Master's level social worker and have been in the field of geriatrics now in the medical field for about eleven years and so if you can imagine as a medical social worker we see quite a few things. In medicine social workers aren't always just working with those without funds and I think that's very important to realize that when you're in the medical field doing social work anyone that crosses the threshold of your service is who you provide services to and so often there is sort of an over assumption that we social workers only focus on those that are indigent but in the medical field what we find is we have are there to provide services for those that are homeless with no income to those with millions in the bank and have no financial concerns usually we're also part of an interdisciplinary team with the services that we're providing so often on our team will be working right alongside internally people like physicians and nurses they are pissed other social workers chaplains bereavement coordinators depending on sort of what field that we're in specifically but then outside of that pool we're also working with a large subset of community providers and so we're often sort of the hub for a lot of what's going on. Now what's called an aging Life Care Manager which. Will let you help me there you're fine which is sort of especially subset for primarily master's level social workers and registered nurses where we primarily help clients that are very met medically fragile or that have very complex concerns and so we've worked with. A variety of people I had a very interesting case recently with a referral that was made to me of a lady that had a DUI And I was actually in jail when I got her as my client what we found is that the seizures that she was plagued with for about the last year before. Or she was given back her keys to the Dr and they get in this accident and then to jail was that she actually had Crossfield Yakob switches basically human mad cow and so sometimes the cases look very different when we're going in to when we start taking around and trying to put the pieces together so part of our job is aging life care managers is to walk into very difficult situations and I like to say start that magic board so I feel like I'm on C.S.I. and I'm just on but a little bit of it and trying to figure out really the basis of what's going on and then help the families map through that I also feel very blessed because I married a techie my husband is actually a mechanical engineer graduate of Georgia Tech so he was very excited to know that his wife is coming to speak at tag this morning so. So when I was talking to him about this presentation I wanted to take it from you know the field of social work the field of dairy intolerant to how this is going to sort of cross over to research design and some other things so he definitely helped me a lot with a lot more of what you guys do so that I had a greater understanding of how it all interplays So what I find very very interesting in this field is that people come to where they are for a variety of reasons so for those that are in research or design often it might be something that's close to your heart so I find that when you ask why are you interested in this particular thing sometimes there's a family story so sometimes it's you know my grandmother suffered from that or I had a neighbor's brother's cousin I mean the stories get really interesting but what you find is often there's a personal connection sometimes they come to it as a team so you know I'm involved in this and we all had this great idea and so we're going to work together as a team I find that a lot of people are interested in the topic because it's just academically thrilling there's a lot of things especially coming out now I went to a presentation not two days ago now on stroke technologies that are. Coming and they are in the leave a bowl some of the cases that they were able to save now that were literally just a pat on the head ten years ago. So I find it very interesting how people get to a point where they want to get involved with a certain topic so one of my very favorite questions when I'm talking to other people in the field is the why why do you do this because I think that really boils down to a lot of the passions behind their work so when I was talking to Jason who's my husband about sort of a standard method of how all this comes to play he said OK so you get an idea from some reason and then you start with sort of a more methodical process than what I'm used to so you start with this idea of design and then you start developing different brainstorming you look at things very carefully you start developing prototypes and then you test it and evaluate untested evaluate it and that's to valuate it and then sometimes it goes all the way back up to the top and starts over but at the end the goal if ideal is that you come out with this amazing thing that is helpful and that's the end goal but beyond that beyond having this great product is to be able to put it in the hands of the clients that are going to use it you know my grandma always said something's only worth what you're willing to sell it for so if we can't get it from A to B. That's a problem and so you can develop the best product in America but being unable to get it there is very difficult at times and so what I want to talk about today is sort of the gap not necessarily in the design phase but the gap between I have an idea in my brain to literally putting it in the lap of the clients to use in the process with that just because I don't want to keep saying services educational models products I'm going to use the word product to mean basically everything that could be in this. So we're looking at physical products we're looking at digital products we're looking at educational goals like we heard from in the Harrington and how they're trying to push out a matter of balance so that is included as well as human service products such as the home carriers the Home Health those types of models. So today I'm going to pick the topic for us so today I want to talk a little bit about Parkinson's and I'm sure that you guys are all familiar and our opinion this is by far one of the most complex illnesses that we're seeing we're actually seeing a huge upswing in this and diagnosis