 Hello folks. Hello. Hello. Hi folks. We're gonna get started on the panel while we enjoy lunch as well. I just want to thank everybody again for coming today. We have a thank you for participating in the activities we had earlier and we're super excited for the second portion of the day. I'm just gonna briefly introduce myself and then I'm gonna introduce the panel. Good afternoon. My name is Kirk Rankin. I use he, him pronouns. Thank you all so much for attending today. It's, as I mentioned, so nice to see familiar faces and new faces as well. And we really appreciate you coming today. So welcome. I'm from Washington DC and I'm a senior at the University of Vermont. This semester I'm the advocacy intern for the Vermont chapter of the Alzheimer's Association. As a student in high school, I began to see two close grandparents in mind, experienced struggles with dementia and later Alzheimer's disease. It was a pivotal point in my life and seeing what my parents and a set of family had to endure was truly frustrating as they navigated the best way to provide for my grandparents. Having experienced this was left the impression of sadness, but also commitment. And last fall I embarked on this opportunity to intern with the Alzheimer's Association, and it felt fitting to involve myself, not only as a student, but as a community member. Right now in the state, we're seeing roughly 13,000 Vermonters who are 65 and older struggling with Alzheimer's. However, as many you know, these numbers do not reflect the reality of the situation here in Vermont. Given family members with early onset dementia, people who are misdiagnosed, and people who would rather not be diagnosed due to stigma, this demonstrates how this number in the demographic is in fact way larger. I also want to mention that in Vermont we see approximately 26,000 unpaid caregivers supporting our family members with early onset dementia and other Alzheimer's. On a given day two thirds of our caregivers are women, more specifically over one third of dementia caregivers are daughters. I feel humbled today to introduce our all women panel as speaker as our speakers reflect a devoted cohort of stakeholders in Vermont. I'm super serious about that, you know, those statistics reflect their reality, and I feel humbled to introduce them. The problems loom large, but we're starting to address how we go forward. And right now I want to introduce Rhonda. Rhonda Williams comes to us from the Vermont Department of Health, where she holds the position of chronic disease prevention in the division of health promotion and disease prevention. In this role she works on health systems policies and strategies to prevent and reduce risk of chronic disease and illness and improve population health and reduce health inequities. Since 2020 she is the director of the Alzheimer's and healthy aging program funded by the CDC's building our largest dementia bold infrastructure grant. She has been with the Department of Health since 2011 and previously was the deputy director of programs, policy and medical education at the respiratory health Association for Metropolitan Chicago. In 2021 she was appointed to the National Advisory Council on Alzheimer's research care and services and serves on the CDC public health center of excellence on dementia caregiving stakeholder engagement advisory board. She lives near Virgins with her family and is a distinct caregiver for her mother who has Alzheimer's and vascular dementia. Welcome Rhonda. Nice introduction. So I'm going to, right, so I'm going to try to be, and I apologize because I'll probably go over slightly Meg. So my intent today is just to give you an idea of what the Department of Health is doing on Alzheimer's as a public health priority. And you, is the sound okay? I hear a little bit of echo. It's okay. All right. And so I have some slides to share with you. So in 2018, the Congress passed a very significant bill and is called the bold infrastructure for Alzheimer's. And why? It's because we need action from public health departments, state and local health departments. And several intentions of the bill is to create centers of excellence. And these centers include on dementia caregiving, on risk reduction for dementia, on tribal health, as well as early detection. And so in this infrastructure building is at the state level to Vermont was one of the first states funded for this work. And we received $250,000 a year for three years that ends in September of next year. So not a lot of money, but enough to get us started. Also want to just share that, you know, this work is not alone, right? This is all of you are likely some way involved in healthy aging in Vermont. But often is what is Dale doing? And what is Department of Health doing? So I put together just very simply, these are core activities that each of us are doing. But then together, we're also working concertally on building capacity among our clinical infrastructure. I'll talk a few more minutes about that. I'm raising awareness about caregiver supports and increasing those as we can. But importantly, as I've heard, right, we need more communication and coordination. So