Bruce Kassover: Welcome to Life Without Leaks, a podcast by the National Association for Continence. NAFC is America's leading advocate for people with bladder and bowel conditions, with resources, connections to doctors, and a welcoming community of patients, physicians, and caregivers, all available at NAFC.org.
Welcome back to another episode of Life Without Leaks I'm your host, Bruce Kassvoer, and joining us again today as always is Steve Gregg, the executive director for the National Association for Continence. Welcome, Steve!
Steve Gregg: Hi, Bruce. Great to be here today.
Bruce Kassover: Today, we're talking with Tina Harris. She's the Vice President of Clinical Affairs for TenderHeart, which is a company that helps put people with incontinence on the right treatment path. They're a trusted partner to NAFC because of the outstanding customer service they deliver, and their approach to patient care is really unique. They're not like your typical product provider, and I have a feeling this is going to be something that our listeners find really intriguing. So welcome, Tina.
Tina Harris: Thank you so much, Bruce and Steve, for having me. Glad to be here.
Bruce Kassover: Before we get going and start talking about TenderHeart, I'm wondering if you could tell us a little bit about yourself. How did you get to the point where you're speaking with us today?
Tina Harris: Sure. I appreciate that question. So I am a registered nurse and have been for over 20 years. I stopped counting after 20 years, actually, Bruce. So I've worked in all facets of healthcare. I started at the bedside, like most nurses start, ended up in emergency and trauma care, and then eventually started branching out into educating nurses and starting to look more into patient advocacy and the quality of care that we're delivering.
I have worked in several different fields as an educator also worked as a, under management as clinical operations. My longest tenure was working for a managed care organization where I oversaw their health services delivery and their coordination. And one of the things that I saw working there, especially being in the home with the patients, is that we saw a lot of incontinence issues. There were patients who had just stacks and stacks of incontinence products lined along the wall in their bedrooms or in their living rooms, they weren't sure how to use them.
They were having skin breakdown from things like that. And so it prompted, you know, me, one, to begin to look a more about the quality of care that we're delivering for patients and making sure that that patient education piece, which is so important, is presented to patients along with making sure that they understand how to manage their incontinence.
Once I left that, that healthcare organization, I joined TenderHeart in 2021 to help oversee their clinical programs. We are a value-based company, which we'll get into that here shortly. But I started getting into that field by joining TenderHeart, joined the Wound, Ostomy and Incontinence Association and started looking a little bit more into how do we provide better care for patients and their caregivers.
Bruce Kassover: Yeah, it's interesting how you talked about being surprised by how prevalent incontinence really is. And I think that that's probably the case for a lot of people out there. You know, I mean, people like us who, who deal with this as an issue you routinely, you know, it's obvious, but for people on the outside, it's really startling when they realize just how common it is.
I mean, you were saying that you just wind up seeing it everywhere across your practice of nursing, didn't you?
Tina Harris: Yeah, absolutely.
Bruce Kassover: Yeah, so now you got into treating patients who are dealing with these issues and you've come to TenderHeart. Tell us a little bit about what TenderHeart actually is.
Tina Harris: So TenderHeart is a company who, we've been around for over 20 years. We're based out of Austin, Texas. That's where we started. We've got multiple locations around the country. But we are a durable medical supply company, but I have to say, but because there's a difference there between, most people have an idea of what durable medical supply companies do, we specialize specifically in value-based incontinence services.
So we assist patients, their caregivers, managed care organizations to help those living with incontinence manage their incontinence better. So we provide personalized incontinence coaching to ensure that the patients are receiving, one, high quality incontinence products that meet their needs and, two, that they understand how to use the product and they understand how to manage their incontinence.
So our, one of our missions or our mission is to deliver superior incontinence support to the broadest amount of people that we can reach, and also we want to make sure that those folks are living happier, confident, and more independent lives.
Bruce Kassover: Yeah, I think that word “support” is what really came through. When I was taking a look at the website and seeing all of the information you have and the way that you present yourself to consumers and to patients really does come across as as much of a support company as a product provider – in fact, more of a support company than a product provider. It seems to really be what distinguishes you from almost everybody out there that I'm familiar with.
