Predicting Comfort: Charlotte Mather's Vision for Hospice Care

[00:00:00] Welcome to the Chalk Talk Gym Podcast where we explore insights into healthcare that

[00:00:07] help uncover new opportunities for growth and success. I'm your host, Jim Jordan.

[00:00:21] Welcome to today's episode of Chalk Talk Gym. Our guest today is Charlotte

[00:00:26] Mather. She's over three decades of nursing experience and she's dedicated her life to

[00:00:31] transforming patient care specifically in the hospice and palliative care area. Her journey

[00:00:37] starts from a neonatal nurse and ends up today as a vice president of nursing operations showcasing

[00:00:43] her relentless pursuit of quality and of life care. Today we explore the forefront of healthcare

[00:00:49] innovation discussing predictive analytics, the evolution of hospice care, and the impact of

[00:00:54] technology on patient and family experience. Charlotte's insight should light on the critical

[00:01:00] balance of art and science in nursing and the challenges of healthcare delivery and the future

[00:01:05] of hospice care. So grab your headphones and be prepared to be enlightened by how compassion

[00:01:11] and innovation and technology are reshaping healthcare. So Charlotte, please give the audience

[00:01:17] to myself a little bit more about your background. This line of service been a nurse for over 30

[00:01:24] years and practiced in a number of different environments, large academic hospitals,

[00:01:30] hospice or end of life care. Now I saw palliative care in there too. Do you consider that the same?

[00:01:35] Maybe define the differences for our audience so they understand it? Yeah, so palliative care

[00:01:40] is a little bit different than hospice instead space. I want quality of life but I'm not at

[00:01:47] end of life yet. But I'm just making different decisions about my health care and what I want to

[00:01:53] do with maybe chronic disease management and what that looks like. So focus on quality. And then

[00:02:00] when you get to hospice care, you've really made a decision that we're not going to be

[00:02:05] sure of anymore but we're going to quality of life, not going to use in death, not going to get

[00:02:12] there quickly, but we're going to give you quality. Now does palliative care that definition does

[00:02:18] have doctors act a little differently with pain meds and different things like that?

[00:02:22] Can you share that a little bit? Yes, it does have them at a little bit different. How

[00:02:26] they treat some so palliative care, you might still be going down to curative paths in bigger picture

[00:02:34] where in hospice you're not curative anymore but you are going to palliate symptoms or manage

[00:02:40] symptoms that give you quality. So that's a great definition because I was talking to some of

[00:02:44] my older relatives in preparation and their definition of in their minds, palliative care is

[00:02:52] you're still on the journey to hospice where that is not the case. You could be curative. It could

[00:02:56] be the case. It could not be the case. Right. Exactly. You're kind of in this in-between space and it

[00:03:02] allows you the opportunity to explore. Okay, very good. So did you start your career out in this space?

[00:03:10] No, funny story. I started my career out as a meal natal nurse in an intensive care unit in

[00:03:18] a children's hospital so babies. That's my younger daughter. It went down that path. Yeah.

[00:03:25] I think the writing was on the wall for me because I remember this was 30 years ago. So we still

[00:03:31] took our nursing boards on paper. They still mailed you the results like in the US mail and you

[00:03:37] went to the mailbox and then to check did I pass? And I remember getting that notification in

[00:03:43] the mail that said you're an RN, you pass their boards. I was so excited to be able to go to work

[00:03:49] that night, worked the night shift and be able to sign RN after my name and you know, be fully

[00:03:54] in my profession what I had worked for. And I was assigned an infant that night that was born without

[00:04:00] a brain but had enough of a brain stem that was able to breathe and still able to have a heartbeat

[00:04:07] but we were nearing end of life. And I remember my supervisor giving me my assignment for that night

[00:04:12] and she said, okay Charlotte, I'm here's the goal. We don't want this baby to die alone. The

[00:04:17] baby is going to die tonight. And so that was my job to take care of that baby. Parents weren't in

[00:04:23] the story and just that was such a profound first assignment for me as a brand new RN. And I think

[00:04:30] impacted my career over time no matter where my clinical focus was until I arrived in doing

[00:04:36] hospice and end of life careful time. What an interesting pathway. What a sad event. I know

[00:04:41] my daughters had some of those experiences and I remember being a cath lab often and you'd walk in

[00:04:48] sometimes in the places silent and you'd say what's going on it's like we're cathing or we're

