 Now my heart in my and welcome everyone to this webinar on cultural considerations in aged care, organized by Wonka the World Organization of Family Doctors and also supported by the University of Otago in New Zealand. My name is Tanya Morinhart. I'm the chair of the Working Party on Ethics and Professionalism at Wonka and Dimity will also introduce herself. Yes, welcome everybody. So my name is Dimity Pond and I'm chair of the special interest group in aging and health for Wonka. I'm actually the outgoing chair and we have a new chair coming in at our upcoming conference Leon Geffen. It's an honour to introduce these three speakers to you tonight or this morning or this afternoon in fact wherever you happen to be. And but first I'd like to just start with a bit of housekeeping. We have a Q&A option which you can get by just hovering your mouse over the bottom of the screen. You will see a Q&A option and all attendees are invited to post questions there or any technical issues. We can see them but you will not be able to see a question unless we decide to answer it online. The chat is disabled for attendees so if you've got technical questions or anything like that just post them in the Q&A because we can see them. Lastly, this webinar will be recorded. Hopefully when you logged on you were given that information and it will be made available on the websites of our Working Party and Special Interest Group. So we're looking forward to hearing from our three speakers. Yes. For those who are not familiar with our Working Party and Special Interest Group, we will post a link in the chat so that you can find our website and some more information. And it's also a good time to remind you that the Wonco World Conference will take place in Sydney at the end of the month. That will be from 26 to 29 October and both our Working Party and Special Interest Group will present a workshop there and will also hold our annual meetings there. And we're keen to engage with both Wonco members and a wider global audience of people working in primary care on timely and relevant topics like we're doing today. We're looking into ethical considerations of emerging technologies, how to teach ethics to medical students, identifying and managing dementia and elder abuse. It's a wide range of topics. And of course today we will talk about cultural considerations in aged care, and it's an honor to introduce our first speaker. Haki Demir Kapu is a general practitioner and a tutor for GPs in training in Brussels in Belgium. His PhD work at the Department of Family Medicine and Chronic Care at the Free University of Brussels focuses on advanced care planning with ethnic minorities in Belgium. He's also a coordinating and advising physician in Belgium's first culturally sensitive nursing home. And in his presentation today, he will explain how the nursing home operates, and he will focus on the adaptations that they introduced to make it accessible for older adults with Muslim background. So the floor is yours, Haki. Hello everyone. As Tanya said, Safir is the Belgium's first cultural sensitive nursing home, which is responsive to the needs of all older adults by taking into consideration their culture, religion and values, which results in personalized care. It's a multi-cultural nursing home whereby the first two floors from all origins, Belgian, Spanish, Italian, African, etc. But the third and the fourth floor is exclusively for Muslims, but the nursing home in general, it's really an inclusive nursing home. As you can see on the pictures, on the third picture along the wall, we have illustrated the migration history of Belgium whereby in 1930s the Italian and Spanish people came to Belgium, and then in 1960s the Belgian, the Turkish and the Moroccan people. So in this way we will show them that they are really important, that they have also created Belgium, because they work in mines, in textile industry, in really hard circumstances. So it's a kind of showing their importance for us and for Belgium. In our nursing home, we have really a multi-cultural stuff across all departments. I will point in this point because in some nursing homes here in Belgium, they say they have diverse teams, but it's not always true because the people from other backgrounds are really, for example, in cleaning teams, but not in all departments. In our nursing home, we have, for example, our directories is somebody from Moroccan origin or occupational therapist from Spanish origin. We have head nurses from Albanian, from African, from Tunisian origin. So we show the diversity because in Brussels we have more than 180 nationalities. So we show it also with our team and we have four official spoken language. So not only Dutch and French, but also Turkish and Arabic, and we use these languages in leaflets, in signage, in buildings, in our social media posts. As you can see here are some pictures of the wall in Arabic and in Turkish. So the people who are in our nursing home, they feel themselves also welcomed because we are using their language too. We have adaptor facilities. So each floor has its own dining and living room, allowing respect for cultural diversity. And on the walls, Arabic letters of photos from Morocco from Turkey. They have all individual rooms with also private bathroom. It's not always the case in nursing homes. They have foreign TV channels in different languages. We have also prayer rooms joined by a washroom for ablutions. On the ground floor we have a grand café open to everyone. It is a central meeting place for residents and their families, but also residents of the neighbourhood are welcome. They are coming, they are drinking, eating something. The members of different associations are coming and then talking with our residents too. In some cultures, family is really very, very important. And in cultures as people