we're working toward that. We are cost sharing on a new full time healthy aging analysts starting in May. And we are also sharing between the Department of Health and Dale a substance use prevention specialist for older Vermonters substance use opioid use alcohol misuse tobacco all contribute to brain degradation. So we need to be very proactive in this area. So in terms of what is the bull program doing? So I'm just sharing a couple of bullets here. And, and so you can see those for yourself. But what we've accomplished thus far is we've hired a full time program manager at DeMont. We've also funded surveillance. And we've started communication campaigns and I'll share you a couple updates on what those communication campaigns are doing. But importantly is over time, we want to address stigma. We want to help people feel more comfortable about raising their concerns or memory concerns with her with her providers and that for those providers to feel comfortable and capable and having the tools to address those memory concerns without having to refer to the memory program in Burlington. There's a nine month to 12 month wait at the memory program and that is very hard for anyone to have to face. So importantly is data without data. We don't understand the full significance of the problem. We can't identify the gaps or assess our progress. So we've working toward having a brain health and healthy aging data plan. And every year our intent is, and especially with your support health department, please feel the caregiver module health department please feel the subject of cognitive decline module. I can't do that alone. It's determined by a committee that with support from others. They hear that Vermonters are wanting this data and that we use this data to improve caregiver supports and to understand the burden and the opportunity for addressing Alzheimer's in Vermont. We're also taking steps to building the clinical capacity. So we are in a real estate, we have very busy PCPs and, and I think some of the historical and cultural piece of this is let's just refer, let's just let's give you referral to the memory program at UVM. When it's estimated about 80% of memory concerns cognitive decline diagnosis can be done in the local primary care office. This is what we're building toward. We have three projects underway that are listed here. And these are intended to help primary care providers feel like they've got this. Well, it's going to take a little time. It's, you know, it's, it's can be daunting, but there are tools available and we're, we're, we have training underway through project echo, which started last September and is concluding in, in May, but it's been very, very engaging with over 100 participants. We also have a new platform for my health learn and on there we're building out dementia curriculum that anytime 24 seven clinician, you know, a social worker can go on here for free and earn continuing medical education credits. And so this is 13 out of 14 areas or counties of the state are participating in project echo. And like I said, we had a robust response to this learning opportunity. And this is what it looks like. So in terms of we're taking so Dr. Levine was involved in the early planning, how can we learn from the opioid response and apply it to Alzheimer's and related to matches. So this is illustrating what we're intending to do is basically that local primary care offices can be the spokes can be the resource go to for those families, caregivers, and importantly is those who do get diagnosed with dementia to have the support they need. So this describes it a little bit. And this is what we're measuring. So we created an evaluation plan. I'm happy to share that with anyone who's interested. And these are the measures that we're using to see for on the mark. Are we making progress? What else do we need to do so that people feel supported locally in their clinical treatment. And then also I just wanted to spend a minute or two on communications. So health promotion, right? It is a field where we are working to help people be the healthiest versions of themselves. And we do have funds to help people understand that chronic disease prevention and management of your diabetes, of your asthma, of your hypertension, all are linked to improved brain health, improved oxygen delivery to nutrients to the brain. Smoking cessation for example does that. Smoking robs your brain of oxygen, quitting helps and improves your heart health too. So we're working on these campaigns. Let me show you a few examples. Last October we used these ads on Facebook. We got the strongest response we've ever received at the health department for $1,000. Three weeks and people, over 12% of people who visited might help you do it. Sign up for more information or for a class on diabetes prevention and management. So we have free resources that are available and we're really trying to help for monitors now that they're out there for them that help their brain health and reduce risk of dementia. So here's an example of a diabetes management workshop. These are known, a diabetes management workshop proven to reduce risk of diabetes