Alz Talks 2018

There is someone I want you to hear before you hear me. A voice that never failed to command attention. The voice of my father Tony McMahon.

Dad was a sports broadcaster on local radio for 27 years and his specialist subject was horse racing. Each year, he covered the Cheltenham Festival, each year he picked his choice for the biggest race of the week – the Gold Cup. For the third consecutive year, he tipped the Michael Hourigan trained Beef or Salmon. Trust me, it won’t matter if horse-racing isn’t something you are familiar with. I just ask that you listen to him, his words. I want you to hear him.

Sadly for many punters, including myself – Beef or Salmon didn’t win the Gold Cup that year. As Dad used to always say winning races is an inexact science. As so many things are.

I didn’t know it for many years but this was one of the last times my father ever spoke on the radio. That was March 18 2005. Three weeks later he was diagnosed with Early Onset Alzheimer’s at the age of 58. He had Alzheimer’s when he gave this interview. No one knew.

When many people try to imagine what Alzheimer’s is, they don’t imagine this. They imagine people who are missing or losing parts of themselves; they imagine they have the ability to see it. To hear it. You don’t hear that when you hear Tony because you can’t. You can’t hear that Tony couldn’t read a clock. You can’t hear that Tony shoved unpaid bills into drawers at home because he didn’t know what to do with them any more. You can’t hear that he often trailed off mid-sentence, that he couldn’t make a cup of coffee. You can’t hear that he was running red lights or driving on the right-hand side of the road. And I’m sure you can’t hear that Tony knows there is something wrong, that something had been wrong for years. A few weeks later he told the doctor he had been experiencing memory problems for three years. You hear someone who challenges the myriad of common misconceptions associated with Alzheimer’s because you hear nothing.

My father voice was always heard whether he was on air or not. His voice was the mask Alzheimer’s hid behind. His vocabulary would inevitably and cruelly fail him as time went on but as long as he could shuck and jive with pals for pints after work on the first Friday of every month and croon a Frank Sinatra song at a sing-a-long he was heard. He was heard but those of us worried about what was happening to him were not heard for a long time.

My mother and I not only heard Dad, we saw because we lived with him. It was Tony’s actions that betrayed him, the behaviour of a confused person who seemed stuck that no mask could hide. We were so afraid, we found ourselves unable to speak about it to each other. The worse it got, the more isolated from each other we became. I was withdrawn and detached in college. The weight fell off my mother. Tony, perhaps out of fear or denial, refused to admit anything to us. He hid behind the person you just heard speak.

You know who first diagnosed my dad? The internet. Dr Google. I thought if we typed in his symptoms that we might get some idea of what was wrong. So I used keywords based on what I’d witnessed over the last year. Short-term memory loss. Confusion. Poor judgement. Unable to carry out everyday tasks. Quick as a flash Google had found sites for me. Unfortunately, every site was about Alzheimer’s. Three pages – nothing but Alzheimer’s. But of course Dad couldn’t have that, he’s only 58 – that’s an old person’s disease. I bought into this misconception and if I’m honest I knew why I did it all along. Not knowing was less scary than even considering it might be Alzheimer’s.

The first time I ever used the word Alzheimer’s was when I tried to tell my mother that I’d Googled his symptoms. I had to build up to that moment, and I didn’t look at her as I told her what I’d found online. She didn’t buy it either – she replied her grandmother had it in her late eighties and that was the response I had expected to hear. But the day his doctor requested to speak with her privately and asked her what she thought was wrong, she told him I had been looking things up. She said one word: “Alzheimer’s.” She didn’t look up when she heard the doctor tell her she was right. The first time someone heard my mother and told her she was right she was simply unable to look at them.

The night I learned of his diagnosis I was in college in Dublin and I was waiting for my mother to call and tell me what the doctor had told her. She waited until Dad went to bed. I don’t remember anything about that call other than my mother saying: “He has what you thought he had.” I knew what that meant. The word Alzheimer’s was never used during that conversation.  I don’t know if it was a word we ever used in the early stage. If we spoke about it at all, we spoke in whispers and smiled at him as if there was nothing wrong.

