A story of rehabilitation and recovery from Long COVID: An employer representative, physical therapist, and employee share an inside look at what's working in Minnesota.

Welcome to Absence Management Perspectives: A DMEC podcast. The Disability Management Employer Coalition or DMEC, as we're known by most people, provides focused education, knowledge, and networking opportunities for absence and disability management professionals. DMEC has become a leading voice in the industry and represents more than 16,000 professionals from organizations of all sizes across the United States and Canada. This podcast series will focus on industry perspectives and provide the opportunity to delve more deeply into issues that affect DMEC members and the community as a whole. We're thrilled to have you with us and hope you will visit us at www.dmec.org to get a full picture of what we have to offer, from webinars and publications to conferences, certifications, and much more. Let's get started and meet the people behind the processes.

Heather Grimshaw: Hello, and welcome to Absence Management Perspectives: A DMEC podcast. I'm Heather Grimshaw, communications manager for DMEC. I'm here today with David Dubovich, a DMEC member who is going to share some insights about how North Memorial Health has helped employees return to work after COVID-19 related absences. David, who is a member of the DMEC Employer Advisory Council, shared some successes with a rehabilitation service that helps employees return to work after experiencing Long COVID. We also have someone here with us today from Nova Care, the organization that North Memorial Health partnered with, and we'll hear an employee perspective as well. David, would you kick us off by introducing yourself?

David Dubovich: Sure. I'm David Dubovich. I'm a disability case manager for North Memorial Health System, which consists of North Memorial Hospital in Robbinsdale, Maple Grove Hospital, and Blaze Health, which is a consortium of various clinics connected to the North Memorial System. I coordinate and facilitate return to work for team members that have medical conditions, whether it's related to a work injury or a personal, non-work-related medical condition. I become involved if they're losing time from work or if they have restrictions that can't be accommodated. I arrange for temporary transitional work. I also get involved on the non-work-related side and job accommodations, and when someone's returning from a leave of absence that can't do the essential functions of their job and working with a team member and the manager on return to work.

Heather Grimshaw: So, David, how many North Memorial Health employees have used NovaCare for rehabilitation from Long Covet?

David Dubovich: There's just around a dozen, if not more, that participated in the program. Kurt was probably one of the first individuals. He was diagnosed with COVID and was off work for a period of time when I got connected to him, but we've had quite a bit of success with other team members going through this program.

Heather Grimshaw: Okay, and can you give us a quick overview of how the program works and why North Memorial Health chose this service for its employees?

Heather Grimshaw: I appreciate that uncharted waters comment, and I'm sure it will resonate with employers listening into this conversation. I think this is a great place to introduce Dr. Kristine Trimble, a doctor of physical therapy and revital certified therapist, recovery and Reconditioning Program champion of Minnesota with Nova Care. Doctor Trimble, I'm hoping that you can share an overview of what's entailed in the therapy for people recovering from Long Covet and what the average timeline is for return to work.

Heather Grimshaw: Sure, I can imagine that it would be very customized, and I'm hoping that you'll give us a real tactical kind of explanation for what this therapy looks like. And David referenced Kurt earlier. And Kurt Rodmyer is with us. He is one of the employees who has experienced this service. And so he'll be chiming in a little bit later with some details. But I'm hoping, Dr. Tremble, you can help us really imagine or picture what this looks like for an employee who has experienced long COVID.

Heather Grimshaw: That's helpful. Is it fair to assume that you then customize that rehabilitation for the patient's specific symptoms?

Kristine Trimble, PT, DPT, SDN, SCCE: Correct. Sometimes it starts out with very cognitive-based therapy, getting occupational therapy involved right away. Sometimes the brain fog and cognitive deficits are addressed later on after a few visits trying to assess a patient, but really looking at how the person responds. It is very much very tailored and really looking at how that person is responding using the vital signs assessment and also assessing all of the other symptoms as we're going through the therapy to ensure that we are making continued progress.

Heather Grimshaw: Okay, and can you talk a little bit about how this therapy approach is different from other types of debilitating illnesses and conditions that you all treat?

Kristine Trimble, PT, DPT, SDN, SCCE: So, COVID-19 itself creates a multi-system inflammation response. So unlike other diseases or pathologies where one thing might be affected, this really affects almost all the symptoms in some way, shape or form in patients. So it really is using the skill of that trained therapist to screen for the cognitive, to screen for that autonomic dysfunction, to screen for cardiopulmonary issues that might need further investigation. It also really looks at how the person is responding and knowing whether to push that patient or maybe to back off and teach more pacing. A lot of times a traditional therapy approach is that graded exercise, we want to improve strength, we want to improve endurance. And what we are finding with post-COVID rehabilitation is that is not people don't respond that way to this type of traditional therapy.

Heather Grimshaw: Okay, that's interesting. So if I'm understanding you correctly, one of the differences you all are seeing is that patients with long COVID are not responding well to the graded exercise. That is maybe more traditional with other issues that are addressed with these kinds of services.