and even prevent diabetes. And then also we have what we call rat cards and these are cards that are available to any of you. You can contact me. I can help you order or order for you. You can co-brand with a CDC and they're intended to help raise awareness around how can I have a healthier brain. Very tip specific, science-based. And then lastly is that we're updating the state plan and we've had over 40 individuals and organizations give us their input. But if you haven't and would like to give us input, please let me know. This is intended to be an action plan on Alzheimer's and healthy aging that is used that is improved over time and that we assess our progress. So help hold us to that and we're coordinating as best we can with other state plans that are in creation. Importantly and lastly, we need to work upstream to and the social determinants of health in terms of who has access to housing, who is able to be socially engaged and physically active in their community. This is where we need to make it equitable for all of our monitors by addressing social determinants of health. We're a small program, but what we can do is speak to the importance of working upstream together. And I thank you for you being here and speaking to the need for those with Alzheimer's. Very nice to be here and I should go the right way. There's my contact information. Thanks very much. Thank you so much, Rhonda. And I would like to introduce Jenny and her daughter and care partner Betsy. They're joining us today from Killington, Vermont. Jenny is not the famous diet lady, but like that Jenny has voted her life to helping others before being diagnosed with Alzheimer's eight years ago. Jenny was an independent world traveler and community volunteer who was enjoying her retirement from an accomplished career as a school social worker. During the early stages of the disease, she moved to Vermont to be near family and participate in the clinical trial for Adju Kenema. Unfortunately, she was forced to stop the trial when she had an adverse reaction, but does not regret her involvement because it helped advance science. Jenny and Betsy participate in Alzheimer's fundraising and awareness raising activities and have traveled together to Washington, D.C., advocating for research, funding and support for Alzheimer's. She's in mid-stage now, Jenny and Betsy. So mom? Yes, dear. So we're going to just kind of do this very easy so you can answer what you want and you don't have to answer what you don't want. Okay, thanks, dear. But tell us how you feel today. It's been a long time since you had your diagnosis. What does Alzheimer's feel for you today? It's very bizarre and I miss myself because I used to be smarter and more full of life and a naughty person as far as jokes and going places and trips that we took and the rest of it. So it's sad and what happens is that there's no way that we know about to stop the problem of it's kind of like dying out. You know, I can't play the games and have the fun that I used to because once you get Alzheimer's, it's sort of like you get tucked away and it's not the people are quiet about you. They just smile and keep walking. How's that? And that's the way it is. And my best friends smile and give me a hug and we know that's what the situation is. And what we need to know I think all of us is what are we missing? What can we do about what we haven't been able to find out that would help people or that would keep you more in the world that you have been or we have been than we are now. And it is what it is. But there's probably stuff that we should be thinking about that we just haven't gotten to figure out how it works or is this really something that is never going to be okay? I don't know. But I sure would like to know what you all feel. So do you have a piece of advice for somebody that just got Alzheimer's diagnosis? Well, talk to everybody you can about it and make sure that the people that you got the diagnosis from know what they're doing. And so that it's the right diagnosis and not just somebody that just said, okay, you know, that's the best you're going to be, babe, and move on. So what I know is the fact that it's just not fun anymore. When you get this age and you can't do, you can't make things work the way you used to be able to make things work. And that's really annoying, especially if you've had a, you know, a good, you know, time growing up, finding out stuff, playing music, a whole bunch of things that dwindle away when you get Alzheimer's. And so what we need to do is to more and more find out what we can do about to keep us circulating and knowing who we are and keeping us interested and full of fun and finding a way to smile and laugh with everybody continually as we continue to grow older. Anyway, I'm done. Thank you. For our next person on the panel, I'd like to introduce Pamela. Pamela lives in East Middlebury with her husband. Her daughter functions as a primary caregiver and lives nearby. Pamela moves to Vermont to attend Middlebury College and decided to say to raise her children here. She feels thankful to have two children and two grandchildren. Pamela spent her career