Many of us with elderly parents or loved ones are eventually faced with a difficult decision: whether or not to put a family member in a nursing home. Sometimes, it’s impossible for family members to care for a senior spouse or loved one because they don’t have the professional nursing skills that are needed.
Unless families can afford to hire a caretaker, long-term care facilities are the only option. Unfortunately, some of these facilities that promise to provide compassionate, professional care end up setting a stage for nursing home abuse and neglect, injuring the vulnerable seniors in their care. In some cases, these injuries – bedsores, sexual abuse, dehydration and over-medication – lead to death.
Sometimes the only help available is through a nursing facility. What are children and spouses supposed to do then? How do you hold facilities accountable? Some of them purposely go to great lengths to hide information from family members and don’t like to answer questions.
Carole Herman is the founder of the Foundation Aiding the Elderly (FATE). For over thirty years, she led the organization in a fight against the nursing home industry, crusading for better care and an end to abuse. This is a fight she continues today. She and FATE were instrumental in holding a number of California regulators accountable and the non-profit assists families across the county.
She joins me on this episode to talk about some of the signs of abuse and how to prevent it as well as the underbelly of the nursing home industry.
Disclaimer: The Foundation Aiding the Elderly (FATE) is not an attorney referral service.
Carole, thanks very much for the work that you are doing and welcome to the show.
Thank you for having me, my pleasure.
Now, I understand that there is a very personal story that got you started into it. Could you share when you founded the organization and what led to the founding of it?
I had an elderly aunt who broke her hip and ended up in a nursing home. So, the end of this horror story was uhm, she was obviously chemically restrained in this facility. She stopped talking and stopped walking and obviously the rehab stopped. And I got a call one day when my mother was out of town, that they were taking her to an acute hospital for surgery.
Oh my goodness.
And I went, "What are you talking about?" Well, she developed a stage IV bedsore that we didn’t even know about. Well, she ended up dying from that stage IV bedsore. She got blood poisoning. So she never made it after they debrided the bedsore. She never made it. She died. So we're going, we're in shock. So I started investigating nursing homes. Like who owns them, who monitors them, who runs them. And I learned all that, so I put together a huge complaint to file with the regulators in California. And I filed that complaint and for the next year I dogged them, kept calling "Where are the results, where's the results?" And they . . . we were stonewalled for over a year. The end result was is that I got a response from the head of the department that my complaint was unsubstantiated, that the facility didn’t do anything wrong. She just died from a stage IV bedsore. So, I asked for this internal affairs investigation when they went into the department, there was no complaint on record. Never even registered in.
And so I discovered that the head of the agency actually destroyed my complaint to protect the nursing home operator.
And you guys were there all the time.
Yeah, so this was something that happened. They were basically, what, hiding it from you, essentially, because you were there all the time.
Oh yeah, they were. And of course they wanted to keep her there because she was private pay and ...
Of course, yeah.
In private pay, if you’re a private pay patient they can charge whatever they want.
The money. I don’t think people understand how much money people make in this. Especially when they get the patients that are basically on Medicare or Medicaid. Right? And they just sort of keep billing everything and they don't even do what they say, right?
That's right. There's a lot of Medicare, Medicaid fraud going on all over the country because no one is monitoring it. You there's all these regulations but they're not being enforced. So, the industry knows that, they're not afraid of the regulators, they're not being held accountable. There's billions. We're talking billions of dollars. Because 87 percent of the people in nursing homes are being paid by Medicare/Medicaid. In California it's called MediCal. So there's this open tap of money flowing and nobody's monitoring it.
No, and then you are getting these people that overnight decide to start a nursing home. That don’t have any, they're just business ...
They're business men ...
They're business men right, business people all kinds of people that have nothing ... no business being in healthcare.
There's a window of opportunity to make a lot of money and it's really basically not very well monitored by the system. So, it's an opportunity to go in and make a lot of money. And I'm not saying every nursing home operator is like this.
Oh, of course not.
The majority are. The nursing home industry, their lobbying group, we're also paying for those people. Because it’s all based on government monies.
Oh, boy, isn't that great? We're paying for them to lobby more of this.
We're there to – we're paying the lobbyists their fees to go in and lobby for the best, for the benefits of the nursing homes operators, not the consumer. Then, we pay their legal fees when they get in trouble and it's all a part of the reimbursement system through the government. All the money that they spend every year goes into this pot and then the government decides on how they get reimbursed. So it’s really quite an ugly business.
