Nursing Home costs

Discussion in 'Politics' started by Mensch1351, Sep 21, 2011.

  1. Mensch1351

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    I've said before that I work with older adults in a self pay Independent Living Retirement Community. Our average age is 87! The people who live there have done fairly well in life making average Middle Class incomes carefully managed, PLUS the fairly hefty capital gains they made after owning their homes for 45+ years! (Our county is a bedroom community of Kansas City and is quite prosperous!) We are one of the more reasonably priced facilities costing about $1,800 for a small studio apartment; $2,300 for a one bedroom and $2,900 for a 2 bedroom. This includes 3 meals, light housekeeping, 24 hour manager on duty, entertainment (that's MY job), and transportation 5 days a week, 8 hours a day. There is NO buy in -- it's strictly a month to month agreement!

    Other facilities like ours in our area can run upwards of $6,500 per month for 1 bedrooms and many have an $80,000 to $100,000 up front buy in cost.

    I have seen many of our residents HAVING to be transferred to a full care nursing home for many reasons; Altzheimer's progression; a serious illness; stroke; etc. For our married residents, sometimes the one spouse lives with us while the other spouse is in a full care nursing home.

    Just recently, one of our residents who currently pays $2,300 per month, had to put his wife in a full care nursing facility. On the parking lot in our conversation he told me that the cost for her alone is $7,000 per month. "Don't you have long term care insurance?" I asked. He replied, "Well, they are going to pay $2,000 per month of that $7,000!" I was stunned. Between he and his wife, even with long-term care insurance, he will personally be responsible for $7,300 per month! Over just 1 year, this will amount to $87,600! And this does NOT take into account whatever MEDICAL bills accumulate for various reasons.

    We have individuals in our building that have lived there for more than 8 years, and I have seen some of those transferred to nursing homes living there for more than 5 years!

    Given that the Republicans want to cut back on Social Security, Medicare and Medicaid ----- just how in God's name is any "Average Joe" going to be able to afford any kind of quality of life with these kinds of costs? Do the people running our government have a CLUE just what kind of massive burden BOTH continuing good quality care for our growing elderly population is going to cost as well as the individual burden people will have to bear if the government pulls the rug out from under some of these people will be? Surely as a nation, we can "collectively" find a way to reasonably fund the programs we have now AND insure that they WILL be there as a safety net for people who live into their 90's!

    I would be very interested to know (if you are aware) what the costs of full care nursing facilities are running in your particular area of the country.

    If you're in your 30's ---- do you have any idea what these kinds of costs are going to be (especially if they are corporately run with the particular goal of profit) in another 40 years?

    If you're in your 50's or 60's what kinds of plans are you making now to ensure some quality of life into retirement if the government just decides, "We can't AFFORD to continue being the safety net for those in dire straits!"

    Will be interested in your responses. (also some stories you may have of personal experiences with elderly parents, etc.) Thanks!
     
  2. FuzzyKen

    FuzzyKen New Member

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    In New Mexico they are cheaper. I cared for my Mom until her death which was in the Coachella Valley (Palm Springs area) in Southern California. I had no choice because even though I was making good money, it was cheaper by miles to care for her than it was to try and pay the care bill. She had moderate dementia and because of severe osteoporosis she was not ambulatory. The estimates for a facility that was a total snake pit was about $6,500 per month. If I had taken her to a place that would not have drugged her at her first complaint into even higher profits I would have been looking at over $10,000 per month. This meant at that time that I would have been working for nothing and could not have paid my bills. Most of these places are snake pits and if the old men or old ladies complain they are drugged until they are nice and quiet. In addition, this is a great profit "enhancer" because the lower the function level of the patient the more they cost. I have seen many run into bankruptcy by this kind of care.

    You bring up a very good point with this posting and it is a shame that most are not aware of what they face if and when Mom and Dad or either one in a singular capacity need a level of help you cannot give.

    The one thing is that there is help available at home. Many private insurance carriers will pay for care givers and other help in the home of the children or relatives and if things get really bad a few MD signatures and the care becomes "hospice".

