523: Dr. Monique Caruth: Surviving Covid-19 as a Home Health Business Owner

Jan 18, 2021

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In this episode, CEO of Fyzio4U Rehab Staffing Group, Dr. Monique J. Caruth, talks about how she, as a businesswoman, reacted to Covid-19.

Dr. Monique J. Caruth, DPT, is the CEO of Fyzio4U Rehab Staffing Group providing home health services in Maryland. She currently serves as the Southern District Chair of Maryland APTA and is the Secretary-elect of the Home Health Section of the APTA. She holds a Masters and PhD in Physical Therapy from Howard University, and she is a proud immigrant from Trinidad & Tobago.

Today, we hear what it’s like treating potentially Covid-positive patients, Monique tells us about the screening tool she developed, and we hear about the impact of the pandemic on mental health. Monique elaborates on the importance of Ellie Somers’s list of notable PTs, and she talks about her experiences of losing patients. How did she pivot her business to keep it afloat? How has her perspective as both a clinician and a business owner helped her pivot her business?

Monique tells us about obtaining PPE, offering Telehealth visits, and she gives some advice to Home Health PTs, all on today’s episode of The Healthy, Wealthy & Smart Podcast.

Key Takeaways

“We started seeing a spike in clients in mid-April when the hospitals didn’t want to discharge patients to the nursing homes; they were discharging them directly home, so the majority of our clientele were Covid-positive patients.”
Monique has started compulsively disinfecting all surfaces.
Monique’s screening tool: Step 1: Check temperatures every morning before seeing a patient.

Step 2: Ask questions about symptoms, traveling, and possible contact with Covid-positive people.

Step 3: Ensure PPE is worn.

“Gone are the days of spending extra time and doing extra work there.”
“One of the biggest things for therapeutic outcome is having a good relationship with your patients. Going into the home, you’re probably the only person that they’re getting to talk to most days. I saw the need to improve on soft skills and being approachable with your patients.”
“Some sort of contact needs to be maintained. Even though some patients may have been discharged, they would contact the physician via Telehealth visit and ask to be seen again.”
“Everyone deserves to get quality care.”
“Some people say, ‘this person probably got Covid because they were being reckless’. You can slip-up, be as cautious as possible, and still get Covid.”
“We’re going to see a huge wave of Covid cases coming in the next few months. With elective surgeries stopped, that’s going to be our only client population. To prevent the furloughs from happening again, I would just advise to do the screenings, get the PPE, and go and see the patients.”
Why don’t women get recognition in a profession that’s supposed to be female-dominated? “People send out stuff to vote for top influencers in physical therapy. You tend to see the same names year after year, but you never see one that strictly focuses on women in physical therapy. I see many women doing great things in the physical therapy world, but because they don’t have as many followers on Twitter or Instagram, they don’t get the recognition that they deserve.”
“The thing that I love about Ellie’s list is she put herself on it.”
“In doing stuff you have to be kind to yourself first and love yourself first. Many of us don’t give ourselves enough praise for the stuff that we do.”
“You can’t save everybody. When you just graduate as a therapist, you think you can save everyone and change the world – it takes time.”

More About Dr. Caruth

Suggested Keywords

Therapy, Rehabilitation, Covid-19, Health, Healthcare, Wellness, Recovery, APTA, PPE, Change,

To learn more, follow Monique at:

Website: Fyzio4U

Facebook: @DrMoniqueJCaruth

@fyzio4u

Instagram: @fyzio4u

LinkedIn: Dr Monique J Caruth

Twitter: @fyzio4u

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Read the Full Transcript Here

Speaker 1 (00:01):

Hey, Monique. Welcome to the podcast. I'm so happy to have you on.

Speaker 2 (00:06):

Oh, thank you for inviting me. It's a pleasure to be on once again.

Speaker 1 (00:10):

Yes. Yes. I am very excited. And just so the listeners know, Monique is the newly minted secretary of the home health section of the APA. So congratulations. That's quite the honor. So congrats.