with Turkish or Moroccan background, we try to have a participator approach to facilitate collective and individual wishes. So we organise regularly residents and family meetings and we use their feedback to rearrange our planning and to review our functioning. It's important because it's first time that people from different non-Western migration backgrounds are coming in a nursing home and they don't know it. It is in Turkey and in Morocco, they know it, but in Europe it's the first time, especially in Belgium. So we try to meet the needs of each person and to rearrange our planning. We learn also every day, it's not we have this and you should follow our rules. No, we are trying to review our functioning too. We take decisions with the residents and if the resident is agree with the family too. We have adapted family visit hours. It means 24 hours, 7 days a week they can come. They can stay overnight if they wish. Most of all, in the beginning, they are sleeping with their parents too. They can eat together. We try to involve the family and care so they can give a bath to their parents. They can cook together in our nursing home and they also participate to activities. Because the first people, older adults from first generation, they don't know a lot of activities. So we try to adapt our activities and in the beginning the family is also participating with their parents. During care moments, I say always to the caregivers, try to make small talks. So try to find out what makes them happy. It is the most important thing that they wish the residents talk to talk and we should give or that we are interested in their life history. So we try to give time to specific also to the life questions such as feelings of loneliness, loss of functions, depression, old age and interpretation of the last stage of life. We try to ask the residents how they want to be bathed. So door closets and sometimes they prefer genitalia covered, especially with Muslims. And if requested also for Muslims, men bathed by males and women by females, if it is possible, it's not always possible to try to do our best. And we give also help with ablutions before prayers. There is also possibility of using water instead of only toilet paper in the toilet. It's also important for some people. So we ensure a bottle of water is always available for this purpose. We have tailored meals. So we use diverse range of herbs. So with similar ingredients, we have always two meal options. As you can see in the second picture, it's a turkey steak and butter and potatoes with parsley. But in the third picture, the same ingredients, Turkish stew with olive princesses in a Tajine form. It is known well known for Moroccan people. We have halal meals. It's also very, very important because these older adults have eaten always halal during their life. So they will continue it so they can eat even meat and chicken in our nursing home because it's halal. We have Belgian beer, we have French wine, but also Turkish tea, Turkish coffee and Moroccan manti. It's very important to them after having their meal that they can drink manti. We have activities for all. So our animations, workshops, games, musical experiences, TV moments are all adapted to the habits and the language of residence. For example, we do Christmas market visits, but also Hena workshop, as you can see in the second picture. It's well known for people from Turkish and Moroccan origin. As you can see in the photo right side, upper side, you can see the dancing or residence are dancing to Turkish music. But just under this photo, we have also Belgian residence who are dancing in a nightclub. So it's activities really for all of them. All religions are welcome so our staff are allowed to wear headscarves. So we have regularly scheduled visits by a priest Sunday morning, as you can see in the first picture, but also from an Imam. Every Friday, as you can see in the second and the third picture, he is calling to prayer and he read Quran. As you can see the third picture or residence on a meal chairs, they are listening to the Quran from the Imam. So there are also possibility of fasting during Ramadan. We adapt our times, meal times, lunch times for the residents. And on the fourth photo, you can see a present given by our social assistant to a resident to celebrate end of fasting month Ramadan. In the upper photos, you can see a Muslim resident who is making a high moon sign from Islam and just behind him, another Belgian resident who are making a cross sign from Christianity. So everyone is welcome. We try to celebrate all cultural and religious feast. So Christmas, but also Adel Fettar is the end of Ramadan fasting month, as you can see in the first picture, but also Adel Adel festival of faculties, even the Chinese New Year. So we try to know from which culture, from which religion, and we try to celebrate also their religious or cultural feasts. We have, we organize Christmas meal with family members, but also after meal during the Ramadan fasting month. And it's very interesting. So during the Ramadan fasting month, the people who are non-Muslims, but who are in our resident residency, they participate also, as you can see in the first picture. And otherwise during for the Christmas meal, they are Muslims who are participating. So we live together, all in peace. We work with local volunteers, so with associations in the neighborhood of our residency nursing home. So because there are a lot of communities from different culture and religions. So in the first photo, you can see they baked the pancakes. They made it more than one meter and they have a record. And on the right side, the young people of a Moroccan cultural association who visiting or residents who making small talks with them and giving flowers. You can see a lot of activities that we are trying to organize with local