and you'll see right now there's about sixty thousand diagnosed annually percent which are after age sixty and so if we're talking about aging and what's truly affecting clients this is something that we're going to see a lot of so I think if we're looking at things a lot of your research when you're looking at Design is how does this affect a person we're seeing with Parkinson's affects are going to run anywhere between eight and twenty years depending on so this is a very long time when these symptoms can surface can be managed can resurface can worsen because this is truly a progressive neurological disorder so if we look at all of these concerns and again not really knowing too much about the cause they know that it greatly affects the dopamine receptors in the brain that there's a lot of cell death and when the dopamine is affected which is a neurotransmitter the flu fluidity of movement really isn't there so there's a lot of things that come from that and as you can see there are so many systems within one's body as say from the toes to the nose are truly affected with this diagnosis so if we go back to that sort of engineering design loop and we identify that this is where we want to put our focus and we get a little deeper and let's say just for discussion purposes we want to focus on swallowing concerns and so we. We decide that that's where we want and we start talking to neurologists maybe occupational therapists getting more information we develop this prototype and we test and we retest and we test and. You have in your hand the best product ever made to help us wallowing best one out there. So now what. I'm definitely not a marketing expert I can tell you I'm very much a social worker I like the connections and marketing but that's not really what I do so I'm not here to really tell you how to take that now what and put it in the hands of somebody willing to purchase that concept or product not what we're talking about I don't even want to talk about really how to market that product in the industry that's not really the purpose of this talk but what I want to really focus on is when you have that concept in your brain and again you come up with this amazing product water that there are years that this product is interim into what is the world that these clients are in and so that's what what I really want to talk about today. So typically in health care. This is. It's not as linear as it looks but I want you guys to get an idea of this is how health care is experienced. I want to pay particular attention to this first block. So we have a client again client can be patient whatever you want to call it let's call it client so you have a client and you have a support system what we find in about one hundred percent of the cases are these are parallel tracks. They're parallel the thing about a caregiver is you don't become a caregiver until you give care. So often people have this role before they even know they this role so they're on this parallel track and what happens is sometimes minor symptoms start affecting and we're not necessarily talking about Parkinson's now but. Just in general so it might be everything from cold symptoms to I've got osteoporosis now to cardiac concerns to a variety of things but minor symptoms start affecting their ideals their life and sometimes they'll go to a doctor for those things and again often that's still this parallel track so often it's still the individual themselves that is dealing with this and then we get to sort of the bottom square at some point. It is forced to join in most situations and so you have this client that has been a care receiver from the system and you have a caregiver that might have been sort of alongside them and all of a sudden they're thrust into the situation and so I can't tell you how many caregivers I talk to on a normal basis that say Dad was perfectly independent he was doing just fine at home and then here we are with the cardiac event or something where they're now hospitalized and so what happens that that dynamic I think is very important because not only is the client who was very typically independent is now maybe not as much but then you have a support system which isn't always familial thrust very quickly sometimes like a brick in the face into being a caregiver. And in this time I'm not going to really talk about health how stressful this can be in the brain chemistry that happens when we're under stress. But this is when so many things are thrown at them is when they're sick and they're not feeling well and they're going through these huge psychological transitions and so it's really tough for a client to all of a sudden need from a child it's a really tough place for a child to all of a sudden need to provide care for a parent especially those that are trapped as they call in the same when they're taking care of their own children and I have right now a situation with this where I've had a client. Even though she's in her ninety's she's been basically stable she's right now in the hospital and so the son you know just we had plans for this and dinner and dinner and boom we're all in the hospital together on Saturday night and so this isn't really planned for Typically it just happens and so after that happens then they're thrust into this variety of care providers which will talk a lot about more wherever their home is will need more management they are so it's whether you're bringing in services whether the families getting a little bit more involved we have more specialists that are involved we have home modifications happening there's a variety of things happening you hope that they're connected to the best of the local resources but that's not always the case you hope that through those resources that are appropriate services are provided but as you'll see with as well as the engineering like this is another loop so things can go in Khost for a very very long time and then bam and so we find that most people handle health care in a coast and crisis coast and crisis and so that is where they find themselves in dealing with health care. So if we're talking about older adults and adults with disabilities it is very very important to know the effects of Medicare. Medicare is by far the primary insurer for those in that group. So it's important I'm not going to go