The Need for Effective, Efficient, and Safe Therapy Solutions

Hello! I’m Laszlo Bayer, Senior Vice President and Head of Sales and Marketing at Therapeutic Industries. I’m excited to share an insightful conversation I had with Nadine Heideman, a true leader in the world of rehabilitation services. Nadine has been a cornerstone in the therapy field since 1981, with a rich background in Occupational Therapy and Therapy Management. Currently, she oversees all rehabilitation services for Generations Healthcare through TheraGen, where her expertise continues to shape the future of patient care.

In our discussion, we dove into some of the most pressing challenges facing rehabilitation services today, particularly the need for effective, efficient, and safe therapy solutions in various healthcare settings. Nadine shared her perspective on the importance of comprehensive therapy services and how gaps in care can impact patient outcomes. We also explored how the Barihab Treatment and Assessment Platform can play a pivotal role in addressing these challenges. Nadine highlighted how our platform’s innovative design can reduce the physical strain on therapists by minimizing patient transfers, ultimately enhancing safety and efficiency in facilities like skilled nursing homes.

This conversation was a fantastic opportunity to discuss how the Barihab can not only meet but exceed the needs of modern rehabilitation environments. Nadine’s experience and insights truly underscore the potential of our platform to transform patient care. I hope you find our discussion as enlightening and inspiring as I did!

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Transcription:

Laszlo Bayer:

Nadine and I have been friends for years and years and years. Yeah. So she’s a big reason why we’re still here. Yeah. We’re so excited to chat today and I’m glad you can join us.

Nadine Heideman:

Us. Yeah, thank you. Thank you.

Laszlo Bayer:

So anyway, what I wanted to do here is just have a conversation. I don’t want it to be like an interview, interview.  I just want to talk. So anyway, are you at home?

Nadine Heideman:

Yeah, I’m at home.

Laszlo Bayer:

Oh, nice. You take the Mondays off now?

Nadine Heideman:

No, no, I’m retiring soon.

Laszlo Bayer:

Are you?

Nadine Heideman:

Yeah. Yeah.

Laszlo Bayer:

That’s fantastic. That is really fantastic. So you know what, I’ve never asked you… what got you into healthcare? How did your interest get started in that?

Nadine Heideman:

Well, when I think about it now, my brother and I were playing tug, and when we were young, I was nine, He was seven, and I chased him out into the street and he got hit by a car.

Laszlo Bayer:

Oh my God…

Nadine Heideman:

And he almost died. He was in the hospital in a full body cast for a year, mids of school. And I never really connected that, but I think that that experience kind of made me realize looking at rehab and getting him better and him walking again. And I think I’ve always liked people and I like working with people and that it was easy for me to care about people. I think my parents did a good job with me, and so it was easy for me to want to do nice things for people. And when I was in college, my roommate was going to be a physical therapist, and we looked at what it took to be an OT and a PT. And I thought I can do this. And so every year I just started with the basic classes and as it went on, and then I volunteered at UCLA and I thought, this is what makes me feel good, and I think I do a good job at it. So that’s how I started my career.

Laszlo Bayer:

So how did you make that leap from volunteering at UCLA and doing those things into starting your own company?

Nadine Heideman:

Well, I think we all think we know how to do things better than everybody else. That’s true. So I started out, my first job was working with kids in a school for the disabled, and I loved that. And then I went on to do cardiac rehab and then I moved to Orange County. I had a new baby, and I just started saying, well, what can I do? And I found this company that contracted out therapists to different facilities. So I was going to a number of different facilities and I realized that there was a lot missing, that we could do more, we could be better. And so when the opportunity came about that I was asked to take over some of these contracts, my biggest fear was how do I do payroll? I wasn’t worried about doing good care. And so I took that leap to run my own company and I was very lucky. It was at a good time where therapy was really important. There was a lot of money available, so I could do really nice things for everybody. I could pay people well, I could do things for the patients. I bought an electric wheelchair for one guy. He couldn’t afford it. And we could just do really good care. We would see our patients sometimes six hours a day.

Laszlo Bayer:

Wow.

Nadine Heideman:

And that’s where I met Eddie.

Laszlo Bayer:

Right, right.