Kristine Trimble, PT, DPT, SDN, SCCE: Yes, some people do respond that way, but if someone is not responding, this is where this program really helps because it takes into account, for example, post exertional malaise, which is that fatigue that a lot of people post COVID will experience that lasts for a few days after doing an activity like helping mow the lawn. Someone might be not able to do daily activities or not be able to get up and go shower after doing that. So really looking at making sure we are safe within our parameters to keep that patient moving forward without creating more difficulties.

Heather Grimshaw: That's really helpful. Thank you. So I'm going to introduce Kurt Rodmeyer, who is here with us today. Kurt is a registered nurse on the critical care response team and has agreed to chat with us today about his experience with this rehabilitation approach. So, Kurt, I'm going to ask you to give us a quick overview of your role, and then I've got a couple of questions for you.

Kurt Rodmyre: Hi, I'm Kurt Rodmyre. I'm a registered nurse at North Memorial Medical Center, also known as the CCRT, which is the critical care response team. My main focus in the hospital is the stabilization rooms at North Memorial. There are four of them. It's where ambulances bring in the severely injured and the very ill patients that need to be stabilized before they can move into the main emergency room or be admitted to the intensive care unit. When I'm not focusing on the stabilization rooms, I support the intensive care units with their critical patients, and I also respond to the medical floors in the hospital for medical emergencies, rapid response teams where a patient is declining and the primary nurse and doctor need help stabilizing that patient, and they usually end up in the intensive care unit. And then I also respond to code blues in the hospital, and I also take patients down to diagnostic studies like MRI and CT scan from the intensive care units, which can be quite the process because of ventilators and all the pumps.

David Dubovich: So, Kurt is someone who you want if you're in an emergency.

Heather Grimshaw: Yes, absolutely. I was just going to say those are some very important roles that you have, and it sounds like a lot of juggling goes on there.

Kurt Rodmyre: So, I'm basically the paramedic, I guess hospital is kind of the way you can look at the job.

Heather Grimshaw: Okay, yeah, it sounds like certainly an appropriate summary there. So, Kurt, what was your experience with COVID and the return-to-work process?

David Dubovich: He returned to work, according to my data, at reduced hours around late July and subsequently worked up to regular duty in October of 20.

Heather Grimshaw: So Kurt, can you tell us a little bit about what your therapy experience was like?

Kurt Rodmyre: Sure. The therapy started slow. They started me with weightlifting, working on my endurance, stretching and lots of vital signs. They would follow my vital signs through every process and see how well I did.

Heather Grimshaw: Okay, great. And when you're talking about the stretching, are those normal stretching? I'm actually lifting my arms up and doing like a stretch here as I ask. I'm just curious what that was like.

Kurt Rodmyre: No, the therapist would actually focus on my chest and would stretch and just expand my chest system.

Heather Grimshaw: Okay, and can you talk a little bit about how the therapy has helped your symptoms and maybe when you first started seeing some improvements?

Kurt Rodmyre: Yes, after COVID, basically my therapy was just walking. I would just walk and try to get my stamina back. And I think the combination of the weight and the focus, I can't think of the word I want to use.

Kristine Trimble, PT, DPT, SDN, SCCE: So not only is there a lot of chest involvement with the difficulty breathing as well as coughing that usually goes along. So, when Kurt was talking about the stretching and stuff for his chest, super important to get the ribs moving and the chest expansion and lung expansion back to pre-COVID. The other part is working on overall core and some of those muscles proximal. So like shoulders, hips back. Because people are frequently debilitated for quite a while. We sometimes forget how much strength we lose quickly, and we need to work on gaining that core strength back as well as the stability so that you can go about and do your daily work activities. Especially in a job like nursing or paramedic. Because you have to work quickly and there's a certain amount of adrenaline that happens and we need to be sure that you are safe in order to go back so you're not going to be injured.

Heather Grimshaw: That's such a good point. I appreciate the comment, Dr. Trimble, about how we forget how much strength you can lose quickly. I've heard that's especially true with and Long COVID-type symptoms, so I can certainly appreciate that. Kurt, I'm curious, are you finished with your therapy or is this an ongoing type of therapy?

Kurt Rodmyre: No, I'm finished… I think it was around six weeks and I improved and worked my way back into work, started four-hour shifts and worked up to my 12-hour shift by, I guess the end of August until I think it was the middle of October when I went back full time.

David Dubovich: Right, wow.

Kurt Rodmyre: Yeah.

Heather Grimshaw: That's wonderful. Okay, so that graduated reentry, I'm sure was, or I can imagine would be helpful, especially as you're moving through these types of symptoms.

Kurt Rodmyre: In the therapy, the weights and the walking upstairs, downstairs, and just the way they pushed me through my weakness and my easy exhaustion, I think, was the main factor how I could get back to work as fast as I could.