Speaker 2 (00:26):

Thank you very much. And

Speaker 1 (00:28):

We were just talking about, you know, what, what it was like being an elected position. I was on nominating committee for the private practice section. I just came off this year. Not nearly as much work as a board member. But my best advice was you'll you'll make great friendships and great relationships. And that's what you'll take forward aside from the fact that it's, you know, a little bit more work on top of the work you're already doing

Speaker 2 (00:57):

Well, I better get my bearings, right. So I will be on task from the one. Yeah.

Speaker 1 (01:04):

Yeah. I'm sure you will. And now, today, we're going to talk about how you as a business woman pivoted reacted to COVID. So we're, Monique's in Maryland, I'm in New York city. So for us East coasters, it really well, we know it hit New York city very hard in March in Maryland. When did that wave sort of hit you guys? Was it around the same time?

Speaker 2 (01:33):

I would say mid March, April because I had returned back to the rest of the first week of March. And then things just started going crazy. They were saying, Oh we have to be aware of COVID. But I was still seeing my clients that I had. Then we started getting calls saying that family members are worried that we'll be bringing COVID into the home. So they wanted to cancel visits. So we were getting a lot of constellations and then electric surgeries was shut down and that meant a huge drop in clients as well. Then we started seeing a spike in clients in mid April when the hospitals didn't want to discharge patients to the nursing homes, they were discharging them directly to home. So the majority of our clientele was COVID positive patients.

Speaker 1 (02:36):

And now as the therapist going in to see these patients, obviously you need proper protection. You need that PPE. So as we know, as all the headlines said, during the beginning of the pandemic, couldn't get PPE. So what do you do?

Speaker 2 (02:54):

Well, we were fortunate in Maryland that governor Hogan had PPE equipment ready at state health departments for agencies to collect. So they did ration them out. Also one of the agencies that I contract with MedStar hospital provided PPS to all the contractors and employees that were visiting COVID patients in the home. So we had the goggles face shield gowns mask, everything. There would be a specialized bag with vital sign equipment for that patient specifically that would be kept in that house and then taken back and disinfected at the end of the treatment. So we, we were shored through weekly conferences on what to do do South screenings and screening prior to each visit. So for my contractors, I developed a screening tool to ask questions if clients were having symptoms or if any family members in the home are having symptoms. And if they had exposure to anyone where COVID symptoms in the past 14 days, so we'll know what you will, that person as a person on, on the investigation or somebody who's COVID positive. So we had done the correct equipment when we go into the homes.

Speaker 1 (04:18):

And what does that, what does that look like? And what does that feel like for you as a therapist, knowing that you're going into a home with a patient who's COVID positive? I mean, I feel like that would make me very nervous and very anxious. So what was that like?

Speaker 2 (04:36):

To be quite honest, I was scared at first I try to avoid it as much as possible. But I got to a point where I needed to start seeing people or, you know, the business would go under. So you're nervous because nobody really knows how the disease will progress, what would happen. So it's a risk that you're taking. I, I probably developed compulsive disorder, making sure everything was like wiped down and clean. Even getting into the car, you know, this is affecting the stairway, the door handles double checking, making sure that they know the phone was wiped down. You know, as soon as you get in the house, after you strip washing from head to toe, making sure that, you know, you don't have anything that could possibly be brought onto the home.

Speaker 1 (05:35):

Right. And so when you say going back to that screening tool that you say you developed, what was, what was, what was, what did that entail for you for your contractors? Because I think this is something that a learning moment for other people, they can maybe copy your screening tool or get an idea of what they can do for their own businesses. Well, it's

Speaker 2 (05:58):

One that they we use to make sure that we don't have any symptoms. So checking the temperature every morning before you actually go to see a patient and asking the question, like certain questions, when, when you're scheduling a visit if they're filing in a coughing or sneezing when was the last time they got exposed or if they've been exposed to someone who traveled in the past 14 days or who's had any symptoms in the past 14 days. And so that was basically if they answered, no, then you be like, okay, fine. All you just need to do is wear the mask and the gloves and make sure that the patient that you're seeing wears the mask as well.