associations. Myself, I give regular cultural sensitive care trainings to our staff. It consists from Q&A sessions about religion, what is halal food, ablutions, why they are tweaking and how they do it. They talk about Christmas, Christmas feast, etc. But also training on how to deal with conflicts with family, because what I'm experiencing in this nursing home, as it is first time, the family have a lot of high expectations from us. They want it, that's the same as home, but it's not always possible. And on the other side, the older adults are sometimes angry to their children, because they say some, I have some older adults who say, I have seven children. I have raised up them, grew up and even seven children can't look after me and they put me here in this nursing home. So there are some conflicts and it's always the staff who should deal with these problems. So I try to give training. I also have a lot of meetings with the family and the residents to try to find a solution. Also, there are residents mistrust towards the staff during the disruption of medications, etc. So I try to give training to staff how to deal with all these issues. So that was it. Thank you for your attention. And if there are questions afterwards, I can try to answer it. Thank you, Haki. That's great. Looks like a very interesting project and it's great to see how you can combine different people from different backgrounds and cultures and religions together. And you may just have found recipe for world peace, I think in that nursing home. I'd like to introduce Joanna Hikaka. So she's a pharmacist and senior research fellow at the University of Auckland in New Zealand. She's a co-director of the newly established Center for Co-Created Aging Research at the University. Her clinical and research work focuses on older adults and Māori health, with a current focus on exploring Māori elder experiences and expectations in residential and community settings. Her presentation will address how aged residential care as a sector can provide culturally safe care options for Māori as they age by including Māori cultural values and practices. Thanks very much for that introduction, Tanya. I'm just going to share my screen. Great. Okay. So I'm going to talk today about aged residential care and Māori in the context of Aotearoa, New Zealand. So I firstly wanted to start by just saying a big kia ora or welcome to everyone here. It's an informal way of saying hello in the Māori language of New Zealand. And here you can see some Lord of the Rings scenery from the South Island in New Zealand. Just to provide a bit of context for those that maybe aren't as familiar with New Zealand as a country, New Zealand's situated in the southern hemisphere, sort of at the bottom of the world. And the top right picture is a picture of my daughter's tiny in that picture. She's climbing along the rocks about five minutes away from my house. And then in the bottom right hand corner is the mountain that I fuck up up to so that I have connections to through my Māori heritage. New Zealand has a population of 5 million and around 17% of the population are Māori or the indigenous people of New Zealand. And we see globally that there's an aging population. The same is so in Aotearoa, New Zealand. But what we see is that the ethnic diversity of those in the older adult age bracket is changing. So it's becoming more ethnically diverse. For example, although the New Zealand European population is going to increase by about 50%, increased by about 50% over that 15 year period. For the Māori population, it's increasing by 115%. When we look at the population of older Māori, Māori are a younger age group than non Māori in New Zealand. So the life expectancy for Māori is around 7 to 8 years lower than the life expectancy for non Māori. And so we see that reflected in the older adult population. So although 17% of the general population are Māori, there's only about 7.5% of the population 65 or above that are Māori. And when we get to age residential care, only about 4% of the total population of people in age residential care in New Zealand are Māori. So we can see that not only is the percentage small, but we know that the need for that age residential care is going to increase because of the increasing rate and rapidly growing Māori population. So Māori will be becoming a larger proportion of those that are in age residential care. When we look at the type of people that are at a level that aged care would be appropriate in New Zealand, we see that 45% of those people with high care needs live in age residential care compared to 75% for non Māori. So what that's saying is that for Māori, 55% of those with high care needs remain in the community. And some of those issues I'll come to later. So some reasons and barriers for age residential care I'll come to later. But one of them I wanted to touch on was similar to what Haki was talking about the cultural expectation or the cultural sort of norm that family would look after their elders. And so when people do reach that level of care where they could benefit clinically from aged residential care, there's that extra burden of it being seen as something that you don't do within your cultural norms or it's not how you should usually function. So for family that provides extra burden. What we know, so the population's aging for Māori at a more advanced rate for non Māori, due to the earlier onset of chronic comorbidity in Māori, due to a range of socio economic factors. There's going to be almost a 200% increase in those that have high level care needs for Māori compared to a 75% increase for non Māori. So again, we see that the proportion that will need aged residential care or that level of care will increase dramatically over the next 10 to 20 years. The predictors for entry into aged residential care differ a