Pets At Work

While we recognise that pets can have a large ecological footprint and as a society we should probably be looking at reducing the number of pets we have, particularly large ones, there are benefits to having pets we are only just beginning to truly understand.

Pets are being used as psychiatric service dogs to reduce anxiety and be alert to triggers of psychiatric situations to help calm an owner.  ‘Court dogs’ are starting to be used to help witnesses remain calm when giving stressful evidence. Dogs, (and other pets), in other words can be beneficial to our emotional wellbeing, helping to keep us calm in stressful situations.

Stress is a major problem in the workplace. According to the National Health and Safety Commission work related stress accounts for long stretches of absenteeism in Australia and over $133.9 million is being paid in workplace stress claims in a single year. Workplaces are beginning to recognise that having pets at work can reduce these levels of stress. So, while the ecological footprint of pets may be high, their social and health benefits within the workplace alone, may be good reason to make a compromise.

Beneficial evidence is beginning to emerge on how pets can impact wellbeing at work. They remind employees to pause, take a break through short walks and a little playtime providing small distractions to allow mental breaks and reduce stress. Some studies have shown that not only do pets have calming effects but can also induce more cordial and productive staff.

With these types of benefits in mind offices are designing their interiors (and exteriors) to be pet friendly and encourage these ‘fur kids’ to work. Bark & Co. for example have a dog treehouse in their NYC offices, as a great place for pets (and humans alike) to take a break. The US game developer Zynga have provided an interior play space for their pooches complete with fake grass and Mars Petcare’s new HQ in Tennessee includes “…a WiFi-enabled dog park, indoor dog play areas with full-time “pet sitters,” automated pet water bowls, furniture with pet-friendly fabric, and more.

Back in Australia, it has been the creative and new industries such as IT, media, fashion, advertising and design who are the early adopters to pets at work. However commercial landlords are starting to get used to the idea of allowing pets into buildings and employers are also beginning to see the benefits.

It should however be noted that not everyone is comfortable with animals. Allergies, emotional fears and anxieties can be reasons not to have pets at work for some businesses.

However, while we integrate strategies of biophilia, yoga rooms and 24 hour ‘restaurants’ in our workplaces to improve the social and wellbeing aspects of sustainability, it may also be worth considering our furry friends.

K-9s For Warriors

Army veteran and Lexington resident, Tanesha G. recently returned home with her new service dog, Spoonie. Spoonie is trained to help Tanesha manage symptoms of Post-Traumatic Stress Disorder that resulted from her military service.

On why she applied to K9s For Warriors, Tanesha said, “I saw a graduate and asked about the program. I thought it would be a great way to get me back into society and out of the house. I wanted a more independent life, one that allowed me to spend more quality time with my children, doing different activities and just enjoying life again.”

Upon arrival to K9s For Warriors, Tanesha was paired with Spoonie, a rescue dog from Kentucky Animal Control, who had already completed formal service canine training in the months prior. In the COVID-19 environment, the training program has been modified to comply with CDC guidelines, implementing new sanitizing and PPE protocols for all staff and Warriors. Along with the other members of their class, Tanesha and Spoonie trained in public every day wearing PPE, received instruction on matters of Service Dog access, dog health care and more, and established a bond that would facilitate Tanesha’s healing from military-related trauma.

K9s For Warriors CEO, Rory Diamond, explains the program’s mission:

“The rate of veteran suicide in our country is unacceptable. These are the people who volunteered their lives so that Americans can enjoy their everyday independence. But PTSD steals their independence, and worst of all, suicide steals their lives. K9s For Warriors is here to give both back to them through a new, loyal battle buddy – a Service Dog.”

K9s For Warriors is a national nonprofit that procures eligible shelter dogs and trains them to be Service Dogs to mitigate symptoms of PTSD, Traumatic Brain Injury, and/or Military Sexual Trauma for servicemembers and veterans. It operates from two facilities in North Florida that procure and train the canines, pair them with an incoming veteran, then train the veteran and canine pair together. After three weeks with his or her new Service Dog, the veteran has learned how to reintegrate into society and, most importantly, reduce suicidal ideation.

Therapy Animals

Victoria’s presence encourages elementary school pupils to read aloud in front of others.

Her companionship elicits smiles and nuzzling from nursing home residents. And her disposition, enhanced by a year’s worth of certification training, is to ignore sudden noises, her ears being tugged and nearby animals.