David Dubovich: And he worked with a vocational rehabilitation consultant from the state of Minnesota, registered with the state of Minnesota because he was losing time from work. So she worked with him as well as NovaCare on his planning.

Heather Grimshaw: Thank you, David. I appreciate you chiming in there, and I would think that multi-tiered approach would be incredibly helpful, both for Kurt and other employees who are going through this, which is somewhat of a daunting process, as well as from the employer vantage point to know where things stand and what to expect next.

David Dubovich: It's not only mandatory that we provided, but it's really to provide additional support. Kurt was losing time from work, and nobody you know, as I said, this was such a territory where I used the word uncharted waters. Nobody knew where things were going with all of this and whatnot. And we tried to provide as much resources as possible to the team members to get through this. Such horrifying circumstance.

Heather Grimshaw: I think that's well said. Horrifying circumstance. It is something that no one expects and certainly seems to be very unique for every person who experiences it. David, I'm going to shift gears a little bit and ask you to talk about what the percentage of people is who receive these services and are able to return to work or have a shorter duration of absence.

David Dubovich: Yeah, certainly, I would say all of them were able to return. Kurt was probably one of the first ones to start with this program. A lot of our team members that went through the program, they've all returned to work. Now, some take longer than others, but I have received nothing but positive comments when I present the idea to team members that were experienced. Long Haul COVID syndrome. We would email out the brochure, people would read it and say, that is what I need, that is what I need. And we would encourage them to either call NovaCare, talk to their physician, check it out, go visit them, and ensure that it's something that they want to do. And I know Kurt, as well, had offered to be any of support.

Heather Grimshaw: Wonderful.

Kristine Trimble, PT, DPT, SDN, SCCE: Yeah.

Heather Grimshaw: I did see a reference to tele rehab and was curious both from Dr. Trimble's perspective as well. Kurt, if you're willing to chime in how that works, and Kurt, if you went to a facility to receive the rehabilitation or if that was a tele.

Kurt Rodmyre: Rehab situation no, I went in person over to the Coon Rapids Nova Care and worked with them there. I did no telecare. It was all in person.

Heather Grimshaw: Okay, thank you. And Dr. Trimble, how frequently are patients taking advantage of that telerehab? Or is most of the work done in that Coon Rapids facility we have.

Kristine Trimble, PT, DPT, SDN, SCCE: Actually, I can't remember if the number is 20 or 22 of our facilities within Minnesota that do offer the recovery and reconditioning program. Telerehab is a great tool and most of us use it from time to time, especially in the beginning when it is very difficult to tolerate one getting up, getting dressed, getting out of the house, finding a ride to therapy. The telehealth option is a great tool to allow someone to get the care that they need without expending all of that energy. And then we work on building up their tolerance for daily activities and then they are in the clinic. The other thing, if they're having a really bad day, especially as Kurt mentioned the graduated return to work. Sometimes a lot of education goes into, okay, what were you doing at work? Where were you having problems? How can we remedy this if you were getting, say, dizzy with some of the quick movements? Let's problem solve that and see how we can help that.

Heather Grimshaw: I would think from an employee vantage point, that would be really helpful.

Kurt Rodmyre: Yes. And the therapy was gauged towards using my muscle groups for moving patients and moving equipment. I think that helped dramatically.

Heather Grimshaw: I bet.

Kristine Trimble, PT, DPT, SDN, SCCE: And we are really spoiled. In the location I work at, along with three other locations within the Twin Cities, we have the work conditioning. So if someone needs to build up that tolerance, that program is up to four hours a day, five days a week. And the location I'm at, we have the use of the lifetime fitness that's next to us. So we get to do all of those activities and really ensure a smooth transition back into a high intensity or high repetition job.

Heather Grimshaw: Okay. And David, I think the one question I had left for you is really what, if anything, about the therapy or the experience for employees. Do you wish you had known earlier.

David Dubovich: I don't know. I was grateful that we found out about it because we were, I think, spinning our wheels, like, what's going to happen? Of course, as Kristine alluded to earlier, you were watching everything overseas and hearing the people dying and what were we going to be faced with? I don't know how to answer that question other than to say I was grateful that NovaCare came up with this program that was out there to assist these team members that were experienced the low stamina endurance issues as well as the shortness of breath and brain fog, so to speak, and on and on. I promote this whenever I can. So I don't know if it could have come any earlier than it did.

Heather Grimshaw: Yeah, I think that it has been a learning process, I think, for everyone. And I think the fact that Kurt has very generously offered to support other employees going through this process is so generous because I think just like his willingness to share his experience today, hearing what that process looks like, what's entailed, and the successful outcome would be incredibly important. So I greatly appreciate all of your willingness to share your stories and your perspectives with us today. And Kurt, wish you all the best moving forward and look forward to continuing to keep in touch with you all to hear how things are going. Thank you so much.

Kurt Rodmyre: Thank you.

David Dubovich: Thank you, Heather.

Kristine Trimble, PT, DPT, SDN, SCCE: Thank you so much.