working in human services after earning her master's from UVM and went on to working, went on to work in mental health. She was a case manager, therapist, crisis clinician, guardian and executive director, amongst other things in the field. She first noticed symptoms at the age of 50, was diagnosed at age 52 with younger onset Alzheimer's. She now says that advocacy for herself for folks with Alzheimer's and in particular for folks with younger onset Alzheimer's is her purpose and passion. Thank you, Pamela. So, I was given a couple questions, so I'm just going to kind of roll with those. So, how did it feel to get an Alzheimer's diagnosis? You bet. Oddly, the first one was relief. I've been complaining to my doctor for two years every three months saying something's wrong, something's really wrong, something's really, really wrong. And got lots of misdiagnoses along the way. So, when I confirmed, yes, you have younger onset, well, okay, you know, not, not totally crazy. Something's actually wrong. You didn't do it. I didn't do it. But to speak to one of your points, my IQ dropped 40 points. And you really have to restructure your life when you were a highly competent person. And now you need your daughter to do financing for you because you can't do it anymore. Let's see, my next thing was feeling vindication because I've been saying something was wrong for so long. And in the end, I was right, something's wrong. And then sadness started hitting. You start mourning the things that you're losing for abilities. The mourning sort of grew into grief and even depression. I feel pretty clear that the anxiety and the depression that I feel now is consequent to Alzheimer's. And it's not because I'm not having memory problems because of it, which was one of the things that I was told. I was a crisis clinician for 18 years. I, anxiety was not part of me. My daughter was always saying, you should, there are times you should have been a little anxious. But I was just so that was a brand new thing for me. I felt very alone. I'd never met anyone with, with younger onset. I think we're, we're even more isolated. I think we're even more embarrassed. Here we are at the height of our careers often and now I, you know, I had to drop out. And I felt useless. You know, here I was, somebody spent a career helping people and now that career was gone, you know, nearly overnight. It was gone. And what good was I going to be now? And I, and I felt and feel fear of what is going to become of me as things move along. Next thing, what type of stigma did you feel an experience? I felt very ashamed and very embarrassed. But mostly is that I was internalizing the stigma. So for a year, I didn't tell anybody but my closest family members, it was, I got diagnosed literally like the week COVID started and the state shut down. I was diagnosed over zoom. So it was easy to hide, frankly, very easy to hide. But after about a year of that, I decided that I was sick of that stigma doesn't change unless somebody sticks their head out and works to change it. So I, I, in my county, I'm not like famous, but I'm pretty well known because of the jobs that I've held. And so I decided to write a letter to the editor and was quite full about my experience and I posted on Facebook. And I thought, well, now I don't have to tell people one by one, they're going to find out in mass. But you know, I got, of course, lots of nice responses. But the main thing was I wanted to say I'm done with hiding and I'm done with not living. That's, that has been sucking. I don't like it. So, so instead I went the other way. I tell people readily, you know, I'm at the gym and the owners like, gee, you should, you should move things along or whatever. And I'm like, I have Alzheimer's if I move stuff, I don't know, I will not be able to find it later. And he's like, oh, you have Alzheimer's. So I just say it very matter of factly. This is just what it is. When I was telling people one by one, which you still end up doing, they don't know what to say back. And the interaction often ends up with me making them feel better about how bad they feel for me. And that's kind of tiring. That was sort of why I was like, can I just tell everybody and then that it, that's, you know, everybody has to process it. How did I share the news, pretty much told you told my closest friends, I told my supervisor at my job that I was no longer capable of doing my job. I had fallen behind in paperwork, in some cases six months to a year, though I had kept unbelievable notes because I couldn't, I couldn't remember who I saw this morning. I couldn't remember who was at the meeting that I went to this morning. And so I started having to write notes like a maniac and keep a calendar with tremendous detail. But that was hard, you know, making the phone call that ends my career and saying it's because I'm not confident anymore to do this job that I love. The big thing was, I finally found a support group that was based out of Massachusetts and somebody there was working with their legislature on a bill to get equal access to services for people with early younger onset Alzheimer's. And I went, huh, I think