The 7.4-pound, nearly 1-foot-tall Maltese will accompany her handler to Butler County Community College’s Lawrence Crossing location in New Castle this month for a noncredit course that introduces students to therapy animals.

“Everything You Always Wanted to Know About Therapy Animals” will be held from 6 p.m. to 9 p.m. Sept. 8 at BC3 @ Lawrence Crossing, 2849 W. State St. It costs $29.

The course is one of nearly 40 to be offered in Lawrence and Mercer counties this fall by BC3’s Lifelong Learning, whose classes can help students enrich their personal lives by expanding their knowledge and skills, said Paul Lucas, director of BC3’s Lifelong Learning.

Victoria, likely the product of a puppy mill in Michigan, adopted by Allegheny County attorney Kathleen Vello in 2008 and certified as a therapy animal in 2013, will assist Vello’s presentation about the differences in certification processes and roles of service animals, emotional support animals, and therapy animals such as Victoria.

“A lot of people think, ‘My goodness. My dog would be so good at that,’” said Vello, Victoria’s handler. “And they very well might be correct. But it is important for people to understand the different types of working animals. People will learn in the class that an innate positive disposition is a quality that the therapy animal absolutely has to have.”

“She just makes them light up” Victoria’s innate positive disposition is “pleasant, always gentle, energetic and obedient,” Vello said.

After becoming certified as a therapy animal by Animal Friends, Pittsburgh, Victoria has helped elementary school pupils to read aloud in front of others, Vello said, adding that “There are a lot of studies that show that animals lower people’s anxiety and allow them to perform better in general.”

Victoria also holds the attention of nursing home residents, and is sometimes held herself, Vello said.

“I’ve had caregivers tell me before that the resident doesn’t smile often,” Vello said. “But when they see Victoria, she just makes them light up.”

Social distancing measures will be enforced to maintain a safe environment at all BC3 facilities.

Additionally, face coverings, such as a face mask or face shield, must be worn in shared spaces inside BC3 facilities and must cover the nose and mouth. Face masks are preferred, but face shields are acceptable.

Therapy Dog, Toby

Ozzie’s K-9 Ceremony

The Delaware County Sheriff’s Office paid tribute to their late K-9 Osman Steele (“Ozzie”) with a ceremony Monday at the headquarters in Delhi, NY. A plaque was unveiled to remember K-9 Ozzie and all fallen K-9 officers. Ozzie died in April due to a number of health issues. Sheriff Craig DuMond says “the bond between a K9 and their handler is eternal and a trust between them in a nameless language”.

Ozzie’s handler was Major John Demeo, who described his relationship and partnership with Ozzie as “an inspiration to me as well as many others in Delaware County”.

All K9s are highly trained special dogs who are required to not only track down suspects but to regularly visit with children in schools and must stay calm while kids pet them and possibly pull on their ears, much like a therapy dog. Switching back and forth between those two “modes” of behavior is difficult and makes a K9 special. K9 Eli (pictured below) is currently in training with Deputy Karcher.

Battle For Little Girl’s Service Dog

The federal Department of Justice and the Gates Chili Central School District have settled litigation over a student’s use of a service dog while on campus — a fight that began in 2012 and prompted a federal lawsuit against the school district in 2015.

In that lawsuit, federal Department of Justice officials argued that the school district had violated the Americans with Disabilities Act, or ADA, by requiring that the student’s family provide a handler for the dog. School officials did allow the dog on campus, but contended that their responsibilities ended there.

The long-fought case appeared to be headed for trial this year, before a January hearing before U.S. District Judge Charles Siragusa, at which each side staked out its positions. At that hearing, Siragusa urged the two sides to work toward a resolution.

“If we can’t resolve this, we’re ordering a trial,” Siragusa said, according to transcripts. “I think if you both step back — and I don’t mean to put words in your mouth — but I think you both feel this is a case that can be resolved in a fair fashion.”

In 2012, Devyn Pereira, then a kindergarten student, attended school with her guide dog Hannah, a white Bouvier des Flandres that has since died. Her family maintained that Devyn, a student with special needs, could handle Hannah; school officials said she could not do so all day.

Devyn has Angelman syndrome, a neuro-genetic disorder that causes developmental delay, lack of speech, seizures and problems with walking and balance. Hannah helped her with balance — standing and sitting —  and also could detect life-threatening seizures.

