Welcome to RTD Financial’s Aging Well Webinar Series. The fifth and final installment in our series features Patricia Hanson of IKOR, presenting “Recognizing and Preventing Elder Abuse”.
- Recognizing and preventing elder abuse
- Financial, psychological, physical, emotional, sexual, medication, self abuse and neglect
- Risk factors
- Caregiver stress
How to Address Elder Abuse
- Call 911 if immediate assistance is needed
- Contact Adult Protective Services (APS)
- Contact Department of Aging
Monica Garver (00:04):
Hello everyone. And thank you for joining us for the fifth and final installment in RTDs aging, well webinar series. My name is Monica Garver and I’m a senior financial planner at RTD. This series was created to address some of the challenges our clients may face as they themselves or their loved ones enter the latter years of their life. This afternoon, our webinar will focus on recognizing and preventing elder abuse. With us today is Patty Hanson. Patty Hanson is managing director and local co-owner of IKOR of Western Pennsylvania. IKOR is a growing national provider offering advocacy and life management services to seniors, disabled and medically fragile adults and children with special needs.
Patty works with a team of highly skilled registered nurse patient advocates, personal needs, coordinators, and financial advocates who work collaboratively to support medical and routine living concerns of those. They support. Please note that this presentation is educational in nature. We appreciate Patty taking the time to share information pertaining to our aging well series. RTD, Patty and IKOR are not affiliated in any way formally or informally. RTD’s sole purpose in offering this webinar is to provide a means to share information that we feel may be useful to you from other professionals and specialists. Throughout the webinar, please feel free to type any questions you may have, and we will address them at the end with that. I’ll pass things off to Patty for today’s presentation.
Patty Hanson (02:19):
Good afternoon. And welcome. Thank you, Monica, for that kind introduction. I am just getting ready to enter from. Okay. So I will. Elder abuse is a community issue that everyone needs to be aware of and understand. Today we’ll talk about elder abuse, what the depth is, what defines elder abuse. I’ll share with you some statistics, demographics, some indicators that you can understand about elder abuse, contributing factors and barriers that cause elder elder abuse to be rather prevalent in our society, caregivers stress, and how to support a caregiver by addressing caregiver burnout. And and then we’ll go into sharing how to address elder abuse. Throughout the presentation I’ll share some different stories on cases that we’ve worked with in this in the area of elder abuse or what might be considered neglect to kind of further drive home the the theory and the, the process of the presentation.
Patty Hanson (03:46):
So so an elder in elder abuse is any person over the age of 65. Elder elder abuse is an act of omission or commission by a person who stands in a trusted relationship relationship that results in harms and harm threatens harm to the health or welfare of an older individual. And a caregiver is anyone who has the care custody, control of or stands in a position of trust with an elder or a dependent adult. So in this, what you w what’s good to recognize, it’s not even just doing an activity that would harm the health of an older adult for their welfare. It’s also active omission and not providing care support for an older adult. So that’s an important thing to recognize.
Patty Hanson (04:53):
According to the best available estimates between one and 2 million Americans over the age of 65 or older has been injured, exploited, or otherwise mistreated by someone that they depend on for care and protection. The current estimate puts the overall report reporting of financial exploits, case exploitation, and one in twenty-five cases. But they also suggest that there may be at least 5 million financial abuse victims each year.
Patty Hanson (05:32):
Nursing home abuse exists in one out of three nursing homes across the United States have been cited for nursing home abuse or other related infections. 11% of nursing homes have been cited for unnecessary dispensing of prescription medications. A fourth of the aides within nursing homes have been prosecuted for abusing patients and have previous criminal records. So that’s or I’m sorry, a fourth of the aides prosecuted for abusing patients have previous criminal records and 5% of nursing home aides across the nation have criminal records. So it’s really understanding that you know, especially, I, I would say in Western Pennsylvania, Southwestern Pennsylvania with our aging adults, it’s becoming more challenging for home care agencies, as well as nursing homes to find quality individuals to address care related concerns.