    The sad part is that there is no actual way to make plans for this kind of care. There is no guaranteed investment and no legitimate insurance that will not take scissors to the bill and leave you the kids of the needy still holding the greatest percentage of the bag.

    The only alternative is to have the kid or the relative take care of you and that is it. There is no real "safety net" on this one with the exception of incredible wealth and I am talking millions here.

    Want to get really rich! Open a nursing home where you can hire a staff of which 85% is paid minimum wage and the few professionals you fire when they want a raise. Then you buy the cheapest food that you can "nuke" in bulk. Then all you have to do is to make certain that the areas they check are always perfect. These include the cleaning, any odors, water temperatures, the heights of shower dams, the condition of shelving and refrigeration. Your only problem will be that every family who can't pay the bill will counteract your efforts by calling Adult Protective Services and making up stories to avoid paying the multi-thousand dollar bill each month. I have known many in this business and I have watched very few of them lose money, with most getting VERY rich very quickly.
     
  3. D_Percy_Prettywillie

    D_Percy_Prettywillie Account Disabled

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    I'm in my twenties and to be honest? I feel like I'm more likely to see a UFO than I am to see a social security check and by the time I'm old enough to qualify for any sort of governmental assistance growing old in this country will, again, equate to growing poor.

    Based on what I do for a living I'm never going to be uber wealthy and that isn't my goal in life. So when I project out, beyond the point I'm able to take complete care of myself, the view is kind of grim. I think things to myself like "Why not smoke? I won't be able to afford any kind of real assistance anyway, so why prolong it?"

    I want to live out my final years with some dignity. I want life to equate to more than just paying for the last ten years of it. Hopefully, I'll do enough in my life to make that possible but then again, how in the name of all that is Holy does one prepare for the sort of exorbitant end of life care costs that are seemingly on the rise?

    It seems like there isn't a way (at least the Greatest Generation didn't find it.) And if it's up to Congress to do something about the prospects? My hopes sink even further. There's a serial killing rapist loose in Mayberry and I'm not convinced the local PD is up to the task.





    JSZ
     
  4. B_jdunhill

    B_jdunhill New Member

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    I am in Canada and it is 1900$/month for my grandpa. 87 slight dimensia, managed diabetes, and severe kidney issues related to it and congestive heart failure. A little over a week and a half ago he came back to his room and found a new resident in it, and in his always sharp wit told him to get the hell out of there...this guy beat him up and he broke his hip right at the ball and got 28 stitches on his arm. he is now medicated to the point that the dimensia is all encompassing so he needs a nurse posted at the door. Post surgery and with anaesthetic issues with the elderly the home is saying that I need to scource out a private nurse to keep him in bed post surgery and another nurse for his physiotherapy and rehabilitation. He has only been in this facility for 6months and it was onlny because I couldn't care for him in his own home anymore on my own. I have no siblings and greedhead parents who insist on retiring south to flee the winters here for 7months. He made it through WW2 without a scatch and now this may be his undoing....it was a miracle he made it through such an invasive surgery, so I am interested in the experiences of this group in this thread. All new adventure day by day to me. I have a house 6 blocks away from him and a job even closer now thankfully. While I am aware the costs are significantly less in Canada, I am more curious as to quality of life and the performance of facilities run for profit such as these.
     
  5. FuzzyKen

    FuzzyKen New Member

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    The reason that your Grandfather is going downhill on a bobsled is that he is probably being "drugged" by the administrators of the facility. They usually hire "cooperative" MD's who are willing to "play the game". If you feel that your Grandfather's problems are not characteristic there are other things here. The facility where your Grandfather was staying IS 100% liable for the physical assault and battery committed against him by another patient and I would get a local Attorney involved in that one very quickly. I can guarantee you that if this had happened to my family member I would be filing suit against the facility. Allowing a situation accidental or otherwise to happen to your Grandfather is absolutely positively wrong and is legally actionable in the United States. Because this involved a criminal act it is very likely actionable in Canada as well. Get with an Attorney quickly on this one and find out what their responsibility is. This is six figure lawsuit territory my friend and the financial proceeds of that litigation could pay the co-pay and or provide a great deal of luxury in the final days of your Grandfather's life!
     