Court records show that school officials argued that Devyn could not control the dog at all times, while her family and Justice Department lawyers said she could. Records show that Hannah was particularly attuned to Devyn, often recognizing immediately when she planned to stand or move from her seat.

Hannah sometimes prepared for class to end moments before it did so, records show.

“She was a very well-trained service dog and a unique dog,” Department of Justice attorney Megan Elizabeth Schuller said at a hearing.

Under the settlement, the school district agreed to provide some assistance in cases with a service dog, such as helping with water and tethering and untethering. The District also is paying $42,000 to the family for out-of-pocket expenses and emotional distress payments.

“The ADA guarantees individuals with disabilities equal access and equal opportunity in all areas of community life, including in schools,” James P. Kennedy, Jr., U.S. Attorney for the Western District of New York, said in a statement. “This agreement is an important step forward in ensuring that students with disabilities can fully participate at school and in all educational programs.”

In a statement Thursday, the Gates Chili Central School District said: “The resolution of the case confirms the district’s position that there was no discrimination. The settlement agreement between the district and the Department of Justice reaffirms that the district is not, and will not be, responsible for the care or supervision of a service animal.”

Devyn’s mother, Heather Pereira, and Devyn have moved to the Hilton Central School District. In a 2019 Democrat and Chronicle story, Heather Pereira said Hilton school officials have been accommodating and helped her daughter “reach goals we didn’t know were possible before now.”

The Democrat and Chroniclereported in the story that, at that time, the Gates Chili Central School District’s legal costs had topped $600,000. The family initially sought a $25,000 reimbursement in the lawsuit.

“Invoices obtained via a Freedom of Information Law request show the district’s lawyers, largely with Harris Beach PLLC in Rochester, billed at least $609,000 in connection with the matter between October 2013 and December 2018,” the Democrat and Chronicle reported. “About 85 percent of that was paid by the district’s insurer, but out-of-pocket costs for Gates Chili taxpayers so far exceed $90,000 in a legal war sparked by a request from the child’s parent for a $25,000 reimbursement.”Court records show that there were earlier possible proposed resolutions from attorneys that did not meet the approval of the School Board.

Dog Day Everyday

It’s normal for pet parents to be obsessed with their pet babies. Right from choosing the perfect leash to the apt food for their furball, a pet parent goes the extra mile to ensure their pup’s happiness! A lot of pet parents also want the skills extraordinaire of their pooches to be used for the right profession!

“I think it’s very important to keep your pet baby physically and mentally stimulated. This helps in their overall happiness and channelises their energy positively. There are so many professions a pup can pursue,” says Arnab Haldar, a Delhi-based pet parent and pet foster dad. Many pets are social media stars, and have verified Instagram handles with millions of followers. Haldar adds, “I’m training my pet to become one such Instagram star. I’ve been teaching him simple and basic tricks like shaking hands, rolling over, and even the most trending trick on social media, of fitting his nose into my curled up fingers!” Those pet parents who want to give back to the society are also choosing to train their dogs become therapy masters. There are NGOs that provide such training, and even certification for the same. “We have all types of dogs who have undergone training, and now they are well experienced therapy dogs,” shares Minal Kavishwar, from the NGO Animal Angels Therapy Foundation. Elucidating with an example, she adds, “One such dog is Lucky, an indie dog who was rescued from the streets and nurtured by the owners, and then evaluated and trained to be a therapy dog. Lucky works with children who have multiple disabilities, as part of our Animal Therapy program, at Bal Kalyan Sanstha in Pune. Another example is dog Uno, who was abandoned and rehomed twice when just four-month-old; before being adopted by one of our Mumbai-based team members. Now, at the age of three, he is an experienced therapy dog, and works with people with autism.” Some pet parents have even groomed their pups to become show dogs. Niti Kaur, a Delhi-based pet parent, says, “My Shih Tzu has a full coat and I brush it three times a day to maintain it. She is also on a special diet, and has a timetable to do various exercises such as running through hoops during the day. When it’s hot, she does it indoors. We have together participated in various dog shows that are conducted yearly.” Another noble profession that pet parents can choose for their buddies is ‘emotional care giver’ for scared animals. “Puppies can also be trained to give emotional comfort and support to other dogs who have been rescued or are being fostered,” says Shweta Gupta, a Gurugram-based animal trainer. Gupta adds, “One of my clients rescues animals and fosters them. She has a Golden Retriever who comforts the newly rescued pets, and makes them feel calmer with his presence. He has been trained to be patient and happy.” For city folks who love to travel and vlog, a puppy can totally brighten up your videos by being your partner in travel. “I’m always on the move and really want my puppy to be able to accompany me wherever I go. I’ve been watching how some pet parents take their pets along with them wherever they go, and document their journeys throughout. I’m planning to do that too as soon as the pandemic ends! I’ll create my dog’s own YouTube channel,” says Yash Babbar, a Gurugram resident.