Telling him would have destroyed him. It just seemed unconscionable to tell a man who valued all that he put into his brain that it would be taken away from him piece by piece. For those who mourn my father, they don’t just miss the man, the horse racing tips, the charm, the character, the sense of humour, the songs, that voice. They miss his mind.
Lonely is the only word to truthfully describe what it was like to be 19 and find out your parent had an illness you couldn’t talk about. I didn’t know how I was allowed to feel so I retreated. No one hugged me. No one knew what to say. I didn’t know what to say. College was over after that, my heart had left the night I learned Dad had Alzheimer’s. I had a new job to focus on, a newsreader in the radio station my father worked for. I had looked forward to partnering him on Sunday afternoons as a colleague but sadly it was not to be.

As hard as life became on this meandering path that took us deep into an undiscovered country those of us who loved my father realised we had a finite amount of time with him. We made everything of it. When I recall the hardest parts of our journey I balance them with the memories we made or that I was a part of. I remember our trip to Wales for the Heineken Cup final to see Munster beat Biarritz and lift the trophy. Dad always said he could die happy once he’d seen Munster win the Heineken Cup and luckily, my mother never took the credit card from him and we booked it before they got through to the final in 2006. When I took him to the cinema or a show he would sing along with the music and I just let him – it was worth it, even at the risk of being thrown out. I remember the day he called me to tell me I had a niece and her name was Fay. I remember the first time he held her after he whispered he was afraid he’d drop her. He never did. Every year my mother held a birthday party for him for the rest of his life. While he could he went off with his friends or former colleagues for coffee or to the races with his brothers. He lost the voice but he never lost the love of music and one could almost see a part of him sing as we played his favourite songs. Today, six years on after his passing he is remembered for the impact he had on so many lives and for the beautiful memories he left us. And for that voice.

My mother once said Alzheimer’s changed everything. It changed the trajectory of my life. It challenged my fear because I had no choice but to learn what it was and learn it’s language, so I could understand what was happening to Dad and more recently my grandmother who was diagnosed last year. Alzheimer’s changed me as a person, and sometimes I don’t know how to feel about that. Who might I have been if Dad was never diagnosed? Yet thirteen years on I don’t think so much about what I was lost. I think of what I was given. A voice. A voice that is finally heard.

Hoarse

It was my mother who gave me the note many years ago after she got it from a trusted confidante. Speaking about the difficulties she had looking after my father who was in the early stages of dementia she was told: “You are his voice.” It was figurative and almost literal as my father’s ability to convey what he was feeling or thinking declined rapidly. We all deferred to her as we saw her as his voice, knowing she instinctively understood what was best for her husband because she knew him inside out. It was a voice that never faltered, nor took him on a wrong turn right up until the end of his life.

When I began my first steps in advocacy I carried that note with me telling carers: “You are their voice.” There are so many pearls of wisdom you can pass along to a new carer to help them see it all in a different light, although to be honest, I don’t know if it makes it easier. During my father’s illness, I saw myself as a backing singer to my mother, chiming in when it was appropriate. For four years I have felt I am a voice on my own, one worth listening to on the subject of caring and dementia. Initially, I welcomed this and the platforms it gave me to speak about my experience of living and helping to care for someone with dementia. I spent the initial years of my father’s illness almost silent on the subject having been deemed a liar, or told that I was exaggerating or over-reacting. I cried in a lot of bathrooms for the first year because I was afraid of what people would say to me for having feelings so I learned to become silent.

 

 

 

Launching Talk About Dementia with Mayor Jerry O’Dea and I Love Limerick’s Richard Lynch. This was my first step in advocacy work.

 

This year that voice has had a chance to sing thanks to the opportunities the Dementia Carers Campaign Network has afforded me. I have given quotes for a press release, an interview with the Irish Times and participated in a website project in conjunction with UCD. Looking at my father’s name in his favourite paper he bought long after he stopped being able to read I had a sad little smile that six years after his death his story is still sadly relevant because so little has changed.

I thought after 13 years of dementia there was nothing that could silence me. Then this week happened.

This week I made a phone call from the department I recently called out in an interview in the Irish Times which you can read here. My mother had visited this department to find someone who used to look after my father just to see if they were still based there, to seek advice on someone she cares for now who I will just refer to as “the/this person”. Once again, my mother has found herself as someone’s voice, albeit with many new challenges. The staff member my mother was looking for was no longer based there but before anyone could tell my mother another staff member – we’ll call her Elaine – who had already spoken to my mother on the phone that morning came rushing out.  My mother emphatically denies she had any wish to speak with Elaine, but Elaine wanted to speak with her. These are just a few things Elaine said:

“This is not a dementia unit.”