It is, and they kind of prey on people's needs to have their loved ones taken care of.
And you know, I guess they do a lot of setting up because you, people might go and visit and think oh, this is a great home and you know, what have you, and of course when they're not there they don’t know what's going on.
No, and I always try to, you know, one thing that we have done throughout the years is to educate the public as to what their rights are in that environment and whether their family have rights . . . you know visiting, there are no visiting hours for family members in nursing homes in this country. The nursing homes will post visiting hours and people will think that applies to everybody. It does not under the federal law. Federal law says there are no visiting hours for family members. So there's all kinds of ... and they try to get rid of family members of you ask questions.
Oh, of course.
There are a lot of drug being given, anti-psychotics, there has to be informed consent before you can ever give an anti-psychotic because they are considered a chemical restraint.
Now, talk about that a little more because I don’t think people are familiar with that term.
Restraints come in two forms. Chemical restraints which is a form of drugs, and some of these very strong anti-psychotics they give to the elderly for behavior control. The physical restrains are actually, tie them to the bed.
So, this is sort of a way for them to control people and not have to deal with them. Because it basically makes them listless, right?
Yes, and the anti-psychotics, one of the side effects is that it hits the muscles. So, you quit ... you have a hard time swallowing. So all of a sudden you have this patient in there and oh they're having swallowing problems, then, oh let's put in a feeding tube because they can’t eat. Well, then there's more money. Or if they’re having a behavioral problem, rather than figuring out what’s the behavioral problem, well here’s this person who is coming off of surgery that's still under the anesthetics from surgery and trying to rehab them and they're kind of acting out because a lot of elderly people get delirium when they're under anesthetics for surgery and then they just fill them up with more drugs. And then they can't rehab, so they fall.
They're deteriorating then, at this point, right?
Right, and then it’s, you know, more money to the facility. Let's put them on a breathing apparatus or let's put them on a feeding tube. And it’s all about the money. To make it easier, because the industry is notoriously understaffed. They don’t staff the facilities to meet the needs to the patients.
Now, I read somewhere that that's because that's the easiest place for them to cut corners, right, to not hire people. Or qualified people at that. They might have bodies, but not people that can actually handle patients with dementia, right.
And they don’t train them. I mean, the training is not that good, and they just want somebody there for a a count. They have to have certain nursing hours per patient, which they are in violation all the time. And one of the things that we were able to do several years ago in California is that I filed 65 public interest lawsuits, we don’t do this for money and we, fortunately don’t have to pay the lawyer's fees either, they get paid through the courts there. Public interest lawyers, not ...
Oh, then that's great then, you get to do what you need to do without, you know, wow ...
Right, but you have to be a non-profit. They don't ...
They only represent non-profits, but they don’t do it for the benefit of the public only. So, obviously I'm really in there because I do it for the benefit of the public. So, we were able to get an audit to go back after we had all these lawsuits where we made them sign that they would keep the staffing ratios at least to the minimum according to California law. An auditor would go in and audit the payroll records.
Oh, to make sure they were actually doing it.
Yes, because I would see sign in, they would check sign out sheets for the day. And say, let’s look at this sign in sheets and see how many staff people are on today. Well, sometimes there are people on there that didn’t even work for the facility. So in California for them to check on staffing ratios they have to go to payroll records. Now since we did The New York Times expose several weeks ago ... the Medicare rating system? Medicare is now is going to make some changes to their requirements and I think they are going to start using payroll records now to check staff. So that was a real good outcome. As long as the inspectors do it.
Oh definitely, of course. So we talked a little bit about the uh, chemical restraints and the physical restraints and I think that there are so many different kinds of abuse and neglect that go on in the facilities. And some people might not be clear as to what actually constitutes as abuse. Could you go over some of the more common and uncommon perhaps too, types of abuse?