I could do that. I've been advocating for other people for the last 30 years. And why don't I use that skill for myself, but really for the broader community who are all sitting home alone feeling embarrassed. It's really feeling like somebody needed to say that, that we exist to type of caregiver support do I need. We need comprehensive case management, we need the kind of case management that adults with intellectual disabilities get those people need that service. And I've come to feel if you acquire a cognitive disability, then you need the same level as somebody who already has a cognitive disability. We're expecting our families to know how to do case management. That's crazy. I was very lucky in my family. I was the one making the calls. And at the end of the day, I'm like, this is crazy. The lady with Alzheimer's is the one who's trying to find the service. I didn't say, I didn't say it angrily. I was crying. I was sobbing at that point. And Aaron was also making calls and getting the same run arounds because I'm not on Medicaid. Well, my husband is 47 years old. He has to work. He pays child support. This is, you know, he's young, which has its advantages, but not for collecting Social Security and Medicaid. So I'm not going to get Medicaid. So there were age limits on programs. There was you have to be on Medicaid. Nobody said you can private pay at the rate that we get Medicaid because I believe, you know, that would be fair. So we need affordable comprehensive case management akin to what adults with intellectual disabilities get. And I know because I was one of those people and I know the range of what can happen. We need in-home support, again, that is affordable. We need training for families. There's a lot about training caregivers better and the doctors and I couldn't agree more on that. But the same training that we're saying it paid in-home support people need to get through this must be extended to family home providers. They're dealing with it way more. They don't get to go home and have it disappear. So I would like to see more of the trainings that are available to quote-unquote professionals because the reality is our children are professional at what they're doing. They are doing case management. They are doing in-home support. They are not getting paid. I don't understand that. If person X gets paid for doing this service, I don't understand why a family member can't be paid. And since familiarity is so critically important for people with Alzheimer's, you know, we need to stay in our homes. We're in a community that we can walk around. We need to have people in our lives that we know and trust. That's enough on that, I guess. That's it. The last thing that I think I was asked was, I'll be really quick though. Challenges relying on family. One, most family needs to go to work and earn money. So then they're not available to us. Most have no experience in performing case management or financial planning for other people. There's a lot of skills that we're expecting family members to know that in the reality, people go to professionals for those things. And we are left feeling a burden to our families. It exacerbates the shifting roles that are needing to happen. And typically our family members aren't getting any support for that or limited support. Piece of advice. Act quickly to get your wishes codified. This, I mean, the second I got diagnosed, I went, I completed my will. I revised my advance directive. I got my power of attorney who has financial rights completed. I got my beneficiaries up to date. Have your chosen financial person attend the Alzheimer's Association financial planning class so they do get some clue of what to do. We lose our confidence and we want to make sure when we're making decisions that they're done while others recognize we are still confident. And then the very last thing is tell everyone, don't be afraid. Don't be ashamed. Don't be invisible. Keep on living. Thank you so much Pamela. I would now like to introduce Lisa. In 2018, Lisa lost her mother to Alzheimer's disease. 18 months later, she lost her father to a really body dementia. With a tremendous amount of assistance from others, Lisa and her siblings were able to take care of their mother at home. They weren't able to do so for their father and place him in a dementia care facility. Through these two experiences, Lisa learned how challenging it is to find resources to help with dementia care and also how limited those resources are compared to what's actually needed. She witnessed the toll caregiving takes on the whole family and the financial impact of caring for parents with dementia. She has become an advocate in the hopes that her story and experience will help identify ways to bridge the gap between what's needed for care and what's actually available for care. So in 2015, three years before my mom passed, it became very clear to me and my siblings that my mother's care needs were increasing while my father's abilities to care for her were decreasing. The signs were subtle at first and often being hidden by my father who thought that he had everything under control and didn't want to worry