[00:04:53] working on an infant it certainly is a difficult and heartbreaking thing. So right maybe tell me

[00:05:00] a little bit more about your organization and where you fit in it because your organization covers

[00:05:05] quite a continuum. It does cover quite a continuum and I think that's what's great about our

[00:05:11] organization in that post acute care space knowing people's journeys aren't in a linear fashion you

[00:05:17] can go from home health to palliative back to home health to hospice personal care services. And so

[00:05:23] I think it's a great opportunity for our organization to be innovative in that space to serve

[00:05:28] patients and communities. So I'm focused on the nursing care of the hospice piece of our

[00:05:35] organization obviously I'm passionate about nursing care large part of health care is delivered by

[00:05:40] nurses and we want our patients and our communities to have the best possible care in my case

[00:05:47] best end of life experience whatever that looks like to the patient their family their chosen family

[00:05:53] it's going to be different for each person and so we try to have multiple ways we support the

[00:05:59] patient and their families in the journey and the end of life. So as you moved up the nursing

[00:06:05] into the administration leadership what issues are you dealing with or what contradictions

[00:06:10] in your goals do you have that might have been different when you were just treating a patient?

[00:06:14] Yeah I think when I was a staff nurse at the bedside my focus was on delivering patient care

[00:06:20] and I think now I'm supporting the organization so that we have the right nurses good qualified

[00:06:27] nurses making sure they have what they need to do the job and the other clinical professions as well

[00:06:32] so that they can support the patient to have the best experience. So it's a different view it's a

[00:06:38] different perspective but at the end of the day there's a patient in the story and that's everybody's

[00:06:43] goal that how do we get to the patient? So in my position how do I have the right workforce to get

[00:06:49] to the patient? What other tools do we have in our toolbox to get to the patient? So recently

[00:06:56] in the last year and a half ish we've started using some predictive analytics software that runs

[00:07:02] in the back of our EMR that's evidence based in it is super slick there's some AI in it but it's

[00:07:10] pretty accurate in predicting the patient's end of life time frame. So it has eight different risk

[00:07:17] categories and at the highest risk category it's telling me these patients are going to die in the

[00:07:23] next seven to 12 days and it's got over 90% accuracy rate so it's that intersection of our

[00:07:30] science so as a nurse leader we can work with our clinical teams to say okay we need to deliver

[00:07:37] the right year at the right time and this patient is in that time frame so how do we support

[00:07:45] the patient and the family? How do we educate them about what symptom they may experience next

[00:07:51] and how we're going to support them and address that symptom. Some want a family member at the

[00:07:56] bad side or a friend and they might live on the other side of the country we can share with them

[00:08:00] in confidence with a level of confidence that now's the time they should get on the plane and come

[00:08:06] this is the time you want people here maybe it's a specific religious or cultural ritual that's

[00:08:13] important to know now's the time and so it really helps us meet the patient's needs right here

[00:08:19] right time it also allows us to use a very valuable resource or workforce to get them in the

[00:08:26] right place at the right time for the patients. I think it's an amazing thing for our audience

[00:08:29] to think about because we think about artificial intelligence analytics is more focused on

[00:08:35] the business aspects have the right drugs there because this is going to go on maybe the right

[00:08:39] catheters whatever it has but I think what's incredibly important is technologies also helping us

[00:08:45] make it a more human experience to have people and family members there because I myself have

[00:08:50] traveled to a bedside a hospice thinking that the relative or whatever was going to pass and

[00:08:56] it ended up being a lot longer and you know your away from work and you're in a hotel or whatever

[00:09:01] it becomes unaffordable at some point in time so it becomes quite an issue now when we we're

[00:09:06] nursing turnover all the time and the high rates of turnover is hospice more or less.