Sure. Well, obviously, abuse takes many forms. A lot of it is fiduciary abuse. Because you know the older generation, you know the women that outlive their husbands and these are the women from you know, World War II era. They were savers, you know, they saved their money. There were no credit cards. If you didn't have the money, you know, you just went without. And we all did real fine, didn’t we? So now, there's abuses at home, you know all kinds of abuses. But in the long term care setting, you know there's from you know, psychological harassment to deprivation of food and water, verbal threats, broken bones that happens when you're in a long term care facility, you know, poor hygiene, abrasions that all of a sudden show up on somebody's arm and you say, how did you get all these cuts or bruises you know, unusual weight loss. You know, no access to telephone, uhm denial of a healthcare professional of your choice. Under the patient's bill of right, the patient has their own right to choose their own healthcare provider. Problem being that if you want a different doctor, they don't want to come into nursing homes because they don't get paid enough. These doctors that are there that you know, you feel like you have to use them. But, so those are the kind of things that are happening, you know, in the long term care setting.
When there's any kind of sexual abuse going on, they jump on those right away. It’s sad because it's maybe sensationalism, but at least it gets out there.
Exactly and I've had those cases here, where believe it or not one of the cases I had and it was in an assisted living environment and both the patients were in the dementia unit. And they told the family that they were consenting adults. Absolutely absurd. But you know, I've had clients that nobody even knew they were abused until they got into a hospital environment and were checked out.
So, now you have clients. What happens, do these people kind of go through the regular channels and say oh my goodness, I need help because we don’t even know where to begin. Is that when they end up calling you?
Right, we get those kind of calls. What do we do, do we, you know. I'm not a litigious type person so we don’t really go to we'll file a lawsuit. However, because the state regulators all across the country are not doing their job and they’re kind of turning their head to this because it’s very political. The politics behind this are horrendous. Then, they'll consider a lawsuit because they want somebody held accountable. It’s not just that they want money. They want somebody held accountable for abusing their family member. And if the state regulators aren't doing it, they are turning to the legal community to do it.
Real quick here, let me take a quick break and when we come back we'll talk a bit more about what you just touched on when there is nowhere else to go except perhaps file a lawsuit. So we'll be right back.
Welcome back to the show, my guest today is Carole Herman and we've just been discussing the types of abuse that some elders go through and discussing what sometimes ends up becoming a lawsuit because of lack of enforcement by the government. Thanks so much again Carole for being with us.
Well, thanks so much for having me. You know when you are a victim of abuse, you have a different attitude and a different purpose. And we have a lot of volunteers that come in and help us in this mission. We're just a non-profit so we have a lot of volunteers. And every volunteer that comes in to do the…work for FATE has been a vi – they've been clients of our so they come in and they volunteer and they are mostly retired, you know, in their 60's and had family members that went through this so they wanna give back as much as they can and alert other families so they don’t have to go through the heartbreak of having a family member abused like this. It's very, you know. My mother never got over the death of her sister cause of this and the guilt that goes along with it, so. Our volunteers here are also victims of abuse.
Now, we were discussing before we went on the break that sometimes because the government…you may go through all the proper channels as you did when you went through your own personal thing, right. You went and filed all the complaints and did all you could but, yet, you know, you were basically hitting a wall at every turn. Now, you did not go and end up filing a lawsuit at that time. But, some people end up doing that as you mentioned before, of um, you know as a way to hold people accountable.
Now, why do you think this ends up happening so often? That people end up having to file a civil lawsuit to get something done?
Well, I think the reason why they are doing it is that they are seeing that the system that is in place to protect us, protect our loved ones, is not working. So, nobody is being held accountable. So, if the industry is no held accountable for abusing our family members, well why would they be…why would they act any different? They're not being held accountable. So, the family members when we go to the state regulatory boards and file these complaints and they come back unsubstantiated or we substantiated that your family member did fall and break her hip but he was not holding the facility accountable for that. And that's when they consider a lawsuit. And it's draining on the family, but they stick with it because they feel it’s the only that the industry is being held accountable for abusing their family members.
Now, I heard, I actually read in the Sacramento Bee which has a lot of great coverage right now. You've participated in some of those stories about the ownership of nursing homes.
We certainly did.
Which is the craziest thing that anyone can hope to try to do on their own. I understand this is sometimes why families end up going to attorneys because then they go and dig for all these pathways of the owners of these nursing homes.
And how many different ways they basically try to hide who the real owner is.