Speaker 1 (06:41):

Yeah. That's the big thing is making sure everybody's wearing a mask. Have you had any problems with people not wanting to wear a mask in their home when you go into treat them?

Speaker 2 (06:51):

We've had some, but most have been very compliant with, you know, wearing the mask because they realize that they, they, they do need the service. So like some patients who have like CHF or COPT that will have problems breathing while doing the exercises, I would allow them to, you know, take it off briefly, but I will step back six feet away and make sure that, you know, they get their respiration rate on the control. Then they put it back on. We'll do the exercise.

Speaker 1 (07:22):

Yeah. That makes sense. And are you taking, obviously taking vitals, pull socks and everything else temperature when you're going into the home?

Speaker 2 (07:31):

Yes. Yeah. Yeah.

Speaker 1 (07:34):

Okay. And I love the compulsive cleaning and wiping down of things. I'm still wiping down. If I go food shopping, I wipe everything down before I bring it into my home. And I realize it's crazy. That's crazy making, but I started doing it back in March and it seems to be working. So I continue to do it. And I'm the only one in my apartment, but I still wipe down all the handles.

Speaker 2 (08:02):

I would say don't lose sight of it though.

Speaker 1 (08:07):

I am. And I love that. You're like wiping down the car. I rented two car. I rented a car twice since COVID started. And I like almost used a can of Lysol one time. Like I liked out the whole thing and then I let it air out. And this is like in a garage going to pick it up for a rental place. And then I have like, those Sani wipes, like the real hospital disinfectants. And then I wiped everything down with those. And then I got in the car.

Speaker 2 (08:36):

Well, I saw it's very difficult to find Lysol here right now. So when you do find it, it's like finding gold. I know,

Speaker 1 (08:44):

I, I found Lysol wipes. They had Lysol wipes at Walgreens and I was like I said, Lysol wipes. And she was, yes. I was like, Oh my gosh. And then last week I found Clorox wipes, but in New York you can only get one. You can't there's no,

Speaker 2 (09:04):

Yeah. Care's the same thing. Toilet paper, whites, Lysol owning one per customer. So yeah,

Speaker 1 (09:09):

One per customer. Yeah, yeah, yeah. Oh, that's yeah, I was a thank God. I, I found one can of Lysol, one can at the supermarket and it was like, there is a light shining down on it and it was like glowing, glowing in the middle of the market. I'm like, Oh but I love, I love that all the screening tools that you're using and I think this is a great example for other people who might be going to P into people's homes who may be COVID positive. And I also think it's refreshing for you to say, yeah, I was nervous.

Speaker 2 (09:47):

I'm not going, gonna lie. You know, you still get nervous because you never know, like someone could be positive. And you're going in there, but you always want to be cautious because you're like, Oh my God, I hope I didn't like allow this to be touched or you forgot to wipe this and stuff too. So

Speaker 1 (10:07):

How much time are you spending in the home? Because there is that sort of time factor to it as well, exposure time. Right.

Speaker 2 (10:16):

It depends on the severity of the condition. But anywhere from like 30 minutes to like 45 minutes.

Speaker 1 (10:25):

Yeah, yeah, yeah. I know gone, gone are the days of, you know, spending that extra time and doing all this extra, extra work there, because if they're COVID positive, then I would assume that the longer you're in an exposed area, even though you're fully covered in PPE, I guess it raises your

Speaker 2 (10:48):

Well. Yeah. And, and the, in the summer, I would say, you know, depending on the amount of work that you had to do, like if you had to do like bed mobility and transfers with the patient, you'd be sweating under that gong. So you really want to want to be in there like a full hour anyway. But they were advising to spend, you know, minimum 30 minutes and to reduce the risk of you contracting it as well, too.

Speaker 1 (11:17):

Makes sense. So, all right.

Speaker 2 (11:20):

Decondition so they really can't tolerate a full hour.

