 So we're going to get started, so for those of you who I didn't formally introduce myself, my name is Anthony Knox and I'm the Community Relations Manager for the Visiting Nurse and Hospice for Vermont, New Hampshire. And within, I mean I have a variety of different things that I do within my role, but one of my favorite parts of the job is to be able to do some training and education about the services that we provide within the VNH as we refer to ourself. One question that was asked prior to the start of the presentation here was kind of the affiliation between Dartmouth Health and Visiting Nurse and Hospice for Vermont, New Hampshire. And what Dartmouth Health is the overarching umbrella of organizations that, you know, it's kind of like a governing body to be able to get consistency across the board for all of the different affiliates that are a part of the Dartmouth Health System, which includes Dartmouth-Hitchcock Medical Center, Alice Peck Day Memorial Hospital, Mount Skutney Hospital and Health Center, Cheshire Medical Center, New London Hospital, and the Visiting Nurse and Hospice for Vermont, New Hampshire. And just recently we have started the partnership with Southwestern Vermont down in Bennington. So, and then there are, you know, if you've been catching up on the news, there are some articles about Valley Regional Hospital in Claremont, New Hampshire is also in the process of becoming part of the Dartmouth Health System. So, but for all of the different organizations, we are all independent to one another. We have our own CEO, we have our own board of directors, and, you know, we all have different, you know, goals and objectives that we're trying to provide to the community members. But under the umbrella of Dartmouth Health, we're all just trying to have that same consistency and expectation of services that are being provided to anybody who needs those services. So, and of course, mine is Visiting Nurse and Hospice. So, today's presentation is going to just be able to go through talking about all the different services that are available to you right from within the comfort of your own home. You know, it's something that is different than obviously a traditional hospital setting because that we don't have, you know, we don't have a brick and mortar location that you're coming to. We're coming to you to be able to provide the supports to you. And so, you know, we're dedicated to providing outstanding care to you within your own home. You know, and it could not, it could be someone you love, someone you care for, you know, in your home, outside of your home. But again, we're coming to you. And the other piece of it too is that people don't understand is that it doesn't necessarily just have to be your actual home. We work with a lot of individuals who are homeless that, you know, are in a shelter, in a hotel, you know, if they happen to, you know, unfortunately live in a tent. You know, we'll go and provide those supports to individuals wherever they need that support because at the end of the day, we just need to take care of people. We need to try to get them into a better position. We cover over 140 towns throughout Vermont and New Hampshire. And the next slide will show you a map of all those areas. And again, it's a variety of services, skilled nursing, rehabilitation, hospice, personal care services, and that's from birth to end of life. You know, we don't, you know, we're not just an adult service agency. We also provide supports to children and we'll go more in depth throughout the presentation. And again, we're a nonprofit, so our only goal is to help you. And we don't disqualify somebody from being able to receive services based on propensity to pay, having insurance, anything like that. If you need the supports, we're going to go provide those supports to you. So that's just a little bit of background for us. As you can see here with our service area map, you know, we are primarily in Vermont, specifically Windsor and Wyndham counties. But then we head on over to Orange County as well to be able to provide support. And then we have a little bit of New Hampshire that we cover throughout our catchment area. And, you know, one of the things with the fact that we provide services in Vermont and New Hampshire, we're the only Vermont agency that does that. So, and again, it's a smaller territory within New Hampshire. But again, we try to provide as much care as humanly possible in our areas. So we have technically five different departments of visiting nursing hospice for Vermont and New Hampshire. We provide home health care, which includes skilled nursing, physical therapy, occupational therapy, and speech therapy. Within that as well, individuals can also get home health aids to be able to help with personal care needs specifically around, you know, bathing and things like that. And then we also have social work services available, you know, to, you know, essentially, you know, a little bit of case management supports to try to help direct people to additional supports that they can utilize that, you know, potentially when we're done providing that support to them, that home health support. But they still need some additional supports. We can connect them with local councils on aging or just other social service agencies that can provide that support to individuals. We provide hospice care, you know, which can sound really scary and we'll go a little bit more in-depth about, you know, what hospice care is. But understanding that it's just the support that's being provided at the end of life for somebody who, you know, is done with any sort of curative treatments that's just ready to, you know, live the life, their best life possible with whatever time that they have left. We have a long-term case management