Pets Help Humans With Mental Health

Animal lovers already know how good it feels to interact with their pets. But research has shown that this positive effect can also be applied in a therapeutic setting.

Leveraging the power of pets is becoming a vital tool in the treatment of a variety of medical conditions and disorders — particularly those associated with mental health. Here are a few of the different types of pet therapy making their mark and how they can successfully help treat a wide range of conditions.

Pet therapy is a guided interaction between a specially trained animal and an individual or group, facilitated by the animal’s handler. Also known as animal-assisted therapy, pet therapy interactions help improve patients’ mental, social, emotional, and physical functions.

Therapy can take place in a wide range of settings including hospitals, care homes, and treatment centers and can involve different activities such as walking, looking after, and grooming the therapy animal.

Just like any other form of treatment, doctors and handlers decide the specific components of the pet-therapy program on a case-by-case basis so they address the particular needs of each patient.

Trained animals benefit patients suffering with emotional and behavioral disorders, depression, autism, substance abuse, and dementia among other conditions.

Animals accept us as we are — they don’t judge and they don’t threaten — so patients can wholeheartedly interact with them safe in the knowledge that there’s no hidden agenda.

Individuals with emotionally based disorders in particular may find it difficult to open up and trust another human being, but discover this process is much easier with a therapy animal.

Frequently reported benefits from pet-therapy programs include a reduction in stress, a boost in self-esteem, improved mood, and better communication skills.

Let’s look in a bit more detail at three health and wellness areas where therapy pet therapy can make a real difference — mental health, dementia, and substance abuse.

Doctors and handlers now treat a wide range of mental health conditions through pet-therapy programs. For instance, interactions with animals can offer benefits to patients suffering from post-traumatic stress disorder, autism, and challenging psychiatric disorders.

Vulnerable prison inmates have also benefited from animal-therapy programs. Animal therapy is also used extensively to treat depression. For example, petting an animal can cause the release of endorphins (feel-good neurotransmitters) which can have an extremely positive impact in patients dealing with depressive disorders. More detailed and developed interventions often rely on the premise that, by focusing on the animal and their needs, the patient’s attention drifts away from their own problems. Patients also have an opportunity to develop their nurturing skills and a sense of empathy with the animal.

Dogs and other animals have taken part in visiting programs to assisted living centers for elderly people for many years. Although this type of interaction can certainly lift the spirits of those living in such centers, Alzheimer’s experts felt patients could gain more through structured animal-assisted intervention programs. One pilot program in Germany involved six months of structured dog visits to 17 nursing home residents with mild to severe dementia. The results showed this type of activity may improve social behaviors in elderly patients with dementia.

Participants who took part in the animal-assisted therapy sessions demonstrated improved verbal communication function and greater attentiveness. However, patients who took part in similar group activities without therapy dogs enjoyed fewer positive results.

A research team from the University of Nebraska Medical Center College of Nursing also reported that dementia patients they worked with exhibited fewer symptoms of “sundown syndrome” as a result of an animal-therapy program.

Sundown syndrome is a distressing condition associated with dementia which happens in the early evening period and involves behaviors such as restlessness, confusion, wandering, hitting and kicking. Having therapy dogs present during the early evening period appeared to distract the patients and also seemed to relax them. Therapy animals have also successfully participated in treatment programs for individuals with substance abuse issues. The presence of an animal can, in itself, help calm the patient down and prepare them to face their demons.

Addicts sometimes focus almost exclusively on themselves. Engaging with an animal can encourage them to think about the needs of others. Delivered in a group setting, addicts are also more likely to interact socially with others if animals are involved.