  6. dandelion

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    My grandfather was cared for at home during his last days by my aunt. Lived with her for years previously after my grandmother died. My uncle and great aunt were cared for at home by my mother after also living there for their last years. Certainly none of them could have paid for private care and I doubt they could have survied in state care for nearly so long. My grandfathers aunt lived with him and his wife untill she died of a heart attack. My grandfather then had to move in with my aunt as I said, but his aunt who was then about 103 had to go into state care. She lasted barely a few weeks. I'm not saying it was bad care, but it was the shock and dislocation which killed her. My fathers granparents in earlier days moved in with him and his parents and they all pooled resources to move into a suitably bigger house. In due course the oldest generation died at home. My mother has an elderly friend who is getting weaker. I don't know that she would want to, but if it comes to it, I am sure she would be welcome to move in with my mother. My sister has said mother would be welcome with her if it comes to that.

    I guess I am saying this is the traditional answer to health care costs. Some of these people have had quite modest state payments which you can get in the Uk to help care for someone who is sick.

    What experience I have of institutional care is that the chance of accidents of one sort or another is a lot higher than at home. An elderly neighbour was taken into hospital last year after she collapsed. They finished her off in a few weeks. She had no relatives, but I would suspect she would be alive now if she had the choice to be cared for by someone living at home. No, I am sure she would.
     
    #6 dandelion, Sep 22, 2011
    Last edited: Sep 22, 2011
  7. witch

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    Board & Care homes in San Diego run about $1500 to $ 2000, which mostly hire their help from out of the USA ……… care is shabby to down right criminal. But the owners know how to “play” the Game, so complaining to State Licensing Boards can put your loved ones in danger.
     
  8. Jason

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    This is a UK issue also. Residential care is typically £500-£800 per week. Almost no-one has long-term care insurance - the insurance market scarcely exists. In a few cases the state will pay, but bluntly the facilities paid for are dire. Many state-funded residents share a room with a stranger, unless they are classed as too I'll. There is no facility to pay a top-up for something better - it's either put up with state provision or pay £700pw for something better. Or easily a lot more.

    Care in the community works reasonably well. The UK system covers nursing care, domestic support, meals. Typically a person can have five visits a day from services, plus an emergency button. In many cases this support does seem appropriate.

    Best of course is families who care for their relatives. The state offers very little support for this.

    Some of the saddest individuals are people with dementia who do need 24 hr supervision, which makes a residential home necessary for most advanced sufferers. As support can be needed for years it is very often state funded, even if individuals start off privately funded. it is not nice.
     
  9. B_jdunhill

    B_jdunhill New Member

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    I have to focus on him taking a first step right now. Then my next step will be legal. He had his stitches out and first day of physiotherapy yesterday. This facility is well aware of my displeasure and has circled the wagons so to speak with staff and admins. They are overcompensating now but it is all too late. I am focusing on getting him back to some semblance fo normal before I consider aggression against them....can't be in two places at once.
     
  10. dude_007

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    This is exactly why healthcare costs are so high.
    Life happens, and people sue. Why is the facility responsible for this? While it is terrible what happened to he gentleman's father, is it really the facility's fault this happened?

    People don't want to take care of their elderly parents so they put them in a nursing home and then complain or sue. If you only knew the constraints with operating a SNF... you've left quite a bit out in your description of operating a skilled nursing facility.

    And they are expensive because they have 24 hour Skilled Nursing care....that is a Director of Nursing, enough RNs to meet state ratios, LVNs and CNAs. Then you have housekeeping, dietary, an activities coordinator plus the staff in that department, occupational therapy, physical therapy, speech therapy, an administrator and business office staff, psych and social services....
     
