggers the schedule to make sure there are a minimum number of people in the clinic at a time. “As a result of this, massage is running lower than capacity, at about 70 percent of what it was,” Anshutz said. “But nutrition is at 120 percent. We’ve never been so busy.” She added, “I think there are several reasons for this. People love telehealth, because it’s easier to fit it into their schedules, and, unfortunately, because of the stress of COVID, people are really struggling with their relationship to food right now. Also, maybe people just finally have the time to address their concerns around their worries about weight, food and nutrition.”
In order to accommodate the increased demand, Synergy opened a location in Redmond on August 1 for nutrition and diabetes services, and has added another dietitian onto the team to help with the larger client load. “We are offering some in-person appointments for those who don’t have a computer, or if telehealth isn’t right for them. This felt really wild to be expanding during the time of COVID, but it’s about getting the patients and providers spread out to decrease the number of contacts in the building at one time. It felt right to do this even though it was risky at this time.”
Another program that was put on hold due to COVID is the WalkStrong 5k training program. “We are partnered with FootZone on these offerings and, like them, we have put these programs on hold until we can safely have groups together again.” She added, “Our athletes are missing this program! We hear from them regularly that they are eager to return, as are we, but not until we can safely do so.”
Anshutz said the silver lining she sees in this strange season of change is the unexpected success of telehealth. “We are seeing how well telehealth is taking off. It’s giving patients access to us who would not otherwise have had access. We are all amazed. It’s worked out so beautiful, because as a whole, it’s balanced out the areas where we saw a dip in business.”
The drop in massage therapy is the most challenging aspect of this time, she said, because maintaining safety is their top priority. “We are just really having to reimagine how we do things, especially with massage therapy. We reopened to massage in June, but there was not a ton of support for the massage industry in terms of how to move forward. We are trying to get back up to capacity to help that part of the business survive.” Anshutz said they are looking at doing massage therapy outside, or offering outdoor chair massage at corporate facilities. “Historically, three days a week, we were going into businesses to do massages, but all of that is still on hold. It’s just not safe to have staff going into businesses like that,” she explained. “So we are looking at where to go from here. Maybe we can go to businesses and set up outside. We are starting the process of talking to companies. We are getting really creative and just figuring it out.”
Now that Synergy has been back up and running for three months, Anshutz said the staff has developed a flow and has settled into the new routine of PPEs, screenings and other protocols. “We had to reimagine how we do things almost overnight, but now we are in a pretty good routine of it, though the staff would love to be done with it,” she said with a laugh.
In Physical Therapy, Virtual Appointments Help Patients in Pain During Pandemic
When the pandemic broke out, the people of Central Oregon did not stop hurting, so the providers at Step & Spine Physical Therapy quickly went into action to develop a way to keep practicing. “We had to develop a virtual connection between patients and therapists, because people were still hurting. They can’t function throughout the day if they are hurting, so we set up Ring Central (a platform similar to Zoom but tailored to the medical industry) meetings,” said Clinic Director Glenn MacLean-Talbot, PT, DPT, OCS. “It’s just like a normal appointment. Therapists did the meetings from the office most of the time so that they still had access to all the equipment and tools, like the skeletons, books, anatomical charts and diagrams. We also have the space to work, so therapists would go through the exercises and the patients would follow along.”
As a heavily education-based field, MacLean-Talbot said his staff educates their clients on the do’s and don’ts. “It’s really important to teach people what to do and not to do, and the strict form needed in terms of exercise. This doesn’t work over the phone; they really have to see the therapist demonstrate it. And the therapist has to be able to correct a patient’s form so that they exercise without compensating,” he explained. “It went really well. We ran a lot of people through physical therapy virtually. Within the first two weeks, we had a whole online site up and running. Insurance companies came on board quickly to accept this. They agreed to the virtual appointments early on.”
MacLean-Talbot said that although his staff got up and running virtually very quickly, the clinic stayed open the entire time for those who needed hands-on work. “We took extreme measures for those needing to be isolated; we cleaned every surface every single time, wore masks and distanced within the clinic. We have private treatment rooms where we do most appointments. We also do a lot of screening ahead of time; we pre-screen who we allow in the clinic, and we are taking temperatures as well.