Doctors observing how the addict deals with the animal also get a greater insight into the patient’s self-esteem issues, helping them identify specific coping mechanisms and healthier new behaviors.

Often integrated into counseling programs, animal therapy can help addicts learn more about teamwork, communication, trust, and self-expression. Animals can also introduce some fun into sessions which can help defuse tension during challenging discussions.

A Service Dog’s Journey

When the phrase service dogs comes to mind, many people immediately think of a dog that is serving someone with a visible disability. Most people think of military veterans, individuals who suffer mental disabilities, or individuals who have Post Traumatic Stress Disorder. The fact is, there are many people who have service dogs who do not have a “well known” disability or even a disability that is apparent to the public.

Service dogs are not only for individuals who are suffering in one form, but they can also be for individuals who feel they need a service dog for a variety of reasons. One such person who owns and trained her own service dog is Patty Grotberg. Grotberg has been training dogs since the age of ten when she found she enjoyed the process. “I became interested in Service Dogs several years ago, when it became apparent that I would benefit from having one,” said Grotberg. “Service Dogs are expensive. It is common to pay twenty-thousand dollars and up for a fully trained Service Dog. This was not in my budget, so I looked at alternatives and became involved with an owner-train program. This is where a dog and handler go to classes once a week with a professional Service Dog Trainer. They learn new skills each week and practice daily homework. These classes can last one to two years as the training of a Service Dog is extensive and time consuming. This more economical approach was a good fit for me since I have a background in training dogs and was willing to put in the work.”

Grotberg’s journey has led her to interact with other people who own service dogs and gain extensive knowledge about the service dog world.

“I have had my current Service Dog for nearly a year. Bailey is a 1.5-year-old Labradoodle,” said Grotberg. “He is still in training. This stage is known as SDiT, Service Dog in Training. In NC, SDiT have the same public access rights as Service Dogs. Puppy training, Obedience Training, Public Access Training, how to behave anywhere and everywhere, from the mall to a restaurant, and Task Training, the actual work the dog will perform to mitigate the disability of handler, are all part of the dog becoming a service dog.”

For individuals interested in service dog training, or a service dog of their own, the process is extensive and requires an ample amount of time and training. There are several tests that are used for the Service Dog assessment. The CGC (Canine Good Citizen) and the PAT Test (Public Access Test) are two of the tests that the training dog must pass to become a certified service dog.

“Owning a Service Dog is a huge privilege, and I am so thankful for mine, because these highly trained dogs mitigate individual disabilities and can greatly improve quality of life. They are also a lot of work,” stated Grotberg. “A Service Dog must be clean and well groomed at all times, training must be ongoing to keep behavioral standards high, the dog must be given opportunities to relieve itself before and after each outing and often during as well. For example, when I go clothing shopping, I often leave the store for a potty break for my dog and then head back in again. I must consider the needs of my dog at all times and must train him to wear unusual equipment for a dog, such as protective boots to shield his feet from summer’s hot pavement. I do not believe that most people would keep a service dog long term unless the benefits outweigh the negatives for them. They are just too much work.”

One thing that should be known to the general public is that there are many different types of support animals. Emotional Support Animals, Therapy Animals, and Service Dogs are all different and they all play a different role with their owner. Emotional Support Animals require no special training, only have rights through HUD, and they have no special Public Access rights. Therapy Dogs have special training to visit places like hospitals, seniors homes and prisons. They typically must be tested and licensed for insurance purposes. Service Dogs perform specific task work to mitigate disability for one person. They are highly trained and have full public access rights. They are legally considered medical equipment.

“There is a great deal of public confusion regarding SD in the USA. Many people are confused between Emotional Support Animals, Therapy Dogs, and Service Dogs,” said Grotberg. “This confusion can cause a great deal of difficulty for service dog users because the public and businesses may not be aware of their legal access rights. I have experienced such issues. Generally, the only public places service dogs may not legally access are sterile environments, such as hospital operating rooms. Service Dogs are considered required medical equipment under the law. Basically, anywhere a disabled person would be allowed to bring or use their wheelchair, a service dog would also be allowed.” “Businesses are, however, protected against abuse of their property by poorly behaving service dog teams. According to ADA regulations, they may ask a SD team to leave the premises if the dog is defecating on their property or if the dogs’ behavior is unsafe or disruptive (i.e. barking, lunging, jumping).” Along with the public misunderstanding the different types of service animals, there is also a proper etiquette that is construed when the public sees a service dog. If a service dog appears without his or her owner, one should immediately follow the dog. The service dog has been trained to find the closest help possible if they are unable to perform the task needed. Do not try to corral the dog or catch the dog, simply follow them to the location of their owner.