Tina Harris: Absolutely, yes. In the typical durable medical supply space, a lot of medical supplies, specifically incontinence, is driven by volume, right? It's how much can you get out to the patient. Well, you don't really know how much the patient needs unless you talk to them. And in the typical DME fee-for-service type of space, you get an order from the physician that, you read the order, verify that it's correct, and you send out what the physician has asked you to send out, right? But you never make contact with the patient. You never assess their needs and what's actually going on in the home to make sure that you're delivering exactly what it is that they need. And so that is what makes us different. You're exactly right, Bruce, is that we actually reach out to those patients and we do those individualized care plans so that we want to know what's happening in your home, what's happening about your incontinence care that's concerning you so that we can make sure that we educate you if there's an area there of need, and then also that we get you the product so that you can live the life that you're meant to live.
Bruce Kassover: Now, it sounds like what you're describing might be a little bit different than what a lot of our audiences used to. I think, I would imagine, that a great many of them, their idea of getting products to treat their symptoms involves going to the pharmacy or going to the supermarket, picking up something off the shelf and just, you know, hoping that they picked the right product and if they made a mistake, you know, trying to, to just sort-of keep on going until and keep on purchasing new products until they find something that works. It sounds like you are not just dealing with the patient, but also dealing with the physician as well. So how is this different for somebody who's just used to, you know, going down to the corner and getting it at the store?
Tina Harris: Right, so what the public may or may not know is that, depending on what type of health insurance you have, incontinence care is covered under a Medicaid plan. And so anyone who fits kind of a Medicaid eligibility has the opportunity to get additional support through their physician as well as through their insurance company to provide, you know, financial support on the medical supplies. So when you're looking at someone who's self pay, which we also deal with self pay as well, those individuals may go to the physician and they may or may not have a conversation about their incontinence with the physician.
In most cases, patients who are going to grab something off of the shelf at a retail store, they may not have any idea or have spoken to a doctor or family member for that matter about their incontinence. And so they're out in the retail shops, basically, you know, kind of trying to find what products work, right?
And so what we can provide for them is we can give them that support to help them understand more about their incontinence. What's feeding, what's driving that incontinence, right? What type of products are you currently using? Are those products working and are there products that we can potentially recommend to you that would help?
We do get the physician involved because if there isn't a medical diagnosis, so say the patient hasn't spoken to the physician, we will, you know, ask them, you know, well, who is your physician? Would you mind us reaching out to at least let them know that you're having, you know, issues in regards to urinary leakage. And we also recommend that the patient follow back with their provider to have that conversation.
Bruce Kassover: This is really interesting. So maybe you could help make it really clear for people like me who are easily confused and anybody out there who's listening who might want a little bit of a better understanding how the process works.
So let's say that I happen to be a patient who's on Medicaid, what do I do, exactly? I go to the doctor I talk about my symptoms and then from there, what happens so that I could take advantage of your services?
Tina Harris: Yeah, thanks, Bruce, for asking that. So there are three ways that patients can get in contact with TenderHeart. One of them is they can call us directly, and so I will provide our 1-800 number and several contact pathways at the end of this. They can call us directly and we can get their orders started there.
The second part is they can have a discussion with their provider, which is something that's really important to do because providers drive diagnosis for patients. And so if a patient is in cotton, a doctor needs to have identified that. But the doctor can also make a referral into TenderHeart on behalf of the patient.
The third way is that most Medicaid plans offer a case manager or a service coordinator that takes the responsibility of making sure that the patient gets what it is that they need. So if a patient does have a service coordinator or a case manager or someone in the health plan or insurance agency that is providing care for them, they can also ask that person to submit a referral to us.And then in return, we will reach out to the patient, take the necessary information and get their order started.
Bruce Kassover: Now let’s say that I'm a patient and I've done this, once I've reached out to you, is there any paperwork or anything that's involved on my end to help move the process forward?
Tina Harris: Not from the patient. No, the only thing we ask from the patient is just information, like normal, what we call demographic information. So the age of the patient, we want to know if they're currently, you know, receiving products. We want to know their address, little, normal demographic information. And then we also want to know who their actual provider is. But after that, that is the extent of what the patient responsibility is. After that, we start talking with the physician, collaborating with them to make sure that we get the supplies that that patient needs.
