At her mother’s home in Illinois, Tracy Balhan flips through photos of her dad, Bill Speer. In one picture, he’s smiling in front of a bucket of sweating beers and wearing a blue T-shirt that reads, “Pops. The man. The myth. The legend.”
Balhan’s father died last year after struggling with dementia. During one episode late in his life, he became so agitated that he tried to exit a moving car. Balhan recalls her dad — larger than life, steady and loving — yelling at the top of his lungs.
His geriatric psychiatrist recommended she take him to the emergency room at Endeavor Health’s Edward Hospital in the Chicago suburb of Naperville because of its connection to an inpatient behavioral care unit. She hoped it would help get him a quick referral.
But Speer spent 12 hours in the emergency room — at one point restrained by staff — waiting for a psych evaluation. Balhan didn’t know it then, but her dad’s experience at the hospital is so common it has a name: ER boarding.
One in six visits to the emergency department in 2022 that resulted in hospital admission had a wait of four or more hours, according to an Associated Press and Side Effects Public Media data analysis. Fifty percent of the patients who were boarded for any length of time were 65 and older, the analysis showed.
Some people who aren’t in the middle of a life-threatening emergency might even wait weeks, health care experts said.
ER boarding is a symptom of the U.S. health care system’s struggles, including shrinking points of entry for patients seeking care outside of ERs and hospitals prioritizing beds for procedures insurance companies often pay more for.
Experts also warn the boarding issue will worsen as the number of people 65 and older in the U.S. with dementia grows in the coming decades. Hospital bed capacity in the U.S. may not keep up. Between 2003 and 2023, the number of staffed hospital beds was static, even as emergency department visits shot up 30% to 40% over that same period.
Number of hospital beds at issue
For older people with dementia, boarding can be especially dangerous, Chicago-based geriatric psychiatrist Dr. Shafi Siddiqui said. One research letter published in June 2024 in the Journal of the American Medical Association looked at more than 200,000 patients and found long ER stays could be linked to a higher risk of dementia patients developing delirium — a temporary state of mental confusion and sometimes hallucinations.
“People need to be enraged about (boarding),” said Dr. Vicki Norton, president-elect of the American Academy of Emergency Medicine.
National emergency physician groups have lobbied for years to keep boarding under control. While they’ve made some progress, nothing substantial has changed, despite concerns that it leads to worse patient outcomes.
Dr. Alison Haddock, president of the American College of Emergency Physicians, said that’s because boarding is a failing of the entire health care system that manifests in the ER, so solving it demands a systemic approach.
Federal and state policy decisions made nearly 40 years ago limited the number of hospital beds, said Arjun Venkatesh, who studies emergency medicine at Yale. People are now living longer, he said, resulting in more complicated illnesses.
In 2003, there were 965,000 staffed hospital beds compared to 913,000 in 2023, according to the American Hospital Association. And another JAMA research letter published in February shows there are 16% fewer staffed beds in the U.S. post-pandemic.
The ones available may be prioritized for “scheduled care” patients who need non-urgent procedures, like cancer care or orthopedic surgeries. Insurance companies pay hospitals more for those surgeries, Haddock said, so hospitals aren’t likely to move patients into those beds — even as emergency rooms fill up.
Where can people go?
Though long stays in the emergency department are common, there isn’t good data that tracks the extremes, emergency medicine experts said.
The Centers for Medicare and Medicaid Services recently ended a requirement that hospitals track the “median” wait times in their emergency departments. An advisory group that develops quality measures for CMS recommended that the agency try to more accurately capture long emergency department stays. That measure has recently been submitted to CMS, which can choose to adopt it.
Patients’ families worry that long emergency room stays may make things worse for their loved ones, forcing some to search for limited alternatives to turn for support and care.
Nancy Fregeau lives in Kankakee, Illinois, with her husband Michael Reeman, who has dementia.
Last year, she said he visited the Riverside Medical Center emergency department several times, often staying more than four hours and in one case more than 10, before finally getting access to a behavioral care bed. Riverside declined to comment on Reeman’s case.
During long waits, Fregeau doesn’t know what reassurance she can offer her husband.
“It’s hard enough for anyone to be in the ER but I cannot imagine someone with dementia being in there,” she said. “He just kept saying ‘When am I going? What’s happening?’”
Since November, Reeman has been going to the MCA Senior Adult Day Center in Kankakee. Fregeau said Reeman treats the day center like it’s his job, offering to vacuum and clean, but comes home happier after having time around other people and away from the house.
In Illinois, there are fewer adult day centers than there are counties, and other resources for people with dementia are shrinking, too. A report from the American Health Care Association and the National Center for Assisted Living found that 1,000 nursing homes in the U.S. closed between 2015 and 2022. At least 15 behavioral health centers, which are facilities that specialize in treating mental health issues, closed in 2023.