There is a shortage that in of caregivers through in, in this region and probably across other areas of the United States. So it’s just realizing that keeping your eyes and ears open when you’re supporting someone or visiting a nursing home or any type of care community, it’s important to recognize that there is that it’s nursing home abuse statistics are important, but there are other types of care givers and having a hard time finding people to give care can cause people who are hiring people to hire people that are at a lower standard of what might’ve been previously acceptable. One to 2 million Americans over the age of 65 have been abused, neglected, or mistreated by their primary caregiver. One in 10 people over the age of 65 will spend some time of their lives in an adult care facility or a nursing home. An estimated 50% of nursing home patients suffer from pain that’s untreated. And in 1999, 5,000 death certificates of nursing home patients listed dehydration, malnutrition starvation, or bedsores as the cause of death.
Patty Hanson (08:23):
CNN reports that over 90% of the nursing home facilities are understaffed. These staff shortages lead to increased instances of health problems, neglect and abuse. Only 16% of elder abuse cases are ever reported according to the national elder abuse incident study. 20% of the elder abuse cases involved emotional views, 16% involve physical abuse, 3% involves sexual abuse and 12% involved caregiver neglect.
Patty Hanson (08:59):
The demographics of an abuser. One of the ways that I, you know, when I under understanding the demographics of the abuser kind of can cause you to, when you see that demographic with an elderly person the majority of the elder abuse victims are female. So you can understand that if you’re supporting a female client, she’s at a higher risk to having to being a victim of elder abuse. And the majority of perpetrators of elder abuse are male. Abusers are most often the primary caregiver, 50% are adult children and they’re and then spouses, they determined are 20 to 40%. Males abuse more than females.
The abuser is oftenly often financially dependent on the victim and understanding the relationship between the abuser and the victim helped frame the mistreatment on the continuum of domestic violence. So what this is saying, if you have an elderly female client who has often a son who is, who is the primary caregiver, and he lives in the home with her and is financially dependent on her, then that’s just a thought that you can kind of keep in your back of your mind and you can kind of, as we walk through the different the ongoing slides, we can you can kind of take a look or keep your mind open.
Patty Hanson (10:58):
So which I mentioned before financial abuse is an area of elder abuse. I would say in the cases that we work on 75% of the cases that we tend to work on, I would say have some sort of financial abuse or some level of undue influence. We became guardian of a woman a couple of years ago, whose son wasn’t paying the nursing home bills. So they appointed a guardian and he was paying his child support out of her trust, but he wasn’t paying her nursing home bills. So that’s an example of elder abuse. So some category, other categories of elder abuse is psychological or emotional. Someone who’s undermining a senior or emotionally degrading them. Then there’s physical abuse that would consist of, you know, hitting, pushing not addressing some of their needs. Then there’s sexual assault and sexual assaults are kind of common in nursing homes, but they can be you know, they can be perpetrated by a trusted caregiver or someone, you know, who visits often.
Then there’s neglect. Neglect can be active. You know, not giving someone food, not making sure they’re eating it or passive, just leaving someone who can’t prepare meals for themselves or get around unattended. And then there’s medication. Over-medicating someone or stealing their medication narcotic medication that they need to prevent pain is also another category. And then there is a category called self neglect. If a senior isn’t may suffer from dementia or they’re not able to care or manage themselves or manage their home, that can be considered self neglect. Risk factors for elder abuse. The family, usually the senior usually has a history of spousal abuse, a complicated family dynamic there a level of isolation or someone tries to isolate the seniors. So they don’t have access to the other person or that the senior person. Troubled relatives, friends, or neighbors.
We had a client that had a fentanyl patch for pain, and she was setting out on her porch and someone in the neighborhood came over to chat with her. And they ripped the fentanyl patch off of her arm and like ran off to, to steal the fentanyl. So, you know, troubled neighbors, families, friends we’ve had other incidences where someone gets to know the the, the senior client recognizes that they have even a little bit, even the smallest amount of money. And we had one gentleman that emailed a trust officer that got access to our client’s account or email account because she gave him the password to help her with something and knew she had a trust. And he emailed the trust officer acting as if he was her to try to get access to money from her trust. So the risk factors, you know, there’s often some seedy looking characters hanging around and another risk factor is a caregiver or someone that’s living in the home with the senior that really just doesn’t have the, the skills, the capacity or the ability to support and cope with long-term care.
