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Expert Topics

Alzheimer's, Dementia, and Parkinson's Disease

- Douglas Scharre, MD

Asset Protection & Financial Management

- John Greener

Cancer Care

- Richy Agajanian, MD

Caregiver Challenges

- Sue Salach-Cutler

Communication Through The Generations

- David Solie, MS, PA

Diabetes

- Joy K. Richardson, RD, CDE

Elder Care at Home

- Ethan Kassel, MSW, LCSW, C-ASWCM
- Steve Barlam

Elder Law

- Howard S. Krooks, JD, CELA, CAP
- Ellen Morris, Esq.
- Shana Siegel, Esq., CELA

End-of-Life Issues

- Vincent Dopulos, MA, LPC, RDT

Fitness

- Deborah Quilter

Geriatrics

- Robert A Murden, MD

Home Care Solutions

- Emma R. Dickison

Home Health Care & Palliative Care

- Pamela Fishman, LCSW

Home Health Modifications

- Connie Hallquist

Senior Housing Solutions

- Tiffany Wise
- Mike Campbell

Incontinence Issues

- Brian Christine, MD

Integrative Medicine

- Rashmi Gulati, MD

Live In Care

- Kathy N. Johnson, PhD, CMC

Managing Medicare

- Ross Blair

Memory Care

- AnnaMarie Barba
- Crystal Roberts

Mobility Issues

- Nick Gutwein

Nutrition Know-How

- Dr. Gourmet, Timothy S. Harlan, M.D.

Quality of Life

- Joan Garbow, MSW, LCSW, CCM

Safety and Hospitalization Concerns

- Martine Ehrenclou, M.A.

Senior Healthcare

- Archelle Georgiou, MD

Senior Medical Issues

- Chris Iliades, MD

Senior Transitions

- Mary Kay Buysse, MS

Home Care Solutions

Emma R. Dickison, President of Home Helpers, is a Certified Senior Advisor® and a successful franchise industry veteran. With nearly 20 years of experience in franchise management, Dickison’s credits include helping to build two of the country’s top franchise brands.
View Emma's full Bio
Q:

Five years ago my grandma, now 97, asked me to take care of her and never put her in a home, and I moved her into my home. We started getting hospice care in a year ago as we thought she was going to pass. She is in better health now and we want to take her off hospice, but they keep finding a reason to keep her as a patient. We live in a beautiful home and she is well cared for by my wife and me. Hospice now wants us to move her out because they think she needs more care. We have an hour gap when grandma is alone (she is bed ridden) and we hired a nurse to come for two hours a day to cover that time frame. Hospice still wants her out and is threatening to call adult family services if we don’t. We think they have a hidden agenda. Can they do that or can we deny their services instead without consequences? Thank you. 


Shane from OH
A:

Hello Shane,

I understand you want only the best for your grandma. As such, you may consider being proactive by contacting Adult Family Services yourself to seek their advice and recommendations. In response to your question, in most states, hospice agencies are mandated to report any concerns or suspensions of abuse.

For ongoing recommendations on ensuring your grandma receives the best care, you could also reach out to your Local Area Agency on Aging:

• Local Area Agency on Aging: Call for the phone number of Adult Protective Services.
• National Adult Protective Services Association: Visit http://www.apsnetwork.org/Abuse.index.html for a list of agencies and phone numbers by state.

 

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Q:

My dad has been moved to a rest home so that he can get physical therapy on his ankle. He is 78, has lots of medical conditions and cannot take care of himself, let alone walk. He is insisting that he goes home even though he can clearly not take care of himself. My mother is beside herself with worry. He could fall and hurt himself and her. She is not able to fully take care of him in his present situation. He is too heavy for her to lift or even help him up. But he will not listen and the facility says they cannot hold him if he wants to leave. I don't know what to do and I’m worried sick for both my parents. 