Speaker 1 (11:23):

Right? Of course, of course. Yeah. That makes, that makes good sense. So now we've talked about obtaining the proper PPE. What other, what other pivots, I guess, is the best way to talk about it? Did you feel you had to do as the business owner? What things maybe, are you doing differently now than before?

Speaker 2 (11:49):

Well, as I said, I had to start seeing most of the cases to make sure that people were still being seen and like using telehealth. We started doing that. So eventually, well sky came on board to offer telehealth visits. So we were able to document telehealth visits as well. And people are responsive to those which worked out pretty well. So with some cases we'll do a one visit in the home and then do the follow-up visit telehealth. So one visit being in a home one weekend, one telehealth, if it was a twice a week patient. So that would also reduce the risk of exposure.

Speaker 1 (12:40):

Yeah. Yeah. Excellent. Now let's talk about keeping the business afloat, right? So yes, we're seeing patients. Yes. We're helping people, but we were also running a business. We got people to pay, we got people on payroll, you gotta pay yourself, you got to keep the business afloat to help all of these patients. So what was the most challenging part of this as from the eye of the business owner? Not the clinician.

Speaker 2 (13:07):

Well, you, you get fearful that you may not have enough patients to see, to cover previous expenses. So that was one of the reasons I did apply for the PPP loan. And as I mentioned to you before I was successful in acquiring that probably like around July and that, you know, cover like eight weeks of payroll, if that but it was strictly dedicated to payroll, nothing else. So everything else I had to do was to cover the bills and stuff, because that was just for payroll. Some of the agencies that we contracted for were having difficulty maintaining reimbursing. So that became a challenge as well, too. So what does that mean? Exactly. so when we contract with agencies, they're supposed to be paying us for this, the rehab services that we provide. Some of them were late with their payments as well, but I still had to pay my contractors on time.

Speaker 1 (14:19):

Got it. Okay. Got it. Oh, that's a pickle.

Speaker 2 (14:22):

Yeah, that's the thing. So that meant like sometimes some, you know, weeks of payroll, I would have to probably go over the lesson and making sure that the contractors were paid.

Speaker 1 (14:37):

And how about having a therapist? Furloughs? Did you have any of that? Did you know, were there any people, like maybe therapists in your area who were furloughed from their jobs and coming to you, like, Hey, do you have anything for me? Can you help? What was that situation?

Speaker 2 (14:54):

Yes. So I started getting free pretty among the calls about having to pick up to do work because they were followed or laid off. We currently have one contractor was working for ATI full-time that got followed. Now she's doing the home health full-time right now as a contractor we have some that are still doing it PRN, even though they went back to like their full-time jobs. But yes, we had people looking for cases to see, just to supplement the the income. Then we had a reverse situation where some people more comfortable getting the unemployment check than seeing patients at all. So, so that you had different scenarios, but it wasn't that we were in need of therapists during that time because people were willing to work.

Speaker 1 (16:00):

Yeah. Excellent. Excellent. And from the, I guess from your perspective being owner and clinician, so you're seeing patients you're running a business where there any sort of positive surprises that came out of this time for you, something that, that maybe made you think, Hmm. Maybe I'm going to do things a little differently moving forward?

Speaker 2 (16:30):

Yes. incorporating more telehealth visits. Definitely one of them and using the screening to there it helps in a lot of situations. So it makes you aware of what you might possibly be going into when you're going into the home. And I am realizing that there is one of the biggest things for therapeutic outcome is having a good relationship with your patients. So since most people aren't locked down, a lot of the patients that we do see they live by themselves, or they may just have one or two people in the home and they may possibly be working. So when going into the home, you're probably the only person that they're getting to talk to most days. So you, I saw the need to improve on soft skills and being approachable with your patients. So that was definitely a, a big thing for me.

Speaker 1 (17:46):

And how is that manifesting itself now? So now, you know, you figure we're what April, may, June, July, August, September, October, November, December eight, nine months in, so kind of having that realization of like, boy, this is this, I may be the only person this person speaks to today, all week, perhaps. I mean, that's can be a little, that can be a big responsibility. So how do you, how do you deal with that now that you're, you know, 10 months into this pandemic and yeah. How do, how do you feel about that now?