bit between Māori and non Māori. So in New Zealand we see that Māori, if they're older age and living alone, they're predictors for entry to aged residential care compared to non Māori where it's actually more around the functional dependence. So dependence in ADLs and higher rates of poor or fair self rated health. I co-authored a report a couple of years ago now for the New Zealand Health Quality and Safety Commission, which looked at older Māori and aged residential care. So we sort of collected all the data that was available in the grey literature and publications to understand the context of Māori and aged care and also discussed with people working in the sector about their experiences, did some case studies. So I'm just really alerting you to that and the references there if people are wanting to look at more detail. Certainly two years ago that was about everything in that report was the extent of the literature available around indigenous health in New Zealand and aged residential care. And I think Haki gave a great presentation of how things can look if you take into consideration the cultural norms of living and what one of the quotes from one of the people who participated in that report. They said, kaumātua, and that's the Māori word for older people, need to see here and feel the presence of Māori cultural values and practices for whānau or for family or for themselves to be able to thrive in aged residential care. So really that absence of seeing those cultural values, those Māori cultural values in aged residential care prevents people from coming into care and prevents them from feeling safe when they do need to enter into care. So what are some of the barriers? Haki talked about how the workforce sort of reflects the different cultures that are in their care facility. And certainly when we look at the care staff that work in aged residential care, Māori are again not likely to be those involved in the care staff. And so there needs to be a workforce development in terms of bringing up Māori care providers, but also increasing the understanding of people that are working in aged care in New Zealand. So in New Zealand we have a lot of people that were born outside New Zealand working in aged residential care, so may not have been brought up being exposed to Māori cultural norms and values. There's a lack of Māori governance and leadership in aged residential care. And often if there are any initiatives which incorporate Māori cultural values, they might be dependent on a particular person being there as opposed to it being the sort of business as usual standard practice for a facility. As I said, there was that variation in cultural norms. Funding models can be difficult. So the New Zealand government does pay for some people to be in aged residential care, but it's means or asset tested. So depending on how much money you have, if you own a house, for example, you might have to sell your house to go into aged residential care. And this can have more of an impact on Māori families when there's higher rates of intergenerational living. So if the grandparents own the house, the parents and the children might have to leave to be able to afford aged residential care for that person. The other complexity is that there's land or housing tied up potentially in tribal trusts and or family trusts. And so it becomes quite complex. And when you add in the fact that for Māori who have been colonised, who have had land taken in a historical context, when that's added into, you know, now at the end of life, we're having to give up our land, give up our resources, which we've fought for through generations, then adds to the complexity of the situation. In New Zealand, there's sort of not really in practice a flexibility of admission. So it's seen as a one-way door. So once you enter into aged residential care, it's hard to come out again. High proportions of Māori live rurally and there's increased, there's reduced access to aged residential care facilities in those rural settings and reduced choice. And also the question of ageing in place. So for Māori who might, I talked about my tribal connection to my mountain. It's actually in a different location to where I have lived for the last 20 years. But for some Māori returning home means returning back to ancestral lands where and maybe aged residential care facilities aren't available there. So that's just a resource again for just to show, I guess, another reference for people if they're interested, but also that these issues that I've talked about are similar to other Indigenous populations around the world. I just wanted to mention three types of cultural practices that this facility has introduced into their aged residential care facility. So the first one is porphyry. So when people are traditionally welcomed into a Māori meeting house or traditional community, there's a porphyry, which is a formal process of welcome. It involves song, it involves speeches, it involves the people that are already living in one place, welcoming visitors. And so this facility has a formal welcoming process for their residents. So they get to come in with their families, the songs that they like are sung, people know about them and they find out a bit about themselves and they find out things about the staff and the people that work at the facility. And similarly, when people leave a marae or that traditional meeting house, there's a formal farewell. And so this facility has instigated a formal farewell process when people leave often because they're passed away. Where again, there's a formal goodbye and it gives the family a chance to say goodbye to the staff members, but the staff also to have a formal process of sort of officially ending that relationship with that person. And then thinking about the potential for other types of care models within for