It’s really insane and one of my things to is like some of these corporations are publicly held. You know right off the bat that you do not break any laws. The SEC, the Security Exchange Commission, they will pull you right off the bat and you will no longer be trading on the stock market. That's not applied here and I've even informed the SEC why aren’t you looking at this but I don't get any feedback. I mean, it’s pretty quiet. There's a lot of money being made. So a lot of, and you look up, you know I did research on campaign contributions. And when you start looking into seeing how much campaign contributions are from the health care industry, including the nursing home industry, assisted living and all that, a lot of money that's going to the politicians and people that are in nursing homes, long term care facilities, they're not campaign contributors. So, it doesn’t take a rocket scientist to figure out who's getting protected. Because of the 87 percent of the money going into facilities is government money, Medicare and Medicaid, well, we're actually paying for elder abuse. It doesn’t make sense.
No, it doesn't.
But it's actually going on.
Yep, it certainly is. Now you mentioned assisted living assisted living facilities and nursing homes. I was under the impression that assisted living facilities were for people that were still somewhat independent? But I think we've almost been using them somewhat interchangeably is that the case?
No, I never refer to an assisted living facility as a nursing home. A nursing home is a skilled nursing facility people are there for rehab or they are there permanently because their, their health is so bad and their acuity is so bad that they will never ever leave that type of environment. Most of the abuse is coming from the nursing homes. Skilled nursing, totally different, totally regulated . . . here in California it’s the Department of Public Health regulates nursing homes. Department of Social Services regulates assisted living residential care facilities that are really popping up that a big industry now. You know, for six people or less? That's big. That's really popping up all over. Thirty two years ago there weren’t all these assisted livings, residential care homes like there are today.
Which do you think that sort of a good change in the industry? That there are more choices that people can choose from for this kind of thing?
Oh, yeah. The difference being that assisted living there are some states that have pilot programs as far as the government getting involved and helping pay for assisted living. Basically it's private pay. So the people that are going in to those places have the money. Most of the people we serve are low income. People that don't have the money.
Yeah, people that don’t have the choice or the luxury.
Yeah, and the people that do have the money, they keep their loved ones at home and get in home care. It's very expensive.
Oh yeah, definitely, but you know what, even a nursing home – not even the best – is actually pretty expensive. I think I was seeing that the average year was around $80,000. For an average facility and so I'm, this is…and of course this is what you would think is a more decent place. But then again, even the cost doesn’t always tell you what kind of care you are going to get in some of these places.
Oh, absolutely. I did a little article for The L.A. Times – look under the sheets. Instead of just looking at the facility that's so beautiful that you invested in, what's happening to the patient care? Aesthetically, it's beautiful but what's really going on with the care. You can go into a facility that's not as beautiful, maybe old building but maybe the care is a lot better. And then I always tell the client too the only way you are really going to see what the background is on this particular facility is to go to the state licensing office and look up their public records. So, if you go into the state that is licensing that facility and say, I want to see the public file on this nursing home, they have to show it to you. It’s public record. So you can look. To see what type of complaints have been filed. A lot of times it's very difficult, you know, but the consumer is entitled to look at that.
And I think they don’t like people to know that obviously. They don’t want everyone checking in on them.
No, they don’t want anybody checking in on them.And I mean, you can interview anybody that's had someone at a facility for you know any period of time and they'll tell you, and I know they'll tell you the same thing. Well they didn’t like it and they didn’t like us asking questions. There were times they told us they had to leave the facility and they don’t like people asking questions.
And it’s sad because you go there and of course you want to make sure you know the staff who's taking care of your loved one, you know. And they are with them every day.
What's scary is the times when you are not there is what's really scary about it. Under the federal law you can, if you're a family member. If you're an immediate family member you can walk into that facility at 3 o'clock in the morning, which I tell people to do it. Go there at 2 o'clock in the morning. A lot of them will go there and find this. The staff, they can’t find the staff, a lot of them are sleeping sometimes, I mean it's pretty alarming.
I think I started thinking about this too, because my dad at one point he had an issue. He got the flu really bad and it ended up becoming pneumonia, well, he was in ICU for about a month and then after that he had to go in to a long term care rehab. So we were there and he was just basically there to get his functioning back from being bedridden for so long, but if my stepmom hadn’t been there with him? She pretty much camped out there with him. It was really eye opening to see how ... or what would go unnoticed. You know alarms and things go off and people would just ignore them. I'm like doesn’t this mean something bad?
It means that they don't have enough staff. My whole theory is if you don't have enough staff it's automatic negligence. Because you cannot meet the needs of the patients. And they are excepting Medicaid or Medicare dollars, but they're not doing what they are supposed to do.
