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Long Term Care Administration

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Title: Long Term Care Administration


1
Long Term Care Administration
  • Agenda
  • Thursday, September 16, 2010
  • News Stories
  • Study of Aging
  • BC Ministry of Health
  • Coffee Break
  • History and Evolution of Long Term Care
  • Group Presentation Prep Time

2
History and Evolution of Long-Term Care
  • Long Term Care Administration
  • September 16, 2010

3
History and Evolution of Long Term Care
4
History and Evolution of Long Term Care
  • Gerontology is the study of aging. It is to be
    distinguished from geriatrics, which is the study
    of the diseases of the aging (medical studies).
    Gerontology covers the social, psychological and
    biological aspects of aging.
  • Gerontology includes these and other endeavors
  • studying physical, mental, and social changes in
    people as they age.
  • investigating the effects of our aging population
    on society.
  • applying this knowledge to policies and programs.
  • As a result of the multidisciplinary focus of
    gerontology, professionals from several fields
    call themselves "gerontologists".

5
History of Evolution of Long Term Care
  • The term "gerontology" was introduced in 1903 by
    Elie Metchnikoff, a Nobel laureate and professor
    at the Pasteur Institute of Paris.
  • In North America, the emergence of gerontology as
    a scientific movement can be traced to a small
    group of leaders who, in the mid-1930s,
    recognized that the health of the American
    population was undergoing a change from
    domination by infectious diseases to chronic
    diseases.
  • The Gerontological Society of America was founded
    in 1945, and the International Association of
    Gerontology about five years later.

6
History and Evolution of Long Term Care
  • Earliest References to the Aging Process?
  • King Solomon
  • Ecclesistes Chapter 12
  • 1 Remember then thy Creator in the days of thy
    youth, before the evil days come, and the years
    draw nigh, when thou shalt say 'I have no
    pleasure in them'
  • 2 Before the sun, and the light, and the moon,
    and the stars, are darkened, and the clouds
    return after the rain
  • 3 In the day when the keepers of the house shall
    tremble, and the strong men shall bow themselves,
    and the grinders cease because they are few, and
    those that look out shall be darkened in the
    windows,

7
History and Evolution of Long Term Care
  • 4 And the doors shall be shut in the street, when
    the sound of the grinding is low and one shall
    start up at the voice of a bird, and all the
    daughters of music shall be brought low
  • 5 Also when they shall be afraid of that which is
    high, and terrors shall be in the way and the
    almond-tree shall blossom, and the grasshopper
    shall drag itself along, and the caperberry shall
    fail because man goeth to his long home, and the
    mourners go about the streets
  • 6 Before the silver cord is snapped asunder, and
    the golden bowl is shattered, and the pitcher is
    broken at the fountain, and the wheel falleth
    shattered, into the pit

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BC Ministry of Health
19
Ministry of Health
20
Ministry of Health
21
Ministry of Health
  • 2006 Budget Spending

22
Ministry of Health
  • Budget 2006
  • More than 100 million over three years for
    operating costs associated with government's
    commitment to add 5,000 new residential care,
    assisted living, and supportive housing beds with
    home support by December 2008.
  • This builds on the 75 million in each of 2005/06
    and 2006/07 that was provided in the
    September Update to strengthen and modernise the
    full range of health care services for seniors,
    including purchasing temporary residential care
    and assisted living beds, increasing home support
    hours, enhanced adult day care, falls prevention,
    palliative care, health promotion programs, and
    acquisition of specialised equipment.

23
BC Ministry of Health
  • Our mission is to guide and enhance the
    province's health services to ensure British
    Columbians are supported in their efforts to
    maintain and improve their health.
  • The Ministry of Health works together with BCs
    health authorities to provide quality,
    appropriate and timely health services to British
    Columbians. 
  • The ministry sets province-wide goals, standards
    and performance agreements for health service
    delivery by the health authorities. 

24
Home and Community Care
  • Home and community care services provide a range
    of health care and support services for eligible
    residents who have acute, chronic, palliative or
    rehabilitative health care needs.
  • These services are designed to complement and
    supplement, but not replace, the efforts of
    individuals to care for themselves with the
    assistance of family, friends and community.