Nadine Heideman:

And so yeah, I was very lucky and I guess I did a good job and as one administrator would leave and go to another company, they would take me. And then a friend of mine was the medical director at Huntington Beach Medical Center, and he brought me over to do their TCU. And I knew nothing about TCUs, but I said, I can learn. And I said, I knew everything about TCU when I went for the interview. So then I ended up doing all the TCUs in Orange County, starting them all up.

Laszlo Bayer:

So what year did this happen?

Nadine Heideman:

Well, probably 35 years ago.

Laszlo Bayer:

Wow.

Nadine Heideman:

Yeah. So I’ve been very lucky to have a great career. And then when I sold my company, I still stayed in touch with Tom, and then he asked me to come on board at generations and I was going to do one building and just do consulting. And I told the students that was 30 years ago and 30 buildings ago. So I just feel very lucky that I was allowed to create another company under generations that ran the way select therapy did that freedom to do that. And so in both select therapies and dargen are continuing and doing well, and so that makes me feel good too.

Laszlo Bayer:

Yeah. They are doing well. I remember, I don’t know if you remember the first time you and I met,

Nadine Heideman:

I do in the lobby of our office building.

Laszlo Bayer:

Talk about that a little bit.

Nadine Heideman:

Well, I was telling somebody the story the other day, and I said, I had this Coda, Eddie Estrada, and when he was working with the patient, he said, Nadine, we need to have a mat that has a chair in it so that I don’t have to be behind that patient and holding them up. I can do better treatment. And so he said, I’m going to invent that. And I said, go for it, Eddie. And so he would call me, he ended up working somewhere else, but he’d call me and say, Nadine, I got that mat. I got that chair. And I’d say, okay, Eddie, but it’s still wood and we have to change. We have to get it to be electronic. And he go, okay, I’ll come back. And I said, okay, Eddie, you get that and I’ll buy it from you. And one of the people at generations called me said, oh, there’s this guy trying to sell this piece of equipment.

I go and he goes, just meet with him. And I go, okay. And I think you called me. And I said, well, you can come to me. I’m not coming to you. So you brought this huge mat into the lobby of our building and you were showing it off to me. And I thought, wow, this is a great piece of equipment, but I can’t buy it because I promised Eddie that if he ever created something like this, that I would buy it from him. And I said that to you. I told you the story, and you go, well, what’s his name? And I go, Eddie Estrada. He goes, that’s my nephew. And I go, okay, great. Okay, we’re buying these mats. And that was great. And I think that I was one of the first people to buy them, and everybody that worked with me loved them.

And every time we had a therapist come from another company, they would go back to their company and say, we need that piece of equipment that Nadine has. And I think it’s been great over the years because you’ve adopted the pieces of equipment to meet the needs of the acute hospitals and even the ICUs. And that’s been fun for me to watch your progression and how you’ve always been able to, even though you’re not a therapist, to be able to look at the needs of patients and adapt your mat to meet those needs, which I am always very impressed with.

Laszlo Bayer:

A lot of it is just being able to listen to what therapists have to say .Right? It’s just getting their feedback over the years and making suggestions, what their challenges are, and actually just watching them. I think a lot of people don’t realize you go into a facility and you’re there for half hour , an hour and then you leave. You never realize the therapist’s there for eight hours a day lifting, transferring, working with these patients. And so we started to get a real good understanding of what would really benefit them, all the way down to the simplicity of adding a catheter bag hook. Right.

Nadine Heideman:

And that was one of our issues because that was kind of a problem that we were having with the mat. And that’s what I love about you is that you listen to what the issues are and you have the foresight to adapt and not just say, well, this is the piece of rehab equipment we have. And look, we’ve seen miracles with it, which is always wonderful. We’ve had family members cry because they see their loved ones stand again for the first time.

Laszlo Bayer:

We’ve witnessed that as well. And I think that’s the reward at the end of the day, Is that you’ve impacted people’s lives, not only the patient, but you’ve impacted the therapist’s life as well. And you see this happen right in front of your face and you go, Hey, this was really, really cool. You remember a gentleman by the name of Michael Torgan?

Nadine Heideman:

Yes, I do. Yeah.