As with many health-care practices in the region, Step & Spine has seen an increase in clients since the pandemic began. “We are still active in Bend. There are still a lot of people hurting and getting injured, even if they aren’t working. They might even be playing more if they are working less, so we have taken in new patients. From a physical therapy aspect, there are a certain number of people who have relied on exercise and activity to maintain health, but during the COVID outbreak, they were not able to do that, so they had a decline in health.” This, he said, is due to gym closures, a decrease in work activity and weight gain, which increases symptoms. “We have had people slowly getting tighter, weaker and heavier due to the changes in activity level. Those ten pounds really make a difference, and can take a long time to take off. Our bodies feel that.” He added, “The other part that is challenging is that people working from home sometimes have really poor ergonomics; we started seeing lots of neck and shoulder issues.” To help with that, MacLean-Talbot said the staff reviews how their clients’ workstations should be set up with them. “At home, on the couch, in a month your back is going to start talking to you.”
Although his staff is still conducting virtual appointments, MacLean-Talbot said the number is decreasing as people are becoming more comfortable with coming into the clinic. “The community seems to feel more comfortable going into the health-care world now,” he said. “We make sure the staff is committed to following social distancing. We say that if we want to keep our doors open, we have to commit to social distancing outside of work too.”
The positive outcomes to the pandemic, said MacLean-Talbot, is that people have had to take charge of their health by developing home programs and home gyms, and by going outside into nature. He said adding the ability to do virtual physical therapy has also proven to be a good thing. “This is a whole aspect that therapists just haven’t had in the past. We have this whole secondary setup now.”
His advice to others? “If it hurts to work at home, that’s not normal. You need to find a setup that doesn’t hurt your body. If you have new or old aches and pains, don’t ignore them.” He added, “These lifestyle changes will be with us for a while, so addressing these now is necessary. It will be easier to fix them now than if you wait another six months.”
Local Vision Care Provider Added Third Doctor to Ensure Staff & Client Needs are Met
When the COVID shutdown first occurred, many health-care providers were forced to lay off staff. Ironically, since the reopening of businesses, a good number of practices have now added extra staff to accommodate the changes brought on by this pandemic. Elemental Eyecare, which provides traditional eye care as well as vision therapy, is one such business.
“Because of the pandemic, we hired another doctor just to make sure we have the needs covered for the clinic, including the staff having kids in school — but not really — and all the other scheduling challenges,” said Gabby Marshall, OD, owner of Elemental Eyecare. “It’s fantastic.”
When the schools first closed on March 16, Marshall said she made the decision to close the practice. “We continued to deliver optical goods on a limited basis, and also saw very urgent or emergent appointments. But we utilized telehealth for history-taking and triage, and offered remote vision therapy appointments.” After that, the clinic began slowly re-opening, with one doctor coming back as of May 4, and then a second doctor returning as of June 1. The vision therapists, she said, are still on reduced hours due to childcare issues and attempting to plan for the new school year.
To ensure the safety of staff and clients, patients must have their temperature taken and wash their hands upon arrival at Elemental Eyecare, and the number of people in the exam rooms and the waiting room is limited. “We are all wearing masks, distancing and cleaning more,” said Marshall. “We only allow one family at a time into our optical area to make sure we can maintain distancing and sanitize the frames. We also have our office administrator working mostly from home since she can do a great deal remotely.”
Since reopening, Marshall said the greatest challenge she and her staff have faced is encouraging patients to be proper mask wearers. “We want to be safe, and it can be tricky managing other people’s beliefs and behaviors.”
Despite the challenges, however, Marshall said that adding a third doctor has been highly beneficial. “We are now able to be open on Fridays to better serve our patients, and we also have better coverage for vision therapy and head injury rehabilitation,” she said. “This also takes a little pressure off our providers, as three out of four have school-aged children, and there are just so many unknowns right now with school schedules.”
She continued, “We feel very blessed to have amazing and understanding patients as we have navigated this challenge. Also, we are very thankful for all the support we have received from Health and Human Services, Oregon Health Plan, The Bend Chamber of Commerce and the NWX community at large. What a great community we live and practice in!”