program, which is, you know, for, you know, from some other social service agencies, it's that case management support to help keep somebody living in their home as long as possible. It's to be able to get them connected to other social service agencies on a more long-term basis. So, you know, essentially, if you qualify for long-term case management, it's not going to go anywhere unless you are ready for it to, you know, stop providing that service or you reach a higher level of care that's needed where you're going to have those supports around you at all times. So, you know, it helps provide the ability for people to stay in their homes longer than maybe they would have been able to otherwise. We also have a help at home program, which is kind of within long-term case management, but it's still separate. The biggest difference with that is that it's a pay for, it's a fee for service. So, you know, it's not, there are some insurances that cover it, but if you can tell me what insurances actually cover it, that would be lovely. But for the most part, it's a fee for service that people can pay to have somebody come in and provide a variety of services that will go more in depth with later in the presentation. And then we have a maternal child healthcare program. And so, literally, this is a program that is when the child hasn't been born yet up until the age of 21. And again, we'll go way more in depth as far as all the different services that are provided to that individual and as well as their families as we get later in there. So, before I start diving into anything, if there are any questions that anybody has, all right, we'll keep going. All right, so home healthcare skilled nursing. So, commonly, the supports that are being provided to somebody with the home healthcare skilled nursing side of things is after an injury, illness, surgery, or it could also be complications related to chronic illnesses that they have. So, essentially, for all of these supports, a primary care doctor, the surgeon, the ER doc, wherever that individual may be would determine, hey, you can actually use some supports inside your home. We, you know, and that there are services available to you to be able to come in and help with those services. We come in and assess what's happening with the individual based on the medical history that's been provided to us. You know, again, if it's a surgery, it's a little more clear cut. We know, okay, you just had your hip replaced. These are the things we need to work on so that way you can walk, you know, normally, you know, get back to, you know, how you were walking prior to having surgery kind of thing. You know, but again, for illnesses, I mean, it could have been a stroke. It could have been, you know, a variety of different medical conditions that happened that now require some additional support within that home. And, you know, again, whether it's PT, whether it's OT, whether it's speech therapy, wound care, you know, bandage changing, whatever, you know, whatever it may be, if there's a skilled nursing need, our skilled nurses would be able to come in and help you with that. And some of the things, you know, again, that we do within that is, you know, we assess your current physical condition. We provide whatever the appropriate treatment is. So upon the assessment, we determine, okay, we need to do x, y, and z. And, you know, in good, bad, or indifferent, there is going to be some homework that's going to be done, expectations of doing some of these exercises or whatever the case may be in between visits. And then we can also help with modifying or reorganizing your home. Because a lot of times, too, you know, we get in there, it's just like, oh, okay, you know, this, based on kind of how your house is set up and the flow, things like that, it could, you know, perpetuate the injury. It could, you know, cause the injury to get worse, not heal as quickly. So we try to assist with, you know, swapping some things around and kind of helping out. We can also, you know, as part of the social work case management supports, we can also try to help connect you with organizations that may be able to help, maybe with some home modifications, because, you know, maybe your walking isn't going to be exactly the way that it was prior to your injury, and now you're going to need a ramp to get into the house, or, you know, maybe you need railings attached or something like that to your house. We can also try to help facilitate getting people into, to help with that. We, ourselves, are not personally going to fix, you know, things within the house, but we may be able to help adjust some things as we're going. Yep, so our nurses have the ability to do, to take labs where needed, you know, do different tests, things like that, and then we work with, you know, whatever the local hospital is, to be able to go and drop off that, you know, that lab work and things like that. So, and again, it's all based on providers' orders. So we can't do anything unless a doctor has essentially prescribed it for us. So, yes, yes. So, I mean, again, you, you know, you could call for, you know, for your husband and say, you know, I think my husband can really use this and we're going to direct you back to your doctor, or, you know, in some cases we may be able to reach out to your doctor and be like, hey, this is, you know, kind of what was brought up, but the easiest way to, you know, speed up the process is to reach out to your doctor directly, or, again, you know, if you had a medical emergency, you were in the ER, you're going to have a bunch of doctors around you, and it's just like, hey, I need a referral to, you know, VNH, your home health services to, you know, help me once I, you know, get home kind of thing. And again, you