With fewer places for patients to go after being discharged, hospital beds are being used for longer, exacerbating the boarding problem. It’s becoming more difficult to get a specialty hospital bed, especially when patients’ dementia causes aggression.
That was the case for Balhan’s father, who became increasingly agitated during his ER stay. Hospital staff told Balhan the behavioral care unit wasn’t taking dementia patients, so Speer was stuck in the ER for 24 hours until they found a behavioral health facility, separate from the health system, that would take him.
While the hospital couldn’t comment on Speer’s specific situation, Endeavor Health spokesperson Spencer Walrath said its behavioral care unit typically admits geriatric psychiatry patients, including those with dementia, but it depends on factors like bed availability and the patient’s specific medical needs.
Balhan feels that the U.S. health care system failed to treat her dad as a human being.
“It didn’t feel to me like he was being treated with any dignity as a person,” she said. “If anything could change, that would be the change that I would want to see.”
Novo Nordisk A/S slumped after a pill from rival Eli Lilly & Co. helped patients shed weight and control blood sugar about as well as its injected blockbuster Ozempic.
The stock dropped as much as 9.8% to 380 kroner early in Copenhagen, the first trading day since the Thursday announcement that buoyed Lilly.
The triumph of Ozempic, Wegovy and related drugs including Lilly’s Zepbound has set off a push toward the next frontier: a pill that’s easier to take and less expensive to make. The Lilly study puts pressure on Novo, whose market value has dropped by a third since the start of the year.
The potential competition prompted Naresh Chouhan, an analyst at Intron Health, to cut his sales forecast for Novo in 2030 by 20% and slash his price target for the shares.
The Lilly data “looks like it is set to transform the GLP-1 space and raise the bar for both oral and injectable therapies” as Novo’s Wegovy already struggles to compete with Zepbound, Chouhan wrote.
The Danish drugmaker said it has filed with US regulators for approval of a high-dose pill with the same active ingredient as Ozempic for weight loss.
Obesity shots made by Novo and Lilly have generated billions of dollars in sales. While rivals including Pfizer Inc. have suffered setbacks, analysts said success in the pill category is critical to creating the $130 billion market they predict by the end of the decade.
Novo has been selling a lower dose pill with semaglutide, the key ingredient in Ozempic and its sister drug Wegovy, since 2019 under the brand name Rybelsus.
Cisco’s U.K. chief exec got her first job at 11, bought a house by 18—and now, at just 45, she’s already at the top of the $240 billion tech giant’s ranks
Being in the C-suite is a high-pressure job with long hours, board responsibilities, and intense scrutiny. But what is it like to be a top executive when you’re off the clock?
Fortune’s series, The Good Life, shows how up-and-coming leaders spend their time and money outside of work.
Today, we meet Cisco’s U.K. CEO, Sarah Walker.
The 45-year-old Fortune 500 boss started out in the world of work at her local sports centre, manually setting up bowling pins at just 11 years old.
Looking back, she says, the early job experience taught her “a ton of skills I would later use in my future sales career, like staying self-motivated and gamifying work to keep things fun and productive.”
Unlike aspirational new hires today—Gen Z job hops every two years and three months, on average—since her bowling stint, Walker has had just two employers.
But you’d be foolish to think that means her career was by any means stagnant.
In 1997, Walker joined the £18 billion ($24 bn) British telecommunications giant BT, where she scaled its ranks over 25 years, from the sales team to its director of corporate and public sector.
Promotion after promotion, she earned multiple internal “Directors Club Awards”—recognition that came with lavish reward trips. One of the most memorable? A once-in-a-lifetime getaway to Cannes and Monaco with her mum.
“Fun fact? Nearly every internet connection in the U.K. touches Cisco. From the NHS to the police force and even the FTSE 100, we help keep things connected and secure,”
Sarah Walker
Following a mini micro-retirement, she then joined Cisco as managing director in 2022. Just two years later, she was promoted to the top job as chief executive of Cisco U.K. and Ireland—now she’s steering the tech giant through the fast lane of digital transformation, with clients ranging from high-street retailers to global banks.
“Fun fact? Nearly every internet connection in the U.K. touches Cisco. From the NHS to the police force and even the FTSE 100, we help keep things connected and secure,” she adds. “I’m beyond excited to keep the momentum going.”
The finances
Fortune: What’s been the best investment you’ve ever bought?
I’ve always been quite sensible with money. I had a relatively comfortable upbringing, which, whilst we didn’t want for anything, taught me valuable lessons on budgeting and prioritising what’s important. At 18, I took the plunge and got my first mortgage—it felt like the smart move at the time.