25
Home and Community Care, cont
  • In-home services, for eligible clients, include
    home care nursing, rehabilitation, home support
    and palliative care.
  • Community-based services include adult day
    programs, meal programs, as well as assisted
    living, residential care services and hospice
    care.
  • Case management services are provided in both the
    home and community.

26
Home and Community Care Services
  • support clients to remain independent and in
    their own homes for as long as possible
  • provide services at home to clients who would
    otherwise require admission to hospital or would
    stay longer in hospital
  • provide assisted living and residential care
    services to clients who can no longer be
    supported in their homes and
  • provide services that support people who are
    nearing the end of their life, and their
    families, at home or in a hospice.

27
Home and Community CarePhilosophy
  • home and community care services will promote the
    well-being, dignity and independence of clients
  • palliative care services will provide the best
    possible quality of life for people nearing the
    end of their life and their families
  • clients and their families should have the
    information required to make their own decisions
    about lifestyle and care and
  • clients have the right to make their own care
    decisions.

28
Community Care Services
  • Home Support
  • Choice in Supports for Independent Living
  • Home Care Nursing and Community Rehabilitation
  • Adult Day Centres
  • Caregiver Relief/Respite
  • Assisted Living
  • Residential Care
  • Group Homes
  • Family Care Homes

29
Community Care ServicesHome Support
  • Home support services are designed to help
    clients remain independent and in their own home
    as long as possible. Home support provides
    personal assistance with daily activities, such
    as bathing, dressing, grooming and light
    household tasks that help to maintain a safe and
    supportive home.
  • If home support assistance is recommended, a case
    manager will help the client determine the
    assistance that will best suit their needs and
    will make the necessary arrangements.

30
Community Care ServicesChoice in Supports for
Independent Living (CSIL)
  • Choice in Supports for Independent Living (CSIL)
    is an alternative for eligible home support
    clients. CSIL was developed to give British
    Columbians with daily personal care needs more
    flexibility in managing their home support
    services.
  • CSIL is a "self-managed model of care". Clients
    receive funds directly for the purchase of home
    support services. They assume full responsibility
    for the management, co-ordination and financial
    accountability of their services, including
    recruiting, hiring, training, scheduling and
    supervising home support workers.

31
Community Care ServicesChoice in Supports for
Independent Living (CSIL)
  • Who is Eligible for CSIL?Eligible clients
  • require daily personal assistance
  • have the ability to direct all aspects of their
    care or have a client support group to do so and
  • have demonstrated the ability to manage care
    services.

32
Community Care ServicesChoice in Supports for
Community Independent Living (CSIL)
  • Getting Help Managing CSIL ServicesSeniors and
    people with disabilities who are unable, or not
    always able, to direct their own care can obtain
    CSIL funding through the formation of a client
    support group.What is a Client Support
    Group?A client support group consists of five
    people who have registered as a non-profit
    society for the purpose of managing support
    services on behalf of a CSIL client. Family
    members, friends, neighbours, an advocate, family
    physician or others may be members of the client
    support group.The client support group takes on
    all the responsibilities of an employer. CSIL
    funds go directly to the group to purchase home
    support services on behalf of their client.

33
Community Care ServicesChoice in Supports for
Independent Living (CSIL)
  • Payment to Family MembersHome and community
    care recognizes that families have the primary
    responsibility of caring for and assisting family
    members. Families remain the most important
    source of support for clients.CSIL clients have
    greater flexibility in their care options and the
    opportunity to pay some family members as
    caregivers. Family members who do not live with
    the client, such as siblings, aunts or cousins,
    may be eligible. Although family members who do
    live with clients are not usually eligible, some
    exceptions may be made.

34
Community Care ServicesHome Care Nursing and
Community Rehabilitation
  • Home care nursing and community rehabilitation
    are professional services, delivered to clients
    in the community by registered nurses and
    rehabilitation therapists. Nursing care is
    available on a non-emergency basis for British
    Columbians requiring acute, chronic, palliative
    or rehabilitative support. Rehabilitation
    therapists can also provide assessment and
    treatment to ensure a client's home is suitably
    arranged for their needs and safety.