    #10 dude_007, Sep 25, 2011
    Last edited: Sep 25, 2011
  11. dude_007

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    Also, I do not know where all the people you claim to know opened skilled nursing facilities, but I used to do the reimbursement and accounts receivable for a corporation that operated skilled nursing, and none that I know of were goldmines. In fact, most made very humble profits.

    Also, if one does adequate research, you can find good places with caring people.
     
    #11 dude_007, Sep 25, 2011
    Last edited: Sep 25, 2011
  12. dude_007

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    And to answer the OP, no, I do not think the people who want to cut social security, Medicare and Medicaid know or even care what happens at that point. You think nursing homes and health care in general are bad and expensive now, just wait until those programs get cut.
     
  13. travis1985

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    Every legal regulation put in place raises the cost. If the cost is getting prohibitive, it's time to re-examine what the reason behind it is. (The staff of most nursing homes is NOT rolling around in $100 bills, if that's where you think the money is going.)

    The only real solution to the problem is to ensure that your financial situation is taken care of. A previous poster lamented that the Greatest Generation had not found a way to do that. Maybe not each member of it, but several certainly did: for example, all four of my grandparents, who were considered lower-middle class. No generation is going to have a 100% success rate when it comes to saving for old age, but the Greatest Generation certainly did a better job with their money than any since. Saving adequately to be self-sufficient in old age is easier said than done, I know, but everything in life is, and financial virtue is its own reward.
     
  14. dandelion

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    Modern society is set up on the assumption that you will borrow. Must borrow. Therefore you will not save. Simple, really.
     
  15. FuzzyKen

    FuzzyKen New Member

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    Sorry to say that Healthcare was for decades our "family business". My Stepfather was an MD who reported two separate facilities in Southern California when he found RN's giving patient that were "complainers" medications that were NOT ordered by MD's to "shut them up".

    You yourself have made my point. Your own statements talk of the number of supposed skilled workers in these facilities. A man is physically assaulted by another patient and nobody in that facility is responsible?

    I am sorry because I have unfortunately had a great deal of first hand experience with this. I have personally seen more atrocities than I care to even recount for this board.

    Rooms designed for 3 beds with beds stacked to get more and more patients in less space to bring in more money.

    When you place a loved one in a facility that is by law a contract where you are entrusting the care and well being of an individual with diminished capacity to others who are as part of their responsibility supposed to provide a safe and caring environment in place of the relative themselves giving that care. I can go into the legalities and where in law this is covered and under which legal precedents.

    A more clear example would be a post surgical hospital patient being wheeled out of surgery and falling off of a gurney breaking bones in a hallway. The person is at that time under the influence or is unconscious from the anesthetic yet to wear off. If that happens the facility and it's ownership is 100% responsible.

    It is a total misconception that this "raises medical costs". Litigation filed based on this against incompetent or substandard facilities reduces the costs of patient care by removing dishonest and disreputable facilities from the business. Litigation like this goes to State Licensing and I can name facilities who were quickly closed by licensing in Southern California for far less than this.

    As you and I would both agree, there are some real scum bags out there who learn how to as we also both agree "to play the game". But, absolving a facility of "wrong doing" when a patient is assaulted and is the victim of battery by another patient is absolutely wrong.

    There are patients who as they develop dementia are prone to violence and temper outbursts. These are patients that are not suitable for conventional facilities and the facility admissions people or those "placing" a patient with this kind of problem in a facility where they can be a danger to themselves or to others is again a reason for litigation not a reason against it.

    Now, here is the HOW one raises costs:

    When you file litigation against a res care, these facilities by law are required to carry insurance for problems such as this. The insurance companies rarely fight these cases when a patient is the victim of battery, and the reason that they do not is if they are prosecuted successfully, they usually lose far more money than if they walk in with a pile of money and try to settle "out of court". Where the "cost increase" comes in, is that as is common in the insurance industry as a condition of settlement, most insurance carriers try and get a "gag order" on the family of the victim and if they are competent mentally, the victim of the battery. They do this to protect the inferior facility partially, but, the main reason they do this is because they the insurance carrier as a penalty to that facility raise the insurance premiums the facility pays much as a malpractice carrier raises premiums on an MD who has a dismal track record. When their insurance premiums are nuked to the stratosphere because of problems it is true that the facility in question will either be forced to accept reduced profits, or they will be forced to increase their charges to the patients that they are supposed to care for.