know, within, within the home health services, we provide a bunch of different therapies for individuals, you know, following surgery, stroke, injury, illness, you know, whatever, whatever it was that you needed this additional support with. And again, physical therapy, occupational therapy, and speech therapy will all come directly to your home. And what we also find specifically with, you know, P-T-O-T and speech therapy is that if you're doing these exercises in your home and you, you know, understand how to do them within your home, you're far more likely to get better than you go to an outpatient physical therapy office because you're learning how to do stuff in that setting and things like that. And sometimes it translates to home, but a lot of times it doesn't. And so, like, you have a really good understanding. You can get in that, that routine right at your home, understanding it. And, you know, and eventually what, what our goal is, is to get you back to baseline, you know, to get you back to a point where you could then start going to outpatient, you know, outpatient, you know, nursing visits or P-T-O-T, you know, things like that. But we help, we help get you back to baseline of where you were or back to a point where it's going to be easy for you to actually get to these appointments. And we'll talk a little bit, too, about how to qualify for, for these home health services, which is, we're going to talk about it right now. So the, the primary thing around home health services in particular is that you're tech, you're quote, unquote, homebound. Now, homebound just means that it's a taxing effort for you to get out of your home. You know, it doesn't mean that you're, you're actually stuck in your home. It's not like you have to stay home, you know, during the, you know, however long of a process we're going to be in your home. But you have, it has to be very difficult for you to get out. And, and again, most pre-op patients are also considered homebound because you're going to be on pain medications, especially at the beginning. You know, a lot of the pain medications, they say don't drive, don't operate heavy machinery, you know, all these different things. So you're probably going to, you're probably going to qualify for home health services based on that as well. But absences from your home are, are infrequent. So, you know, you know, you're not, you know, maybe prior to this injury, you're, you know, you're living your best life. You're always on the road. You're doing all these fun things. You're going to concerts and baseball games, whatever the case may be. Right now, you're probably not going to, but there are still reasons why you're going to leave your home. And, and again, you're probably still going to have some medical appointments even though we are providing some care to you within your home. You know, special occasions, you're going to go to, you're going to go to your kid's birthday party, you're going to go, you know, you're going to go watch your grandson play baseball, you know, whatever the case may be. You know, you go to church every Sunday, you know, you have, you know, you have a hair appointment, you know, there's a bunch of different reasons why you, you would still leave your house. And all of these reasons are beneficial, specifically, probably for your mental health beyond anything else. So, but again, it's not, it's not like from sun up to sun down, you're going to be gone all day because then, well, then you're probably moving around okay, you're, you probably don't actually need some in-home services at that point, but, you know, and then individuals who, you know, maybe have some vision impairment in particular, you know, would be considered homebound because, you know, you need that support potentially to get out of the house. You know, individuals with Alzheimer's and dementia, you know, those cognitive disabilities where, you know, you're going to need somebody to provide support to you in-home and, you know, you probably don't get out of the house as much as you would like. Cardiac disease is another big thing. So, you know, we know a lot of people with cardiac disease and heart troubles and things like that, you know, have a lot of fatigue and even getting out of the house is very difficult for them. Those are people that for sure qualify for our services to be able to come in and provide that support within the home. And then, you know, again, you have the ability to drive around, but you, you know, it's still very difficult for you to drive around based on what your current medical condition is. Those, these are, you know, these are just some of the reasons as to why you would qualify for in-home support to get better. Hospice care. So, you know, one of the things that I will say right off the bat is I know that, you know, a lot of people's minds, hospice care means that that person is going to die very soon. You know, it's, you know, it's a very scary thing. It's a lot of people think that it's just that little bit of support right at the very end of life. But one of the things that I want people to really understand about hospice care is that it's a service that is available long before the end, quote, unquote. And we'll talk a little bit more about that in a moment, but in order, in order to qualify for hospice care, two providers would have to agree that there is a life expectancy of less than six months. So our medical director, Dr. Christy Maloney and the primary care provider, the ER doc, whomever is essentially assessing this patient would make the determination that this individual has less than six months to live based on their current medical prognosis as well as just understanding that if there was no treatment being provided and we just let the disease run its natural