Do you ever find the holidays overwhelming? There are lights and music, decorations and crowds, shopping and cooking, parties and dinners, rich food and alcohol, late nights and busy days— sometimes it feels like you need a holiday to recover from the Christmas season!
If we feel overwhelmed during this season—and we are cognitively well, our brain is fully working—then imagine how overwhelming the holidays may be for someone who has dementia. Someone with dementia may not remember what “Christmas” or “the holidays” mean because they become abstract terms.
Here are some holiday tips to help a loved one with dementia through the holidays!
Beware of Decorations
You see an impressively life-like St. Nicholas welcoming people to your front hallway, but what does your loved one with dementia see? Is she concerned about “the man in the hallway who isn’t having dinner?” Life-like or oversized decorations can be confusing or even scary to someone with dementia. Consider from their perspective how the decorations could be misinterpreted.
Flashing lights draw a mixed response. Some people with dementia are mesmerized by flashing lights; others become alarmed or agitated. Keep consistent bright lighting in all rooms. Dark rooms with candlelight or just the tree lights may be fearful for someone with dementia.
Remove all ornaments that are not edible but look like real food. Fake gingerbread men or houses, fake candy canes or apple ornaments should all be avoided. Someone with dementia may not realize that it is just an ornament and may attempt to eat the decoration.
Have a Quiet Room
You want to include your loved one who has dementia, but you also need to provide a space where they can retreat and have some peace and quiet. People with dementia typically interact best in small groups or one-on-one. If a loved one with dementia is attending a large family gathering, set up a separate room—well lit with comfortable furniture—and recommend that family take turns visiting that person, one at a time. This allows for quality interaction in a way that best matches your loved one’s needs.
Routine is often the first casualty of the holiday season. We stay up late at night, we don’t eat meals at the usual time and we often stray from our usual, healthy diet. Remember how you felt last January after eating heavily and having your routine interrupted? Now imagine someone with dementia. The person with dementia cannot rationalize why they feel different, all they know is that something doesn’t feel right.
As much as possible, keep routine familiar and consistent. Try to maintain regular meal times (even if that means eating separately from the party), and try to limit intake of rich, sugary foods or excessive alcohol. Respect nap times and bedtimes—sleep is as important as ever! By maintaining routine as much as possible, your loved one may be able to better handle the surprises that come with the season
If family members live at a distance, they may be visiting for the first time since the last holiday season. Your loved one may have changed significantly since last holiday season. Advise family and friends in advance so that they know what to expect. Request their assistance in making the holidays easier for your loved one, and outline exactly what you need them to do. Here are some suggestions:
Please do not ask “do you know who I am?” this causes undue stress. While she may not be able to name you, grandma knows you are an important person whom she loves.
Please be aware of the fact that mom now needs to take some time away from the crowd. She finds noise and groups over-whelming. We will have a Quiet Room set up and we invite you to visit mom one at a time in the quiet room.
Please do not encourage alcohol consumption by saying “it’s only one drink!". Dad is now on a medication that does not react well to alcohol and he will not enjoy the event as much when he is trying to process the alcohol.
Set Realistic Expectations
Set realistic expectations for your loved one by limiting the number of events they attend. No more than one event or activity in a given day; only a few in a week with recovery time between events. Step back and try to asses what is realistic for your loved one. Maybe a dinner with 50 people will not be a successful event, but attending a hymn sing would better match your loved one’s preferences and current abilities.
Your loved one will not be able to suddenly do more or handle more because it is the holiday season. If anything, their coping abilities may be taxed and they may become agitated or stressed more easily than usual. Be realistic when scheduling the season.
Select the Top Priority
What is more important—that your loved one attend every event and every tradition is followed in detail, or that your loved one has a merry Christmas feeling loved and happy?
If the top priority is your loved one having a wonderful Christmas season, then focus on the elements that create that sense of joy, peace, and love for them. If you really analyze it, you’ll realize it has nothing to do with decorations or traditions. It has everything to do with family and interaction.
If you are stressed because of holiday prep, your loved one will feel that stress and not enjoy the season. A person with dementia would rather have you slow down, match their pace, and be patient than present a tray with 15 varieties of home-baked cookies that stressed you out!
Your loved one with dementia might enjoy singing a few familiar Christmas carols (because the words of those favourite tunes tend to stick), rather than feel the pressure of keeping up with an animated conversation at a cocktail event.