Māori is important, I think. So what does care at home look like? How can family be better supported to care for people that have high level care needs? That second word, Papakainga, is a traditional way of living where it's around all generations living in sort of a home environment. You might have sort of 10 to 20 different houses and people living together and living in community with each other. And work I'm doing at the moment is investigating what other models of care could look like both within the age residential care setting and outside the age residential care setting. And I think the other thing is trying to balance for people that at the moment a lot of Māori feel that they have to make a choice between going into age residential care or having their cultural values valued or upheld. And so how do we provide that high level of cultural safety within the age residential care setting so that they can benefit from the clinical aspects of age residential care? I'm just putting this in there in case anyone's interested in learning more about the Centre for Co-created Aging Research. I'm hoping to collaborate internationally as well. And so our focus is on addressing ageism and its widest sense. And so that's there if anyone's interested. And I'm happy to answer questions now or later. Thank you very much Joanna. That was really interesting. And there are some questions, but I think we might come to them at the end if that's okay. So I'll now introduce Danica Rota, who is a family doctor in Slovenia. She's coordinated several international projects, including a European led international study on improvement of older patient involvement in medical care. That's called improve. She's the head of the working group on palliative care of the Association of General Practice and Family Medicine of Southeast Europe. Danica will focus on healthcare for older refugees, presenting the results of field work in a transit centre. Shantil, I hope I got that right Danica. Thank you very much. I hope that we hear each other. So I will present my work at Shantil Transit Centre for Migrants from 2015 and 2016. I shall say that this year we have the same number of migrants passing Slovenia, my country. We have two million inhabitants in Slovenia and, as I said, the comparable number is passing Slovenia this year as well. In comparison with 2015, there were bigger groups, the transport were better organised, but today they pass themselves walking, mostly walking through or taking bus for example. So these are the pictures I saw in a live in 2015. And I was working and researching under the tent in which medical care was organised. There was also another reception centre at Brijice, but as I said, I worked at Shantil. The same Schengen border was between Slovenia and Austria. As you know now it is between Croatia and Bosnia. So nowadays we do not have Schengen border anymore in Slovenia. Yes, these are the routes from 2015. And just statistically it's important for me as a primary care physician that we have to care about human suffering and we have to help the people, especially the vulnerable groups. And the problem is because we don't know exactly what is to be a homeless, what is to be a migrant, what is to be a disabled person. So we have to learn ourselves and we have to learn our staff, as Haki said, that he's educating staff in Belgium. Here is the article we published in a journal. If somebody wants to read it in complete, just have to open it. And here you can see all those people who passed. I still remember that the problem with food. For example, we gave them a lot of food and there was conserved meat. So these food were left here because they don't know what is inside, what is the specification of this meat. So they, for example, they took biscuits because it was clear, more or less, but all this food with meat, they left it. And I believe that everybody would do the same link to his or her personal religion. So we did research, as I said, we asked the people and we asked medical staff about their experiences with healthcare. For elder people, we used pictograms for all of them. And we had the translator. His name was Muhammad, but when Muhammad was absent, this was in the afternoon sent in the evenings. We had to do for ourselves without translator. So translator was not with us all the time. So that was the other problem. And we found five main areas which we should cover in the future, we think. And these problems are language barriers, then traumatic experiences in the past or in their root. For example, some of them they talk about passing Serbia without having a chance to go to the toilet. They had to stay in the bus all the time, all the younger children, everybody. So they told us how they've solved these hygienic problems. So they had traumatic occurrences in the root and in the past. Then in some regions they need negative attitudes among health workers. Of course, there were also cultural differences. Major health problems were linked to war and travel. They had a brutal wound, some of them. For example, our perception before we start to work with them was that their health system was not so developed as ours, which is not true. So some of the passengers, some of migrants, they had mobile phones and they showed us what happened with their orthopedic or trauma operations. They had everything on mobile phones. The pictures of HIP, so they showed me, I worked as a health worker, as I said. So, first of all, we saw that they were not so bad equipped. Mental health problems. For example, we met some people with psychosis. And some persons who accompanied them, they gave us a sort of writing from Greece, for example, what happened there. And they wanted to pass faster than the others because of their mental problems. And we couldn't help them because there was no accepted professional