Hospice: Dealing with End-of-Life Care During the Time of COVID
In the world of hospice, COVID hasn’t really changed what the providers do much, according to Kandice Dickinson, director of PR for Heart ‘n Home hospice. “We are still seeing patients at end of life. Nobody escapes this way out, so we certainly have still been providing hospice care for people with terminal illnesses. That has been steady,” she said. “We have just had to take additional precautions with PPEs, making sure we are safe for patients and for us. Since the beginning of the pandemic, we have continued to see our patients and provide the person-centered, quality end-of-life care each person deserves when on their final journey out of this world. We have swiftly adapted to requirements as we go along and have utilized telehealth for virtual visits when in-person visits were required to be limited.” She continued, “This helped us connect in a different way with patients and families. We have also continued to accept new patients. We believe it is our responsibility to all humanity to compassionately care for seriously ill individuals and are committed to serving patients and families impacted by COVID-19.”
In order to facilitate this, Dickenson said Heart ‘n Home created a COVID-19 Rapid Response Team that is dedicated to COVID patients. “This has given peace of mind to our partners, patients and community. Our team has been properly fitted for masks, have all the necessary personal protective equipment and are taking all safety and sanitation precautions to protect patients, families, staff and our community. Hospice professionals are extremely well-trained in bereavement and grief, so we have been able to offer support to frontline workers and their teams who have experienced many forms of loss via virtual platforms, which we hadn’t done prior to COVID. There are many processes and changes we will continue to do because they are more efficient and have better outcomes for patients and families.”
Diana Hergenrader, RN, Heart ‘n Home’s La Pine executive director, said that in the beginning of the pandemic, keeping staff feeling safe and supported during the constantly changing directives about what to do was a challenge, as was finding the needed supplies and knowing what to stock up on or prepare for. Fortunately, the staff has sufficient supplies now, she said, and has found ways to strike the balance between safety and involvement.
“Holding community events with the restrictions needed to be COVID-safe has been difficult, but being actively involved in our community is who we are,” said Hergenrader. “So we are looking at it as a growth opportunity, and will be figuring out how we can still do some activities safely. It has challenged us in a new way of thinking outside the box, and we’ve grown from that.” One such event that took on new meaning this year was Heart ‘n Home’s annual “Chalk the Walk,” which fell during the height of the shutdown. “The Heart ‘n Home team got extra creative this year and, with permission, chalked walks all over their communities,” said Dickenson. ‘We rise by lifting others,’ ‘I love you,’ ‘Your kindness can change the world’ and ‘Without change there would be no butterflies’ were just a few of the many messages encouraging hope that were chalked around town. We were able to partner with other agencies, including chalking senior centers and facility sidewalks and driveways for residents to enjoy, in hopes of lifting their spirits.”
Hergenrader said that dealing with patients who have COVID has been challenging, because it is such new territory for the staff, who had never dealt with someone ill or passing away from this virus before. “We’ve had four COVID patients pass away very peacefully. We were a little worried about what the passing of a COVID patient would look like, as our main concern was that we wanted them to be comfortable and pain-free,” she said. “We have also had patients battle COVID and become COVID negative! We’ve been able to personalize COVID and hospice through stories of what we are still able to do for patients and families, and how we have been able to give compassionate, end-of-life care to patients through the pandemic.”
To support patients and the facilities in which they are housed during this time of COVID, the Heart ‘n Home staff has connected families and patients virtually and through pictures. “We had a veteran patient who had dementia and couldn’t understand us through our masks, so we pre-recorded the poems and card we wanted to read to him, and held it by his ear so he could hear it well. He kept showing us pictures of his naval ship and smiled. We didn’t let the mask get in the way of the feeling that was created during that ceremony.”
“Our team has been very creative, flexible and sacrificial,” said Billy Gehm, Heart ‘n Home Bend executive director. “We developed a team of clinicians to be our COVID Team, and this allows the other team members to cover all the other needs around town, so that we know we are being as responsible as possible to not increase the risk of community spread. This has greatly helped the facilities that we serve; they can know with confidence that we have a thoughtful plan of how to serve any terminally ill patient.”
Dickenson added, “We’ve learned a lot. We are pushing the boundaries of technology, communicating as a team and providing telehealth opportunities for patients and families who are rural or from afar. This is new territory for hospice.”