[00:09:13] When we look at our rates for our power with healthcare as a whole and I think we're still coming

[00:09:19] out of the pandemic in the impact on the nursing workforce so I don't think what we're experiencing

[00:09:25] our organization or you know post acute care spaces different than what our acute care partners

[00:09:30] are seen as well it's a concern for healthcare in general how do we have the right people to take

[00:09:36] care of patients in the right locations nursing is the largest segment of the healthcare workforce

[00:09:43] and little bias I think we're really important so. All having family members who are nurses

[00:09:48] absolutely agree with that and I think that the reason for me asking that is we have had a few

[00:09:52] family members who are hospice nurses that find it to be a very special event and a privilege

[00:09:59] and so as I've noticed other family members that are nursing in other fields they tend to move

[00:10:04] around more than the hospice folks so that's why I was asking that question to see that if there is

[00:10:08] a change there so what's changed in hospice in the past five years in terms of the tools and the

[00:10:14] business models that you have available to you is anything changed radically or is it still basically

[00:10:19] the experience that maybe many people have had in the past yeah I think people are talking about

[00:10:24] hospice care more than they have in the past and understanding what a valuable benefit that is

[00:10:31] in our country I think there's maybe some misunderstanding about what hospice is it's not this

[00:10:36] German balloon it's a normal part of one's journey and we can make it the best hospital end of life

[00:10:43] experience so I think there's some misconceptions about what it is or maybe what it's not and I do

[00:10:50] think that the technology that we see now is very different than even five years ago and I think

[00:10:56] that has a huge impact on better quality care for our patients we're able to communicate

[00:11:03] better with from clinician to clinician about a patient because we're sharing an electronic

[00:11:08] medical record versus paper that I've got to get to someone else versus I can get a nurse on

[00:11:14] the phone quickly and they can see everything about the patient to help the patient in the family

[00:11:20] with whatever the current situation is so I recently had about a year ago the friend of mine

[00:11:25] had a parent that passed and the last week of their life they went into hospice and one of the

[00:11:31] interesting things that this person said to me is this person was obviously in critical

[00:11:36] condition for weeks prior to that and so being at home and helping out keeping the drugs

[00:11:41] keeping the schedule so they were so focused on the house management they actually said they did

[00:11:46] not realize until they went to hospice when everyone else is taking care of that they actually just

[00:11:51] got to be there for their parent just to have conversation talk about families you know and have some

[00:11:56] actually made some memories now who pays for that is this a regular insurance is Medicare pay for

[00:12:04] hospice yeah it's a Medicare benefit so if you're you know a Medicare beneficiary you have access

[00:12:11] to hospice services it's a covered benefit commercial payers also if you're not yet to

[00:12:16] medicare commercial payers most of them also have has this benefits so it is pretty readily available

[00:12:24] and covered it's rare that it's not that's great so when you look at your organization what challenges

[00:12:30] are you facing with products and services as you're trying to align to what the future of health care

[00:12:35] is I think like any organization right how do we provide better quality care at a lower cost

[00:12:43] and that's always our challenge our focus is on the patients we want to have the best quality care

[00:12:49] hospice is largely covered by Medicare or our largest payer is Medicare and so living on Medicare

[00:12:56] rates is sometimes challenging and so I think that's some of our challenge is knowing our biggest

[00:13:02] care is Medicare which you know is a very conservative payment rate trying to be very nice about

[00:13:10] but you know making sure the patient has what they need having the workforce that the patient needs

[00:13:15] all conspacted a patient but I think those are some heat age constraints right now

[00:13:18] well I think there's some quality measurements I don't know if this space has quality measurements

[00:13:23] like he does inside they do okay so there's an aspect of the hospice experiences I've had I call it

[00:13:30] like a nice living room with a bed in it where you can go and have a very comfortable environment

[00:13:36] and family members can move in and out in a very natural way and arguably in some cases more

[00:13:41] natural than if someone had a bed in a living room at home or something like that but historically

[00:13:45] reimbursement doesn't cover those kinds of things they're very quick to give you

[00:13:50] you know surgical rope water equipment or catheter or something but these things are not usually

[00:13:56] they're in the overhead rate but not very generous about it so how do you balance that part of it

[00:14:00] with the technical part of it yeah so in hospice there are four different levels of chair that are

[00:14:06] covered eligibility for each one just like in patient outpatient and then acute care world

[00:14:13] and so there's routine level of care which means we deliver hospice care in the home for the patient

[00:14:18] part of the hospice benefits also like if you need DME or equivalent that's part of the benefit

[00:14:24] your medications that while you are on hospice are covered that's part of the benefit and we can do

[00:14:29] that in the home there is also a it's called continuous care level of care and that is there

[00:14:36] is some symptoms maybe that need to be managed and we need a nurse on site for up to like eight

[00:14:42] hours a day or nursing services as part of that for eight hours a day in the home just to help

[00:14:47] manage there's something going on there's also then a GIP level of care general in patient