Speaker 2 (18:29):

Well, I still feel like some sort of contact needs to be maintained. So even though some patients may have been discharged they would contact the physician via a telehealth visit and asked to, you know, can you see it again? But you still maintain contact, make sure that, you know, you dropped a line and say, Hey, just following up to see if you're okay. That sort of stuff. So they, they will remember and they'll keep coming.

Speaker 1 (18:58):

Yeah, yeah, yeah. Oh yeah. It is such a responsibility, especially for those older patients who are, who are alone most of the time. I mean, it is it's, you know, we hear more and more about the mental health effects that COVID has had on a lot of people. So and I don't think that we're immune to those effects either. I mean, how, how do you deal with the stress of, because there's gotta be an underlying stress with all of this, right. So what do you do, how do you deal with that stress?

Speaker 2 (19:38):

Well, one was warmer. I would try to at least take the weekends off to go do something or those and like being around people where you can, you know, laugh and, you know, watch movies, you know, goof up, you know, I have to think about work, those things help.

Speaker 1 (19:59):

Yeah. Just finding those outlets that you can turn it off a little bit. And I love taking the weekends off every once in a while. I have to do that. I have to remember to do that. And I'm so jealous that you're just, you just came off of a nice little vacay as well.

Speaker 2 (20:19):

Well it was needed. I probably won't be taking one on till probably sometime next year, so yeah. But it was, it was definitely needed.

Speaker 1 (20:32):

Yeah. I think I'm going to, I think I'm going to do that too. All right. So anything else, any other advice that you may have for those working in home health when it comes to going to see those during these COVID times, whether the patient has, has had, has, or has had COVID what advice would you give to our fellow home health? Pts?

Speaker 2 (21:00):

Well, I know I've been hearing quite a lot of PT saying that they didn't want to treat COVID patients and they should not be subjected to treating COVID patients, but as we get more awareness of what the diseases and we take the necessary precautions, I think we will be okay. Cause everyone deserves to get quality care. And I know some people will say this person probably got COVID because they were being reckless and stuff. I mean, you can slip up, be as cautious as possible and still step up and get COVID. That doesn't mean you should be denying someone to receive that treatment just to make sure that you're protected when you do go in. Because we're gonna see a huge wave of COVID cases coming in the next few months and with elective surgeries being stopped and everything like that, that's going to be our only client population and to prevent the fools and the layoffs from happening again, I would just advise them, you know, do the screenings, make sure you get your PP and we'll see the patients. It's it's not as bad as, you know, they make it seem.

Speaker 1 (22:16):

Yeah. Excellent advice. Excellent advice. And now we're going to really switch gears here. Okay. So this is going to be like like a, a three 60 turnaround, but before we went, before we went on the air, Monique and I were talking about just some things that, that you wanted to talk about and recent happenings in the PT world, and you brought up sort of a list of influential PTs that was compiled by our lovely friend Ellie summers. So go ahead and talk to me about why that list was meaningful to you and why you kind of wanted to talk about it.

Speaker 2 (23:03):

Well, you know, for the past few years I've been noticing like people send us stuff to vote for like top influencers and, and physical therapy and stuff. Do you tend to see the same names like yesteryear? But you've never seen one that just strictly focuses on a woman in physical therapy. And I see a lot of women doing great things in the physical therapy world, but because they do not have as many followers on like Twitter or Instagram, they don't get the recognition that they deserve. For example, Dr. Lisa van who's I think she's doing incredible, incredible work with the Ujima Institute. I actually consider her a mentor of mine. She, she calms me down when I try to get fired. What's it and stuff,

Speaker 1 (24:03):

Not you. I don't believe it.

Speaker 2 (24:06):

So I appreciate her for that. So for Ellie to actually construct this list and, you know, I've, I've been observing her, her tweets on her posts for a while, and I see that she questions. Why is it that, you know, women do not get the recognition in a profession that is supposed to be female dominated. So for her to do the side, you know, it was, it was really thoughtful and needed.