us. But then there started to be what I would refer to as crisis moments. Sometimes it would be that my mother had fallen and he couldn't help her get up. Sometimes it would be that she was doing something that he knew was unsafe for her to do, but he couldn't redirect her. And so those challenges became bigger than him and he started to having to reach out to us for help. And in those moments, we realized that we needed to do more for my mom and care more for my mom. The fear of something happening to her in one of those crisis moments was just too great and we worried about it constantly. So we decided that somebody needed to move in and help care for my mom. I had a younger daughter of my own and a full-time job and it was just not an option for me to move in to care for my parents. My brother and his wife, who both also had full-time jobs but their children were full-grown and out of the house, had moved in to help out my parents. My brother's wife, who is a saint, took care of my mother when she wasn't at work and my brother took care of the house. That left the financial planning, the legal and the medical care, the case management stuff that you had spoken about. That left that all to me. That was my role. And so I started to take over those responsibilities. At that point, my father had approximately $400,000, probably a little bit more than that in savings that he had built up over his life. It seemed like enough at that point. $400,000 really did. And we didn't know he had the lead body dementia, but it really did seem like enough at that point. But then I started to hunt for some assistance to supplement my brother and his wife living in the house. I was sure there was more resources out there. I was sure that there was more financial assistance. And I quickly realized that there really wasn't, and that a lot of that care was going to fall on us and bringing people into the house and the financial expenses associated with that. And as I started to total that kind of stuff up, I realized maybe we don't have enough money to do this, and that was concerned. So we used resources such as Meals on Wheels, Age Well Vermont, the Dementia Respite Grant. They did cover some, but they did not cover enough. They didn't even come close to covering enough. Oh, excuse me, adult day programs in home caregiving services are very expensive, but we had no choice. We had to turn to programs like that and we had to pay for those out of pocket. Alzheimer's disease is a very slow progressing disease. There's no predicted timeline. We had no clue how many years we were going to have to do this for, and we really didn't know if we were going to have enough money. You can't budget and plan for something that you don't know how it's going to turn out, how long it's going to last for. After a while, we were referred to an estate planner, but not just any estate planner, one who specialized in elder care. And that was the recommendation to us. With his assistance, we were able to qualify for the Choices for Care program. It took some extreme measures for us to qualify. We had to remove my mom from the deed to the house. We had to put the house in a life of state plan. We had to remove hers of beneficiary from everything. We had to remove her from the checking accounts. At the end, she owned nothing, but qualified for financial assistance as a result. I've even heard a story from another caregiver who was recommended that he divorce his husband in order to protect his own assets. So it's kind of scary what you have to do to qualify for assistance. The financial assistance was helpful, but we still had to supplement the difference. And that sometimes cost us over $2,000 a month, even with the financial assistance in place. When my mom passed away in 2018, my dad had approximately $200,000 left. Caring for my mom over three years, even with that financial assistance, took over half of his life savings. It was much easier to care for my mom in the home due to the fact that she was much smaller and rarely moved around much. But my dad was much larger and Louie Body Dementia is a very different disease. He was unaware of his limited physical abilities and his hallucinations led to wandering. It didn't take us long to realize that it was no longer safe for him or for my family members for him to be in the house. And we had to place him in a facility. Budgeting $10,000 per month for such a facility, I became very concerned that we weren't going to have enough money. Body Dementia is also a slow progressing disease. We had no idea how much longer he would be with us. It was impossible to know if we had enough. 