What will make your loved one smile? When will they seem most at peace? What will have them feeling safe, secure, and loved? Aim to focus on those elements and your loved one will have a truly blessed Christmas.
What do you get for the grandparent or senior who already has everything? The great-grandparents are even harder to shop for! What is the perfect gift for someone who is 80+? Different gifts are ideal depending upon where someone lives. Here are two gift list ideas to suit different living situations.
4 IDEAS FOR SENIORS LIVING AT HOME
If your 80+ relative is living independently at home (either a house, condo, or apartment), then the best gifts you can give them are practical items that will prolong their independence. Your loved one is likely very focused upon remaining at home for as long as possible; any gift you give that helps in achieving that goal is a good idea.
Here are some suggestions
1. Gift Certificates for property maintenance. The physically demanding activities of home maintenance are likely difficult, so provide your loved one with a gift certificate for regular home maintenance chores such as snow shovelling, grass cutting, garden upkeep, window washing, etc.
2. Homemaking and Household Assistance. Out-door house maintenance is not the only area of challenge for the elderly. Household chores can also become quite onerous. Your loved one will greatly appreciate a gift certificate for housekeeping.
3. Assistive Devices. Assistive devices can include a whole range of products to help with any variety of needs. There are specially designed items for challenges such as hearing impairment, sight impairment, weakness following a stroke, dexterity, memory loss, etc. You might be surprised at some of the items available for purchase at your local assistive devices store. Your loved one will truly appreciate this gift if they have already acknowledged challenge in a particular area.
4. Transportation. Many elderly seniors no longer have a licence and no longer drive. No access to transportation can be isolating, especially in the winter months. Providing your loved one with pre-paid driving options ensures that they will not be home-bound when the winter weather hits. Warm Embrace caregivers are pleased to drive your loved ones wherever they need to go.
4 IDEAS FOR THOSE LIVING IN NURSING HOMES
If your loved one lives in a retirement home or long-term care centre, then different gifts might be more appropriate. Their personal quarters are much smaller, so they do not have space to keep many belongings. Here are some ideas that won’t take up too much space but will still bring a smile on Christmas day.
1. Window Ornaments. Glass window ornaments are pretty to look at, and cast a cheerful glow when the sun is shining. There may not be much shelf space available for knick-knacks, but adding a personal touch to the window doesn't take up any additional space.
2.Personal Items. Residents in long-term care use their own preferred personal care items such as hand soap, lotion, toothpaste, etc. A care package of your loved one’s favourite items is always appreciated! The scent is strongly linked with memory and emotion; selecting a favourite scent can induce positive memories.
3. Blanket or Lap Quilt. Having a cozy item such as a small blanket or lap quilt is always comforting. It can be left on the bed or on a chair in your loved one’s room. If recognition of new items is difficult for your loved one, a blanket on the bed implies its purpose in a way that new clothing items do not.
4. Companionship. Providing your loved one with on-going visits is probably the best gift you could offer. Warm Embrace provides Companion Aides to long-term care centers across the region. Companion Aides visit one-on-one with residents and can take them on personal outings into the community. They provide mental and social stimulation, as well as an opportunity for physical activity. This is a gift that keeps on giving long after the holiday season!
FOR SENIORS LIVING ANYWHERE:
Triple Vitality. This gift is suitable for someone living in retirement or long-term care, as well as those still living in the community. Triple Vitality is a proactive approach that focuses on three areas of health—physical fitness, mental stimulation, and social interaction. By maintaining strength and functioning in each of these areas, people maintain independence and enjoy an increased quality of life.
If you just have questions about the above list of gift ideas, please don’t hesitate to call. We love to know that the seniors in this area will have a meaningful holiday season!
I know an elderly gentleman who is a veteran and whose story stood out to me. His medals are proudly displayed in a showcase on the wall in his home; hung below the showcase is a framed photo of him in uniform.
He is both proud and dismissive of his service. He is proud in the sense that he still smiles fondly when remembering his comrades, and his identity is closely linked to his military service. He is dismissive in the way that he doesn't feel he was any different than any other young man who readily volunteered for service. He felt it was his duty, and he wouldn’t have it any other way.