“The Public Access issue is probably the biggest concern for the service dog community. We are often given a hard time or even denied access illegally, when our dogs are behaving exactly right because the public is unaware of ADA regulations,” stated Grotberg. “General public response is also very challenging at times. Proper etiquette for the public is; no talking, no touching, and no looking at Service Dogs. The dogs are working and need to concentrate. Interact with Service Dog users just as if their dog was not there. Do not ask why a person has a Service Dog. You are unintentionally asking them for their personal health information.” “It is very common to have people want to talk to Service Dogs, bark at them, call to them, try to pat them, follow them around stores, and ask the handlers about their personal health information,” stated Grotberg. “I personally try to be patient, friendly and educational with people who are interested, but it is really difficult to be harassed by people following us and barking or grabbing at my dog as we walk by. My favorite responses are from the people who ignore us, address only me, or just smile. I really appreciate that.”

Puppy Therapy

It was six months ago when Florida’s first COVID-19 patient was admitted to Doctors Hospital of Sarasota.

Janell Albers, a nurse at the hospital’s intensive care unit, had just returned to work from maternity leave.

“For me, it was a whole new meaning of scary because you have the unknown, and then I have a baby at home, and I also have a toddler,” she said.

Now, as the number of COVID-19 cases across the state begin to slow down, so have virus-related hospitalizations at Doctors Hospital. A unit that once occupied four halls on the fifth floor of the hospital now only takes up less than one.

“We’re kind of getting used to it,” said ICU nurse Whitney Olund. “(Coronavirus) is kind of like an everyday thing, like any other thing that we deal with.”

On Tuesday, Albers and Olund were among other health care workers at the hospital who got some much-needed “puppy therapy” from six of Southeastern Guide Dogs’ “ambassador dogs.”

The Palmetto-based nonprofit breeds, raises and trains Labrador retrievers for those with visual impairments or PTSD.

Cathy Mithaug, who has volunteered with the organization for eight years, said the dogs needed the affection just as much as the health care workers did. The ambassador dogs typically make visits to hospitals and nursing homes – places that have limited visitations in recent months to help mitigate the spread of COVID-19. “Just feeling the dog is very calming for a lot of people,” Mithaug said.

Bob Meade, CEO of Doctors Hospital, serves as vice chairman on the board of directors for Southeastern Guide Dogs. He said hospital staff have taken extra care to check in and show appreciation for employees, and he was “thrilled” with how Tuesday’s event came together.

“Today has already had an enormous impact,” he said. “I’ve talked to people I’ve passed in the hallway that have already been out here, and they just absolutely loved it. It’s a highlight of their day – probably their week or month.” Meade added that while the state’s coronavirus cases are encouraging, he is still concerned about the potential for another spike in the fall, as cold and flu season returns and students head back to school. He stressed the importance of wearing face masks and following other CDC guidelines regarding personal hygiene.

“It’s hard working in the hospital all day – especially people in the COVID unit – and then you go out into the community, and you see people that don’t really take it seriously,” he said. “If you’ve ever seen anyone on a ventilator, you’d take it seriously.”

Respiratory therapist JoAnn Inners was among those tasked with caring for the hospital’s first coronavirus patient. “We’ve learned a lot about how to take care of these patients over the last six months,” she said.

As soon as Inners gets home from work, she throws her scrubs in the washing machine and heads to the shower. What was already a habit for her has only “ramped up” since the coronavirus outbreak began.

Added Allison Mills, another respiratory therapist: “Nobody comes near me when I get home at all.”

But the shared sense of purpose and appreciation make the pressures of the job worth it, said respiratory therapist Stephanie Johns.

“I think things like this are amazing,” she said. “They have done a lot of things for us, like lunches and snacks throughout the day, just to keep everybody upbeat and motivated.”’

Mills added that the appreciation doesn’t end when she walks through the hospital doors at the end of her shift, either.

People out in public “notice that you’re in health care, and you get a lot of thank you’s and a lot of appreciation,” she said. “And that helps. That really does help.”