Bruce Kassover: At that point that I reach out to you then, is that also where the coaching aspect comes in?
Tina Harris: Correct. Once we get in contact with the actual patient, that's where we have a conversation with them in regards to their incontinence care.
Bruce Kassover: Okay. And what is a coaching session like, or how does it, how does it work exactly?
Tina Harris: So the other thing that makes TenderHeart different is that we actually have specialized trained staff that know all there is about incontinence, and my staff will probably laugh at me. It's like, “we know all of it.” Like, you guys know all of it, but we spend a lot of time dedicating our training resources to making sure that we have specialty staff that can talk to the patient. So, when we make contact with the patient, we will go through what we call an assessment.
And that assessment is a list of questions that will ask, already mentioned some of those, which are asking about their incontinence, right? What they're experiencing what they're currently wearing. And we'll ask some demographic information to make sure that we have correct sizing on the patient.
And so once we go through that, looking at the amount of leakage that they're having, the frequency of the leakage, all of those things are in consideration. And we also will begin to educate the patient about certain aspects of incontinence care, right? And so it's important that there's a proper product selection when you're looking for an incontinence product.
So size and fit is extremely important, making sure that you get the right absorbency level, extremely important to prevent leaks. And so we start having that type of conversation. Some patients also think that if I don't drink anything, that'll make my incontinence better. It won't. It actually will put them at risk for adverse conditions. And so we speak to some of those things that are kind of misconceptions about how to care for their incontinence. After that, we will make recommendations for products that will help the patient to live a healthier life.
Bruce Kassover: Now sometimes those recommendations or suggestions aren't necessarily for products either, right? Is that correct, that you, you will also talk with them about other treatment methods, you know, might be? So, so what are some of those other treatment options that that you do wind up discussing with them?
Tina Harris: Yeah, so we do talk about, so I mentioned some of them… We talked about this product selection for incontinence, but we also talk about nutrition, so that came into play, in regards to the not drinking, you know, if I don't drink anything then my incontinence will be better.
We also talk about falls with the patient because people living with incontinence are more at risk to have falls. So we talk about, you know, ways that you can prevent falls. We also talk about skin health, right? So a lot of times, you know, people either over moisturize or they don't moisturize enough, right?
And so talking to them about how do you keep your skin healthy, right? The other part is making sure that they understand medication adherence, right? It's very important because there are medications that can, not worsen the incontinence, but worse than the leakage, the volume of the incontinence.
Right. And so though those medications are needed for chronic conditions, and you want to make sure that you follow the schedule that the doctor has put you on. Sometimes if you don't take the medication or you do take the medication, you need to know that you may need to make an adjustment on your products. If you're taking something like a diuretic, right, which causes you to have to urinate a lot more frequently, right? So those are examples of some of the conversations that we have in regards to other management for the incontinence outside of the products.
Bruce Kassover: Now I would imagine, though, that in addition to some of the practicalities that you're talking about, and, you know, actual treatment methods or products that might work or, you know, behavioral strategies that they can do to help address some of their symptoms, I would imagine that that your people deal with a lot of people who are struggling with an emotional, with the emotional side of things as well.
Tina Harris: Yeah, we do talk about, depression comes along. Anxiety comes along, right? The worry of, “If I go outside, I'm going to leak. Somebody is going to notice that I have on you know, a pull up or a brief. You know, I can't go to my, my granddaughter's graduation because you know, I won't be able to make it to the bathroom in time.”
And so we do talk about those things. There's a lot of social isolation that can occur when your incontinence is not managed properly. So our value to the patient is to make sure that they understand how to manage their incontinence, right? Are you changing appropriately? Do you have the right product?
And our hope in the program for patients is that it empowers them to be able to walk outside confidently. You don't have to stay inside all the time. You can go to that graduation, you can go to that party, you can go to the grocery store, you can walk to the mailbox. We want to empower patients to be able to live their fullest life.
So we do give, you know, tips and tricks on ways to prevent some of that mental health that goes on.
Bruce Kassover: I love hearing so much of what you're saying because it really dovetails so perfectly with so much of what we do over here at the National Association for Continence as well. We talk about exactly the same issues, the social isolation and the depression and the anxiety, but also the behavioral aspects.