It basically is but they don’t advertise; they do look after people with dementia who present with psychiatric issues. My mother is acutely aware with the department does as she attended many meetings there with me. Elaine also repeated this to me, I unfortunately never got to recall my genuine but over the top collapse into my mother’s arms after learning my father would never walk again in that same “unit”. Or the hours I spent there going over the last few years of my father’s life with one of the doctors after obtaining the right to view his files under the Freedom of Information Act.

“Ye are getting 12 hours anyway.”

That refers to the outside care we as a family get for the person we care for. That is 12 hours over 7 days (or, according to Siri 168 hours), and by right every family looking after someone with dementia deserves more than that. It’s implied that Elaine possibly thinks this is enough support.

“They are just medicated here anyway.”

Oh God Elaine. Elaine Elaine Elaine. No, they do not just medicate people in your department. The balance of medication with anyone with dementia is very delicate and it takes a long time to get it right. More often than not a person is just getting used to their medication and the dosage and there is a cognitive decline. The doctors meet with the patients and the families to discuss the decline, the adjustment of medication and any behavioural issues that are presenting. I also think it’s a bad look to depict your place of work as a dementia/psychiatric drug den.

Elaine continued to speak over my mother who at this point was unable to hide her emotions and began to cry. She’d walked the hallway she and Elaine were standing on so many times and the image of the door at the end of it was all too familiar. She saw herself on the other side of it with her husband eight years ago when he was finally given an appointment because he was lashing out in his nursing home and was close to being ejected. The meeting that day was for 4PM; she arrived at ten to. She pressed the buzzer again and again, but no one answered. She had no choice but to turn around and bring her husband back to the nursing home. That is what she saw as Elaine continued to patronise her.

“It’s history repeating itself,” she said as she walked through the door. She turned to see Elaine close it in her face.

I have already written and spoken about what it has been like to see my mother facing a carer’s nightmare. It’s heart-breaking and it’s frightening to see the toughest nut in the family crack. She has made me promise repeatedly not to get involved in situations as I am not known for being able to keep my temper. There was absolutely no talking to me after she recounted this story. When one voice is silenced, there is another who is able to speak. I called Elaine.

Elaine told me how she knew I was going through a very difficult time and experience, which I’m glad she did because I didn’t know what I was going through until she kindly pointed it out. Once again, she said her department was not a dementia unit. That the department had discharged the person my mother and I were helping to care for because she was fine. She told me of the family members she had spoken to and some of what she said to them.

I never asked her any of this. I simply asked her what transpired between her and my mother. I never got an answer. So I pulled a classic McMahon move and asked for the name of her superior. It has never failed us.

Caring for someone with dementia does things to you that you’ll be talking about in therapy 20 years later. It changes how you see the world and everyone in it. It breaks your heart harder than you could have imagined and every day is not just a day, it’s a test of your endurance. When you hit a crisis situation you start to wonder when you will inevitably crack. You know that after its gone, that after the person it inhabits dies that what is left of you will have to figure out how to keep going and form some life that until now had been on hold because of dementia. So, when you resume the role of caring for someone else, you don’t need people like the Elaines of this world. Unfortunately, they exist. They are the silencers of voices. They think that they can shut you down and often they do. Elaine was a test to the voices and the voices somehow prevailed. But that tale is for another day. Elaine isn’t a problem anymore. You are.

I like to think I’m finally being listened to with the opportunities I have been given. I know that my voice has been valued because it has been used in campaigns, interviews and press releases. It’s when I reach out on my own platform that I feel I’m not heard. So, my voice gets louder and louder. The last seven days I’ve been shouting and for the person we are caring for it has been somewhat effective. On the general disgrace of how the services figuratively and literally close doors on people and drown them out I’ve had a tepid response. Which is more disheartening than a door closed in my face.

It’s not that long ago the media were heralding a new Ireland after more than two million people voted to repeal the Eighth Amendment. The op-eds accompanied by emotional images hailed us as progressive. I cringed, even at the ones that were well written. We’re not new, nor are we progressive – we’re playing catch up and we’re still behind. I have had to deal with a system that has hardly changed since 2005 where somewhere along the way I’ve had to deal with an Elaine. I keep saying it and the people that pay attention are the people that know me and know what I experienced or people that are familiar with the intimate details of this situation and the person we are caring for.