into detail because while the asleep but Medicare primarily covers inner mitten services that are skilled. So you're looking at hospitalizations you're even looking at things like counseling in the home durable medical equipment which is important for you guys to know really the throws of what that means we're looking at lab work doctor's appointments but things that are really. Touch and Go touch and go services are what Medicare covers and so a lot of people what we find go into this thinking Medicare covers a heck of a lot more than it does and. So you'll be like Medicare don't cover that what you mean Medicare doesn't cover that and so there is a lot of I guess over assumption that Medicare is a has much more coverage in the day today than it really does so if Medicare doesn't cover it that doesn't mean it's not needed. However what we find is when it's needed and it's not covered by insurance then it has to come from somewhere else it just makes sense so where does it come from normally private pay and that's not only the private pay of the client but also the private pay of the family sometimes chip and by churches we've got all kinds of reasons that funds become available they also can become available if you're not familiar it's good to be familiar speaking of the V.A. of the veterans age in attendance pension benefit this is a special pension that can be brought in to help care and pay for health related needs for veterans won't go into the specifics but that's they are long term care insurance is very important and does have quite a few benefits to people like settlement funding which is the cashing out of life insurance policies we've got reverse mortgage we got a host of things things like government funding like Medicaid we have some diagnosis specific fundings through things like cancer care so there's tons coming for things from a lot of places. And less sure planning on does spending all this time designing a product and then standing on the street corner and handing it out for free which I don't think anyone is. This is very very important to how people actually financially have access to different products so I want to look quickly on the who's involved. Again Parkinson's is a very complex disease process and I'm really sorry this is so small but hopefully I can send slides out after if you want but I want you guys to see the web that people are surrounded by. So when you get a diagnosis of Parkinson's. This is who you're dealing with. And so people might think you'll have a neurologist and you know your family may be a surgeon but when you really start looking at where who's impacting these clients who's providing care you've got everything from the movement disorder specialist which are the neurologists that are specializing to people like myself social workers in a variety of settings nurses we've got pharmacists we've got neurosurgeons home health palliative and hospice we've got Home Care Durable Medical Equipment people like me again aging life care managers we've got elevators if that's needed dentist home organizers move managers emergency room clinicians We've got veterans based services we have research organizations maybe like the American Parkinson's disease we've got family and very very immediate extended and family of choice all involved and then also people get a lot of information from other families that have also been affected so if so and so had a brother or a dad that had Parkinson's a lot of information will get funneled in that mechanism but what I think is so important with this is to know that these are all people that are telling people with Parkinson's what might be beneficial to them so these are the people that are talking products. So. Any questions so far I'm sort of flying. OK. So when we talk about product utilization we have to talk about the person that's going to be using it and so to clarify really from the client's viewpoint what are some factors that they have to think filter through to see if a product is best for them so what they're primarily focusing on is making sure that I'm as safe as I can be and independent as I can be and that's a very grey a difficult balance that they find themselves in. These are things that again we're looking at cost we're looking at legal issues we're looking at brain chemistry problems safety concerns modifications medical need. But in very specific terms I want to talk about some things that we observe in clients that are factors that can judge if a product is needed or necessary. First and foremost we have to talk about cost because that's very important and cost also of course will hinge on insurance provision. We want to look at someone's physical and cognitive usability. Unfortunately because of the number of co-morbidities that are affecting these clients often it's not just a client with Parkinson's it's a client with Parkinson's with C O P D and dementia with no family support So you're dealing with a host of things that can affect and so I feel like we sometimes. Put on blinders when we're looking at researching a project because we're focusing on Parkinson's we're looking at swallowing for Parkinson's but all of these other things factor in appropriateness of fit and I'm talking literal appropriateness of fit I'm also talking and concept of that but sometimes size plays a factor sometimes I mean I had a gentleman the other day six five height plays a little money for three you know side size is incredibly important but you know we had a client on our dementia unit that had to have a pediatric Mary Walker because she was so tiny and so we have to factor in that there is this huge discrepancy sometimes in appropriateness of him. One that cracks me up is that the family needs to identify that it's going to be helpful to them and I call that the yeah that's for me phenomenon that hasta happen and we forget that that the family has to identify that that will be helpful. Helpful literacy and general literacy Sorry. Yeah. That's. Sometimes you have to let them come into their own. Unfortunately I think some of the best education comes in crisis. So you know even though I think we're pretty good at what we do I have to turn to families all the time and say we see that train heading for us. They are not acknowledging that this is a problem stay off the roads between