35
Community Care ServicesAdult Day Centres
  • Adult day programs assist seniors and adults
    with disabilities to continue to live in their
    own homes by providing supportive group programs
    and activities that assist with daily activities
    or give clients a chance to be more involved in
    their community.

36
Community Care ServicesAdult Day Centres
  • Activities vary with each centre. They may
    include
  • personal care services, such as bathing programs
    and administering medications
  • therapeutic recreation and social activities
  • caregiver respite, education and support and
  • in some centres, meals and transportation may
    also be provided or arranged.

37
Community Car ServicesAdult Day Centres
38
Community Care ServicesAdult Day Centres
39
Community Care ServicesAdult Day Centres
40
Community Care ServicesAdult Day Centres
41
Community Care ServicesAdult Day Centres
42
Community Care ServicesAdult Day Centres
43
Community Care ServicesAdult Day Centres
  • Clients may attend an adult day program in
    addition to receiving other services, such as
    Meals-on-Wheels and home support. Many programs
    are connected with residential care facilities,
    while others operate independently.

44
Crossreach Adult Day Centre
  • Crossreach is a non-profit society, located in
    Vancouver, British Columbia, that provides
    services to seniors.
  • Crossreach operates an adult day centre which
    provides a safe setting, social interaction and
    other programs for seniors able to remain at home
    alone during the day or who would otherwise be
    deprived of contact with others, and also
    provides respite for caregivers. We are committed
    to supporting the independent living of seniors
    and improving their lifestyle, so that seniors
    can age in place for as long as they are able
    to.
  • We are located at 3348 West Broadway, in our own
    building, which was specifically designed for
    adults. We provide a smoke-free environment in
    bright, spacious and wheelchair accessible
    premises. We have a commercial kitchen in which
    our professional chef prepares healthy,
    nutritionally-balanced snacks and meals. Our
    dining facility can seat up to 60 people, and can
    be booked for private events.
  • Membership in Crossreach is available to anyone
    for an annual fee of 25. Senior members who are
    clients of Crossreach pay an annual fee of 10.

45
Crossreach Adult Day Centre
  • How Clients are Selected
  • To be eligible to participate in Crossreach as a
    client, you must
  •  be 65 plus live in the West Point Grey area
    of Vancouver (including Kitsilano, Kerrisdale,
    Dunbar and Point Grey) be referred to us
    (either by a doctor, family member or referring
    agency) meet with a representative of the
    Vancouver Coastal Health Authority, who will
    assess your needs and determine if our services
    will be of benefit be issued a long-term care
    number by the Health Authority, and meet with
    our client co-ordinators in your home
  • Our client co-ordinator is happy to help you and
    your family to obtain an appointment with the
    appropriate referring agency.

46
Crossreach Adult Day Centre
  • Crossreach is open for clients from Monday to
    Friday each week. A typical day at Crossreach
    includes a morning snack, exercises and music, a
    healthy hot lunch, crafts and games, outings to
    parks, and other activities designed to
    entertain, stimulate and engage our seniors.
  • Crossreach is authorized to provide its services
    by the provincial Ministry of Health, through the
    Vancouver Coastal Health Authority, from which we
    receive funds for operations.
  • To supplement the funds received from the Health
    Authority, we charge a small "daily fee" to our
    clients to cover part of the costs of the meals
    and activities. We also organize fund-raising
    events during the year and raise funds from
    donations and legacies, memberships, rentals of
    our premises, catering services, family dinners
    and partnerships with business.

47
Crossreach Adult Day Centre
  • A Day At Crossreach
  • 830 a.m. We phone you to ask if you are joining
    us today
  • 930 - 1000 am Handi-dart arrives to collect you
    (Handi-dart charges a small fee)
  • 1030 a.m. Arrive at Crossreach and enjoy a fresh
    muffin and coffee or tea
  • 1100 a.m. Morning Session exercises, yoga,
    music therapy
  • Noon Enjoy a fresh healthy hot lunch prepared by
    our chef
  • 130 p.m. Afternoon activities crafts or games,
    discussion groups, perhaps an outing in our
    18-passenger bus to a local pub, park or Wal-Mart
  • 300 p.m.Handi-dart takes you home 