16 months later, my dad passed. In another three months, his money would have been gone. Shortly before he passed, I had already started coming up with contingency plans that included taking loans out in my own house or borrowing against my own retirement savings. By the end of the battle, it took financial assistance, hospice care, countless hours of our own time and over $400,000 of my father's savings to provide care for my parents in the last few years of their lives. We all know how dementia ends. After all, it is a terminal disease for which there is currently no cure. But until you've seen it firsthand, no one really realizes how bad it is when it begins. We all think we can handle it in the beginning, but then find ourselves in crisis moments desperately looking for resources and help just to find out how little of that there really is. We shouldn't have to wait for the crisis moments. We shouldn't find ourselves in these moments of stress desperately looking for help and then having to wait for those resources to become available. Those resources and assistance should be available as soon as diagnosis is received. We have that toolkit, so when we have those moments, we're prepared for them. We don't have that today. No one should have to navigate aimlessly through the system to try to find help on their own during such a stressful time. The system should be there to support and guide them through it. The systems we have in place today fall short of need, and I hope to see this change. Don't watch Lisa. Now come to our final panel member, Karen. I'd like to introduce Karen. A 15-Karen became caregiver to her mother, who was diagnosed with lung cancer past a year later. Several years later, her father was diagnosed with neurological disorder. She became his primary caregiver for six months until he died. Her role as a family caregiver included negotiating state support in New Hampshire, Massachusetts, and Vermont. She managed all their finances and medical care. After the death of her parents, Karen went to work in human services and homeless outreach. She started a career at the Northeast Kingdom Council on Aging in 2018 as an options counselor, helping elders to find the resources they need to live independently. In 2020, she tapped into her caregiver experience and became director of caregiver and client support, managing the services provided by the Council for Caregivers that include support groups, grants, community education, client and family support, outreach, and management at Geralta, a new e-learning portal for caregivers that provides 24-7 access to informational workshops and classes. Karen's passions be used for dedication to caregivers and improving access to the resources they need to take care of their friends and loved ones. Welcome, Karen. Exactly what I wanted to say before these ladies spoke. Coming to this work hasn't been easy for me, but it's also been pretty rewarding as well. I've lived in the Northeast Kingdom for 47 years, and now I get to help the elders in my community live and die the way they want to, which has been very important to me. My parents weren't afforded that luxury because I was 15 when it started and at 38 when it ended, I didn't know the resources, and I've made it my mission to seek out doctors' offices, community partners to make sure that the pre-planning starts. The Council on Aging, we do provide respite grants, and no, they don't cover everything. We advocate for more money. We're given grants, and if anybody's ever done grant work, you understand the difficulties of grant work. We have guidelines we have to follow. Some of us are willing to push a little bit more than others, but we are there to support. We have our support groups, our community education that I partner with with the Alzheimer's Association to get those classes happening and get the support groups happening. I work with a wide variety of caregivers. I have young caregivers and I have older caregivers. My oldest caregiver is 100 years old right now. She's fabulous. I get to go into my friend's homes. I get to go into my former teacher's homes. I get to be a part of this journey, and it's one of the most rewarding things I've ever done. I wish I could have been there for all of you in the beginning of your journey as I'm listening to these things. The resources are not easy to come by because of where we live. Oh, you live in Vermont? Okay. Location, location, location is a big deal for us here. There are five caregivers, five directors of caregiver in the state of Vermont, and we oversee these programs. We work with our options counselors. We work with our information referral specialists and we work with our case managers. Our case managers at our Treblaze do a lot of caregiver support without realizing what they're doing because nine times out of 10, our case managers are dealing with caregivers, not the client themselves. We work very closely with community partners. Home delivered meals are offered to caregivers regardless of age. There are things that we do all the time to help support our caregivers. I don't know what else to say because this was just, it was very powerful. And I honor the work that you do and the journey that you're on. And I thank you. I just want to take this moment and again, applaud you five for sharing your stories and echoing the parallels between case management, community education, stigma, compassion. All five of you spoke on that and we really appreciate you being here today and telling us your stories. So thank you again. One more round of applause for this five. All right, so now it's time we are going to mosey over to the state house and do some photo opportunities.