Taming from CA
A:

Hi Taming,
Determining the right care option for your father is a major life decision that warrants sufficient consideration. Start by asking yourself the following questions:
• How often is care needed? Depending on the severity of your father’s medical conditions, it appears he may need assistance around the clock.
• What type of care is needed? From what I can gather, your father needs assistance with personal care (i.e., bathing, dressing, transferring), and potentially medical assistance as well (i.e., monitoring of chronic conditions).
• What payment resources are available? Speak with both your parents about this, and explore all options (i.e., Social Security, Medicare, Medicaid, long-term health insurance, reverse mortgage, Veteran’s Aid and Attendance Benefit, etc.)
• What is the ultimate objective? In this case, the ultimate goal is to provide a safe, loving environment for your father in the comfort and familiarity of home.
Many people think their only option is assisted living or skilled nursing; however, these days, many home healthcare agencies, including Home Helpers, can provide 24/7 medical care in the comfort of home.
If you determine that assisted living or skilled nursing is the best option, consider replicating the look and feel of your father’s home by bringing familiar furnishings and décor from the house into his new residence. Senior relocation specialists, such as Caring Transitions, have floor planning software that allows you to virtually arrange items to ensure a proper fit before the move.

 

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Q:

How do I go about finding a home healthcare agency that is Medicare funded? 


Ilene from FL
A:

Hi Ilene,
I would suggest starting your search online at Medicare.gov, the official U.S. Government website for Medicare: http://www.medicare.gov/HomeHealthCompare/search.aspx.
This website allows you to search for and compare home healthcare agencies in your local area that accept Medicare.
 

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Q:

Over the past year or so my mother’s health has been gradually decreasing and she is still pretty young at 69 years old. She gave up her independent living apartment that was based off of her income to move in with one of her sons, who soon realized she was too much work and kicked her out. We rented her an apartment near our condo 1 mile away so that we could help her if need be. The issue now is that she is in and out of the hospital every couple months for high blood pressure and UTI infections, and cannot walk on her own anymore. Her health continues to decrease and she is no longer taking proper care of herself. I do not believe she is able to live on her own anymore—she cannot get up to use the bathroom, cannot shower herself, falls asleep while she is cooking something and makes irrational decisions. Her only source of income is her Social Security, which is not much, so we end up paying everything for her. I know of assisted living facilities that are willing to take her based on her income requirements, but she is unwilling to go. This last time she was in the hospital she started to show signs of early onset dementia. She was having very vivid dreams of things that never happened, for example she thought her son and daughter in law had a newborn child and she called the entire family telling everyone about this kid that never existed. We asked the hospital to do a neuro psych consult while she was in there, and the neuro-psych questioned her and suggested she get a full psych report. She will not seek any medical advice that might allow her son to get power of attorney to put her in assisted living where she needs to be. Is there anything we can do to get power of attorney from her? The situation keeps getting worse as time goes on, and she is so unwilling to let us help her.  


Nikole from IL
A:

Hi Nikole,
In this case, I would suggest you speak with a hospital social worker or discharge planner about your concerns regarding your mother’s health and safety.
Because each state has its own laws and regulations, these additional resources can direct you to local professionals who are experts in senior-related matters:
• ElderCare Locator: Call 800-677-1116 or visit http://www.eldercare.gov.
• Local Area Agency on Aging: Call for the phone number of Adult Protective Services.
• National Adult Protective Services Association: Visit http://www.apsnetwork.org/Abuse.index.html for a list of agencies and phone numbers by state.
 

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Q:

My mother is becoming too attached to her health aide who I believe is taking advantage of it. The health aide says now that "light cleaning" does not include vacuuming. I came home early today and found my mother trying to vacuum and her health aide in the kitchen eating her lunch. I am furious and don't want to disappoint my mother, who feels very close to her aide, but this aide is dangerous in my mind. Am I over-reacting? 


Deborah from NY
A:

You are not over-reacting. Choosing an in-home caregiver is not a decision to be taken lightly, and you hired this person because you trusted that they would provide the care you felt was necessary for your mother. As a home health aide, it is critical that they work toward providing the highest quality of care your mother expects and deserves.

Every client and caregiver relationship is unique; however, the bottom line is that the home health aide must provide the set of services that were initially agreed upon being hired. If your mother’s mental/physical state has changed since the plan was implemented, the care plan may need to be adjusted to fit her current lifestyle.