[00:14:54] level of care and so there's a acute management that needs to happen for this patient maybe they've

[00:15:00] got pain that's unresolved and we need to relook at our plan of care and treat the symptom or any

[00:15:06] other number of symptoms that require 24 hour nursing care and Matt's done in a location that has

[00:15:14] R&S on site 24 hours we have a few locations where we are actually in a hospital and have

[00:15:21] a unit within the hospital that's ours so we'll deliver hospice care in that setting and then maybe

[00:15:27] the patient will go back home once we've managed those symptoms and they're where they need to be

[00:15:32] and they no longer meet the inpatient criteria and then there's also a respite level of care you know

[00:15:38] that caregiving can be burdened some time on the family member and they just they need a break and

[00:15:44] so we will work for up space in the community for the patient for five days to give that caregiver a

[00:15:49] break and take care of that patient so those are the four different levels of care that CMS looks at

[00:15:56] around eligibility and their payment models. So when you look at the circle of hospice patients

[00:16:02] that expire what percent are actually in a inpatient hospice facility? Those are probably the lowest

[00:16:08] percentage by large mobs will be in the home. I think that might surprise a lot of people

[00:16:15] or even like in an assisted loving facility or a skilled nursing facility we go into those

[00:16:21] facilities and we provide hospice care for their patients who are receiving that benefit.

[00:16:27] So it's not just home if you have a loved one who is at their end of life they meet the

[00:16:32] hospice eligibility requirements but they reside in a skilled nursing facility or an assisted

[00:16:38] living facility we can still go in and provide their hospice services to them.

[00:16:43] So when you look at your career can you switch topics because you went from this pathway of

[00:16:49] starting out babies in here? Can you just tell us about a time when you had a quickly

[00:16:54] adapt and shift your strategy and tell us a little bit about that time?

[00:16:58] Oh my goodness I think that's what nurses do best I'll think of an example but I think

[00:17:02] nurses are super creative individuals and just give us a few tools and we'll figure it out. I

[00:17:10] think okay I'm gonna go down a ramp and hold you and cut this if you want but I think nurses

[00:17:15] are the largest segment of healthcare I think we're creative innovative individuals you know patients

[00:17:21] we're the most trusted profession I think we need to have a bigger voice and at the healthcare

[00:17:26] tables solving problems just from an overall national policy perspective I think we've got a good

[00:17:33] insight and can add to the dialogue. And as you've moved into management has there been

[00:17:39] something that pops into your head is something that was required quick adaptation?

[00:17:44] Yeah I think every day right when we started in the pandemic that required quick adaptation

[00:17:49] we went from one day thinking okay the pandemic's coming let's start preparing this is what we're

[00:17:55] seeing the information we're getting and I think like within a week's time frame I remember

[00:18:01] it just totally shifted it was just incredible in one week's time we went from normal operations to

[00:18:08] okay do we have enough PPE what are the protocols how are we testing our employees to know that

[00:18:16] their well-being is in place how do we provide care in a patient's home?

[00:18:20] Ask this was still going into homes during the pandemic and so just in one time frame we had to

[00:18:26] shift our thinking, our processes who was gonna work virtually? Who in our organization could work

[00:18:33] virtually? Who needed to still be going out to homes to take care of patients and so adults

[00:18:39] shifted I think also from a technology perspective being able to do virtual interactions with

[00:18:46] patients and families that before then you know we didn't have that technology in healthcare

[00:18:53] by enlarge so that was some positive disruption I think came out of the pandemic across all

[00:18:59] of health care just the embracement of okay we can can connect for some things virtually not everything

[00:19:06] but there's some things that have remained. So how do you keep current in all the changes of going on

[00:19:11] in your field is there specific magazines or people you follow because everyone loves to

[00:19:16] take this opportunity to see where a leader gets their information from? Yeah so lifelong learner

[00:19:22] here so constantly scouring just like normal healthcare news that you get in your mail

[00:19:28] get ask this news in my email every day backers is a great just general what's going on in healthcare

[00:19:35] but then the professional organizations so our hospice professional organizations are great sources

[00:19:42] of information that we engage with American organization of nurse leaders that's specific for me

[00:19:48] for a profession I'm a fellow in the American College of Healthcare Executive so from a leadership

[00:19:53] perspective that's a great organization to be engaged with around what's current and then finally