recommendation. What shall we do with those people from subgroup of people with mental problems? So we had to adapt on site quickly as we found it. And in that time I started to write to Ministry of Health that we have to solve this problem we have to prepare for the future. We have to prepare guidelines, recommendations, everything for such situations. And then, of course, we had problems with pregnancy, but link to the elder I would like to underline that they didn't want to stay in Slovenia in our place. Even if they were very seriously ill, they wanted to go together with the family to the final destination which was Germany and Nordic countries. So they asked us, they cried, let us go, don't hospitalize us. We have to go with our family. We also found differences between different countries. For example, in Austria, they took x-rays of lung because they were more afraid of tuberculosis. In Slovenia, we didn't take x-rays for those who had coughing problems. Another problem with elderly and elder migrants was that they couldn't speak English and mostly their grandchildren translated about their health problems, which was quite problematic, especially if there were gynecological problems or other problems which older people didn't want to expose to younger. Also, as I said in the afternoon, we didn't have translator. What our professionals spoke about this time, they said that speaking English was a problem, of course. Young and minors could speak English much better than elderly and also even better than 25+. So they helped in translation, in Brejica, everywhere. Then also, they found that mostly children and older people were brought to our health units. Sometimes larger families came. Mostly we didn't have health records from a previous group and we had to discover everything again. Mostly I can say that when I was working first, young females and men came and they explored the situation. They talked to us and then if they found that you are a trustworthy person, they brought elder people. I still remember one female engineer from Syria. She came to talk about causing problems and then when she found that I'm a trustworthy person, she came after half an hour with her grandparents and said, look, now we will speak about their problems because I can speak with you about this. So the trust is very important. Sometimes we had to take care of 120 patients or disabled migrants per day, but sometimes just for 20. It was different. So because of this experience, myself and some friends of mine, we started movement to prepare medical translating tool. We gave tools, especially with medical vocabulary in Arabic, Persian, Russian, Chinese, and Albanian, French and English language. As you can see, we started step by step. So how the person enters and you say hello and then how to proceed, how to take an amnesis, how to make a checkup. Every step is here in these languages. On the right hand side, there are also pictograms. So if you don't have anything, you can show with your finger. This is the result of our work at Shingon border. We published and distributed these vocabularies for health workers. We also did in the past many workshops. Last year I would say after COVID everything stopped. And I'm still disappointed that we didn't refresh these workshops. So COVID stopped our attitudes, our mission to raise awareness of cultural differences in health workers groups. We need education of health workers in the future as I said, and primary care is the best place for do this because we are most accessible in comparison with hospitals. Of course, there are extreme other vulnerable groups, as I said, people with mental diseases, people who were abused, for example, in their route. So we have to get knowledge how to approach these people. So this is just a glimpse of my work in the past and I'm sorry that we didn't document more. After eight years now, I found it that we have to document our work at primary care because it can come back and it can help us in the future. So thank you for your invitation and I'm here to answer the questions. Thank you very, very much, Danika. That was fascinating. And in fact, all the presentations were fascinating. And it's good that you've been able to document this, Danika, at least in this webinar as well as in the publication that you did. We do have some questions and I think, Tanya, the first one is one that you would like to answer. At least a post to Joanna. Question saying generally in your experience, do children of Kaumatu or aged Maori individuals prefer to care for their aged parents themselves? Or would they prefer to sell their parents home so that they can then afford to go into residential care? Sure. So I guess there's lots of things going on in that question. The first I'd say is actually probably in most cases the older person's decision themselves, whether their house is sold, not necessarily their children's because, you know, we're still talking about people having capacity a lot of the time to make decisions like that. And I think that it's a complex situation. So the decision wouldn't just be about the financial thing as actually do we have the resources to be able to provide a really good quality level, you know, high quality level of care at home for this person, because that obviously has financial implications in itself. So, you know, for some people that might be at age residential care level, it could take six to seven people on a rotating system sort of schedule to care for that person well in their own home and to not be completely burnt out and just still be able to, you know, engage in things outside of the home. So I think it's it's tricky. It's not one, you know, you can't sort of say yes or no, certainly not. I think that if people are wanting to look after their family, they'll do that until they can't do that anymore. And then