course, that this individual would pass away within six months. The care that's provided is palliative, which just means managing the symptoms of that individual. It's not curative. So for example, somebody who's been on chemo for cancer wouldn't be able to be on chemo for cancer because that's curative versus managing the symptoms that that individual has. And the full team that provides support to the individual nurses, doctors, chaplains, and our social workers all have a part in providing supports to individuals and not only just the individual who is the patient, but also the care team around that individual. So specifically in the hospice situation, not only taking care of the patient, but also taking care of that patient's care team is as important during hospice. So some of the qualifications for hospice is just kind of the general guidelines. So again, a life limiting condition. So six months or less that that individual has remaining. The progression of the disease. So again, going back to cancer, stage one cancer, maybe not qualifying for hospice based on that stage four cancer, we're probably talking, hospice supports would be a valuable resource for individuals. Frequent hospitalizations, office or ER visits, as this individual is going to the hospital more and more often for a variety of different reasons, there may be some underlying causes that some additional lab work or testing needs to be done to kind of determine perhaps this individual is actively dying and may need the hospice supports that are available. Weight loss is greater than 10% over the past six months. And then the patient or family wants to focus on symptom relief and management and they're not looking to cure. I mean, I personally have experienced some of my family members who fought cancer for years and years and years and finally just said, I'm done. Like I don't want to do this anymore. And so they made the decision, family supported it and they had gone on hospice at that point. And then some of the common diseases to qualify for hospice. And again, I didn't include cancer on here. I kind of feel that that's a very, very common reason for somebody to go on hospice. But again, it's essentially end stage diseases. Once a doctor or provider has determined that they're at the end stage, then they're likely gonna qualify for hospice. But we also provide hospice care to individuals after having a stroke or coma, again, depending on what the prognosis is based on that. And then ALS is another thing. And some of the dementia, ALS, Alzheimer's, things like that can be very challenging to kind of diagnose. But the other thing to understand is that, an individual who has a prognosis of six months or less, that doesn't mean necessarily that they will pass away in that next six months. We have had people on hospice that have remained alive for two years. It's a very slow progression, but with the supports that they were receiving, they were able to live their life for the next two years and not just being stuck at home sick, like being able to go out and live their life, travel, do all these different things. And one of the things, and I don't remember if I put it in the presentation, but just because you're receiving home health or you're receiving hospice supports here in Rochester, Vermont, you can go to Rochester, New Hampshire, Rochester, New York. It was the only three Rochester's I know off the top of my head, but you could go to California, you can go overseas, things like that. And what the home health agency, VNH is able to do is we would contact the local home health and hospice agency in that area that you're gonna be and be able to continue those services right there with you. So say you've got family in California, out in Los Angeles, we're gonna connect with an agency in Los Angeles, transfer your care to them while you're there for however long. And then when you leave, they're gonna transfer it right back to us. So there's no laps in services, no laps in getting whatever treatment that you need. It's just potentially it's gonna be a little bit sunnier where you're going. That's really the only difference. And what does the hospice benefit cover? So one of the things too that I really want to stress related to hospice is that it's an entitled benefit, especially for anybody who's on Medicare. This is for you, like you paid your dues, you paid into the system, you did all these different things and Medicare is gonna take care of you at the very end. And other insurances will as well, I will say, thankfully, most individuals who are on our hospice service have Medicare. There's not a lot that are on private insurance or Medicaid or all these different things. But again, we provide a variety of services that the individual can receive during this time. And not only the individual, but the family providing services. And I want to in particular talk about the social worker and chaplaincy services, which is kind of in the middle of this slide. Our social worker, social work team in particular really helps with advanced care paper, advanced care directives, advanced care paperwork to just have everything in line for that individual. And maybe it was very sudden that this individual is now has a prognosis of six months or less. And there's no funeral arrangements set up. There's no anything set up. Our social work team can provide those supports to help coordinate and get that stuff together. Because we know that especially at the end of life, all of that stuff really falls by the wayside and you really want to just spend time with that individual. And we're here to help with kind of the paperwork aspects of things to just really be able to help the loved ones of that individual. In addition to while the individual is still with us, after they've