As a young man, recently married his beautiful new bride, he heard about recruitment for the Korean War. He discussed it with his wife, and of course, she didn’t want her new husband heading off to war. As he tells the story, the call of duty meant he couldn’t forsake his country; he felt he was married first to the military, and secondly to his wife.
He enlisted for service and then had to break the news to his wife. To ease the announcement, he invited one of his comrades over for dinner and waited until dessert was served to benignly ask his buddy, “so, how long do you think it will take us to get to Korea?”
As you might imagine, his new wife was less than impressed! She eventually came around though and understood her husband’s devotion. His loyalty has served her well too; the same devotion he showed to his country, he has shown to his wife and family ever since. He is a true man of valour.
It is to gentlemen—and women—such as him that we owe our thanks and appreciation as we reflect on Remembrance Day. From everyone here at Warm Embrace, we express our deepest gratitude for the sacrifices of veterans who have served and continue to serve our country. It is our absolute honour and privilege to care for such distinguished veterans in their hour of need.
In 2014, a number of organizations across Canada came together to promote a campaign called Fall Prevention Month. During the month of November, this campaign encourages organizations and individuals to come together to coordinate fall prevention efforts for a larger impact. The goal is to collectively raise awareness about fall prevention strategies and to help everyone see their role in keeping older adults safe, active, independent and healthy.
What are the impacts of falls?
Unintentional falls are the leading cause of injury for Ontarians aged 65 and over.
Recovering from a fall can be very difficult and with an increasing number of falls, it is important we take measures to prevent them.
How can we prevent falls?
The good news is that falls are preventable injuries! There are five key factors that caregivers and seniors should consider in order to prevent falls.
1) Eyesight – vision is an important part of balance and good vision helps to prevent falls. Everyone who is over the age of 65 should have their vision checked every year.
2) Your home – if you have clutter on your floors or stairs, it increases the chance of tripping and/or slipping. Make sure cords, scattered rugs, pet toys, books, etc. are in their proper place. Also, if your home is dark it increases the chance of falling, especially on stairs. Make sure to create a space that is well-lit!
3) Exercise – the most important thing you can do to prevent falls is to stay and remain strong! Walking, fishing, gardening, tai chi. Light yoga – whatever you enjoy! – do it to increase activity levels.
4) Medication – some medications cause dizziness on their own, or when mixed with others. It’s important to properly manage your health! Always take medication as directed and ask your pharmacist to review them if you are taking more than 2 medications.
5) Eating a healthy diet – Vitamin D and calcium help to keep strong bones. A diet to include more greens, lean protein, and less sugar will help you in remaining strong. You may want to talk to your doctor about supplements or other alternatives.
Most of all, don’t do it alone! It takes a community to prevent a fall and we all have a role to play. Here at Warm Embrace, we have a wonderful team of caregivers who can help you and your loved one to remain safe at home.
Someone who is experiencing dementia may exhibit behaviours that we do not understand. These behaviours have been labeled ‘difficult’ or ‘disruptive’ or ‘challenging’, but is that really a fair assessment of these behaviours?
In caring for people with dementia, the focus often ends up being on the disease itself, rather than on the person who is experiencing the disease. Thus, their behaviours are often automatically assumed to be associated with the disease.
Sharon Stap, a Psychogeriatric Resource Consultant, contrasts older understandings of dementia with more updated approaches. In the past, it was understood that dementia was altering someone’s brain, resulting in different behaviour. All behaviour was assumed to be a result of the disease.
The newer understanding of dementia is that the changes in someone’s brain results in a different perception of the world around them, creating anxiety, fear and other emotions which then lead to different behaviours. Understanding that someone with dementia is experiencing a change in perception which causes behaviour should fundamentally alter how we interact with those who have dementia.
Dr. Sherry Dupuis, former director of MAREP (the Murray Alzheimer Research Education Project), feels that we need to reframe our view of these behaviours. Instead of merely seeing the ‘challenge’ or ‘difficulty’ that these behaviours cause for us, or assuming that all behaviour is attributed to disease, we need to reframe these behaviours as a form of communication. Dr. Dupuis views behaviours as a form of personal expression, a unique way of communicating needs. We should then seek to understand the meaning behind the personal expression.
We must remember that people who have dementia were all unique individuals prior to the onset of their illness. They continue to be unique individuals with different personalities, communication styles, interests, life histories, etc. Dr. Dupuis charges us to never lose sight of the fact that a person with dementia is first and foremost a person who requires love, care, and understanding, not just a disease or a ‘case’ that needs to be managed.