the hours of three and four when we know they're driving you know I mean there's things that you just have to say you know you can't help an alcoholic unless they know that they're an alcoholic so there has to be ways that you can gently push through that denial as much as you can I think denial is there for a really wonderful reason it allows us to break it off in small chunks and digest it as opposed to just. Getting overwhelmed a lot of this which I didn't mention but I think is vitally important is there is so much loss. So much loss and you have to think and you know I have a family right now he is sixty seven and she's sixty three brand new retiree's brand new early dementia diagnosis not what they're planning on. And so they're looking now at their future going he's OK now but they're already pulling back on how they're interacting with friends transportation concerns because do we want to driving are we at that point she said Every day I wake up and go should he take his own meds or should I help him with that those are questions that are already starting this wife who never imagine to be in this role is now in this role and so there's grief and loss and curse there's grief and loss on his and that's denial set in very well with that just because it's so protective because socks and I can't tell you how many families that's what breaks it is to sit They only the name and say this so and I'm so sorry. I'm genuinely so sorry that this is your reality however. This we really think this is going to be helpful and sometimes it's truly just the knowledge of that so many people start around it because they don't want to bring up the emotional part of this but you have to think that you know take that split second and say if this were my reality every day. What would I not want to have to think about what peace is what I want to get rid of and so then I'll place this huge part in that so unfortunately not all situations can be helped but I found that if you are willing to sit in it with them for a minute. And and not try to push your agenda but try to see maybe why that resistance as they are in resistance is actually my next point oddly enough but. Yeah OK so so resistance of use is very real. What we find is that happens for about one million three hundred twenty seven reasons but the ones that we see a lot of would be proud in vanity privacy so let's say that you have C O P D and you need to be on continual oxygen and that includes the backpack so you're in Target now with oxygen what does that mean when you boil it down it means that people know you're sick when on Tuesday they might not so now your sickness is what little kids are saying are now and people will feel sorry for you and pay and a man told me I don't know. I don't want to be seen as that guy Brandy I don't want to be that guy that people automatically see and feel sorry for and that goes with everything from something as simple as a cane oxygen and so they are there's resistance for a lot of reasons also the privacy piece and a lot of the technology that I'm seeing unfortunately doesn't play to the fact that these people with private lives again they've handled their health care for a very very long time and often whenever you're losing that grip it even. HIDER because you're so scared of that loss of control so if you pair that with this nail in an absolutely no offense I'm not bashing a product at all but if you have to log in that you've taken a medicine and if you don't it pains your daughter and tells your daughter that you didn't take her mad and your daughter's on the phone now Mama you were supposed to take your Listen to what twelve o'clock why don't you take it is right there in that bar I made it easy for you it is in that thing I need to do it why haven't you done it once I think I've been a loser thirty two years now all the sudden you're a mom often you have to care about me before and then you go. And so but what we find is again there's that the Independence is still thing or the desire to handle this as much as you can on your own and when we as a caregiver all of a sudden notice that care needs to be given we tend to jump in with two feet like GOD MOM You obviously can't handle anything you have dishes in the sink I mean it's crazy what I hear from caregivers going but they're so confused and we have to remind that within any deficit there are strings and abilities and so we're Where is that fine line where we really want to keep people safe and as independent as possible but we need to factor that in so resistance is very much they are denial going into the fact that there's just not issues I don't know what other people are saying. I don't need help why and I can be. Whole systems it's not just the co-op but those are the whole systems that have no idea and sometimes it's because it's been such a part of their life for so long that's always drink was a problem little. I mean he's always during three or four beers and. Now we're factoring in other things. Yes or. No. Well. I think where we falter is we just don't educate at all. And we don't get to the bottom of things because again and we'll talk a little bit more about this in a minute that a lot of things are just brushed over. So take a small example of pain control and I had a client that said Bernie I just can't get my pain under control and I'm looking at the first direction as it makes sense it should be under control of this with a horse was this not under control and I look and so I ask a very simple question that had never been asked when do you take these. Well I haven't been sleeping well so I normally don't go to bed until midnight and then honestly when I get to sleep sleeping like a log so I don't normally get up until like noon. So she was taking them at noon four and eight. So these are pills that should be stretched out a poem longer than that so she was going basically from midnight to noon with no coverage so it was a major problem in her pain control but no one had ever taken the time to say you know it's spaced out for a reason this is why this is like this she just said three times a day cool I'm up during these hours let me space it out somewhat and she was doing the best she knew to do but unfortunately in that case she wasn't getting resolved so what would have happened if she would have gone