    My own experience with these facilities is that that quality of care is in the direct inverse to the number of beds in the facility. A Mom and Pop 6 bed facility in my own experience often provides a greater quality of care than a 100 bed facility. There are good and bad on both ends of the scale, but the larger they are the more the problems are likely to rear their ugly head. They become more cumbersome and hence it is far harder to assure anything from the quality of the food to the quality and training of the hired help.

    I have heard all kinds of stories and whining from people at these facilities too. Those who "bellyache" in this business are amazing. This business has more ways to write expenses and supplies against gross profit than you can imagine. The tax write-offs are staggering and anyone who says they are not has the wrong accountant.

    The cost of health care is being raised by the following: Insurance providers placing profits above care. The FDA under the management of representatives of the businesses it is supposed to control and regulate. Doctors relying on many expensive tests rather than knowledge of diagnostics costing the carriers. I have seen individuals given partial "cat scans" for $3,500 for a broken limb when a common x-ray for 1/10th the cost would have determined the same thing. The worst contributor I see however is the medical insurance providers themselves. Again this was the family business and it would take more space than I have on this board to explain how a medical insurance provider escalates costs. They the insurance carriers create from what I can see a hefty part of the burden. This combined with the other factors has reduced the quality of care and skyrocketed the costs.
     
  16. dandelion

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    Yes there are lots of organisational reasons why care is expensive but the bottom line is care means care provided by another person. labour is expensive. 24 hour care means three shifts a day. three full time salaries. Three people needed to look after one.
     
  17. Mensch1351

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    Thanks Ken -- wow -- very thought provoking (and sadly soooo much truth). I just see the long term upshot to all of this is that people doomed to working low wage jobs for most of their life will have few options if Medicaid is phased out entirely all because it's just one of those "big government give-away programs of entitlement!" Total assets at admission become a big factor (and will become even a greater factor) for whether or not you will be even admitted.

    My mom only had about $80,000 in assets when I had to put her in a nursing home. The FIRST question I asked was, "How many of these beds are Medicaid?" They responded, "All of them!" I was indeed suprised. The last thing I wanted to do was have to move my mom because her assets had been depleted (she could have lived for a few more years as my grandmother did when she had to go into a nursing home). Watching someone you love slowly die is sad enough as it is -- worrying about having "enough" is just an extra burden that I believe our society CAN and should address. Over time, we will be known as a nation who discards their poor and elderly and sick because their wasn't any profit in it!! Those who cried out, "Let him die" at the Republican Tea Party debate were simply giving verbal expression to what a lot of that crowd believes and wants to put into practice: I have -- you don't -- tough shit! And it looks like the "have nots" are going to vastly outnumber the "haves" of the future!
     
  18. FuzzyKen

    FuzzyKen New Member

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    Dear Mensch,

    Care for the elderly and chronically ill is going to be one of the biggest concerns we have in the next ten to twelve years. The longer we wait to bite the bullet and just cover the whole damned country under "Medicare" the worse this mess is going to be. If you look at the major medical insurance providers most of them are in to other forms of insurance. The loss of medical care insurance is not going to bankrupt them no matter what they say.

    HMO's will simply convert themselves over to being care providers, and the number of job losses there will be minimal as well. We are creating not massive unemployment in the insurance industry, we are creating a job shift within that same industry to adapt to the changing needs of the changing times. All of the above can shift their policy needs and convert their existing policies to cover the luxuries in hospitalization and if they want to they can in fact create "impound accounts" for elective cosmetic surgical procedures and actually make money. I believer that Argentina covers plastic and cosmetic procedures under their government insurance plan for their citizens. There is one Country in South America that does in fact do this.