Laszlo Bayer:

Well, Michael, One day at a trade show in Palm Springs, came down the aisle and looked at our table and said, you know what? That’s really a cool table, but if you could get parallel bars to work with that, I would buy it. So we never even thought of doing parallel bars. I went back to my partner, Chris, and said, Chris, can we do parallel bars that work with this? And he goes, well, let me come up with something. A year later, we’re back at that same trade show, Michael Torgan is walking down the aisle again. And I see him and I called him over to the booth and we had our parallel bars there, and he was a man of his word. He bought five tables off that show.

Nadine Heideman:

And that’s really special because that one piece of therapy equipment has so many different usage. And if you have a small gym, a lot of places don’t have these huge gyms. It’s kind of one size fits all. It has so many different areas that it can be used. I mean, I love the knee stabilizer.

Oh, the blocker? Yeah, the blocker. I mean, I think that’s great. And just sometimes we only use one arm. We’re trying to practice how do you get up from a couch instead of a chair? There’s only one side, one arm on a couch. So it allows you to do, and really, I love that you can measure the height of somebody’s bed at home and work the mat from that. So it’s just such a great piece of therapy equipment. And I’m thrilled that so many therapy departments are using it because I think it’s the number one piece of equipment in each gym.

Laszlo Bayer:

We get that feedback about therapists lining up to use it with their patients. So they have a signage sheet. I got it from nine to nine thirty, the next person, the next person. Do you remember when we installed the first table for a generation? Was it

Nadine Heideman:

I think it was Newport?

Laszlo Bayer:

I think so. To 2010 or 2011?

Nadine Heideman:

Yeah, maybe even before that.

Laszlo Bayer:

Well, it could  have been

Nadine Heideman:

2010. I think 

Laszlo Bayer:

Could have been oh nine.

Nadine Heideman:

Yeah. Yeah.

Laszlo Bayer:

So yeah, it’s been a while now. The other thing we’re kind of proud of is how long have they lasted for you?

Nadine Heideman:

No, they’re still going kind of like the EverReady buddy.

Laszlo Bayer:

It just keeps working.

Nadine Heideman:

It just keeps working. And you’ve always been very responsible when there’s been issues. We have actually had to do new vinyl on some of them, but they’re 14 years old and they get used all the time. But if ever there’s been a mechanical issue, you’ve always been very responsive and fixed it and timely too, because that mat wants to be used every day. We don’t want to wait a long time. And you’ve always been great about that.

Laszlo Bayer:

Well, we tried to build our business with building a great product and having outstanding customer service. And I think that’s been a big part of our success over the years and being able to adapt to the different conditions of therapy in general, because the monetary aspect of this business has changed so much over the past 10 years. What do you think the impact of covid had on skilled nursing?

Nadine Heideman:

Boy, I think it just gave us a huge knock. I don’t think we’ve recovered yet. I think that we lost a lot of people. A lot of people got scared about working in skilled nursing. We still have covid in our buildings. You do? Yeah. Unfortunately it’s not gone. And you know it’s hard because people have families. So the people were afraid to bring covid back from the facilities to their homes. People lost people. We had patients die, we had family members die. So I think it was just a really tough time. And I think we haven’t come out of that yet. Not so much. I think rehab’s starting to come out of it, but nursing has just been devastated. And then PD PM came along, and so it was a devil like hit and therapy, which once was, as I say, the king on the throne.

Laszlo Bayer:

It was…

Nadine Heideman:

Got knocked down to probably the jester. And now we work within much shorter guidelines and we have to do more. And unfortunately with CMS, everything’s about documentation. So we’re doing more and more documentation and having less time to really work with our residents. And that’s why it’s so important to use the equipment that is going to give us the outcomes that we need in a quicker time frame.

Laszlo Bayer:

I think the Barihab really addresses that idea of productivity because we know that there’s only so much time you have to spend with a patient. And so working on their rehabilitation rather than transferring them from one apparatus to another to get something done. And we’ve seen how by not having to do these transfers, it’s a little bit easier on the therapist not having to lift and move. And it’s also easier on the patient.

Nadine Heideman:

And as Eddie said, way in the beginning, doesn’t take two therapists to work with a patient because now you can have that patient with the back of the chair up. 