We are up in arms because of the housing crisis, the cervical check scandal, the Gardai at the protest in North Frederick Street. Panti Bliss declared: “This is not my Ireland.” These are all valid things to be angry about, to take to social media to decry and to opine and to take to the streets. I just cannot fathom how this country isn’t mad about how we treat people with dementia – some of the most vulnerable members of our society – and the people that care for them; people who save the country over 800 million a year. People who are mentally and physically worn down by caring for loved ones. I wrote about how two wards were shut down in a local nursing hospital – one ward my father stayed on during respite – because there were “too many resources.” I would love to reject this Ireland but unfortunately, this *is* my Ireland.

I’m hoping the lack of response to that post is because people didn’t see it. If you live in Limerick and care about general social injustice and scrolled by, I applaud how you can pick and choose what you fight for and what you get to lend your voice to. I never have, whether it’s been dementia, homelessness or mental health; they are issues I have personal experience with where I’ve had to battle the obstacles that have faced me. My voice is starting to go and my belief that the injustices carers face will be picked up on by the public is faltering.

While my voice is no more important than any other carer or person with dementia it has merit and I know what I need to say every time. We need sign-posting from diagnosis to dying; we need clear lines of communication between healthcare professionals and carers, we need to build a support network, we need to stop looking at dementia as an old-age disease, we need more funding from the government for resources and supports, the fundamental need of carers and people with dementia is to be heard. I’ve said this so much I wrote that barely thinking of what I needed to write. I have no problem yelling until I grow hoarse, but I wonder what the point is if the response is almost complete silence.

The Irish Times: Calls for new, ring-fenced budget to improve dementia services

I was interviewed for this article by Elaine Edwards. You can read it in its entirety here, but here’s a sample I have to share.

Rachel McMahon of the Alzheimer’s Society of Ireland’s Dementia Carers Campaign Network. She first became a carer in 2005, when her father, Tony, a sports broadcaster, was diagnosed with Alzheimer’s. Photograph: Liam Burke/Press 22

The Government has been urged to create a ring-fenced budget in October to tackle the growing gaps in services for people with Alzheimer’s disease and dementia.

“Emerging gaps in the supports and services for people with dementia and their families across Ireland” were identified in the Government’s mid-term review of the National Dementia Strategy published in May, the Alzheimer Society of Ireland has noted.

Case study: “There’s very little support in Limerick for carers”

Rachel McMahon, of the Dementia Carers Campaign Network in Limerick, first became a carer in 2005, when her father, Tony, a sports broadcaster, was diagnosed with Alzheimer’s.

She gave up studying journalism in Griffith College and moved home to help look after him. She says she had to accept that the diagnosis changed the family’s circumstances.

“He was 58 years of age and I was a student, I was in college in Dublin. I chose to leave and come home and help care for him because we didn’t really know what to expect and we thought we needed to be around, just in case. His mood became erratic and he wasn’t allowed to drive. He couldn’t make a sandwich or fix himself a cup of coffee or anything like that.

“After the diagnosis, there was a fairly swift decline and it was sort of a plateau for a while and then it would go down again after six months. We were always monitoring how he was and how it would change.”

‘Non-stop’

“It was just non-stop. In terms of services, he couldn’t go to old age psychiatry which deals with a lot of people who have some sort of dementia, because he wasn’t over 65. That’s the situation around the country.”

Her father was eventually cared for full-time in a nursing home. He died in 2012.

Rachel’s family is now experiencing similar issues getting supports for her grandmother, who was also diagnosed with dementia. She says more dementia advisers are badly needed, as is “signposting” of services for people newly diagnosed.

“There’s very little support in Limerick for carers. And there’s a knock-on effect. If you are not looking after the person with dementia and providing supports and resources, it affects the people who are caring for them. They get physically sick, they have mental health issues, they are emotionally drained. They start to get really unwell and they need to keep going. They struggle then as well and they need supports and services.”

The deception of dementia: three weeks out

I’ll let the video speak for itself. This photo is of Limerick’s Live 95FM Sports Team in 2000, doing an outside broadcast prior to the Heineken Cup Final between Munster and Northampton. Dad is farthest to the left. Two years after this was taken, he began having memory problems aged 55. Five years after this was taken he would be diagnosed with Early Onset Alzheimer’s.