back to the doctor and said my pains are control they have done. Bumped up the dose and typically that's what happens and that's part of the issue yes sir. Not all. I'm. So. So so. This song. And. So. Lines were yes. I think it all boils down to education and education on multiple levels I find that. And will talk you guys are really like written my presentation for me but. In the end the clients are really making a lot of these decisions it's the families that are reinforcing that this is an important thing and what I find is that families tend to get a better understanding of the why. And are able to see from a little bit further away while there may be resistance able to break through some things and I say family loosely people in their life and sometimes there are better in that scenario than others to do those things. Again our agenda is very important that if we don't communicate that agenda Well it falls back on us on how it's presented so I think if we're presenting and it's failing and we present and it fails what is the whole insanity is doing the same thing over and over and expecting a different result look at both ends so look at maybe how it's being presented is it verbal and it should be written is that you know and there's just a million ways to say you know maybe why is it this is it timing we find timing is huge Does it have to get to the point. It's crisis before a person is able to they have to first try their fail issue first and so I had a client that really needed to be on hospice but the husband wouldn't hear it so I said OK let's put him on home help well let the home health company tell them that his wife is it going to benefit from this and then he's going to be more open to talk to me about what he should have been on first place and so sometimes you have to sort of let them try. And let them try what they think they're doing and then try another intervention and some so I'll sort of set them up with a. Very concrete timeline so I'll say OK we're going to try this for two weeks I think your idea I see the point they're making and I think that's a great idea we're going to try that for two weeks and if it doesn't work in two weeks then can we try my option would that work. Well then I think from INS got to happen if they're not ready to A. To absorb the change you're fighting and I mean it's against a brick wall there's not what you can do. Tim only crowd OK Well let's assume you're talking and I'm talking so if we get to the point of really what matters most so we have all these things that affect the client what is the one thing that matters most I'm going to ask you a really funny question that I remembered in this presidential like holy crap I forgot what is the one factor that affects more than any other factor who you choose to marry. Answered quickly only got ten minutes physical attraction. Money OK what else. Compatibility what else we got the factors that affect who you marry him or OK. What is a location OK Well guess what proximity OK So that is the number one factor so before anything else can be scrubbed down I have to be in their zone I have to be close to them so well. Say Prince Charming lives in Australia. Forget this for a minute Prince Charming is in Australia and he is my perfect most compatible it's financially wonderful it's the cost it's a let's go back the complexity of him his psychiatric concerns his co-morbidities all these other things line up but unless I meet him. I can't scrawled any of this other stuff against if it's going to work or not So really you've got your client here that is going down their path going to hack and something's push them away some things keep them in that parallel track and some things push them towards So the point is how do we take that brilliant idea and get it into someone space time relationship and that is the one thing that effects beyond any of these things that we talked about how people get access to anything products so if it's education if it's a technology if it's a service anything you have to get it in there space for it to make sense so beyond just proximity. Which is access what I call access there's a person here's everything in the health care world that's going to and so I'm going to go really quickly through this list but there's a lot that's in this health care arena some one purpose and some not it's just the reality that's going to affect how a client gets access to products and so we're talking more about finished products in this case so if you have that technology or that. Product that you've developed and it's available for market and so you've got this host of things so saturation of resources I don't think that people really understand how much is out there until they're in this arena Scott how many home care agencies now. Awesome hospice last thing I heard is about four hundred one time. And so you know and if you look at just adaptability products for things or simple things like highly divided plates can there be. There are so much out there and so again you have this client that might not be in their best place to make decisions with a family slash support system that has never done this before and then it's. Here's a ton of stuff in their face and a lot of duplicate services so what what happens is not only is there just a volume of what's they are. The unique services have a hard time to come through because of the oversight volume of the duplicate and within the duplicate so it's hard for those that do things differently truly or can provide a specialized service or product to get through because of just the volume so you might be one of the one thousand four hundred twenty seven and do it bright but you don't have the opportunity to get a proximity and again we're going back to that vacuum focus means if I'm a nephrologist and my client's in the hospital and is in kidney failure guess what I'm focusing on. OK am I focusing on cognition typically not and this happens not only in facility settings but then also amongst all the care providers so people go in sort of blinders like I said and they say you know what do I need to focus on with this person like a communication Holy Smoke if you don't know this happens go one hospitalization with anybody no one talks to anyone about anything. And not only. Do providers not talk sometimes families