Laszlo Bayer:

Right…

Nadine Heideman:

You can still be working with them, but you feel like it’s a safe environment, because they’re not going to fall backwards.

Laszlo Bayer:

So do you think that therapists, when they feel that safety, when they’re working with their Barihab and they feel the safety for the patient and themselves will do more because it’s a safer environment?

Nadine Heideman:

Yes, absolutely. Because otherwise, on a regular mat, there’s nothing that is holding that patient up. So the therapist really has to manually almost do that so it doesn’t allow them the freedom to do other activities like reaching for things or bending over or just even scooting back and forth, working on that, clearing their greater tuberosity, all of those kinds of things. So core strengthening, it doesn’t allow them to do that because the therapist is really holding them up.

Laszlo Bayer:

Right…right.. Do you think that the patient’s fear and anxiety are reduced because of the safety features it has or

Nadine Heideman:

Yeah, absolutely. Yeah. I think we had a patient that was walking, but what he couldn’t do was go from sit to stand. And I think that was just, he just had some anxiety about going from sit to stand. And we had a different therapist work with him that came in and she said to him, what do you need? And he said, well, I can walk, but I can’t go from sit to stand. And she worked with him on the berry hub mat for one hour, and he was able to then do it and feel confident in doing it and met his goal in one treatment session.

Laszlo Bayer:

Wow. Wow. Yeah. Those are the kind of success stories that you know I love to hear about. So switching gears a little bit, do you see the rehab hospital market increasing? Is it replacing what skilled nursing rehab was doing or not?

Nadine Heideman:

No, I don’t think so. I think that there’s still always going to be a need. In fact, as the population gets older for skilled nursing and rehab, one of the things with PDPM was that it was supposed to look at all of the different settings and evaluate cost-wise, who was doing what. So if a skilled nursing, if our outcomes are the same as an acute rehab, they’re not going to pay that acute rehab three times what we get. So they will be sending more patients to skilled nursing and less to acute rehab. So I don’t think there’s ever going to not be a need for therapy in skilled nursing and the mats in both acute and skilled nursing. Where I see the increase in the acute hospitals and in acute rehab is things like the ICU starting to get patients that are on trachs and things, but being able to have them get on the mat and transfer and so that you can work with them because in those beds, it’s really difficult. And I think you’ve seen that.

Laszlo Bayer:

The early mobility movement. I’ve seen it in ICUs where they’re getting these patients up and moving after a very serious surgery. We don’t want these patients to stay in the ICU as long anymore because of infection, because of muscle atrophy, just a recovery from that.

Nadine Heideman:

And pneumonia, pneumonia is a big one if they’re laying flat all the time. So yeah, again, and the other thing I can see is at some point if insurance companies would pay for it at home, because there’s a lot of people that could benefit from having the piece of equipment at home.

Laszlo Bayer:

Right. What do you think of our mobile version? The S two S standing?

Nadine Heideman:

No, I like that one. I said, what happened to the one that was going to be named Nadine?

Laszlo Bayer:

We’re still working on that.

Nadine Heideman:

Oh, you’re still working on that one.

Laszlo Bayer:

Put something out there. Call it Nadine. Perfect. Okay.

Nadine Heideman:

Perfect. That check berries too, Nadine honey, is that used?

Laszlo Bayer:

Yeah. Yeah. I remember that first time we brought it into one of the facilities and we’re wheeling it down the hallway and everybody’s kind of looking at us. What the heck is that?

Nadine Heideman:

Yeah. And I don’t know that you give yourself enough kudos because you are a great teacher and mentor when you come in and you show them how to use the mat, it’s like opens up their eyes and just a whole new world of opportunities for them of how to use the mat. So I know you’re not doing that as much, but

Laszlo Bayer:

Well, our job, which you’ve done so well, and I’m trying to do, is to pass the torch. We have to be able to pass a torch to a younger generation that can carry on what we’ve started. And that’s what I’m trying to do. So we have other educators now that go out. My traveling days are very limited and we’ve done our jobs and if we can raise up others, our ceiling is their floor. That’s what we’re all trying to accomplish. So you’re saying that you’re going to retire? Yeah. I’ve heard you say that now.