Other risk factors are institutional conditions when someone lives in a care community. Age-ism is a big risk factor, lack of knowledge about the aging process. You know, there, if if a young person, 18 is 18 to 25 is living with a 90 year old person and financial dependent, they might they’re, they’re not able to see things through the lens and maybe have a, a good understanding of the aging process and the support that someone needs. A few weeks ago, I received a call from a woman and I’m not sure how she had my phone number, but she was released from the nursing home and her grant, her nephew picked her up and dropped her off at home. And from her call and talking to her, she really probably shouldn’t have been left alone. And she tried to call him to follow up you know, a couple of days, a couple of days later about some things that she needed and he just blocked her call and sent her to voicemail. So, you know, in that situation, he just didn’t totally understand her need or the aging process, or didn’t want to be bothered. And our society has become more and more acceptance accepting of violence so that, you know, we as a society and culture becoming desensitized to violence and aggressive behaviors.
Patty Hanson (17:01):
So now we’ll go through each type of financial abuse. So you can kind of wrap your mind around what might, you know, what financial abuse might look like? An older adult signs, a document, i.e. property deed, the will, or a power of attorney without fully understanding or explaining it. You know, we’ve had, we’ve been involved in situations where a kid, an adult child got a power of attorney written. It was written by the adult child’s attorney and brought to the mom’s house and she was told to sign it. And then later on over a year, period of time, as we, the, another daughter had us become power of attorney, we went through the documents and we saw we calculated $160,000 had been withdrawn from the account after that document was written. The older adult has a lack of financial choices or decisions.
Family members moving in with the older adults saying that they’re going to share costs, but there’s not a defined lease agreement or something to define the relationship. I had a call a month ago from daughter-in-law of a woman whose grandchildren had moved into the home that senior person was living in, in a back bedroom. And the grandchildren had taken over the home and were bringing seedy characters and smoking weed in the house. So you know, someone who’s living there that doesn’t seem to be pulling their own weight. Unexplained discrepancies between known income and the, the person’s standard of living. Unusual bank and ATM activities. Possessions of value disappearing from the home. Utility bill turn off, turn off signs, utility trucks in front of the house. Someone not being able to pay the utilities or the utilities not being well-managed.
Patty Hanson (19:34):
Indications of psychological or most emotional abuse are changes in assets. You know, a senior that was always laughing and fun. You know, seeming solemn and withdrawn. Sleep and appetite disturbances. Someone’s not sleeping well or saying they’re not hungry. Someone just you know, not pulling away from social contact. Social contacts, not showing interest. Someone who normally was well-groomed that has lost interest in caring for themselves. Someone who’s apathetic or having some suicided, suicidal ideation saying, Oh, I would be better off dead. I’m old. I should die that type of behavior. Evasiveness, anxiety, hostility. Notable, notable, behavioral changes. Fear, full passive, kind of withdrawn showing low esteem. Reluctant to talk openly. Sometimes they’ll look to the caregiver to speak for them because they, they don’t want to say the wrong thing and inconsistent statements. Maybe when the caregivers they’re, they’re talking a different tune than, and then when the caregiver goes to the bathroom, they, they say something totally contradictory. You know, someone who’s waiting for the caregiver to respond.
Patty Hanson (21:22):
Indication of physical abuse, unexplained injuries, such as bruising, burns, fractures, or lacerations. Medical attention being sought from a variety of different doctors or clinics that’s often assigned because the doctor’s office is going to note that someone’s having injuries over and over again. Injuries that haven’t received the proper medical attention attention. It is seniors often have a history of accidents and injuries and falls but information that doesn’t seem to add up. Multiple injuries and the injuries are in different stages of feeling. A suspicious ex explanation to about an accident and delays in seeking care are also indications of physical abuse.
Patty Hanson (22:26):
Indications of sexual abuse. Caregiver making sexual suggestions, comments, seeing sexually listed material or something on the computer or television. Lack of personal privacy. Watching someone, putting cameras in a area that would be private. Unnecessary help with dressing and hygiene. Unwanted sexual activity, like if a senior’s flinching and showing fears of being touched. Inappropriate modesty, when something’s being examined, someone who’s taking extra attention to cover the private areas. When they’re explaining something. Bruising on the inner thighs or tenderness bruising, tenderness, or blood in the private area, bruises on the breast and unexplained STDs, including HIV.