don't talk to providers and so there's just not a lot of give and take within that there's also a huge assumption that someone is both unable or unwilling to pay for things outside of Medicare coverage and so often what we find in hospital systems in particular is thing a lot of things aren't offered if they're privately hired because they'll all from things like you're Wilcher is covered by Medicare meant to sign the order and here it is and when it comes to specialty technologies and products that's I mean we have no coverage for those most of the ones that are available now but again people especially social workers are really guilty of thinking everyone is poor and so. We have to get over that hump ourselves to say you know if they even if the client has no funds often it's family members that want to chip in and support the home based services Medicare really doesn't cover many that come into someone's home setting so a lot of the vacuum of how people are touched with health care is in a place that is not they are and so they go to a doctor's appointment they go to a hospital they go to an outpatient clinic so a lot of people are being able to open that door and say whoa we have thirty five cats you know and all the things that can happen at home which could truly affect someone's abilities because what you'll find is people that's what happens and it's often protective. Yeah. No. One. Can. And they're scared and so they go extreme So it's mom can't live in a home she must need to go to a nursing home she's got to go to a nursing home I mean a mom and that's what we had one hospitalization she might make four hours a Care Day low back it up Sally so but because people are really in that environment with clients they're not real clear often on what's going on because a lot of things are insurance provided quick services are happening all the time so if you go into a. Primary Care Physician and you're there for a cold you might have six minutes so the primary care physician which might be your best medical hub and knowing everything going on with you is really able to focus in on that cold they're not able to go Good boy you're also having. Their date can we look at other things. Many providers know how big and who's the one person when we're talking about the huge list of providers that knows everything going on with that client. The client And then beyond that maybe the support system maybe and beyond that there is no natural hub in this entire industry so it's important to know that there's many many people involved and not a real place for them to go to. We sometimes get about thirty minutes to convince a lot of your. It depend the quarterback is not naturally they are now it can be privately hired in certain situations and other things but in ninety nine percent of the cases no I mean and. Under the gun that we're often under we have a very clear direction do you know do you have transportation home do you need home health services do you have a will to her at home if your parents or your family going to come pick you up today welcome to search her and ideally we would love to do more but that's the problem is disciplines want to do this and are able to do this by Center. It's all. Its Own involved again everything goes back to that proximity who's touching not literally but the person. It's. Its heart is it's bad bystander effect I think is huge and I hate that I can't remember the lady's name again another social social psychology term but there was a lady in the sixty's that was murdered in the lobby of the apartment building and thirty people witnessed and no one said anything. Thank you thank you so. This happened. All the time and the victim is very different in health care but what happens is I assume that the doctor would say something and the doctor saying that I said something and what happens is nothing it said and or it's halfway said or it's sort of educated or not and so when it comes back to again just products and access. How much of this is going on how much do you assume is happening in Israel realistically happening so my very last lot of promise I've got two minutes so what can be done I've been Negative Nelly but what can we do within the system again know that it's frequently not the client making these decisions to access things it is often the people that are either professionally or personally connected with them. If you can find a way with whatever you're doing with that person in the industry that is connected to those people that have the proximity to make your product like a green file folder in their drawer in their mind where they go person Parkinson's swallowing issues green file folder I need to tell them about this you have to find a way to make that happen because it has to key into my mind to go that makes sense let me tell them about this and often it has to be in the front of mind identify early who is going to be the ones to bring products closer to the clients that are going to benefit from them and so if it is they're probably going to learn more from their church organizations are there things that are already connected in those ways that you can bring things to light. What we find is not only can they help you in the product design because they're going to give you some really good real life feedback they're also going to be the boots on the ground with a big megaphone going whole way everybody this is all some come use this and so you're going to meet that in the future if this product does anything you're going to need people in the field that are excited about it that want to share it. Again do not assume the health care system makes sense I think we do a little too much but that doesn't mean that we should go it's broken and keep walking. The only reason that we've had all the improvements that we've had in the last couple of years are people saying this will not work and it needs to be better and so we're talking about transitions of care we're talking about other things I just became a care partner for one of my clients that's in the hospital and so they're they're really trying but I think we need to just try to make sense of the much of that as we can and remember nonprofit for profit clinical non-clinical Lastly if you can take when you're designing concepts or opening a bus service or whatever