If the home health aide is employed by an agency, call the agency to discuss potential solutions, including reevaluating the care plan or introducing a new caregiver if the current health aide is unable or unwilling to provide the services your mother requires.

If your home health aide is an independent contractor, sit down with them to review the services that were agreed upon in the contract. If necessary, adjust the care plan or consider hiring a new home health aide to better serve your mother.

A compatible client/caregiver match is critical to ensuring the best quality care is being delivered. As one’s needs change, so may the home health aide and/or care plan, so it’s important to check in regularly and remain flexible as your mother’s needs change.
 

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Q:

Do you have any information available to help with the transition from home to residential aged care facility? 


Liz
A:

To get your answer, we turned to my colleague, John Buckles, President of Caring Transitions:
Helping a parent transition to a new home is often overwhelming for the whole family. Below are some steps to help you plan, organize and reduce some of the stress.
1. Set Goals: Establishing goals helps people manage their time and achieve desired milestones. Start from the move-in date and work backward to allow enough time for multiple tasks. The key is to determine what exactly you want to accomplish, when it has to be done. And who is going to do it. Develop a timeline based on your unique situation.
2. Create a Space Plan: Don’t overlook the cost of keeping things. Many Americans invest thousands of dollars to keep possessions they never use again. Take the time to consider what will fit in your new place. Then decide if you are likely to use the rest of the “stuff” you have, or if it is going to take up space in the basement or sit in a storage unit “just in case.” If you are unlikely to use and enjoy certain personal belongings, someone else may. There are a great number of local charities that will benefit from your donations.
3. “Eclectic” Decorating: Your well-worn, but comfortable furniture helps make a new house feel like home. Be sure to keep your favorite pieces, but don’t hesitate to add new items where the old ones just don’t fit. Often an oversized dining table can be replaced with a more practical drop leaf table for two or four. Your new place doesn’t have to look like a magazine cover—it just has to reflect your personal style.
4. Optimizing Value: As you downsize for a home transition, it is important to recognize the value of your possessions, whether financial value or sentimental value. Experts can help you optimize the value you of items you have been holding onto. A qualified professional can assist with shipments to relatives, online auction or pricing, merchandising and advertising an estate sale.
5. Know your Limitations: Don’t underestimate the time and physical demands of downsizing—packing, arranging donations, hiring movers or realtors and making arrangements for the items you decide not to take. What may be viewed as a simple task can quickly become a huge project or undertaking. Don’t hesitate to ask family, friends, the senior community or professional resources for help and advice.
6. Ask for Help: Family, senior living communities and qualified professionals can all offer help and advice as you.

Choosing Professional Resources:
When seeking a mover, organizer, realtor or estate sale specialist, consider the following:
• Obtain more than one bid from professionals so you can compare the cost and value of services, but understand the lowest price option is typically not the best service option.
• Online referral services can be helpful, but many online resources will let anyone advertise on their websites. Review referral websites to understand if the providers listed have to meet certain standards such as licensing and security background screening.
• Research each company’s licensing, training, credentials, insurance and reputation. The Better Business Bureau is still a great resource, as is your local Chamber of Commerce or State Mover’s Association. Always ask your service providers for references.
• Beware of companies that ask for cash deposits upfront or do not have written service agreements.
• Local referrals from friends, family and trusted members of the community are still typically the best way to find a reliable service provider.
 

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Q:

My Mom lives with me in a 2Bd/Ba condo. I try to care for her all, but 4 hours a day when the morning caregiver comes to my home to help with her. There is no space for a live in, but I do need someone to offload me ASAP instead of me offloading the caregivers. The agencies cannot provide me anything consistent for 3-4 hours in the afternoon or evening! Please advise.
 