[00:20:01] I'm a Robert Wood Johnson Executive Nurse Fellow and so I've got colleagues across the country

[00:20:08] and all aspects of healthcare that it's just a phone call away and lots of different. Yeah so far

[00:20:16] in your journey what is the biggest lesson that you've learned? I think the biggest lesson I've learned

[00:20:22] is that you can't discount the heart and what I mean by that is we work with people every day and so

[00:20:30] sometimes you can think a decision is logical and objective and very cut and dry but there's people

[00:20:37] involved in this story and so you have to understand people in their emotion in our heart

[00:20:44] and their wise. I think one of the best things we can do is parents and grandparents is to make sure

[00:20:49] our wishes are written down because it does cause quite a debate and even with those documents

[00:20:55] you still have those kinds of issues. As you look out 10 years from now what do you see as the

[00:21:00] biggest opportunity of threat in your profession? The biggest opportunity in my profession in 10 years

[00:21:08] and we're starting to take steps in this direction but I think we need to look at healthcare roles

[00:21:13] and so what do we need to do with the nursing role to best leverage the different levels of

[00:21:20] education within nursing so how my working towards or performing my highest level of education

[00:21:27] and training and experience I think we don't leverage that enough. So interesting so I have a

[00:21:34] website that follows healthcare business while it's called healthcare data centers instead of

[00:21:38] dot comets dot center and I just finished an analysis on the physician shortages that we have today

[00:21:44] and what we're going to have tomorrow and that our nurse practitioners and our physician assistants

[00:21:50] that industry can react to putting people out educating them, getting them to work quicker than

[00:21:55] doctors can at 15 year cycle. And doing that analysis and looking at some of the surveys that are

[00:22:01] out there is shocking a whole lot of nurses will say I was educated for more and they won't let

[00:22:07] me do more and I think to your point it's going to be very interesting because I think the shortage is

[00:22:12] going to perturb that a little bit that maybe I don't want to say it's a medical union mentality

[00:22:17] saying nurses can't do this thing but I think that the practicality of the shortage is going to

[00:22:22] elevate and I could tell you that I for daughters and my wife and I we all prefer meeting with the

[00:22:29] PAs so many times or the nurse practitioners just because they have a little more time they go

[00:22:34] a little more deeper and they ask these moments right. I think that's interesting insight going back

[00:22:40] to you know you can't discount the heart. The other challenge that we see is how much paperwork

[00:22:46] both physicians and nurses are doing and how little of their time they actually spend doing the

[00:22:51] thing that they wanted to do. Is there any activities you all have going on to try to improve that?

[00:22:56] Yeah I think I'm going to answer that at 100,000 put level first and then drill down into it but

[00:23:03] just from a generalization standpoint from nursing that's a huge dissatisfierter for nurses

[00:23:10] around. Listen I want to take care of the patients I don't want to spend a lot of my day looking

[00:23:15] for supplies things I need to do my job or the rigors of documentation especially in the EMR

[00:23:23] and it's you know it can cause burnout I think we've seen that in some physician studies as well

[00:23:28] around just the burden of the documentation and so it's finding that balance of we do have to give

[00:23:35] an accounting of the care that we're delivering from a quality perspective there's the legal

[00:23:40] piece of it but how can we get to that with less clips or an easier way or how do we optimize

[00:23:48] what we're doing so that the majority of our time is with the patients and not on some of these

[00:23:55] other tasks. I think we've spent the first 25 years over electronicals record trying to figure

[00:24:01] what should be in there and how to do it I think what we've left out in that is what is the work

[00:24:07] flow of the nurses and the doctors and does this documentation fit that and I do appreciate that

[00:24:12] in the early days when you don't know what's important you're going to have a person of high judgment

[00:24:17] and education involved in helping sweat through that but I think at this point in time we should be

[00:24:23] in a place that's a little different and I go to my dermatologist make a little bit more money

[00:24:27] than most so they have a little more funding but I've noticed in the past few years that my dermatologist

[00:24:33] is actually hired people to follow the doctors and nurses around to just keep the electronic

[00:24:39] record updated and it's changed their lives. They're actually seeing more patients in a day they're

[00:24:45] actually having deeper conversations and this person's listening you know it's a very intriguing

[00:24:51] thing and you know most special these can't afford that at this point in time but hopefully we

[00:24:55] can move in that direction. What's the biggest threat that you see as it relates to what you're doing