and try to scrub some of the things that we've talked about today what it's probably going to do is narrow the scope but that's OK I think so many products are brought to the forefront and says this will help everyone and if we can hone it in as much as we can to say this is very specific again it's going to make a file folder make more sense for it to pop up in a certain circumstance so I so going over my Tom any comments questions anything I hope this has been somewhat helpful and pulling things together. Yes. So. I think the only issue with that is that were assuming that a person has the ability to do so. There it's one in two now over eighty five with a Dementor diagnosis one in eight over sixty five so if we talk about aging and just the basics of dementia a lot of that executive functioning that ability to manage that kind of system is one of the first things to go. So. Are. As long as they allow it. And so there's I think that that's the piece that we don't factor into a lot of this technology is that the client if you're giving the client the right to utilize that then you're also giving them the right not to utilize it. And I can tell you from the clients that we work with they have the ability to afford products like that but I can tell you most of them would end up either in the lake or in a drawer on and off just because of the privacy factor and the fact that they've already experienced so many losses that they really that takes not only a lot of ability cognitively and even in the cases where that's not a problem. It's a lot to manage for them to to check that I've done certain things during the day or to mark that I've done and and I think that again it's going to be helpful what we need to focus on with things like that is. Scrub it down on all sides with all those things we talked about this specifically looking at cognitive ability and psychiatric concerns there are two things. That none of these products we're talking about they're talking about behavior modification of clients. Who have dementia I mean we're good for some of these clients too I mean about my poor uncle Bill with dementia has no idea even has a checking account I mean we're dealing with a much higher deficit than people are willing to talk about and psychiatric concerns a lot of the clients who are working with are coming to this with personality issues long long history a family dynamics work all the families at this link all the family and if you get into that zone it's a problem and so I think. Yeah and so. Yes. Yeah. Yeah. Right. You. Know. You. And find ways to get them access I think that that's what it boils down to the ones that are appropriate for those models if we can get those models into their hands that's going to be the most important thing because that you can't use a resource you don't know exists and that's what we're saying the more than anything it's not that the technology doesn't exist or maybe it's appropriate for Mr Jones. Mr Jones has no one telling him that it's even there and so that's why I said proximity just like picking a spouse is the most important if you don't have access or knowledge of a product you can't use it and if we're looking at usability which is what we're talking about and it's not they are you can't use it I know it's sort of stupid and simple but it is what it is and so we find that because scopes are given so broad this could help everyone with everything and that instead of saying it helps this group of people and really honing in on how to best help that group of people then I think that's going to be better understood because again the followers going to come up and the person is going to go holy I need to tell someone so about this because it worked in this an area where we're too broad we're just too broad right now yes. All along the ground. We did last. Year stand. For you know. Not as helpful as. You. Say well. We did just that nationally. So. Yeah. There. Was. There. One. Is. When. The product ideally works in a certain fashion it's made to help this and when this isn't a problem or becomes beyond that problem it's hard. You know. Well. So. There's a very. Precisely. With you. So. Much that I think. The. There's a definitely a million factors a factor and I mean where I don't want to do is lose hope to see all these problems and say we can't do anything because with all the issues out there there must be something we can do I think it's just making sure that we're very mindful on how all of this can greatly affect again just getting it to where it's useable and I think that that's what we the goal needs to be if you know we're designing these things to help clients these tell clients and so making sure that we're doing the best we can to get to get to that point so any other quick questions. Yes. So you're saying the problem is proximity. Again that the problem is awareness and it's aware it's well that it's that information isn't available to me if I don't know that that exist so where's the gap why do people not know it exist. While And who are we educating or not educating. Yeah you know I mean it's there are so many factors but I think instead of just saying I see it all the time I manage a virtual group of social workers and try to share a lot of these things that are out there but I'm sure I've done Levon years I've done this and I can't tell you how much literally every week to go on credit and you know that existed and then you feel sort of like how we're going to outwork them had no idea that was three miles away from a but it's just unfortunately in a lot of these disciplines we were forced to be reactive not proactive so you know we because of the scenario or situation we're just helping them with the walker because they need a walker obviously we're not showing them all the different steps to get to that point so I think there's so much room for education there's so much room for supporting each other interdisciplinary support I just I want to keep the conversation going I want to identify the issues and then get creative with them what can we do to get through some of these barriers. So. Well I think as generations change. You know when and how people access information is changing. And that's unfortunately what we see most stuff right now is it's situational and reactive. Technologies. Are. The last.