    One of the things I hate here is the "Boo HOO HOO!" Poor little multi-billion dollar insurance carriers that pay million dollar bonuses to CEO's, while allowing people to die horrible deaths in the name of profit.

    They yell we are broke! We are going bankrupt! and if you look carefully you will throughout this country find numerous skyscrapers owned by insurance providers.

    What many Americans are seeing is deliberate "disinformation" designed to increase profits for a few very powerful companies.

    I never thought that I would be in favor of "single payer" medicine or what some who have to put a political spin on everything call "socialized medicine". If the Companies were honest and legit, and put patient care first instead of profit and loss statements they would make the money but in a different way.

    When an insurance company or medical corporation loses in Court, the awards to the victims of their callous lack of care are most often in the millions of dollars. Nationwide, these lawsuits are being won not because the providers are good and victims bad, but, because these individuals have been proven to have directly caused or contributed to the maiming or death of an individual. These cases spend years in court, and still the companies lose. The losses each year by these companies in litigation costs and payments for damage or death in fact are an example of penny wise and pound foolish. If they fixed the problems they would not be in court in the first place. To them they tack their own cost saving measures on at the other end complaining the whole time. Remember that if an insurance company loses and appeals repeatedly and loses again and again that the awards to the family and patients usually escalate as the judicial system and a jury of our peers listen to the same hack crap again and again. They of course have the right to appeal because it is part of our constitutional rights.

    Whenever I hear some individual especially a politician belly aching about paying for medical care I know that the individual making those statements either has never seen an abuse or a loss first hand OR they simply have been bought and paid for by the paid shills of these private mega corporations. These days finding blatant abuse is not all that difficult. They don't want to find it and they don't want to look.

    Just remember that the one thing we all need to do is to say enough is enough and to go and remove all of the obstacles in November of 2012 from having reasonable medical care. If the incumbent politician whatever their office may be screwed with medicine and is in favor of denial of care for Americans they need to go! The only thing that can be done is to throw the bum out of office and put in another bum. Eventually as they become one term office holders somebody is going to figure out that they need to try working for the benefit of those people who elected them and NOT for corporate pay-offs. Sadly, the voting booth and the removal of the extremists is the only way to bring back common sense.

    We never solve anything by lack of communication and roadblocking. We solve problems by teamwork dialog and understanding the good and bad of both sides of a debate weighing the risks and benefits of a given plan of action. It is that simple. . . .
     
    #18 FuzzyKen, Sep 27, 2011
    Last edited: Sep 27, 2011
  19. D_Johnson Withernads

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    At the risk of being shouted down for being socialist or a communist...

    I believe there are some things that are common requirements in everyones lives and I don't see why a profit should be made from these services. Profits generally go to the company owners or the shareholders, to either of which is a financial return for a very small percentage of people who will actually require these services at some point or other in their life times.

    Arguments for privatisation generally centre around the benefits of competition and therefore increased efficiencies. I'm sorry but, in the UK at least, privatisation of many industries has led to a worse service being provided at a far greater cost to the consumer, even allowing for inflation, currency fluctuations, employment costs and the vagaries of financial speculation on resources.

    Why should the many, who in the end are only going to end up being reliant on the state for their welfare anyway, have to put up with ever increasing company profit margins, asset stripping and reduced service for things such as:

    Old age care
    Water supply
    Waste water
    Household power

    Even at the levels today maybe only 10% of people are wealthy enough not to have to consider the costs of their lifestyle. I wonder what percentage will really be able to afford the costs of these fundamental basic services come 50 years time?

    Oh, and back on topic, my Gran is in full nursing care in the UK and pays over GBP1100 per week. So you can kiss goodbye to your house, shares and all of your hard earned savings. Hardly a just reward for being responsible all of your life, is it?
     
  20. dandelion

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    But it certainly is a good reason to be irresponsible.

    Isnt it an irony that the Uk government has commenced asset stripping itself throught the PFI initiative.
     
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