Joanne from CA
A:

As someone who has also spent a lot of time providing care for my aging loved ones, I can understand your concerns. My recommendation for you is to visit the website A Place for Mom (http://www.aplaceformom.com). They are a reputable search database that helps families find caregiving solutions through nursing homes, assisted living centers, home care, etc. A Place for Mom will allow you to search for a caregiver in your area that will cater to needs of both you and your mom. Most importantly, the free service will help find you a caregiver that will provide care on an hourly basis and provide you with peace of mind so that you can get things done without worrying about the state of your mom.  

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Q:

Can you suggest bed rails for my husband who keeps falling out of bed? He has no physical disabilities and is exploring this issue with his doctor, but in the meantime he has fallen out the last two night. We need rails that can fit a queen-size bed, have enough length to keep him from falling out, and still can be easily removed.
 


Mary from OH
A:

From the Parentgiving team: To better help answer questions about choosing bed rails, we created a series of buyer guides. You can read them at: http://www.parentgiving.com/buyer-guides/bed-rails/ 

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Q:

My sisters want my 89-year-old mother to start wearing a medic alert device. She has no real health issues, but her memory is failing and she tends to get confused. She lives at home alone and still drives around town. The stairs in her house are a bit steep (both to the upstairs and the basement). Mom just does not want the device, and I am okay with that, but my sisters think she should wear it in case she falls down the stairs and gets hurt. Rather than lying there in pain, she could be getting medical attention sooner rather than waiting until someone finds her. I see their point, but unless mom is on board with this, which she is not, I'm inclined to let her have the last say. I don't see how we are "protecting her" by insisting she wear this device. Your thoughts? 


Joan from NM
A:

I understand your concern, but here is some background information to help make the decision easier on you and your family.

Statistics show that half of people older than 85 will fall within a year and that those who have a Personal Emergency Response System (PERS) device are able to stay in their homes six years longer than those who don’t simply by being able to get help quickly. Wearing a PERS button is simply a prudent thing to do if you want to remain active and independent for as long as possible.

Additionally, research shows that those who wear a PERS button feel more secure and feel more confident moving in and around their homes (e.g., front porch, basement, garden) because they know they could get help if they needed it. Just like a cell phone gives us peace of mind and keeps us connected while we travel, a PERS does the same for people in their homes. A PERS button also provides a sense of security because the call center can also summon police or fire help in addition to EMS should there ever be a need.

Even if a person is not initially convinced, you can simply ask them to wear a PERS for the family’s peace of mind. Sometimes a person has fear that wearing the button would mean that their family would call less to check on them, but this is simply not the case.

Senior citizens also need to be assured that if they push the button, they are not automatically summoning EMS. They can speak to a call center operator and request a neighbor or family member come to their aid.

Newer equipment is designed so it is not as noticeable as the older versions – the button is very small and water-resistant. Some units even allow for the senior to answer phone with the device.

Home Helpers is affiliated with Direct Link, a PERS that allows you to reach help 24 hours a day, 365 days a year. For more information, visit http://www.directlink911.com/.
 

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Q:

At 103 years old, my mother can escape from any bed regardless of barriers-rails, chairs up against it, etc. She then stands up and falls. Do you have any suggestions? 


Linda from CA
A:

Because of her age, she may require 24-hour supervision by a caregiver who’s licensed in personal care. Given her age, it is possible for her to wake up at any time and be disoriented, resulting in potential serious injury. Personal care services a caregiver can provide include feeding, dressing, personal hygiene and transferring from a bed to chair, or chair to a toilet. These and other personal care activities can often be challenging to people as a result of age, illness, or injury. Personal caregivers can provide the assistance and encouragement to help people receive the level of care that is needed. Having a caregiver by your mother’s side 24/7 will allow for limited concern on your behalf and will ensure your mother is receiving the care attention she needs day or night.
 

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Q:

My mother is coming to live with my husband and me in November. She is 103. We cannot afford a home health agency to provide staff, and I believe as a social worker, I can hire, train, and supervise, in-home care myself. However, I am finding in the state of California that I am unable as a private employer to have the staff finger printed. I was told that even having an individual request their own prints does not allow me to view the results even if they voluntarily give them to me. How can I go about a criminal background check?  