Patty Hanson (23:36):
Indicators of neglect can be active or passive. Malnutrition, dehydration, weight loss medical treatment, not being withheld, missing dentures, glasses, and hearing AIDS. Those are, that’s a big sign. You know, somebody’s hearing aid is missing, or they’re not wearing glasses. You know, basic life necessities aren’t being met. No safety precautions or supervision when it’s necessary, if someone’s not able to manage their activities of daily living very well on their own, you smell urine in the house. The clothing is torn or I’m cleaned, or it’s not appropriate for the season. There are pressure sores. Poor foot care too. A lot of seniors will get sores on their feet, or they’re not able to trim their toenails. Low body weight. And sometimes it’s just you know, the body language of the client that’s fearful, or there’s something that kind of just gives you an indication of, you know, that, that something just isn’t right.
I’ll, I’ll tell a story here a few years ago. I think it’s been about five years ago now. We were called to support a gentleman that had collapsed in his home. He had gone his daughter found him, he went into the hospital, his daughter lived at a distance. He went to the hospital. After the hospital he was discharged to skilled care. And then it was determined that he wasn’t able to go back home. So they found a personal care home that would accept his social security. And about a year later, his daughter went to visit him and he had lost an extraordinarily extraordinary area amount of weight. And the daughter realized that something needed to get done with the health and the helm. And so she called us and this personal care home was kind of out in a rural area. It was really off the beaten path. And I walked in and then as I was walking down the hallway there was a community shower with the door open and there was an elderly lady, probably in her nineties that was on kind of like a bed or gurney in this community, shower area in her.
She was all contracted and she was naked except for being covered with a towel. And, you know, my instincts were like, Oh my gosh. And I, you know, I, she should have never, she was asleep in there and she, should’ve never been left unattended in that circumstance. But I moved on and went, and met the client and, you know, talked with his daughter and about 45 minutes later, I was leaving and that same woman was in that personal, it was still in the bathroom unattended, sleeping on the gurney nude, covered up with a sheet. So when I left that personal care home that day, I called aging services to address. I mean, that was a, a pure sign of neglect. And as I got to know the client, that was our client as, as we moved through and they hired us to support him and find a new place for him, we, as we went through his medical records, we found out that he lost over a hundred pounds while he was in that personal care home.
Patty Hanson (27:35):
So self-neglect is also a form of abuse. It’s described of as a result of an adult’s inability to do physical because of physical or mental impairment or diminished capacity. They’re not able to perform essential tasks of self-care like who is providing themselves with food, clothing, shelter, or medical care. They’re not able to obtain goods and services to maintain health and wellness, and they’re not able to manage financial affairs for themselves. That’s that’s considered self neglect as a form of self abuse. And that’s also a time that you should be reaching out to your local authorities, which I’ll tell you more about later.
Patty Hanson (28:28):
Indications of over medication. Reduced medical or physical activity, assign of depression. Heightened reduced, or absent therapeutic response. Prescriptions not being filled too often or under medication can be if a, if someone’s given narcotic for chronic pain that they’re not being provided to the elderly person is needed.
Patty Hanson (29:02):
Barriers to disclosing love, love for the abuser. Oftentimes, especially when the caregiver is a child or a grandchild or a family member as a senior loves them. So they don’t want to reach out and tell someone they, they, or they don’t even understand that they’re being abused. Shame and or guilt, they feel like they kind of deserve to be treated poorly or they feel guilty, or they’re taking on the response of the abuse and kind of thinking that it’s their fault. As someone who’s not aware of the resources or options, and doesn’t really feel in control of the situation, they just kind of except the abuse and neglect as normal, or they’re afraid that if they, you know, a senior can be afraid that if I if I kind of say that I’m being abused by one of my children what’s going to happen to me? And how is, how am I going to continue to live and move forward?
Patty Hanson (30:17):
Elder abuse is in some ethnic and cultural communities is just a normal way of life. Family violence exists in every community and has across to all cultures and racial class and socioeconomic and religious groups. Sometimes languages is a barrier, a barrier for immigrant seniors. They can be playfully to socially isolated, financially dependent, emotionally dependent. And then there’s a lot of cultural taboos that seniors and that we struggle with in all different types of abuse and neglect that goes on not just elder abuse.
Patty Hanson (31:05):
One of the most important areas of elder abuse can be a result of caregiver stress. And 90% of elder abuses, which I said earlier are perpetrated by family members. Family members are increasingly stepping up to care for seniors, in addition to managing their own daily living responsibilities. Often the caregiver just isn’t aware how stressful providing the care is until they’ve done it for some time making the matters worse. They don’t they don’t recognize that there’s care out there that exists and where to find it, find it. And chronic stress for caregivers can lead to burnout, which places seniors at risk for elder abuse. If you are often what I experienced when it comes to caregiver stress.