The property was £45,000 which felt like a huge number back in the day. It put me firmly on the property ladder early, which I’m super grateful for.
And the worst?
Ah, cars when I was younger! The alloys on some of them were worth more than the car itself.
If you have children, what does your childcare arrangements look like?
My two are older now—one’s off to university, and the other is a pretty self-sufficient 15-year-old with a part-time job at an after-school club. Those hectic childcare days are (thankfully) behind me, although I still very clearly remember the juggle!
“At 18, I took the plunge and got my first mortgage—it felt like the smart move at the time.”
What are your living arrangements like: Swanky apartment in the city or suburban sprawling?
I am lucky to be living in my forever home, which is a restored Victorian house in the Wirral. I love being able to head back home and spending time on the coast after a busy week of travelling. It means I have my family and friends on my doorstep. Technically, I’m 30 seconds from the office, as I primarily work from home when not travelling. The nearest Cisco office is approximately 50 miles away, and it’s about 200 miles to our office in London. All my senior leadership team is based outside of London so we meet up all over the U.K.
How do you commute to work?
Most days, it’s just a quick walk up the stairs to my home office! But when I’m visiting customers or partners, I’m all about mixing it up; planes, trains, cars, you name it. That said, I do love a good road trip.
Do you carry a wallet?
I’ve got a purse for every occasion to match my bags, though these days Apple Pay is my go-to.
What personal finance advice would you give your 20-year-old self?
Keep doing what you’re doing, but don’t waste so much on rubbish cars!
What’s the one subscription you can’t live without?
Amazon Prime. It’s not just deliveries—I’ve got so many auto-renewing subscriptions tied to it. Losing it would be chaos!
Where’s your go-to wristwatch from?
For everyday wear, it’s my Apple Watch. I’m obsessed with the data (comes with the job!). For special moments, I’m lucky enough to be able to wear my Rolex, or a beautiful Cartier watch that my husband gave me for my 30th.
The necessities
How do you get your daily coffee fix?
I’m more of a matcha fan these days! I use my Krups coffee machine as a high-tech milk frother to mix almond milk with matcha powder.
What about eating on the go?
When I’m in the office, Itsu is my usual go-to place. If I’m grabbing a sit-down meal, I love light Japanese food—I’m a big fan of Roka.
Where do you buy groceries?
I am a traditionalist. In our household, Sunday mornings are spent doing the ‘big shop’ in Sainsbury’s. During the week, we’ll grab quick top-ups from M&S.
How often in a week do you dine out versus cook at home?
We tend to cook most nights as the kitchen is the heart of our home. But Saturdays are usually an eating-out day, squeezed between the kids’ football and taking the dog for a walk.
Where do you shop for your work wardrobe?
For me, it’s all about the style, not the label! Everything from Zara to vintage designer brands makes it into my wardrobe.
The treats
Are you the proud owner of any futuristic gadgets?
I recently took the plunge and bought my husband the Meta glasses for Christmas, which have proven to be great fun for all the family. Plus, I’ve got an Oura ring that’s become my go-to for tracking my sleep and wellness goals.
I have become quite fascinated with wellness in my 40’s, I love the insights the Oura ring shares, resilience, readiness. It is amazing the things it can detect through subtle changes in your body.
How do you unwind from the top job?
Weekends are a whirlwind of family stuff. I’m basically a full-time taxi driver, shuttling the kids to sports clubs and helping them keep up with their social lives. It’s non-stop, but I honestly love switching gears and just being in mum mode.
Cooking dinner and walking the dog are my favourite ways to relax. I’ve also started reformer Pilates, which I’m totally hooked on! And once a month, I book a Reiki session—it’s a game-changer.
What’s the best bonus treat you’ve bought yourself?
Bonuses usually go straight into the holiday fund. The best one was when we took a month out to travel across Australia and Bali, we will remember that trip forever.
How do you treat yourself when you get a promotion?
When I get promoted, it’s usually a new bag! For my recent role as Chief Executive, we kept it simple and celebrated with a lovely family meal.
Take us on holiday with you, what’s next on your vacation list?
Our big trip this year will be a family holiday to Orlando, Florida for what may well be our last family trip to the theme parks before the kids get too old. After the theme parks, we’ll then travel down the coast for the second part of the holiday. We’ve also got a few smaller weekend trips planned, including a visit to the Lake District for my birthday and we’ve booked to go to Paris to celebrate mine and my husband’s 18 year wedding anniversary.
How many days annual leave do you take a year?
We travel about four to five times a year, mixing U.K. staycations with European city breaks and one big family holiday. Lake Windermere and Dubai are regulars for us, but we love exploring new places, too!