Linda from CA
A:

For more information on having potential caregivers finger printed, contact the California Department of Justice at (916) 322-3360. To obtain a criminal background check, consider using TalentWise, a company that is trusted by national home care companies such as Home Helpers. TalentWise helps both businesses and consumers make informed decisions by providing background check and public records services. The software allows private employers, like you, to conduct background checks that will include, but are not limited to:
• criminal and sex offender checks
• lawsuits
• bankruptcies
• address history
• marriage/divorce records
Prices range depending on the background check. For more information, visit http://www.talentwise.com.
 

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Q: We're bringing my mother home, she'll be on the second floor of our house so we're concerned she'll fall down the stairs at night if she wakes up confused. And we'd put her on the ground floor but then no one would hear if she were in the kitchen or heading out the front door. What kind of gate or barrier might work well at the top of steps? There is wall on one side and a post/railing on the other. Or whether there's any other kind of solution here. Thank you! PB from MD
A:

Preparing your home for your mother can be a stressful process. Falling is a common fear for the elderly and typically, most hospitalization cases amongst seniors are a result from falling. There are numerous types of stair gates you can install to protect your aging mother from falling. Below is a list of some types of gates offered on the market:

  • Auto Close Gate: Automatically closes for extra security.
  • Screw Fitting Stair Gate: If fitted properly, gate will not become loose.
  • Swinging Gate: Convenient for high traffic areas.
  • Unique Space Stair Gate: Can be used for unusual configurations.
  • Wooden Gate: Good choice if you want something that is not plastic; however, its durability is similar to that of a plastic gate.

The type of gate you choose will also depend on your preferences, such as how you would like the gate to open or if you prefer wood or metal. I do not recommend using a pressurized gate at the top of the stairs. This is because with a pressurized gate, it is possible that your aging loved one can push the gate over since it tends to attach itself in between an opening. When put at the top of the stairs, it presents a hazard for the senior citizen. When picking out a gate, it is critical to do your research to make sure the gate complies with all federal safety regulations.
In addition to choosing the right gate for your mother, another way to help your mother prevent from falling is by making sure your stairwells adequately lit. Also, try installing night lights in all hallways in case your mother needs to get up at some point during the night.
 

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Q: How can I tell if my aging loved one is being mistreated by their caregiver?
A:

While the reported prevalence of abuse is believed to be only the “tip of the iceberg,” between one and two million adults ages 65 and older have been mistreated by someone they depend on for care, according to the National Center on Elder Abuse. The abuse and neglect of older adults remains a problem that is largely hidden and unreported because families overlook a variety of warning signs a by writing them off to old age or clumsiness. Below is a list of the different types of elder abuse and the signs that may indicate victimization:

Physical Abuse
Signs include:

  • Bruises, cuts, welts and scars on the body that may appear symmetrical on both sides of the body
  • Suffering from broken bones, sprains or dislocations
  • Elder informs you that he or she has been hit or mistreated

Emotional Abuse
Signs include:

  • Caregiver’s refusal to allow you to see elder alone
  • Caregiver exhibits threatening and/or controlling behavior
  • Elder shows sudden and unusual changes in behavior that mimic dementia
  • Elder is emotionally upset and distraught
  • Elder withdraws from normal activities

Neglect
Signs include:

  • Severe weight loss as a result of malnutrition and dehydration
  • Poor hygiene, including matted hair or dirty, elongated nails
  • Untreated health problems
  • Unsafe living conditions, such as no working electricity, no heat or air conditioning
  • Unsanitary living conditions, such as mold or insect infestations
  • Elder is left behind at an institution, such as a hospital or nursing facility

Financial Exploitation
Signs include:

  • Significant withdrawals from elder’s bank accounts
  • Unexplained transfers of assets to someone within the family or a stranger
  • Items or cash missing from the home
  • Elder’s signature is forged
  • Unexplained changes to the will

Every year, June 15 is honored as International Elder Abuse Awareness and Prevention Day. Elder abuse and neglect are significant problems, and education is one of the first steps to help put an end to these horrible injustices. If you suspect a loved one may be suffering abuse at any time, the following organizations can provide a number to call in your local area to make a report:

  • Call 911 if a person is in immediate danger
  • ElderCare Locator: Call 800-677-1116 or visit http://www.eldercare.gov
  • Local Area Agency on Aging: Call for the phone number of Adult Protective Services
  • National Adult Protective Services Association: Visit www.apsnetwork.org/Abuse.index.html for a list of agencies and phone numbers by state.