And then, I think goodness. My dad had all his faculties there mostly. And I'm thinking about the poor patients that might have early onset dementia or any kind of mental thing that sort of make it difficult for them to say something.
And there's always that fear of retaliation, well, if I complain too much they're going to treat my family member worse when I'm not here. Yeah, you always have that fear that something is going to happen to them because if you are seeing what's going on when you're there. What's going on when you're not there?
On that note, let me take another quick break here and we'll be right back.
Welcome back to Drugwatch Radio, my guest today is Carole Herman and we were just talking about some of the fears that family members might have in a nursing home setting with how their loved ones are taken care of. Now if someone suspects that a loved one, we kind of touched on this before, is being abused in a nursing home, where should they start? What kind of action should they take?
Well, I'm always a believer that you gotta go to the top. The top person making that decision is the administrator. I mean, if it's not a serious allegation, you know, the food most of the time is terrible – we don’t file those kind of complaints on behalf of our clients. But if you have some concerns about, you know, what kind of a diet, you know things that are not really going to have a real detrimental effect on you family member. I would take it to the administrator of the facility because that's where the buck stops. In the nursing home environment it's the administrator. Or in assisted living they call them executive directors. That's where I would take grievances that are not serious grievances. Serious grievances, if you come in and all of a sudden there's bedsores or you feel that you family member is dehydrated, know that you can have your family member 911'ed out of that facility, in an emergency room, to be hydrated or given nutrition. Don’t ever fear, the client or the consumer should never fear calling 911.
So this is for like an emergency type situation. You go there and you are like, oh my goodness this could really be right now life threatening.
Absolutely, you know if your family member is on a catheter and all of a sudden you see the urine bag is full and it's dark, it's bleeding or it's blood. Oh, 911. If there's fevers, dehydration is very serious in nursing homes, you know liquids should be available to the patients at all times. And if the patient is not capable of doing it on their own the staff is mandated to make sure that that resident id hydrated. And there's a lot of serious thing that happen with dehydration. People don’t think about it.
And that a basic thing, you know, just giving enough water to a patient. You wouldn’t think people would be denying people water.
Well, they don’t do that because they don’t want to change them. Believe me, most people don’t want to know what I know. And you know, the drugs are such a big issue. And I always recommend to family members. If they go into a facility and you suspect anything, you ask to see the medical records, immediately, because the facility according to the law, they have to on demand show you the medical records. In other words, if you wanna see the drug records, I wanna see the, it's called a MAR, medical administration record. I wanna see the drugs and I wanna see how much is being given. I'm not saying that all medical records are correct, because they're not. They have to show that on demand but to get medical records under the federal law the facility has two days to produce the medical records. So in other words, if you request a copies of medical records on a Monday, by Wednesday, by federal law they have to give them to you. I have filed many many complaints across the country for failure to adhere to the federal law on production of medical records. They don’t want to give them to you.
No and ... we were talking here about the drugs earlier that that is probably one of the biggest problems when it comes to people being in homes over medicated all the time, so this is a place where people can find out if that's what’s happening, right? If they look at the medical records?
Yeah, well you know that in the nursing homes. You know, under the federal law you cannot even give an anti-psychotic without consent and it's gotta be in writing and most people don’t even know what that means. They say, oh the doctor consented. No, the doctor doesn’t consent to anything. The family and whoever is responsible for the patient is the one who approves or disapproves any kind of care.
It just seems like they just go ahead and do it in most cases, right?
Oh, they do. Because they are hoping that the person in charge doesn’t know what their rights are.
You know the medical profession is not used to having, being questioned.
No, no, they get angry, actually.
They are used to doing whatever they want. And I understand that in the case of an emergency, automobile accident or something, and somebody's in the emergency room and it's a life or death situation then yes, they should be able to do whatever they want to save the life of that person. But in other situations, that is not the case at all, we have the right as a citizen to choose what we want, how we want to be cared for and what drugs we do want and what drugs we don’t want. But most people are, most people are intimidated by the medical profession. They don’t wanna ask questions.
Like we were saying it's all about money and there are, when you talk about for-profit and non-profit homes. Most of the abuse and all the problems are mostly on the for-profit side, really. Right?
I mean a lot of them really, anyway, a good percentage.
Well, that's because the big percentage of profits is more so than the non-profits.