One of the greatest gifts that we can offer to someone with dementia is the gift of truly relating to that person—validating their personal experiences and feelings. Someone with dementia is experiencing the world around them differently than they previously experienced the world, and differently than you might be experiencing the world around you.
This experience may be frightening, overwhelming, or worrisome, and the feelings that are generated and their emotional response is fully valid. We cannot be dismissive of someone’s feelings or emotional responses just because we do not deem a situation to be frightening to ourselves. The kindest thing we can do is try to understand the emotional response and validate the feelings that someone else is experiencing. Only then can we attempt to change someone’s experience into something more positive.
If someone is distressed or having a negative experience, distraction can be helpful, but it is not the first step in the process. Stap emphasizes that you cannot jump immediately to distraction, otherwise you risk being dismissive of someone’s feelings. Stap proposes a four-step process where distraction is the final step, not the first option.
The Four Steps:
1. Show you care
2. Show you want to help
For example, Agnes has dementia, and she is upset and focused on wanting to return home. The first step is to acknowledge how Agnes is feeling. You might say: “You need to get home, Agnes? I can understand why you’re so upset.” Attempting to inform Agnes that she is already at home—known as reality orientation—is not helpful and only causes more distress; Dupuis and Stap agree that there is rarely, if ever, a good time for reality orientation.
After acknowledging and validating Agnes’ feelings, you want to show that you want to help. You might suggest: “let’s go see if we can find someone who can help us, Agnes”. While on the hunt for someone who can help, you have the opportunity to redirect, the third step. You could say, “I’m tired. Before we look for someone else who can help, do you mind if we rest here by the piano?”. After this, you have the opportunity for distraction, the fourth step. You could then say: “You play the piano, don’t you, Agnes? Would you play me a tune?”
If you had jumped immediately to distraction via the piano when Agnes first approached you, she likely would have felt even more frustrated that her needs were not being addressed. Acknowledging Agnes’ feelings and needs, then assisting her to focus on something that is more comforting, allows for a positive experience overall.
Interpreting all behaviour as a form of personal expression shifts the focus off of the disease of dementia, and refocuses attention on the individual person. Suddenly, behaviours are imbued with meaning and purpose, a form of communication. It is then our responsibility to enable the best possible form of communication and understanding, setting people up for success, regardless of dementia or other illnesses.
Autumn is a wonderful time of year filled with fall colours, harvest crops, hearty comfort food, warm fuzzy sweaters, and long walks rustling your feet through the leaves. Really, all the sights, sounds and smells of fall time are lovely! This season why not try a fun and festive activity with an elderly loved one.
Here are Five Fun Activities to try this Fall Season!
1) Prepare Homemade Treats
Baking, mixing and preparing treats are fun activities that many older adults enjoy. You can follow a family recipe or flip through some cookbooks to discover new recipes. You can make something as simple as apple crisp or a no bake pumpkin cheesecake. Another idea is decorating sugar cookies with your loved one! If baking is too messy, you can always pre-bake the cookies and just decorate them with your elderly loved one.
2) Pumpkin carvings and painting
Pumpkin carvings are a must tradition every fall season. You can carve all sorts of patterns on pumpkins but if carving is too much strain on wrists and hands you can always introduce painting on pumpkins to your elderly loved one. You can have an assortment of paint colours to design a unique pumpkin and then you can put them on display so that everyone can see.
3) Enjoy the natural scenery and fresh air
Bundle up and breathe the fresh autumn air! You can go on a short walk in the park to admire the beautiful coloured leaves that fall brings. You can go to a local park like Victoria or Waterloo Park and walk a scenic trail hearing the crunch of the fallen leaves under your feet. If you can’t take your loved one out too far why not go somewhere nearby? You can relax in the backyard, front porch, or go on a short walk to pick up the mail. If it’s too cold outside for your loved one – you can always go on a relaxing country drive to see all the colours or simply open up some windows and blinds to let the fresh air inside.
4) Get festive with fall decorations
Crafting and decorating are always fun activities! You can help an elderly loved one to decorate their home with fall colours. You can introduce neat craft ideas with dried up fallen leaves, such as collecting them to make cards. If they live in a retirement home you can help them decorate their front door so residents that pass by can admire their festive décor.
