When Elsa Ravnaas was born, her parents knew the girl couldn’t find the health care she needed back home in North Dakota.

So part of the family has stayed in Minneapolis for more than two years, with Elsa receiving home care 24 hours a day from a Roseville company called Pediatric Home Service.

“It would be impossible without them,” said the girl’s mother, Sara Ravnaas. “Elsa has an amazing quality of life because of PHS.”

Among midsize firms with 150 to 499 employees, Pediatric Home Service ranks No. 1 on this year’s Star Tribune survey of Top Workplaces. Another home care company — Right at Home — holds the No. 2 spot on the list, which features everything from a health club and an accounting agency to a pharmacy and a pest control service.

Like most employers on the list, compiled by WorkplaceDynamics, the home care companies are privately held. The list of 50 midsize workplaces also includes a few nonprofit groups and a public sector employer.

At Pediatric Home Service, worker satisfaction comes in part from meaningful relationships with patient families, said Lindsey Paitich, a nurse and case manager. But relationships in the office are important, too.

“The culture here is fantastic,” Paitich said. “We all support each other. And we really stick to the mission of taking care of the children.”

Susan Wingert founded the company in 1990 after working for several years at home care agencies that tended to adult patients. She wondered why home care wasn’t an option for kids, too, and created a company to make it possible to deliver pediatric respiratory care.

Pediatric Home Service has grown to include other services such as providing infused medications and in-home nursing as well as nutritional support and individual therapy. The company now has about 420 employees, most of whom work full-time.

Wingert retired a few years ago. Her son, Mark Hamman, credited his mom with establishing the firm’s enduring culture.

“We’re taking care of really sick kids, and it’s a very rewarding job to have — you feel good about what you do,” said Hamman, the company’s president. “But it’s also a very stressful position. … Families are going through tough, tough times.”

The company strives for a relaxed atmosphere at the office.

Team-building events have featured kickball and Wii bowling. For Halloween, workers decorate the office and invite patient families for treats.

Once a month, there’s popcorn in the lunchroom. The company organizes potlucks, holiday meals and visits from a barista. In May, one department celebrated health care technology management week with a Tater Tot bar.

“We like to gather around food here,” joked Becky Olson, a home care nurse.

Hamman said his mother started the business by draining the family’s savings account, hiring a few people and putting the focus squarely on customers. The company has grown by maintaining that focus, he said, although the concept of “customer” is somewhat complicated in home care.

Obviously, patient families are key, Hamman said. But hospitals and physicians refer patients for home care services, so the company also must make life easy for those who provide referrals.

“It’s all about taking care of our patients,” Hamman said, “and I think our employees feel empowered to do that.”

Sara Ravnaas agrees. Elsa relies on a ventilator and feeding tube, and takes 15 medications each day. Food and medicine are administered on a complicated round-the-clock schedule, and caregivers must be vigilant about infection risks, keeping her artificial airway clean and assessing vital signs.

There are regular nebulizer treatments, plus physical therapy and occupational therapy. Elsa’s heart rate, breathing and oxygen levels must be checked.

“The nurses are like family to us,” Ravnaas said. “We’d be in a hospital if it weren’t for them. Elsa would be living her whole life there, and she wouldn’t be able to crawl around and be a kid.”

The hope is that after a surgery scheduled for this summer, Elsa might eventually be well enough to go home. For the foreseeable future, however, the family is split.

While Ravnaas lives in Minneapolis with Elsa, her three sons usually are back home in North Dakota where her husband works the family farm. Caring for Elsa is often a two-person job.

“I can do all her care with a nurse, but I can just be a mom sometimes, too,” Ravnaas said. “It’s huge, because it’s what Elsa needs to see. She wants to know that I can just snuggle her, and be a mom, versus ‘I need to suction you’ or ‘I need to give you this med again.’ ”