48
Crossreach Adult Day Centre
  • Nutrition Program and Menu
  • We have a commercial kitchen and a professional
    chef.
  • Morning Snack - the morning snack is usually
    coffee or tea, along with a freshly baked muffin,
    scone or other delight.
  • Noon Meal - our lunches are designed mainly for
    our clients who are spending the day with us.
    However, we welcome family and friends of our
    seniors. The cost of the lunch for clients is
    covered by the daily fee. The lunch is
    nutritionally balanced, and consists of soup, a
    hot entree and a dessert. There is always water,
    coffee, tea and juice.
  • Afternoon Nutrition Break - on days when we offer
    afternoon activities at Crossreach, we provide
    afternoon coffee, tea or juice. On occasion one
    of our staff or clients will contribute baked
    goods for our afternoon break!

49
Community Care ServicesCaregiver Relief/Respite
  • Many people receiving home and community care
    services are assisted by non-professional
    caregivers, often a friend or family member.
  • Respite care can give the caregiver temporary
    relief from the emotional and physical demands of
    caring for a friend or family member.
  • It gives caregivers the opportunity to join in
    community activities, while renewing their
    energies so they may continue to provide quality
    care.

50
Community Care ServicesCaregiver Relief/Respite
  • Respite may take the form of a service in the
    client's home. Or, the client may be admitted, on
    a short-term basis, to a residential care
    facility, hospice or other community care
    setting. Caregivers may also take a break while
    the client attends an adult day centre or is
    receiving home support services.

51
Community Care ServicesAssisted Living
  • Assisted living residences provide housing,
    hospitality services and personalized assistance
    services for adults who can live independently
    but require regular assistance with daily
    activities, usually because of age, illness or
    disabilities. Support services promote occupants'
    independence, while involving family and friends
    in their care.Assisted living residences
    combine building features and services that
    enable people to remain in their community as
    long as they are able to self-direct their own
    care. They maximize independence, while promoting
    choice, self-direction and dignity.

52
Community Care ServicesAssisted Living
  • HousingAssisted living residences can range
    from a highrise apartment complex to a private
    home. Units can vary from one room to private,
    self-contained apartments. Residences may be
    located on their own or housed with other
    residential options, such as supportive housing
    (for people with lower care needs) or residential
    care.

53
Community Care Services Assisted Living
  • Building History2006
  • Suites56 one-bedroom suites
  • Onsite Amenities
  • Dining room
  • Library
  • Computer Stations
  • Social Lounge

54
Community Care ServicesAssisted Living
  • Health Care
  • Personal Care Services will be provided.
  • Emergency Response24-hour emergency on-call
    system is provided in each suite. Mount Saint
    Josephs Hospital is a ten-minute drive from
    Clarendon Court.
  • A pharmacy, along with medical and dental
    offices is located in the mall across the street.

55
Community Care ServicesAssisted Living
  • ServicesHospitality services consist of
  • meals
  • housekeeping
  • laundry
  • social and recreational opportunities and
  • a 24-hour response system.
  • Personal assistance services may include
    assistance with tasks like bathing, grooming,
    dressing and mobility.Other specific nursing
    and rehabilitation tasks, such as assistance with
    medication, may be delegated by a health care
    professional to personal assistance staff.

56
Community Care ServicesAssisted Living
  • Moving InPublicly-funded assisted living
    residences are available to seniors and people
    with disabilities who
  • are able to make informed decisions about their
    daily activities and personal assistance
    services and
  • are able to communicate and be understood by
    personal assistance staff or by a spouse living
    with them who can communicate with staff on their
    behalf and
  • are able to use an emergency response system and
    take direction in an emergency, such as a fire.

57
Community Care Services Assisted Living
  • Moving OutA client is required to move out of
    assisted living if
  • they are no longer able to self-direct their own
    care or
  • their behavior jeopardizes their or others'
    safety and well-being or
  • they are not complying with the terms of their
    occupancy (or residency) agreement.
  • If a client's care needs can no longer be met in
    an assisted living residence, they may be
    eligible to move into a residential care facility
    or will be helped to locate other appropriate
    accommodation and services.