5) Prepare for Halloween Trick-or-Treaters
If you are planning to hand out treats to children in your neighbourhood, your elderly loved one might enjoy a little bit of prep work. You can enlist the help of your elderly loved one to sort candy into different bowls and/or containers. You can even prepare small goody bags with lots of sweets to hand out to trick-or-treaters
This autumn season introduce a new activity to your elderly loved one – it may be cooler weather – but it’s a lovely season to spend quality time with friends and family.
Thanksgiving is a time for reflecting upon all of our blessings. Reflection and gratefulness are skills that we regularly see demonstrated by our wonderful clients. We are often reminded to be thankful for all that we have and to be appreciative for all of the small blessings that we unknowingly take for granted.
Our elderly clients, many of whom lived through very difficult times, know all too well how lean years feel. Many lived through the depression era when even basic necessities were in scarce supply; they lived in Europe during the war and experienced shortages, rations, and were in constant danger; they immigrated to Canada and had to build new lives starting from scratch.
They learned how to savour every blessing, to be grateful for each miracle, and to never take anything for granted. Compared to the hardship that our elderly clients once faced, our current challenges seem very mild!
When our clients tell us stories from their youth—stories of courage, determination and gratitude—there is always a common thread. The stories are never focused around possessions or money or things. The stories are centred around the people who mattered most—family, friends and loved ones.
The blessings that are most memorable, even decades later, are the blessings of the most beloved people in their lives. Honouring a friendship, caring for family, falling in love, raising a family, helping a sibling, being loyal above all else—these are the elements that truly matter. These are the blessings to focus upon; these are the blessings for which we should be most grateful.
Our clients teach us many important lessons, but gratitude and the importance of relationships would be at the top of the list. This Thanksgiving season, we want to take the time to reflect upon the relationships that are most important in our lives, and to express gratitude to those people.
From the entire team of Warm Embrace Elder Care, we wish you a blessed and joyful Thanksgiving!
This past September 10th was World Suicide prevention day (WSPD). On September 28th, in honour of WSPD, a play written by Catherine Frid called “AfterWhys” followed by discussion will be held at Luther Village from 9 am – 11 am. Suicide is often perceived as a problem among young people but did you know that men over the age of 80 have the highest suicide rate in Canada. This event is to encourage the message of hope and resiliency to everyone who experiences difficulties with mental health. We look forward to learning more about seniors’ mental health with you. We hope to see you there!
Top 10 Tips for Resiliency in the Face of Depression
Monday, September 10, 2018
Maintaining good mental health requires just as much attention and care as maintaining good physical health. In reality, mental health is a continuum, a scale that ranges from mental wellness to serious mental health challenges. When someone experiences drastic stress in their life, their mental distress level rises. It is important to have adequate coping mechanisms in place to help reduce one’s mental distress level and maintain mental wellness.
The Canadian Mental Health Association defines mental wellness as “a state of well-being and the ability to function in the face of changing circumstances.” This includes handling stress and loss, relating to other people, and making decisions.
Dealing with stress though is not an innate trait in humans; it is a learned behaviour. Whether good or bad, we learn coping skills from our environment. Adding positive and healthy coping skills to our lifestyle is crucial to maintaining or gaining back mental wellness.
Depression is not always something that you can control—it may be related to a specific situation or it could seem to appear for no apparent reason. Depression may be triggered by loss—loss of a loved one, an important role in life, a job, loss of health or independence. Any of these losses create increased stress. Without coping mechanisms, someone’s mental distress level will climb and they may experience depression. Depression after any type of loss is likely due to situational depression, and having the right coping skills will be highly beneficial. It is important to note that clinical depression is an illness that many people experience regardless of their coping skills. In either case, it is important that you speak to a doctor.
The Canadian Mental Health Association recommends a few key coping skills to help maintain mental wellness. By implementing these coping methods when you are feeling your mental distress level begin to climb, you may be able to maintain a higher state of mental well-being.
1. Educate Yourself
The more you know about depression and mental illness, the more empowered you are to protect your own health.
2. Change Your Thinking Patterns
Many depressed people have negative and anxious thought patterns. Learning to redirect your focus can improve your mental health. Celebrate your successes; focus on your achievements rather than focusing on what you are unable to do.