This video illustrates how hard it can be to detect something like dementia in another person. It’s why most people thought we were over-reacting, got a wrong diagnosis (from three doctors) or were lying (true story).

“We Might Have to Bring Him Home”

Tuesday’s Irish Times Life & Style section featured an insightful and compelling article by Professor Desmond O’Neill, a specialist in geriatric and stroke medicine, which highlighted the failure of our current government to address the important issues pertaining to our healthcare system – particularly for the elderly, highlighting the current status of the Home Care Package with echoes of the Fair Deal disaster.

 

The Home Care Package Scheme Booklet – click to read in full

 

The Home Care Package which is an administrative scheme is described in a HSE booklet as: “a set of services provided by the HSE to help an older person to be cared for in their own home. The services, for example [include] additional home help hours, nursing services, therapy services, might be needed due to illness, disability or after a stay in hospital or following rehabilitation in a nursing home.”

This set of services was halted in March but has been restarted and rejigged with new and different requirements for qualification that are still not fully clear. I have tried without success to contact local HSE offices to ask them about the changes.

Professor O’Neill wisely warns the public not to be duped as we were with the Fair Deal. I was never duped by the Fair Deal but I joked without humour that it was the greatest dupe of all time. I may not have actually used the word “dupe”; it’s quite possible the phrase: “crock of s**t” was likely used instead.
In 2010, five years after my father had been diagnosed with Early Onset Alzheimer’s at the age of 58, we realised he was no longer comfortable in the family home and that my mother who was his primary carer and others including myself who were involved in his care in various manners couldn’t provide the sufficient care he needed. Dad no longer felt he was in his home even when he was which agitated him frequently. He would spend hours pacing, wandering into rooms and had to be watched constantly. He could no longer wash himself. He could no longer feed himself. He was incontinent. He was 62.

Dad spent time in nursing homes for respite and before he went into a nursing home permanently they became more frequent. The weeks between respite felt like Purgatory. The weeks he was in respite rarely allowed us any. We wanted him home. We still worried about him. We were usually too exhausted to utilise the break and recharge our batteries, especially Mum. But when he was home we just couldn’t cope.

When Dad entered a private nursing home facility in February 2010 where he had previously attended for respite, we felt a weight off our shoulders. My mother might have a chance at living an actual life! I could come home and revert to my default setting of being totally selfish, throwing myself down on the couch and watching TV for the night. Not to leave out my brother who was just as much a part of this, having been by both his parents side the day his father was admitted into a nursing home – he could now focus more on his own family and the businesses he ran as he should. We all loved Dad but we had a right to lives and peace of mind.

Holding Dad’s Hand in the nursing home

Of course, private facilities are not cheap. Dad’s pension would go towards payment each month. I recall sardonically thinking booking a room in the Georges V with a private nurse would be cheaper. Plus, Paris.

I recall my uncle telling us about the Fair Deal before Dad entered full-time care. Reading through the requirements, I had a feeling of growing dread. The onus of payment for the facility was not on me, I wasn’t earning much but it was on my parents. One who couldn’t even feed himself. The financial requirements section warranted a stiff drink just upon perusal.

The Fair Deal for the great unwashed was established in 2009. Those who qualified paid a mere 80% of their income towards the cost of care of a patient and 7.5% of assets annually. Since my parent’s assets included property i.e. the family home it had to be valued by a realtor and we were given the option that contribution of property assets that this contribution can be deferred until death if it is a nursing home loan.

We applied.

I felt the scheme’s focus was largely on the elderly which was of course incredibly important, but in our narrative my father was just 62 – not even old enough to be seen by a doctor who handled those with dementia in our catchment area, although the same man would go on to see Dad later and devoted hours of his time to me for my book on Dad’s illness, pouring over two years worth of files until Dad’s final day on December 11th 2012. Before that, you had to ‘go private.’

There were problems with the scheme from the outset. First, anyone with half a brain knew a hell of a lot of people would apply and so they did. Second, there was a budget that was capped annually. The summation of these two problems was waiting for a place in a nursing home. That, however, was not our problem. The money was.

Dad was admitted in February 2010 to a private nursing facility. If I recall correctly, Dad was under review for the scheme, he was still on a waiting list for approval. This meant paying the full fees until then. I believed at that time if Dad was approved for the scheme it would be backdated.