58
Community Care Services Assisted Living
  • Health and SafetyUnder the Community Care and
    Assisted Living Act, all assisted living
    residences must be registered with the assisted
    living Registrar. The Registrar ensures assisted
    living residences provide services to residents
    in a manner that does not jeopardize their health
    and safety.

59
Community Care ServicesResidential Care
  • Facility CareResidential care facilities
    provide 24-hour professional nursing care and
    supervision in a protective, supportive
    environment for people who have complex care
    needs and can no longer be cared for in their own
    homes. Residential care services include
  • an assisted meal service
  • medication supervision
  • personal assistance with daily activities, such
    as bathing, dressing or grooming and
  • a planned program of social and recreational
    activities.

60
Community Care ServicesResidential Care
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Community Care ServicesResidential Care
  • TYPICAL Menu
  • BreakfastHot or Cold CerealsCompote of
    FruitFull English Breakfast with Toast and
    PreservesFruit YogurtChoice of Juices
  • LunchChefs Best SoupPrime Rib with Au
    JusBaked PotatoesBroccoliDinner RollsAssorted
    Dessert TrayChoice of Beverage
  • DinnerChefs Best SoupChefs Salad Plate with
    Dinner RollHerb Roasted Chicken with OBrien
    PotatoesMacaroni CheeseAssorted Desert
    TrayChoice of Beverage

65
Community Care ServicesTypical Day Activities
  • 1000 am            Morning Munchies 1100 am
               Sit and Fit Exercise100
    pm              Baking Memories200 pm
                 Name that Tune300 pm             
    Kitchen Kaboodle400 pm              Game
    Room700 pm              Fireside Chat

66
Community Care Services Residential Care
  • Moving to a Care FacilityBritish Columbia's
    residential access policy ensures seniors and
    people with disabilities with the highest need
    and urgency have priority for the first
    available, appropriate care facility
    bed.Clients who have been assessed as needing
    facility care are expected to take the first room
    that becomes available. Once in residential care,
    clients may request a transfer to a preferred
    care facility when there is an opening.It is
    wise to plan ahead for a move to residential
    care. Clients are encouraged to ask their family
    and friends to help them prepare for their move.
    When a room does become available, they will be
    asked to move in fairly quickly - usually within
    48 hours.

67
Community Care ServicesResidential Care
  • What Clients Should Know Before They MoveMoving
    to a residential care facility may not be easy,
    especially for seniors or people with
    disabilities who are moving from their own home.
    Taking the time to learn about the services that
    are offered in the facility, the costs and
    policies will ease the transition and make the
    move less stressful. Here are some questions
    clients may want to ask their case manager before
    they move
  • Can they take their own furniture into the care
    facility?
  • What are the visiting times?
  • What are the facilities' practices regarding
    belongings, pets and mail?
  • What kind of clothing should they bring?
  • Can outings and overnight stays be arranged?

68
Community Care ServicesGroup Homes
  • Group homes are private residences that enable
    adults with disabilities to live as independently
    as possible in the community. They offer an
    important service to residents because they
    provide short- and long-term living arrangements,
    affordable and safe housing, skills training,
    peer support and counselling. Many British
    Columbia communities have group homes, which are
    generally operated by non-profit societies. Homes
    range from single family dwellings to apartment
    complexes and usually accommodate four to six
    residents.

69
Community Care ServicesFamily Care Homes
  • Family care homes are single family residences
    that provide supportive accommodation for up to
    two clients. Family care homes can be an
    alternative to a care facility for some
    individuals.What are They Like?Family care
    homes offer a home-like atmosphere, nutritious
    meals and housekeeping services, along with any
    required assistance with daily living activities,
    such as bathing, grooming and dressing.Although
    family care homes are available throughout the
    province, they are more numerous in rural areas
    where their availability allows clients to remain
    in their own communities.

70
Community Care ServicesFamily Care Homes
  • Who Uses Family Care Homes?Family care homes
    are for seniors and people with disabilities who
  • require a more individualized approach to their
    care than is available in a residential care
    facility or
  • have an immediate need for residential care and
    are unable to find other suitable alternatives
    or
  • find the care environment at a residential care
    facility is not compatible with their religious,
    ethnic or cultural background or lifestyle or
  • need short-term assistance upon leaving hospital
    but are not ready to return to living in their
    own home.