Nadine Heideman:

You sound like my friends. No, no, it’s true because I feel like it is time for a younger generation, and one of the things that we’re doing is getting into more psych buildings.

Oh, yeah. Turning over a lot of our SNFs into psych. Well, behavioral health. Behavioral health. There’s a huge need for that. We’re still keeping our gyms because they need that exercise. That’s part of it. I mean, learning good health and many times because of the medications they take, and for other reasons, they’ve deteriorated physically, they’re still getting therapy and we’re still using ’em. But it’s changing. It’s changing. And there’s young Scot, great. He has new ideas, and I think it is time. I love what I do, and I love treating patients and being involved. They call me the idea person. I like that. But it’s time for other people, as you say, to pass the torch and have other people that have new and different ideas. Right.

Laszlo Bayer:

And just we got the snowball started. Somebody else has got to keep pushing that snowball forward.

Nadine Heideman:

And one of the things that’s really important with PDPM is groups. And we did a group on the Barihab mat. We had three different people, one on each end and one in the middle. And it was a great way to do a group.

Laszlo Bayer:

Right. Is there a little competitiveness there?

Nadine Heideman:

Yeah. Yeah. So, but it was an easy way to do a group and didn’t need a lot of setup because it was there. So that worked out really well. So those are things that we’re kind of looking at more now as groups. How do we do groups that are beneficial to the patients and time-wise.

Laszlo Bayer:

Right. So is Generations healthcare now maxed out in terms of buildings or

Nadine Heideman:

No, we actually just bought two new buildings in Fresno. We bought another one in Heme, another one in Claremont.

Laszlo Bayer:

Wow.

Nadine Heideman:

Yeah.

Laszlo Bayer:

So you’re growing too. I mean,

Nadine Heideman:

I’m still growing too, but I mean, there’s some really huge companies. Providence out there is huge and well, they’re

Laszlo Bayer:

Called Tax now.

Nadine Heideman:

What are they?

Laszlo Bayer:

They’re called

Nadine Heideman:

PPS.

Laszlo Bayer:

Providence had to change their name because of…

Nadine Heideman:

Legal, the hospital system probably. Yeah.

Laszlo Bayer:

So yeah, no, they’re growing by leaps and bounds and Enzyme has grown.

Nadine Heideman:

Yeah. Enzyme’s grown a lot too.

Laszlo Bayer:

So I mean, that shows you there’s a need. And the good operators, the good buildings are going to continue to grow and they’ll continue to be a benefit to the community they’re in. Those that are struggling will be gone.

Nadine Heideman:

Well, that’s what’s happening. They’re just getting eaten up. Because if you’re not a good operator in this environment, you have to have good management. If you don’t, you can’t survive.

Laszlo Bayer:

It’s true. Well, I think that we’ve had a good run.

Nadine Heideman:

I think I’m very proud of you. I think you’re not my child, but I think of the product as my child. Is that your

Laszlo Bayer:

Child?

Nadine Heideman:

No. You know, when you’re with your children, I’m just proud of what you’ve done and what you’ve created. And I think it’s kudos because I think if you look at all of the people that you’ve impacted, and that’s what we all want. We want to know that we make a difference in this world. And I think you have to be very proud of taking Eddie’s idea and making it go on steroids.

Laszlo Bayer:

Yeah, that’s exactly what it is

Nadine Heideman:

It’s, and that all of the lives that you’ve changed and helped and hopefully continue.

Laszlo Bayer:

Yeah, I totally agree. And you know what, I really think our meeting was really kind of divine providence, because if it hadn’t been for you and your belief in what we were doing and your belief in our product, I don’t think we’d be where we are today. So I just want to let you know.

Nadine Heideman:

Oh, thank you. 

Laszlo Bayer:

Appreciate who you are, what you’ve done, our relationship. You always pick up the phone when I call, and that’s amazing. A lot of people don’t do that. So I really do appreciate, and I appreciate the time you’ve given me today, Nadine.

Nadine Heideman:

Oh, well, it’s always good seeing you. I’m glad that life is good. Keep growing and passing that torch, but keep your eye on the ball.

Laszlo Bayer:

We will do. We will. Absolutely. Yeah. Thanks again, Nadine. 

Nadine Heideman:

Right. Thanks Laszlo