There’s always most often one daughter that lives local, that steps up to provide the care for the senior and other family members kind of tend to judge and you know, do Monday morning quarterback of that caregiver and the caregiver that is local. Usually that daughter sometimes the son that cares for the senior person can just become very overwhelmed with the responsibility and feel burnout. So just being aware of caregiver’s stress there’s, if you go out on the internet, there’s something called a caregiver stress assessment, and it’s in PDF format, but a lot of the senior care community is on the web have it there. If you think that a caregiver showing signs of stress or might need a break just going out and pulling that caregiver stress, reassessment stress assessment off the internet and offering it to them is often can be very supportive and therapeutic for them.
Patty Hanson (33:28):
Senior caregivers who are having burnout can often be depressed. They can have a negative attitude, they can have a weakened immune system and come down with colds and flu all the time. They just don’t lack the enjoyment of things that they formerly enjoyed. They have constant fatigue, they feel hopeless, sometimes they’re isolated or withdrawn. They don’t, they don’t see their friends or participate in community activities like they used to. They’re not sleeping well, they’re not eating well. And caregivers who are just burnout in kind of living in survival mode can often seek escape behaviors like drinking or taking medication and drugs as a way of coping with stress.
When you want to support someone or show caregiver burnout, show empathy for the situations, and really just giving them time to vent and get it out of their system offers a lot of help. Encourage the caregiver to seek help from professionals therapists, social workers, and clergy members are versed in helping with caregiver burnout and Allegheny County actually, which is a suburb or which is where Pittsburgh is located. There’s a program called the caregiver first initiative that’s supported by the United way. So whenever I meet with anyone in Allegheny County, who’s a caregiver, I give them that free information they’ll run out. And someone from the caregiver first initiative will go to the home, do an assessment, do the caregiver stress assessment and help the caregivers get support. And many of those programs are available through the department of aging. And another, another way to offer some support is to recommend a life care manager or home care to the senior and, you know, even make the call or to the caregiver even make the call for them. There are programs that can be paid for if people are income eligible through the area on aging, which is offered in every County.
Patty Hanson (35:57):
If you need to address elder abuse, if someone needs immediate assistance, call nine one one. In the United States the first response for elder abuse is to call adult protective services. There’s the department of aging or the department of health and human, which is part of the department of health and human services for every state has an office within every County. And if you go online and look for adult protective services or the department of aging in your local County, there are lots of resources that they can direct you to, and they will take a statement from you and follow up on any statements that you offer to them about elder abuse or any elder issues. They, you notice that someone in your neighborhood who’s elderly, their mails piling up, or there seems to be a lot of coming and going from them, their house from people who you’ve never seen before. You can also call your department of aging and they will go out and do an assessment and address the needs and help the elderly person get assistance. So at this point, we’re going to open up for questions if anyone has any questions.
Monica Garver (37:33):
Thanks, Patty. At this point I’m not seeing any questions being submitted by the audience. But I think one thing that with your comments, we can all see, you know, we may have misconceived or preconceived ideas of what elder abuse is, but surely elder abuse is really wide in its breadth of abuse. I never thought of things like self abuse as falling under that category. So given your work in the field while we maybe allow some time for questions to come in, what would you see as the most, unfortunately the most prevalent abuse that you, you encounter?
Patty Hanson (38:19):
I, you know, the things that tend to get brought to our attention more mostly is financial abuse. You know, people, family members that, I mean, and I can, I can consider financial abuse passive as well as active. You know, I told you the story about the guy who abandoned his mom in the nursing home and wasn’t paying the nursing home bills. But his child support and his living expenses were coming out of his mom’s trust. I mean, that’s active abuse. One of the other areas is passive abuse. We got a call from a power of attorney that hadn’t, who lived in Boston and he hadn’t been home for three years and his mom was 95 and had dementia. And his, he had his brother live with mom and had medical issues and he was taking care of mom and the house was kind of in disarray. So he asked us to kind of come in and she had, you know, over a million dollars in assets.