71
Community Care ServicesFamily Care Homes
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Community Care ServicesFamily Group Homes
  • FolkStone Family Care Home Locations
  • At a FolkStone Home everyone knows your
    name...you become part of the family." FolkStone
    Homes provide a safe atmosphere where the quality
    of life and the desire for independence are
    balanced with the needed assistance.
  • Burnaby Coquitlam Delta Ladner
    Langley Maple Ridge New Westminister
  • North Vancouver Port Moody Richmond
    Surrey Vancouver White Rock

73
Home and Community Care
  • Case Management and Care Co-ordination
  • Case managers act as co-ordinators to help
    clients obtain home and community care services.
    They determine the nature, intensity and duration
    of services that would best meet clients' needs
    and arrange their services.The case manager
    will stay in touch with the client to arrange
    care services and make any adjustments necessary
    in the event their care needs change.

74
History and Evolution of Long Term Care
  • Continuum of Care
  • The coordination or management of care within
    the myriad components of the health care system
    to ensure the provision of the right services, in
    the right place, at the right time.

75
History and Evolution of Long Term Care
  • Case Management
  • Case Managers act as coordinators of care and
    advocates to help ensure that the care plan
    proceeds smoothly and the elderly persons care
    needs are properly met in a timely way.

76
History and Evolution of Long Term Care
  • Three Phases in the Development of Long Term Care
    Services
  • First Phase
  • Social Disinterest
  • Family and Charitable Assistance
  • From Colonialism to 1960s

77
History and Evolution of Long Term Care
  • Elizabethan Poor Law of 1601
  • Required local parishes in England to provide for
    persons who could not support themselves because
    of age, poverty and infirmity.
  • Public taxes funded the Almshouses.
  • Elderly, Sick or Disabled

78
History and Evolution of Long Term Care
  • 1866 Legislation passed in Ontario
  • municipalities to set up houses of industry for
  • Poor persons who could not support themselves.
  • Persons who can look after themselves.
  • Persons who did not make an honest living.
  • Persons who spend time and money in public
    houses, to the neglect of any lawful cause.
  • Persons of low IQ below 20.

79
History and Evolution of Long Term Care
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History and Evolution of Long Term Care
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History of Evolution of Long Term Care
  • Three Phases in the Development of Long Term Care
    Services
  • Second Phase
  • Benevolent Paternalism
  • Institutional and Professional Focus/Control over
    decision making
  • Protect life and improve quality of life by
    various means
  • From the 1960s and tapering off into the current
    period

82
History and Evolution of Long Term Care
  • Saskatchewan Premier Tommy Douglas implemented
    North Americas first universal hospital
    insurance plan in 1947.

83
History and Evolution of Long Term Care
  • National Health Care Funding
  • 1948 National Health Grants, construction of
    hospitals.
  • 1957 Hospital Insurance and Diagnostic Services
    Act, 60 of hospital services funded by federal
    government.
  • 1966 Medical Care Act, 50 medical care expenses
    funded by federal government.

84
History and Evolution of Long Term Care
  • Three Phases in the Development of Long Term Care
    Services
  • Third Phase
  • Dependent adult treated as an adult rather than a
    child
  • Uncertainty over degree of implementation of this
    phase
  • From recent to past to the current period

85
History and Evolution of Long Term Care
  • The Canada Health Act 1984 (Medicare)
  • Public Administration
  • Comprehensiveness
  • Universality
  • Portability
  • Accessibility

86
History and Evolution of Long Term Care
  • Established Programs Financing (EPF) Act
  • Injection of federal cash for long term care
    services in 1977.
  • Residential care facilities public, proprietary
    and charitable, nursing homes, homes for the
    aged, personal care homes.
  • Increase of long term care beds in hospitals.

87
History and Evolution of Long Term Care
  • Regionalization (1980s 1990s)
  • Cost Containment
  • Improved health outcomes
  • Increased flexibility and responsiveness of care
  • Better integration and coordination of services

88
History and Evolution of Long Term Care
  • Closer to Home Seaton Report, BC
  • Royal Commission on Health Care and Costs
  • Examine the structure, organization, management
    and mandate of the current health care system to
    ensure continued high quality, access and
    affordability.
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