And some of the things that might seem counterintuitive to people, like the idea that not drinking can be as aggravating to your condition as drinking too much and understanding that medications have to be taken on schedule and that there are side effects that you need to be addressing and all of those things.
So, I mean, it's really, really rewarding to hear you say exactly the same things and reinforcing the same points that we're making. You know, the more voices out there discussing these things, the better it is. So that is just fantastic to hear.
But one thing you said that I really did want to ask you more about, because I don't think it's stressed enough, is the idea of fall prevention. You know, one of the things we say at the National Association for Continence is that we might not save lives, but we save life, meaning that incontinence is not a deadly condition the way that, you know, some other, you know, horrible things might be, but it's so life limiting that addressing it can restore to people, you know, an enormous amount that they've lost.
However, there is one area where that's not necessarily a really true statement, and that's when it comes to slips and falls, because this is one place, especially when you're talking with people who are older, who might not have the same balance that they had when they were younger, who are walking around late at night when it’s dark, having a fall can be, you know, incredibly dangerous. And so I wanted to ask you more about your approach to that.
Tina Harris: Absolutely. So yeah, having incontinence, you know, can put individuals at risk for falling. Especially as you age you start to lose, you know, some of the muscle mass and the flexibility that you had. So one of the things that we talk to individuals about is making sure that they have regular exercise, right?
So even if it's just doing arm circles or moving your legs in the chair, or just anything, getting up and walking to the mailbox, if you can do that, or walking to the front door. So staying active is one of those ways that you can keep your muscles strong to prevent the weakness that sometimes can happen as you age.
And you're walking, you know, to toilet or to the kitchen or getting out of bed. So the other way is. Having the proper product, right? So what we found in our research is that a lot of patients fall during the night. Right now, the question is, why are they getting up at night? Well, if you are in the incontinence population, it's probably because you have to change your product and your, or you're trying to get to the bathroom to prevent having leakage in the bed, right?
So what happens? They get up out of the bed. They're still a little bit groggy. They fall over the cat, the dog, their shoe, the slipper, the chair, and they end up injuring themselves. So the other way is to make sure that you have proper product selection. So if you are wearing absorbency products at night, make sure that you have one that's going to at least maintain you through the morning time or not to where it's going to fill up so fast that you have to get up in the middle of the night to rush to the bathroom.
So that's one thing, proper product selection. The other thing is to make sure that you have a clear path in your home, right? So things that you can see and during the day, very clearly will become obstacles in the nighttime. And so making sure that you have that clear path as you go to the bathroom. So if there's a chair that's in the way, or there's a table at the bedside, you want to make sure that you remove those things so that you have a clear path.
Having good lighting is also important at night when you're having falls. The other thing is just making sure that you understand your incontinence level, right? Making sure that you know, which products are working best for you. What time you leak the most? Is it at night? Is it during the day?
Also making sure that you limit or control hydration as well. Your personal physician should be the one that's recommending your nutritional levels and your hydration needs. But typically, if you're drinking caffeinated drinks, coffees, all the way up to the time that you're going to bed, there is a high chance that you're going to end up having to get up in the middle of the night.
So maybe, you know, stopping some of that hydration, you know, in the early afternoon or the early evening may help also prevent your need to have to get up in the middle of the night.
Bruce Kassover: Makes perfect sense. Now, one of the things I wanted to go back to that you were talking about are products, and maybe you could tell us a little bit about the product selection that TenderHeart makes available.
Tina Harris: So TenderHeart, we service a full line of incontinence products. So brief splatter, control pads, liners, pull ups, underpads, wipes, barrier cream, the whole line of incontinence products. Specifically, again, we want to match the product to the patient. So it's not a one size fits all. It's a, it's what is your individual need? And that's the product that we're going to get you in.
The other part of that is we do offer a full manufacture range. So, if, whether it's a retail brand that you are pulling off the shelf at Walmart, or whether it's just another national brand, we have a full range of manufacturers that make incontinent supplies. So we're able to get, I'd like to say 99 percent, and I don't know what that 1 percent would be, but we're able to provide all vendor types of incontinence supplies.