Here at The Good Life you don’t have to imagine what life at the top looks like anymore: Get real-life inspiration for how the most successful live life.
Fortune wants to hear from European leaders on what their “Good Life” looks like. Get in touch: orianna.royle@fortune.com
Arborists are turning vacant land on Detroit’s eastside into a small urban forest, not of elms, oaks and red maples indigenous to the city but giant sequoias, the world’s largest trees that can live for thousands of years.
The project on four lots will not only replace long-standing blight with majestic trees, but could also improve air quality and help preserve the trees that are native to California’s Sierra Nevada, where they are threatened by ever-hotter wildfires.
Detroit is the pilot city for the Giant Sequoia Filter Forest. The nonprofit Archangel Ancient Tree Archive is donating dozens of sequoia saplings that will be planted by staff and volunteers from Arboretum Detroit, another nonprofit, to mark Earth Day on April 22.
Co-founder David Milarch says Archangel also plans to plant sequoias in Los Angeles, Oakland, California, and London.
What are giant sequoias?
The massive conifers can grow to more than 300 feet (90 meters) tall with a more than 30-foot (9-meter) circumference at the base. They can live for more than 3,000 years.
“Here’s a tree that is bigger than your house when it’s mature, taller than your buildings, and lives longer than you can comprehend,” said Andrew “Birch” Kemp, Arboretum Detroit’s executive director.
The sequoias will eventually provide a full canopy that protects everything beneath, he said.
“It may be sad to call these .5- and 1-acre treescapes forests,” Kemp said. “We are expanding on this and shading our neighborhood in the only way possible, planting lots of trees.”
Giant sequoias are resilient against disease and insects, and are usually well-adapted to fire. Thick bark protects their trunks and their canopies tend to be too high for flames to reach. But climate change is making the big trees more vulnerable to wildfires out West, Kemp said.
“The fires are getting so hot that its even threatening them,” he said.
Descendants of Stagg and Waterfall
Archangel, based in Copemish, Michigan, preserves the genetics of old-growth trees for research and reforestation.
The sequoia saplings destined for Detroit are clones of two giants known as Stagg — the world’s fifth-largest tree — and Waterfall, of the Alder Creek grove, about 150 miles (240 kilometers) north of Los Angeles.
In 2010, Archangel began gathering cones and climbers scaled high into the trees to gather new-growth clippings from which they were able to develop and grow saplings.
Sequoias need space, and metropolitan Detroit has plenty of it.
In the 1950s, 1.8 million people called Detroit home, but the city’s population has since shrunk to about one-third of that number. Tens of thousands of homes were left empty and neglected.
While the city has demolished at least 24,000 vacant structures since it emerged from bankruptcy in 2014, thousands of empty lots remain. Kemp estimates that only about 10-15% of the original houses remain in the neighborhood where the sequoias will grow.
“There’s not another urban area I know of that has the kind of potential that we do to reforest,” he said. “We could all live in shady, fresh air beauty. It’s like no reason we can’t be the greenest city in the world.”
Within the last decade, 11 sequoias were planted on vacant lots owned by Arboretum Detroit and nine others were planted on private properties around the neighborhood. Each now reaches 12 to 15 feet (3.6 to 4.5 meters) tall. Arboretum Detroit has another 200 in its nursery. Kemp believes the trees will thrive in Detroit.
“They’re safer here … we don’t have wildfires like (California). The soil stays pretty moist, even in the summer,” he said. “They like to have that winter irrigation, so when the snow melts they can get a good drink.”
How will the sequoias impact Detroit?
Caring for the sequoias will fall to future generations, so Milarch has instigated what he calls “tree school” to teach Detroit’s youth how and why to look after the new trees.
“We empower our kids to teach them how to do this and give them the materials and the way to do this themselves,” Milarch said. “They take ownership. They grow them in the classrooms and plant them around the schools. They know we’re in environmental trouble.”
Some of them may never have even walked in a forest, Kemp said.
“How can we expect children who have never seen a forest to care about deforestation on the other side of the world?” Kemp said. “It is our responsibility to offer them their birthright.”
City residents are exposed to extreme air pollution and have high rates of asthma. The Detroit sequoias will grow near a heavily industrial area, a former incinerator and two interstates, he said.
Kemp’s nonprofit has already planted about 650 trees — comprising around 80 species — in some 40 lots in the area. But he believes the sequoias will have the greatest impact.
“Because these trees grow so fast, so large and they’re evergreen they’ll do amazing work filtering the air here,” Kemp said. “We live in pretty much a pollution hot spot. We’re trying to combat that. We’re trying to breathe clean air. We’re trying to create shade. We’re trying to soak up the stormwater, and I think sequoias — among all the trees we plant — may be the strongest, best candidates for that.”
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