that, you know, the implications of selling the home would be have to be taken into consideration. Yeah, that makes that makes sense. Following up from that, there were a couple of questions in the Q&A that Hucky has already answered. But sort of about the financial implications because it's a private home you specified that they need to pay about 65 euros a day. Do you find that there's there are financial barriers to to people to to live in that type of residential care is that is that a struggle. Yes, for some people, it's a barrier, but for people from migrant backgrounds, non-western migrant, as they have many children, so they can participate each of them. So it's okay. But as we know, their pension they get from from the government. It's not so much. It's not enough because they should pay, I think, around 1,800 euros between those 802,000 euros and their pension. I think it's 1,300 or 1,400 euros. So in most cases, the children are helping their parents. And otherwise, it is also some good practice because they feel themselves guilty by placing their parents in a nursing home, but maybe by being a little bit. It's also good for them. They feel them good also. So we have another question also for Joanna about co-create. Oh, yes. Sorry, I was busily trying to type it in the chat. But we so we're always interested in collaboration internationally because I think everyone can learn from each other. So understanding what, you know, goes on in one place. So I've had lots of interesting ideas from both Danica and Haki today just listening into what's happening. But our centre is trying to promote people to work together. We're a transdisciplinary centre, so not just health, but in terms of addressing ageism in its broadest context. We have engineers, architects, housing, town planners, urban designers, IT, tech solutions, mathematicians, creative artists and practitioners. So we're sort of all sorts of people joining together to, I guess, tackle ageism and improve well-being with older people. So the other thing is that our centre really centres on older people and older people driving decisions for the research centre, how we do things, why we do things, what our research priorities are and how we might sort of solve issues that are raised. I see another interesting question for Haki around intimacy in the nursing home. Are there any specific actions undertaken for couples who would like to be intimate, things like double bits? Is that on your mind? Yes, we have also VIP rooms. So it's double rooms when we have more space and when there are couples who will sleep together in the same room, it's possible. And we have some of couples who are staying together, but we have also couples who don't want to stay together. So in a separate room, really, it exists also. I actually have one more for Danika, if I may, because I see that your work was absolutely very relevant in that huge migration wave or refugee wave, I have to say, in 2015, 2016. I think we see the same thing happening now when I look at the news, European migration, you see that there have been many lives lost at sea. It's sort of lost a lot of attention in the media, but it's still there are big migration waves. Do you have, have you done any further work on refugees, especially then related to older adults more recently after COVID? Because you mentioned that it was a bit of a struggle during COVID that it has sort of decreased or attention has decreased. Has that changed? I would like to see to make one local center for families at Logata, 100 kilometers from Ljubljana, that place is well organized, but in a zillum center of Ljubljana, which I visited for many times, because they found myself as most equipped with experiences. They didn't implement the recommendations. So the health care of those in a zillum is still not so well organized, I would say. And they didn't implement things which were suggested. So it's now eight years and the time is quite long. So I expected that they will do it. Now we have substantial problems because people are at a zillum are so numerous that some sleep outside they say, outside the building, which is not acceptable for me. So I'm sorry that they didn't hear that politician. So at one place more rural be organized quite well for families, but for other, we are not successful. And we have another question for you, Dona Curve, from an attendee who says, I've encountered quite a high suicide rate in rural or poor socioeconomic communities and higher mental health issues are likely. Do you notice this amongst your community? Mostly mostly we see mental health problems. And maybe a suggestion for Wunka. Young doctors and nurses are afraid of meet these complex problems. So they even don't want to go with their homes because they are afraid. And we have to equip them. So some people do they do not see a nurse or a doctor for more than a year, because they don't have transport, they are afraid. And it's, it's quite really a big problem as you mentioned in your question. That's really good. And it just raises the importance of the work that both the special interest group and and the working group are doing and Wunka generally to try and improve our quality of care for people. Tanya, I think we need to draw to a close now. Would you agree? Time flies. Thank you so much, Joanna, Haki and Danika for great presentations, very inspiring, I think. And as you said, Joanna, I think we can learn a lot from each other and from the projects that are happening in internationally in different countries and different approaches. So I hope this was an opportunity for the participants and then also for the attendees to learn from these projects. Once we have the recording, I'll share that with everyone who has registered for the webinar, but thank you so much and wish you a lovely day or even. Thank you everyone. Bye.