[00:25:01] in the next few years? I'm going to go back to workforce we've got to have the right work force

[00:25:06] we have to have trained qualified individuals in a variety roles to serve our patients so not just

[00:25:12] nurses but all of the roles add up to the team surrounding the patient I think that's at risk

[00:25:19] in health care in general that we just have to keep our eye on. And I think that I was talking to

[00:25:25] someone several months back who runs a long-term care nursing facility and their challenges

[00:25:32] that they're paying a lot of money to get contractors in for the people that they can't right so

[00:25:36] there's a schism there because someone's making a lot more money there's no regulation around how

[00:25:42] much those contracting organizations can charge which I think personally needs to be looked into

[00:25:48] and then nurses and texts will drive by McDonald's and say I can make more certain hamburger than

[00:25:53] I can actually take care of the patient. I think there needs to be sort of a reckoning from that

[00:25:58] perspective particularly if you're looking for the talent because I think that nurses and doctors

[00:26:02] are some of the most intelligent people we have in our economy right so clearly they can go do other

[00:26:08] things very easily and probably even make more money but the common theme from everyone I've ever met

[00:26:13] is they started out caring about patients and wanting to help people and that's a little

[00:26:18] little different world. Is there anything else you'd like to share with the audience on this space?

[00:26:23] I don't think so I think you know has this care is this state policy we're invited into sacred

[00:26:29] moments with patients and families and so there's anyone out there who's interested in coming over

[00:26:35] to our sector of health care delivery I would love to engage with them and talk with them and

[00:26:41] I'm always interested in talking with students as well as they're exploring different areas of

[00:26:46] health care they might be interested in so very passionate about has this care that's what I want

[00:26:51] everyone to know. Now if I recall because I interviewed another executive several months back but

[00:26:56] if I recall your company has a very solid website with all the employment opportunities do you know

[00:27:02] the website on the top of your head and maybe share some of the positions that people should look at?

[00:27:05] Yeah it's accent care all one word.com and there are a variety of opportunities there's clinical

[00:27:13] opportunities home health has this personal care services there are office opportunities like

[00:27:19] nonclinical business finance so we're a large organization we have lots of opportunities it's

[00:27:26] great place to work I'm going to put my plug in. I will comment because I was on your website

[00:27:30] previously is not only you can search the roles around the country but you can also search it

[00:27:36] by geographic location and I think that's one of the better done websites that I've seen so I just

[00:27:41] want to make sure people wear that well very good. So where do you see technology changing in

[00:27:46] hospice care? Yeah I think having utilized this new predictive analytic software it's called

[00:27:53] news by metallurgics it's their software runs in the back of our EMR I think that continued

[00:27:58] development is on the horizon they've done some just amazing work with being able to predict

[00:28:04] end of life care I would really be interested to see what they do in the future just around

[00:28:09] prior to end of life like that palliative care space that we were talking about with people with

[00:28:14] chronic ongoing health conditions well what can they do around some analytics and predictions

[00:28:21] and algorithms in that space so I think that type of integration in the future is going to become

[00:28:28] much more common and help us deliver better care for our patients. And the predictive aspect

[00:28:34] of it when people hear predictive sometimes they see the negative side of that but the predictive

[00:28:39] aspect of it is about being ready and when you look at COVID one of the things that we've tightened

[00:28:46] up although I wouldn't say it's perfect is there was no wood nation between public health

[00:28:52] and individual hospitals right and today you can go and look up any particular hospital and see

[00:28:58] how many people are coming in I think there's like nine different categories that they're tracking

[00:29:03] and I think that's the good part about the system there's nothing wrong with being over prepared.

[00:29:08] Yeah it's used for good it's you know again right here at the right time helping the patients

[00:29:12] helping the families in knowing where they're at in their end of life journey it's good I know

[00:29:17] it can sound really scary it's a new word artificial intelligence predictive analytics but there's

[00:29:24] a good side to that and that's what we focus on is how do we help the patient how do we help the

[00:29:29] family it's about their journey and how we can be invited in. Yeah thank you well very good

[00:29:35] well thank you for sharing today and spending some time with us. Thank you for having us.

[00:29:39] All right take care. Thank you.

[00:29:43] Thanks for tuning into the Chalk Talk Gym podcast for resources show notes and ways to get in touch

[00:29:50] visit us at chalktalkgem.com