Bruce Kassover: Now, I also wanted to ask you about skin care, because that's another thing that I think that people who are, especially people who are first starting to, you know, explore product choices and dealing with incontinence symptoms may not realize is so really important to their well being, their quality of life, and their overall health. So maybe you could talk a little bit about skin care and skin health as well.
Tina Harris: Yes, absolutely. I'm glad you asked that question. Again, having incontinence and managing it does put you at risk if it's poorly managed for skin ulcers and also urinary tract infections, which can cause irritation in the genital area as well.
So some things that we teach patients in regards to their skin health – I'm going to push this, and you're going to hear this, Bruce, throughout this podcast, you've heard it already – is proper product selection, right? If you get a poor-quality absorbency product, you are going to have skin issues. You're going to have falls. You're going to be you know, have some challenges and difficulties with managing your incontinence care. So you have to have a quality product, okay? And thicker isn’t better. Thicker does not mean that the incontinence product is going to be the right one for you. So you have to discuss with a trained professional what the proper product would be.
So that's one, proper product selection. The other part is how often you are changing the product, right? So, you know, if you're leaving the product on too long, which the rule of standard is every three to five hours, you should be looking at your product at least to see if there's a need for a change, right?
So sometimes there are patients who are not mobile and so they're sitting unfortunately in briefs or pull ups for X amount of hours, right? And so what that does is that's going to cause that urine to sit against the skin and it's going to put the skin at risk for breakdown, rashes, irritation. So make sure that you have proper changing.
So proper product selection. Proper changing. The other thing is making sure that you have a good barrier cream. So barrier cream isn't necessary for proper incontinence care, but it is very helpful to help create that barrier from sometimes the irritation that can happen when you are wearing an absorbency product.
So very thin layer, keeps the skin moisturized. Make sure that every time you have to change that product or it's get soiled that you're wiping your skin off, keeping your skin as clean as you can and as moisturized as you can. But you do want to limit that moisture because you don't want that to impede the actual absorbency product.
And then the final thing is hydration. Skin loves hydration, right? Not over hydration, but hydration. And so the skin needs water. It's based in water. And so you have to make sure, and this may sound like kind of counterintuitive when you say, “Hey, you told me to limit my drinking,” but it's not you limit your drinking, you're limiting it at certain times of the day before you go to bed. But in this case, as it comes with skin, you want to make sure that you drink plenty of water. Water is your friend. And so we want to make sure that individuals that are living with incontinence understand how important drinking water each day, right? The standard is 8, 8 ounce glasses, right? But only the individual knows what it is that they should be drinking.
So if there are folks who are living lives where there's other chronic conditions along with that, that would affect their ability to hydrate themselves appropriately. You know, just make sure that you're following up with your provider and having that discussion.
Bruce Kassover: You know, I think that what you were talking about, about how, how a good amount of what we're discussing can seem either mysterious to people who aren't aware of it or counterintuitive speaks to just how important getting good coaching is, somebody who can, you know, disabuse you of misinformation that you may have heard or misunderstandings, explain why it might seem like this, but it's really like that, you know, somebody who could really put you on the right path, it really can make an incredible difference in people’s lives.
Tina Harris: Definitely. And the other thing I'd like to mention, too, Bruce is there's a misconception about what we call “double padding,” right? And so if I use double products, two or three products, that's going to help me, right?
That's going to keep me from having leaks. Actually, it's not, it's going to actually cause you to have more leaks because you are actually creating a barrier with whatever it is that you're sticking in there, whether it's, you know, the paper towel or whether it's a liner or a bladder control pad, and you're sticking it inside of something else, you're actually increasing the risk that you are going to leak because you're preventing the fluid from the first layer to fall down into the second product. And so that is something that we stress here a lot at TenderHeart is to make sure that patients are only using one absorbency product at a time. That's your best bet for living a leak free life.
Bruce Kassover: It also sounds a lot more expensive and a lot more uncomfortable to have to double up as well.
Tina Harris: Absolutely.
Bruce Kassover: Yeah. So tell me, after you've had your initial consultation and your initial coaching sessions, do you guys do follow up as well?