Dental Care Providers are Working Tirelessly to Play Catch-Up
In the dental care arena, needless to say, PPEs are wildly important, as providers spend most of their working hours hovering over clients’ faces, working in their mouths and dealing with the aerosols that come from saliva being splattered during procedures. But dental care providers in Central Oregon have remained committed to their clients, and are working hard to play catch-up after weeks of having to stall appointments.
Pure Care Dental
“March 18 was when things were really handed down. We were only able to see emergency patients at that point until we were given the go ahead to open again on May 1,” said Brianna Cadwell, office manager at Pure Care Dental in Bend. “There were a good number of dental offices that completely closed and laid everybody off, so we wound up seeing a lot of those emergency patients as well. It kept us afloat.”
During the closure, Cadwell said they laid off about a third of the staff, but that everyone is now back full time. The biggest challenge during the shutdown, she said, was in her role as an employer and the concern she felt over both her staff and their clients. “We were trying to do right by my staff, with no clear answers from anywhere. We were also forced to put off client procedures that could have become emergent if we weren’t allowed to perform them for several months. This was on top of the normal financial concerns. When we were shut down, we wanted to make sure we were taking care of staff as well as patients.”
When Pure Care re-opened, Cadwell said they faced seven weeks of backlog in routine care such as cleanings for patients, and are still working hard to get caught up. “We are getting there,” she said with laugh. “Instead of drinking from a cup, it’s like we are now drinking from a firehose, trying to find the space to place patients in terms of catching up. This is the same story with most dental offices in town.”
When the new safety protocols were put into place, Cadwell said the change was not drastic for them due to the strict sterilization procedures they were already using. “We are back to close to 100 percent of normal operations. We implemented some new things, but it was not a huge drastic change because we’ve always performed sterilization and cleaning between patients. There are a few additional steps we’ve taken, such as utilizing N95 masks plus another mask over that, and we have put some protective barriers up and installed a high-suction system in every patient treatment room to cut down on aerosols. We’ve also been doing a pre-rinse for every patient before any procedure, and we have an air purification system in each room.”
To help offset costs in adding the new equipment, Pure Care was able to procure a local grant in April through East Cascades Works. “That helped with PPE costs; those costs have quadrupled since before the pandemic,” she said, adding, “Things have still been so crazy busy I haven’t even been able to send a thank you note to them yet.”
If there is a silver lining to the situation, Cadwell said it is the “phenomenal, all-in team,” who were ready and excited to start seeing patients again once they were allowed to reopen. “Patients have been very understanding that we can’t get them in for a cleaning for a number of weeks, and that’s been really helpful. It’s surprising how grace-filled everyone has been through this process. We are really thankful for our community, and for the support and encouragement from other businesses and our patients.”
Blue Fish Dental & Ortho
At Blue Fish Dental & Ortho in Bend, pediatric dentist and orthodontist Dr. Cate Quas said her staff made sweeping updates to their safety protocols in March to stand in solidarity with health-care providers and protect the most vulnerable members of our community. “Since COVID-19 began, Bluefish has taken daily action to keep both our patient families and our team healthy and safe,” she said. “Since March, we’ve operated on a reduced schedule, increased appointment times, updated our hygiene protocol, implemented a screening process and have allowed a limited number of patients present in the office. We are also providing telehealth dentistry for select appointments,” she added. “While we hadn’t considered virtual appointments prior to COVID-19, they’re here to stay. We have loved being able to conveniently connect with our community this way.”
In May, as per the Governor’s mandate, Quas said they quickly transitioned to a limited in-office schedule, seeing only urgent and emergent patients. Then in early June, Blue Fish slowly began re-opening and has gradually increased availability ever since. “We’d rather go slow and steady so that everyone feels safe and smiley…because isn’t that the point?”
As a pediatric practice, keeping patients happy and calm is huge, she said. “We’ve used this as an opportunity to wear sloth, watermelon and shark-themed surgical gear. Our hats, gowns and masks have kept our team and patients laughing.”
While the pandemic has created very real challenges in the dental world, Quas and the rest of the Blue Fish staff have looked for the positives. “The pause in practice gave us an opportunity to reflect on what is important and appreciate the gifts that are present every day in our families, our team and our patients,” she said. “Their resilience, innovation and teamwork has made the transition into our new norm a good one. The connection to our patient families is stronger than ever. This is a shared experience that connects all of us to each other in many ways.”