3. Ask for Help
Requesting help is not a sign of weakness; rather, it requires courage to reach out to others when you are in need. Create a support system of caring people whom you can call when you are feeling low. Have a list of 5 close friends you can count on; if one person doesn’t answer, you have 4 more names you can call.
4. Use Problem Solving
Determine which problems are stressing you, explore possible solutions, try a new solution (as the same old solutions will yield the same old results), evaluate the effectiveness of your new solution, and focus on the progress of your problem solving rather than on the problem alone.
When you are depressed, the last thing you may feel like is exercise, but the results make the effort worthwhile. Exercise increases the blood flow not only through your body but also to your brain. Increased oxygen flow to the brain improves mental functioning and mood. Your endorphins are also elevated through exercise.
6. Eat and Sleep
Eat a properly balanced diet, even if you have no appetite. Aim to maintain a regular schedule where you eat healthy food at regular intervals. Sleep on a regular schedule as well. Ensure that you get enough sleep, but do not oversleep. Most adults need an average of eight hours of sleep nightly.
Schedule yourself time to rejuvenate. Prioritize activities that bring you peace and pleasure. This may include: meditation, being outdoors, various hobbies, caring for a pet, having a massage, etc.
Do not cut yourself off from social connections. If large groups are overwhelming, go out for coffee with just one or two people at a time. Isolation only perpetuates depression. Socialize with close, caring friends who are compassionate and supportive. Be sure to hug these close friends; physical touch should not be underestimated.
9. Relax Your Standards.
Many people experience anxiety and stress because they are holding themselves to unrealistic standards. Determine to not expect more of yourself than you would expect of anyone else. Be kind to yourself—sometimes, we are hardest on ourselves!
A sense of humour can go a long way. Sometimes, laughter truly is the best medicine. You don't even have to wait for a comedy act to come to town; through the internet, you can search endless comedies on YouTube and select comedies that suit your particular sense of humour.
If implementing these coping skills does not improve your sense of mental well-being or if you are currently experiencing other symptoms as well, you should see your doctor. Medication may be appropriate for you, or there may be a physical explanation for the mental distress you are experiencing. Your doctor can advise you best.
It is important to know that help is available. You do not need to live in a state of mental distress. To learn more about healthy coping strategies and ways to reduce stress, please visit the Canadian Mental Health Association online at: www.cmhagrb.on.ca Locally, in Waterloo Region, we are blessed to have Here 24/7—a service that is available 24/7 to assist with addictions, mental health, and crisis situations. The number is: 1-844-HERE247 (1-844-437-3247)
Did you know that September 8th is World Physical Therapy Day? It is the date selected by the World Confederation for Physical Therapy to acknowledge the important work that physiotherapists (PT) do. This year’s campaign theme is “physical therapy and mental health.”
It’s easy to think about the role of a PT in the context of a specific injury—if you sprain your ankle or have knee surgery, you might automatically think about how a PT will help you to recover from your injury or surgery. A PT will also help with managing chronic health conditions, such as diabetes or heart disease. Chronic diseases are complex, and a physiotherapist can be one member of a necessary support team to ensure that the disease is well-managed.
But physiotherapy can extend even further beyond acute physical injuries and chronic disease management!
They educate and offer advice about disease prevention, injury prevention, healthy living, and overall well-being. And, one very important aspect of overall well-being is mental health. This year’s campaign theme is to bring awareness to how physical therapy and physical activity play an active role in mental health.
People with mental health issues are more at risk of having poor physical health. However, through advice and exercise programmes, physical therapists support people with mental health issues. Physical activity and exercise protects against the emergence of depression and has shown to be an evidence-based treatment for depression. PTs keep people moving through interventions to help maximize not only physical mobility but also mental well-being.
I’m sure many physiotherapists live by the old age: “an ounce of prevention is worth more than a pound of cure.”
A little preventative maintenance from a physiotherapist might reduce the need for significant therapy down the road—especially in the case of chronic disease, disability or mental illness. Seeking PT help early after diagnosis can help you to create a lifestyle and environment that will best support you as you adapt to your new diagnosis. As you can see, the role of a physiotherapist is broad, and they greatly impact the quality of life for the patient they see.
In honour of all that they do in our community, we say Happy Physiotherapy Day from Warm Embrace Elder Care.