passed away, we, our chaplaincy program still provides support up to 12 months after the individual has passed away. Rather it's one-on-one sessions, phone calls, emails, text messages, whatever it is that you're looking for, we're able to just continue to provide that support. And I say 12 months, we have individuals who on the anniversary of their loved one passing away still reaches out to our chaplains 10 years after the fact. So our chaplains are never going to say, sorry, it's only 12 months. It'll go on for as long as they need that support and they're more than happy to do that. In addition, our social work team also helps with any end of life after the individual has passed away, paperwork and maybe they have a question about like probate corg or all these different things. Like our team is still there to be able to assist after the individual has passed away. And then in addition to, we also help coordinate respite care for individuals. Rather it's potentially somebody coming to the house, more likely than not, it's they have the ability to go to a local facility, a hospital, a nursing home, whatever the case may be. We have contracts throughout the state of Vermont to have people be able to stay in a facility maybe for a weekend. I think it's up to a week, something like that where the individual can go there, get the care that they need, and their caregivers can have a break. And we all know that that's also so important to be able to have those breaks and just get that little bit of extra support. So we help coordinate that as well. Any questions about the hospice benefits or anything like that? So, Jack Boehring Center is one of the places that we work with, but I mean, we would also potentially, I think at one point, and I don't quote me on this, but like Giffer Medical, I think has some respite beds, things like that, to be able to just keep, we try to keep them as local as possible while at the same time understanding that it may be a little bit of a drive. And again, even if it's a respite situation where you, the individual goes there to be able to stay overnight for a few nights so that you as the caregiver have the ability to sleep for a few nights. It's not to say that you're not gonna still go see them during the day and spend time and do those different things like that, but maybe it's just, you need to be able to get a few nights of sleep, kind of thing. So we try to get the individual as close as possible to where their home is. It's all just a matter of availability. And so one of the other big parts is volunteering for hospice. So my friend Nils here in the back is our bereavement and volunteer coordinator for our hospice program. And one of the things that we find is as important as anything the VNH is doing around nursing and chaplaincy and social work and things like that are volunteers to be able to go spend time with the individual. And a big part of this too is to provide a little bit of respite for the caregivers. So that way maybe they need to go, they have a hair appointment. They need to go run, grab groceries, whatever the case may be. We can have somebody come in and hang out with them for a little bit. And even for some individuals who maybe don't have a lot of family in the area, supports in the area, things like that. It's somebody who can come in and spend some time with that individual. So I mean again, this is the smallest list humanly possible of what you could do for being a hospice volunteer. But essentially it's just being there for the individual and providing some support. So again, we're always looking for people who want to volunteer. You can go to our website vnhcare.org to learn a lot more about it. Or after the presentation, just ask Nils. So our long-term case management services. So this is a service that primarily, Medicaid patients in particular are the ones that receive the service, but all insurances are accepted related to it. But so one of the things to understand with this is that so you would have a case manager who's essentially coordinating all the supports that you have. And they're traditionally one of our staff, but there are some situations where you may be able to hire your own case manager to kind of manage all of your supports. And we'll talk about that in a minute. But we help coordinate a variety of different services for you or a loved one to be able to stay in home longer than potentially you would have been able to otherwise. So we provide several things within the home. Again, we help with coordinating with emergency response systems, lifelines and all those kind of things where you compress a button and have somebody come to your home as well as assistive devices, home modifications. I mean we can help coordinate with potentially getting one of those seats that bring you up the stairs or help with building a ramp outside your house. So it's different things like that that may be needed for you to be able to stay in your home. Otherwise you might have to go live with a family member or go live in a nursing home or whatever the case may be. So we do a bunch of different stuff. Outside of the home, we can also help with coordinating supports within different types of living situations. So I mean again, it may not be your home but maybe you're living in a like a next level down from a nursing home kind of thing. Like I'm thinking of the Woodlands in Lebanon, New Hampshire. It's a assisted living facility. Everybody's independent, is able to do different things but there's somebody there at all times to be able to assist with a variety of different things. Like you still don't meet the nursing home level that you may need and you can still live at home but maybe you need somebody to come check on you twice a day kind of thing. We can help coordinate