Speaker 1 (24:40):

Yeah. Yeah. And you know, her shirt talk that she gave at the women in PT summit couple of years ago, I think it was the second year we did, it was so powerful. Like everybody was crying like in tears, she's crying, everyone else is crying. And that was the year Sharon Dunn was our keynote speaker. She got everybody crying. It was like everybody was crying the whole time, but crying in like in, in not, not in a sad way, but crying in a way because the stories were so powerful and really hit home and we just wanted to lift her up and support her. But yeah, and you know, the thing that I love the most about Ellie's list is she put herself on it. Yes. How many times have you made a list and put yourself on it? I can answer me. Never, never, never in a million years, have I made a list of like influential people to put myself on it? Never know. So I saw that and I was like, good for you. Good for you.

Speaker 2 (25:44):

Because you know, sometimes you, you and, and doing and doing stuff, you, you have to be kind to yourself first, love yourself first. And, and her doing that, I, I believe she's demonstrating that that is something that's that needs to be done. A lot of us, we don't give ourselves enough praise for the stuff that we do.

Speaker 1 (26:05):

Absolutely. Absolutely. It's sort of, it's a nice lead by example moment from her. So I really appreciated that list and, and yes, Dr. Vanhoose is like a queen. She's amazing. And every time, every time I hear her speak or, or I get the chance to talk with her through the Ujima Institute to me, it's amazing how someone can have the calm that she has and the power she has at the same time. Right. I mean, I don't have that. I don't, I even know how to do that, but she just, like, she's just gets it, you know? I don't know if that's a gift. It's a gift. Yeah, totally, totally. Okay. So as we wrap things up here, I'm going to ask you the one question that I ask everyone, and that is knowing where you are now in your life and in your career. What advice would you give to your younger self you're? You're that wide-eyed fresh face PT, just out of PT school.

Speaker 2 (27:16):

You can't save everybody. You can't save everybody nice. When you, when you just graduate as a therapist, you think you can save everyone a change, a wall. It takes time.

Speaker 1 (27:33):

Yeah. Oh, excellent answer. I don't think I've heard that one yet, but I think, I think it's true that having, and it's not, that's not a defeatist. That's not a defeatist thinking at all. Yeah.

Speaker 2 (27:54):

I think this year have thing come to more deaths as a therapist with patients than I have probably in the 12 years that I've been practicing. I'm sorry. Yeah, because you know, you do patients that you get attached to, you know, you have this person passed away and stuff like that. So it's good while it lasts, but to protect yourself mentally and emotionally, you just realize that you can save everybody. Yeah. I think this fund DEMEC is teaching us that too.

Speaker 1 (28:35):

Yeah. A hundred percent. Thank you for that. And now money, where can people find you website? Social media handles

Speaker 2 (28:47):

Social media handles are the same on Twitter and Instagram at physio for U F Y, Z I O. Number for you Facebook slash physio for you as well. And www physio for you.org is the website

Speaker 1 (29:01):

Awesome. Very easy. And just so everyone knows, I'll have links to all of those in the show notes under this episode at podcast dot healthy, wealthy, smart.com. So if you want to learn more about Monique, about her business I suggest you follow her on Instagram and Twitter, cause there's always great conversations and posts going on there initiated by Monique on anything from home health to DEI, to words of wisdom. So definitely give her a follow. So Monique, thank you so much for coming on. Let's see. Last time was a really long time. I can't believe it, it seems like 10 years ago, but I think it was really like three, three years ago. I think it was DSM like three years ago though. It seems like forever ago. So thank you for coming on again. I really appreciate it.

Speaker 2 (29:56):

You're welcome. And thank you for having me. Okay. Absolutely. And everyone needs to be safe. Okay. Yeah.

Speaker 1 (30:01):

Yes, you too. And everyone else, thank you so much for listening. Have a great couple of days and stay healthy, wealthy and smart.