And he asked us to come in and his goal was to like get his brother out of the house. And when we, the house wasn’t in good shape, and yes there was moldy food in the refrigerator, but mom herself was impeccably cared for. You know, she had dementia, she didn’t get out of bed that much, but she had she had no skin breakdown, no bruises. He talked about how she enjoyed eating. And we were able to, she had a few moments of lucid behavior. And what we suggested was that they, that the power of attorney worked through an attorney to write up a caregiver agreement to allow the brother that was caring for her to get some, to get paid some for caring for the mom and to bring in some additional caregivers. And the situation that really came down is the brothers that was three hours away. Didn’t really want to spend long money on didn’t want the brother to get paid cause he saw the brother as a freeloader. And you know, the, the, the passive, the passive behavior of not wanting to spend the parents’ money on the care of the parent, I, I would call elder abuse because the quality of care in the person’s quality of life for not receiving the care because they want to preserve the assets for themselves, you know, to me that’s financial, elder abuse.
Monica Garver (41:32):
Absolutely. And another situation you know, a personal situation. I had somebody in a healthcare facility and in a, in a double room and there, the roommate was belligerent and really bothersome to my loved one. And so I addressed it with the administration. And I said, I feel that this roommate situation is an, is an abusive situation to my loved one, because it’s so disruptive. Was that something that you would have defined as an abusive situation?
Patty Hanson (42:12):
I, yeah. You know what, and so I, I tend to get upset and I get on my soap box because there’s a lot of things that are considered neglect or that, you know, might not be considered abuse, might not even meet the needs of neglect. That if we were, if we weren’t involved in the care of a client, like here’s an example, we had this beautiful elderly woman who was on a feeding tube. And as she after her husband died, we brought in a male caregiver and he would like into the nursing home and to kind of take her around and socialize her. And he would bring his guitar and sing to her. And so interestingly enough, we kept trying to prompt her to get her hair done, and we were wanting her to get glasses, but she was kind of down in the dumps. And after he, after we brought him in to kind of socialize some more and take her out of her room and in the nursing home, she started to want to do more things than live.
And so we, one of the things that she wanted to do is she wanted to have the opportunity to eat a little for joy. She, you know, there wasn’t any way that she can sustain herself from the feeding tube without the feeding tube, but she just really wanted like a Blackberry pie. And so we brought in speech therapy and we got her, her swallowing reflex flexes, or so she could start eating and a little bit. And we, one of the things, the speech therapist recommended was that her medic that she be given her medications orally and in the nursing home, the, but it would require probably 10 or 15 minutes for her to take her medications. Well, what we noticed was over, within a six month period, her feeding tube was becoming blocked and she was taken to the hospital. And when someone’s older and ages, the last thing you want to do is take them to the hospital because they get, they can become exposed to many more germs than they would in the nursing home. So we were concerned that she was being taken to the hospital for her feeding tube being clogged twice in a short amount of time.
So our nurse went in and every shift found out what times the meds were delivered and went in on every shift. And lo and behold on the evening shift, someone was CRA was crushing up her medicine and putting it in the feeding tube because it took too long for her to take her medication. And so that was, that was the issue. And if we, you know, this was a elderly woman whose husband had passed away. If we hadn’t been in tune and connected and knew the medical protocols that you know, the fact that we had asked them to, and this was a really good nursing home. I mean, they gave her very good care, but often there can just be one person who’s doing what’s easy instead of doing what’s right. And if they, you know, even good nursing homes, there were times that my family would show up on Easter or Christmas that we come in. And because they assumed that she wouldn’t have any visitors on those days, she was still in her sleeping gown at 10 o’clock in the morning, because they had to spend the time getting ready, getting other people dressed who were you know, who they knew their family members were coming in. So it’s, you know, it, isn’t nursing homes are understaffed. And you know, when you have someone showing up and asking questions on a regular basis, those are the people who get the care and support that they need and deserve. Even though that is abused, it’s still giving them, it’s still something that you just need to be aware of.
Monica Garver (46:44):
Yeah, absolutely. Well, we we are going to go ahead and thank Patty and all of you for participating in today’s webinar. We will be providing a recorded copy of today’s presentation and want to thank you Patty for enlightening us on this very important topic of recognizing and preventing elderly abuse. And thank you again all for participating, have a good afternoon. And did you all do till next time? Thanks, Patty. Thank you. Bye-Bye bye-bye.