For more information and tips on raising awareness and preventing elder abuse, visit Home Helpers at www.HomeHelpers.CC.
 

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Q: What can a home care helper do and not do?
A:

A crucial step when searching for an in-home caregiver is understanding what tasks they are allowed to complete. The tasks a caregiver can perform vary and are subject to licensing requirements in some states. Some caregivers provide medical care and others non-medical care. Because Home Helpers specializes in non-medical and personal care services, I will discuss the numerous non-medical needs a caregiver can provide. Below is a list of categories and non-medical tasks caregivers can generally perform:

Companionship. As parents age, they may simply enjoy having company around them to eliminate the feeling of loneliness. Caregivers can help by providing a friendly face and an ear for conversations, as well as engaging in leisure activities such as playing cards, reading and walking. Companionship services help provide social and physical stimulation to keep people active and engaged.

General Tasks. Sometimes your aging parent may just need help with general chores around the house. Caregivers are able to complete tasks such as light housekeeping, laundry, preparing meals, organizing household items or sorting the mail.

Personal Care. Dressing, grooming, hygiene and transferring from a bed to chair are things that most people take for granted. These and other personal care activities can often be challenging to people as a result of age or illness. Caregivers can provide the assistance that is needed, as allowed by state law.

Transportation. As with anyone that gets older, driving may become more difficult. Caregivers can help take your loved one to and from appointments, run errands and help get your parent to places they enjoy such as the beauty shop and even restaurants.

Recuperative Care. Recovering from an illness or fall takes time and may require additional help around the house. Caregivers can help an individual recuperate by helping them relax and providing peace of mind knowing that everything else is being taken care of for them. Tasks caregivers can help with include but are not limited to light housekeeping, grocery shopping, picking up prescriptions and transportation to the doctor’s office. Certain care companies such as Home Helpers can provide mobility exercises as prescribed by the doctor as well as supplement the care that is required from other family members, physical and/or occupational therapists.

If you have any questions in regard to what tasks your caregiver can complete, make sure to ask the agency or caregiver. Understanding what tasks they are able to do will help you develop a tailored plan to meet your loved one’s specific needs

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Q: How can I find the right fit for my parent in a home helper?
A:

When searching for a caregiver for your parent, trust and a mutual comfort level are both extremely important. The following is a list of steps to take to find a caregiver that will best fit the care needs of your parent:

The Basics: There are fundamental requirements for every caregiver. They should undergo an extensive screening process and meet any state licensing requirements. Screening procedures include but are not limited to interviews, references and a background and criminal check. During the interview process, ask about the caregiver’s training and any required certification.

Your parent’s needs: Determining if a caregiver is a good fit for your parent includes determining what type of care your parent needs. For example, certain in-home companies like Home Helpers specialize in non-medical services such as companionship and personal care services. If your loved one requires medication to be administered, consult with a home care company that provides medical services. Many caregivers are trained and have experience with specialty care including Alzheimer’s, dementia, hospice care, arthritis, mental challenges and physical disabilities. After understanding the type of care your parent needs you will be better able to determine if the caregiver is a good fit for your parent.

Research: Take the time to research and understand the agency the potential caregiver is employed with as it will help you feel confident that your loved one is receiving the best quality care. Many agencies can match caregivers to the individual needs of your parent based on information you provide. Interviews are a good way to get to know a caregiver and see if they will be a good fit. All agencies should allow you to conduct interviews and a good agency will never give you a restriction on the number of caregivers you can interview.

Doing some research and working through the process with an in-home care agency will ensure you select a caregiver who is compassionate, experienced and able to provide the level of care your parent requires. It will also provide you with peace of mind knowing that your parent is in good hands.

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