The fees were enormous and the place was not right for him. The strain of this on our family was a bigger burden than having him home. I do not wish to speak on behalf of my family but I’m certain they shared the worries of the financial burden this placed on my parents – particularly my mother. As I write this I realise that Professor O’Neill was right – we, including myself, were duped. My mother was handed an invoice every month and expected to pay it in full. We should have called BS. But dementia weakens you. You have only so much fight and energy to survive and support. At least now we can call it out for what it really was.

Cost of care for dementia patients in Ireland & the UK courtesy of The Alzheimer’s Society of Ireland

 

There are moments through my father’s illness that will stay with me though I’d give anything to forget them. One day while at work my mother rang me. It was in the midst of the Fair Deal application and the budget was tight – and typical of my mother, she wouldn’t take an extra cent off me (one of my biggest regrets is that I couldn’t help her more financially). Just like that phone call one night in April 2005 when she told me: “He has what you thought he had” I remember little else except her saying: “We might have to bring him home.”

I could not have continued to work. My mother would not have been able to take care of him herself. Dad was getting worse, he needed 24-hour medical support we could not provide. The public nurse who only came to visit once when he was first diagnosed admitted she didn’t know much about Alzheimer’s. The horrible realization dawned on me that no one was going to help us.
In a blind rage of tears, I Googled for a HSE/Fair Deal contact number. I barely remember that conversation too: except repeating over and over again “Don’t you understand? Don’t you understand? My mother rang me crying. We’re in limbo here. I don’t know what it’ll do to all of us if we have to remove him but we can’t handle him. Don’t you understand?”
What could the person at the end of the line do except reiterate the status of the application and promise to have someone call my mother? I went home that night, defeated.

To cut a long story short, we never got it. My mother talks little about the events of my father’s final years so I can only pull from memory and it’s crammed full of events, vignettes, sorrows, and goodbyes. He ended up in better place – St. Camillus Hospital by the grace of a series of incidences that overshadowed the Fair Deal – but you’ll have to wait for the book to hear about that.

Outside our little story, the waiting lines continued to grow and the government was forced to pump more money into the scheme, which was basically the HSE’s version of the Titanic. They might as well have taken their money to Monte Carlo, found the nearest roulette table and put it all on 19 red.

Eventually, Minister Kathleen Lynch removed the budget cap and then the Fair Deal came under review in 2012, the same year my father passed away. If our government attempted anything like it again would be one of the many final nails in Ireland’s coffin.

The comparisons drawn between the Fair Deal and the Home Package Scheme are apt. In both cases, the schemes were faced with an overwhelming number of older people ergo, no lesson learned from the Fair Deal. Waiting lists, therefore, are long. Initially, both schemes were sold to us as a lifeline, but are potentially a noose around one’s neck. Younger people who desperately need the services don’t seem to be considered important. They get one sentence in the entire booklet. Healthcare for the elderly will always be important but there has to be a voice for the younger people out there getting what is sadly still considered “old age” illnesses.

The Home Care Package Qualification Requirements

Part of my campaign, Talk About Dementia tries to help those who are dealing directly with all forms of dementia and aims to guide people and provide helpful straight forward tips. One, for example, is to advise people to discuss with their doctors about when to put the dementia patient into a home, as I learned from my mother that when someone with dementia becomes incontinent, they are often placed in a home because people feel they cannot help them any further at that point. This is a difficult but manageable issue but dialogue with the right people is key. This is what my mother did – she rolled up her sleeves as she did at every juncture, got cleaning materials and continence pants, and Dad stayed home for over a year and a half. If she was paying full price for a nursing home, that saved her under €40,000. Let that amount sit with you for a minute.

I also advise people to get in touch with The Alzheimer’s Society of Ireland and find out what they are entitled to in terms of care and support.
Another part of the current guidelines for The Home Care Package troubles me. While it focuses it’s attention on the elderly as it should, young people who would require this service, people like my father are only briefly acknowledged and only one type of dementia is named. I plan to reach out to The Minister for Health Simon Harris for clarity. I’m not done with this by a long shot.

If the Fair Deal was the previous government’s Titanic, the newly revised Home Care package may be its Britannic. I’m just glad my father isn’t alive to need it.