Tina Harris: Absolutely, we do. So we have trained incontinence coaches that will follow the patient throughout the life of their service with TenderHeart. Each individual who calls us is given a an incontinence staff person that will follow them until they either say, “Nope, I'm done,” or “My incontinence is cured or, or treated whichever way.” And so you have that individualized trust that you gain with knowing “I can call Tina. She's my, you know, my incontinence support person at TenderHeart. I can call whenever I have issues with what's going on with the product.”
So I do want to stress that incontinence is not a individual concern. It's a community concern. And so we are here to support patients as they manage their incontinence. And so we care a lot about what happens with them at their home, that they're getting the right products. And so we want them to know that they're not alone.
Steve Gregg: Tina, one of the things that we learned at NAFC was there's a lot of technology and a lot of science into absorbent products, and that most Americans don't realize how sophisticated these products are. The other piece is, which I think is part of your comments on product selection, is most people don't know that there's a wide range of products based on the kind of need you have. So, for example there are products for people who are mobile, there are products for people who sit most of the day, there are products for people who lay down most of the day, there are products for people who need the product mostly at night.
Can you talk a little bit about that level of sophistication and products? Because what we love about you is that you have people who can help patients understand that, but most patients don't know that a product is not a product is not a product.
Tina Harris: Yeah, I appreciate that question. So that goes back to that one-size-does-not-fit-all. So that's why it's important to talk to a trained professional on what products work most for you.
So yes, there are products that will be adjusted based on the mobility of the patient. So if you're a person who walks around a lot, there's a product there, right? So probably a pull up would be better for someone who's mobile, right, versus someone who's in the bed, or they sit for a while, or their dexterity in their hands are not that that good, or they have caregiver support. They may be better in a brief, right? And so you've got, you know, one that reminds you of an underwear, and you've got another one that reminds you of you underwear with tabs on it, right?
And so you've also got male guards, right? And so those are maybe someone who this is specifically for males who are not, maybe have a high level of incontinence, but they can use that as kind of an insert into their regular underwear. Same thing with bladder control pads. Same thing with liners.
And so it is important that the public is educated on knowing that there's a variety of choices out there. It's not just a one-size-fits-all, “my neighbor’s wearing this, so I should wear that, too,” “my neighbors in this size, we're the same body type, I should be in the same one…” You really have to get that individualized coaching session going on so that you can sit with that, the staff that we have here at TenderHeart and make sure that you understand the selection of products that you have and which products most meet your need.
Bruce Kassover: So Tina, this all sounds very interesting. And if I'm a patient who thinks that TenderHeart might be a good choice for me to explore, how do I find you guys?
Tina Harris: If you're tech savvy and you want to visit us online, you can type in www.tenderheart.com. If you're a person who prefers the phone, you can call us by phone at 877-394-1860. And then finally, if you're a person who likes email, you can also email us at help@tenderteart.com.
Bruce Kassover: Excellent. I'm going to actually add one more thing to that; for anybody who is, you know, looking at the podcast on their podcast player, then you could probably take a look and see that we're going to put links to TenderHeart in the show notes as well, so you should be able to click on those and be brought right to the site.
So Tina, with that being said, you know, the name of this podcast is Life Without Leaks, and one of the things we always like to do is ask our guests to tell us if they had one tip to help patients live a life without leaks, what would that be. So maybe you could share with us your one piece of advice.
Tina Harris: Yeah, I think we've talked about it throughout this process. One is making sure that you have the proper product and two is making sure that you connect with someone that can do an individualized assessment for your need. Living incontinence does not have to be alone. It is a community effort to make sure that individuals are living healthy lives, and so it's not something to be embarrassed about. Especially with TenderHeart, we're more than happy to talk to you about your incontinence, but those would actually be – I think I gave you two – so, making sure you have correct product selection and you know what it is that you're using, and two is to connect to someone, if you don't know it, connect to someone who does.
Bruce Kassover: It's always nice to end things on a note that is encouraging and comforting and motivating. So thank you, Tina. I really appreciate you joining us, and we appreciate what you and the entire team over at TenderHeart is doing to make life a lot easier for those people who are struggling with incontinence. So thank you.
Tina Harris: Absolutely. Thank you so much for having me. It was a pleasure.
Bruce Kassover: Life Without Leaks has been brought to you by the National Association for Continence. Our music is Rainbows by Kevin MacLeod. More information about NAFC is available online at NAFC. org.