stuff like that and still provide supports for that individual there. And then up to everything and eventually getting to a nursing home and where you would have those fully well-rounded supports we can help coordinate and help with long-term Medicaid to help pay for those kind of things and things like that. So we provide a lot of different things within the long-term case management service. And again, within our long-term case management, I mean we're there. We're there to help with whatever it is that you may need. Again, we may not be, as the VNH, we may not be the specific agency to help with everything, but we're gonna help get that well-rounded supports around you. Whether it's we help you get food stamps set up or we help you with rent assistance or fuel assistance or all these different things. We connect with Sevka to be able to help winterize your home and do different things. We're providing that case management supports and it can be a situation where we're there once a month. There's situations where we may need to be there every day. And it's all gonna be determined upon what that individual needs. So we provide, again, it's just to be able to help you stay in your home as long as possible. And within the long-term case management program, we have the ability of doing something that's called flexible choices. And basically what that means is that you would come to us, we'd get you all approved to be able to have this long-term case management, but maybe you know somebody who can be the quote-unquote case manager for you. Maybe it's a brother or a friend or whatever the case may be. And they may be then responsible for ensuring that a plan is developed for how the funding that you're receiving through this program is being used. Within that funding, you would also be able to hire what's called a personal care attendant to potentially take you to doctor's appointments or grocery shopping or running all of these different errands and things like that. But also just some companionship services for you. So essentially it's the same services, but you have more flexibility with who would actually be providing that service to you versus with us with the VNH, it would be one of our case managers, one of our personal care attendants, and maybe you don't gel as well with them and you know somebody that you would gel with better. They're still, those individuals would still be working with the VNH just like you are to ensure that money is being appropriately used to provide these services and whatnot. But again, you have more flexibility. And again, our PCA staffs, maybe they're not keen on taking you out at seven o'clock at night to go do something. But maybe your person that you know is very willing to take you out at seven o'clock at night to do some sort of activity. So, and that's something that can be discussed with our long-term case management team and get that all set up. And I've already explained to you what makes flexible choices different than traditional services. So I'm just going to skip this slide. And then our help at home program again, I had mentioned that at the beginning. Again, it's a fee for service program. As you can see, it's about right now, it's $35 an hour for the first 40 hours and then $45 thereafter. And then there's also mileage involved if you're asking the one of the individual to transport you to appointments and things like that. But, and it's non, it's non medical. Like that's the most important thing to remember as well is that, you know, they're not going to be able to specifically help you with any of the maybe medical things that you need outside of, they can help with setting up like pill planners and things like that, helping with the medications. But like they can't check your blood pressure. They can't check your blood sugar. You know, they, you know, different things like that. Like that's not what they're trained to be able to do. But they can help with personal care stuff like showering or toileting and things like that dependent upon if those are things that are needed. So, and again, this kind of falls under the long-term case management program but it is a separate entity altogether. Yes. So, so from what I understand with some insurances is that it, there are some insurances that have those supports in it but it's for a short period of time like maybe a year or two max. And so it's a matter of just kind of like talking with that insurance company and understanding that some. So for like, for example, like maybe you're on the tail end of being able to live independently but you have this, you know, this insurance that could potentially have somebody come in and help like with home making and things like that. You know, we would be able to, you know, and then, you know, provide that over the next two years and then maybe in that two year timeframe it's kind of transitioning into the next phase of your life as far as where you're gonna live and things like that. But ultimately what I would just say is talk to your insurance agent or that company or whatever and just make sure you have an understanding. I am to have, you know, understand that there are some insurances that it's a lifetime benefit to be able to do stuff like this on top of then, you know, if you need to go into a nursing home it's all set and ready to go. But that is few and far between that there's usually a timeframe in which you can utilize it. And what I understand is like maybe you use it for a year you don't need to use it again for another five and then you use the rest of it like within a year or something like that. So, no, no. So this is, this and long-term case management don't actually require referrals. It's just a matter of calling the VNH and asking us about these services and getting you set