I see, just by real numbers.
You know, mom and pop shops where there's one facility. They tend to be a little better because they just got one facility. There are still problems though. And I hate to keep bashing the skilled nursing, facility – you know, industry but it's true, I mean I'm not saying anything to anyone about my experience in 32 years that I can't back up.
Do you think that the, the problems are on the rise?
I think what's getting better, because the industry is going to try anything, but what's getting better is that people are getting educated. They are not taking the doctors answer to be the answer to any solution. They are not taking the answer to be the solution. They are finding out that they have the right to make an informed decision on their own and I think that the problems will always be there but I think that the public is going to make the change because they are starting to get educated. Once you get educated and know what your rights are, you can stand up to the, you know, stand up to the medical profession. Then, that's half the battle right there. And this is not a sexy topic. Nobody wants to think about, wow that could be me. Consequently, until it affects you, there's a, you put a blinder . . . people put blinders on. You don’t look at it, it doesn’t affect you. But it’s affecting a lot of people and with the baby boomers now? It’s huge.
And education is a big part of it. Making sure what's going on, visit your loved ones often. That's another thing, right? As often as you can.
You always have to take a real approach to preventing any type of abuse. We're doing this research now all over the country. We've got a couple research programs seeing how does that work in the other states, but in California alone we have title 22 regulations. So we're governed, the industry is governed by federal and state nursing home regulations. Which is in most states, well in California the punitive penalties assessment if it causes a death, the fine can be up to $100,000. But that particular citation that is issued under California regulations never appears on the federal website. Only thing that appears on the federal website is when they violate federal regulations. We have very high penalties, up to $100,000 if a death occurs. Now, whether or not they collect that is another thing because the industry has an out. They can file, they can file a lawsuits against the state. And it doesn’t show up on record until it’s over, until the due process is done. But it never shows up in the federal website.
Real quick here, let me take a quick break, so we'll be right back. Welcome back to the show, my guest today is Carole Herman. So now, if people are interested, if anyone listening to this is interested in maybe contacting you and getting more information, where can they best contact you?
Well, go to the website. Which is www.4fate.org/. There's all kind of information on there, they can contact us through the website. We're very responsive; we answer . . . anybody who contacts us, no matter what it's for. We try to resolve their problem. And we get calls for a lot of things, not just nursing home abuse. We get calls for fiduciary abuse. We've got about 400 documented cases of conservatorship abuse, which is the next biggest scandal to hit this country. You know we have people that call here and say, geez, you know my mother is 85 some guy came to her house and wanted to replace her screen door for her and charged her $5,000 and never did the job. So we do, no matter what the problem is if we can’t solve it for you, we will refer you to the agency or somewhere in the government that will be able to help you, but we handle a lot of stuff. You know when I went to school, it's still over the head of the main entrance to the school, high school I went to, "Enter to learn, leave to serve." And I think that when this happened with my aunt like a lot of people, when you are personally affected it’s really different. This work that I do is attacking a big industry and a huge government problem. So, it’s been difficult I've had my life threatened, especially when it got into the drugs when I started talking about the drugs in and out of nursing homes?
Oh boy, yeah, the drugs, the pharmaceutical industry doesn’t like that.
Fine, it didn't scare me off. Yeah, most people get scared off. If you wanna shoot me, then shoot me. I think the system thought that they would get rid of me by stonewalling me in the early days. I never went away over all these years and now we've made a difference.
Well, thanks so much for being on the show today Carole. Because you've given people so much great information. There is a way to be able to take care of these things and take some action.
You can’t get into this long term care environment without any knowledge of what's going on. What's happening to that little lady across the hall that has no family? That's easy prey for this industry.
Well, thanks so much is there any parting things that you might want to give to any listeners?
Prevention is part of the deal. Watch what kind of medications, make for any injuries, stay hydrated you know, and if you are in that environment, watch for what are some of the red flags. You know if you see constant smell of urine and feces all over the place, you see patients slumped over in their wheel chairs all the time, no activities, and obviously insufficient staffing.
That's a big one. And don’t be afraid to speak out and if nobody's listening to you, we're very outspoken for the benefit of the patient. So, you know they can always call our office or contact us through our website. And we're here to serve and help whoever it is that needs the help and we'll do the best job that we can.
Thanks again, Carole.
Thanks for having me.
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