up. And in both the help at home not so much a like assessment and determination kind of thing. Cause again it's a fee for service but the long-term case management they would do an assessment to determine whether or not you meet the qualifications for it. And there's, you know, within the long-term case management there's, you know, there's income requirements and, you know, a variety of different things that you would go through with our intake person related to that. All right. And then, because a lot of people really don't understand that we also have a maternal child health program. So again, we provide care from, you know, birth until the end, you know. So, you know, and we provide services including skilled nursing, strong families which is a very specific education program that we'll talk about and a pediatric palliative care program. So different than our hospice program if there is unfortunately a child who needs to go through hospice care our pediatric palliative care program actually cares for that. So, and it's obviously it's a different skill set to be able to provide that end of life care for someone under the age of 21 versus someone who is in their nineties, you know. So, so skilled nursing. So skilled nursing within the program this has to have a referral from a doctor to receive those services. You know, and it can be prenatal visits, postpartum visits for a mother with history of blood clots, diabetes, hemorrhage and, you know, maybe some breastfeeding challenges. Infant has difficulty feeding or failure to thrive and the children has a new diagnosis requiring in-home education following hospitalization. So, one of the things, you know, especially within our skilled nursing program for children is moms and dads who maybe don't understand how to use some of the equipment that that child is gonna need to use temporarily for the rest of their life, whatever the case may be. So, we're able to provide that care in-home so that they understand better how to take care of their child. You know, again, the primary goals and objectives are to provide that support to the child and the mom in particular. You know, obviously dad is gonna get the same education as mom is in a lot of these situations. But there's a lot of situations where the mom needs to be the primary focus and in particular with the Strong Families program that is available to new moms from the time that the child hasn't been born yet up until about two years. This is a very specific educational program that has been developed. It was actually developed in Australia and Vermont is one of two states currently that utilize this program. We have been trying for it to also be in New Hampshire because we know it's such a valuable resource and New Hampshire has not wanted to do it yet. So, but essentially the Strong Families program helps provide an educational foundation for new moms in particular to be able to care for their child. Within the program, there are 25 specific lesson plans that a mom goes through to just better understand providing the supports. And we have had moms who are on their second or third child who are doing this program as opposed to right after their first one. And it's also something that can be done with every child because we all know every kid is different in that, especially in that first couple of years. So, and it's something that it goes up to two years of age for that child or if you get through all the educational stuff sooner than that, then you're able to quote unquote graduate and you're ready to go. That doesn't mean that we're done, we're all set kind of thing. We're still available to be able to provide education and support to new moms if they have any additional questions and things like that. So, similarly to chaplaincy services after somebody has passed away, we're gonna be in your life if you need us to still be there and provide that additional support. So, and then again, with the pediatric palliative care program for children, it's offered to anybody 21 years or younger with a medical condition, with a prognosis of death that is highly probable to be before the child reaches 21. So, unlike hospice, this support being provided can last 21 years essentially. You know, an individual can also still receive curative treatment during this. So, you know, it's possible that a child is not going to see their 21st birthday, but they can still receive all the treatments that they need to hopefully, you know, beat whatever diseases is happening in this situation. And again, it's very similar to our hospice services, you know, providing that support to the individual in whatever capacity it may be, you know, up to and including, understanding that they're probably not gonna be cured and, you know, they have to come to that realization that unfortunately this individual is going to pass away. And, you know, so maybe there's, you know, some, you know, they just wanna do art, they just wanna do music, you know, for the end of, you know, the end of their life. You know, we're able to provide the supports to that individual, help coordinate, and then of course, you know, providing any family grief counseling and bereavement supports to that individual's family. So, are there any questions that anybody has with anything that I've talked about over the last 45 minutes or so? Well, again, like I said, my name's Anthony Knox. I'm the Community Relations Manager. In the packets that you all have, you have all of my contact information, but there's also some business cards on the back table if there are any questions. Please don't hesitate to call me, email me to be able to answer. And I wanna thank you all for coming and hanging out with me this morning. So, it was great and I hope you all got something out of it. So, have a great day.