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|A Newsletter of FCA's National Center on Caregiving|
January 26, 2011
Volume XI, Number 2
| IN THIS ISSUE|
State Legislation, Policy & Reports
- New York: Governor Cuomo Considers $2 Billion In Cuts To Medicaid Program More...
- California: Governor's Proposed Budget Eliminates And Reduces Services For Elderly And Disabled More...
- Massachusetts: Plans To Make $15 Million In Cuts For Elderly/Disabled More...
- State Budget Revenues Sank 30% In 2009 More...
- Kentucky: Advocate Suggests 1% Increase In Sales Tax To Pay For Elderly Services More...
- Minnesota: State Alzheimer's Plan Released More...
Federal Legislation, Policy & Reports
- Advanced Care Planning Won't Be Funded By Medicare. More...
- Medicare Expenditure For Patients With Advanced Dementia More...
- Changes For Older Adults Under Affordable Care Act More...
- Medpac Recommends Instituting Copay For Home Health Care Services More...
- Study Finds Large Variation In Medicare Spending More...
- Chinese Consider Law Requiring Children To Visit Parents More...
- Poll In Canada Find Many Lacking In Knowledge About Alzheimer's More...
- Study Finds Flexible Working Conditions Facilitate Caregiving More...
- Report Suggests Australia Aged Care System Will Need To Adapt More...
Research Reports & Journal Articles
- Doctor's Role In Posthospital Care Is Critical For Smooth Transitions More...
- Report On California's Paid Family Leave Program More...
- Research Links Depression And Belly Fat To Dementia More...
- Report Provides Updated Statistics On Older Americans More...
Conferences & Trainings
- Applications Being Accepted For New Ventures In Leadership Program More...
- Webinar: "How To Select An In-Home Care Provider" More...
- Webcast: "Public Policy, Elder Abuse, And Adult Protective Services" More...
- NASW Releases Standards For Social Work Practice With Family Caregivers More...
Funding, Media & Miscellaneous
- Lifespan Respite Care Program Reauthorization Input Requested More...
- N4a Announces 17th Annual Aging Policy Briefing April 11-12 More...
- Contracts For States To Integrate Care For Dually Eligible Individuals More...
- PBS NewsHour Focuses On Explosion Of Baby Boomers More...
- Professor In New Jersey Explains Importance Of Direct Care Aides And Contemplates Medicaid More...
- Oregon Center Of Applied Science Seeks Caregiver Participants To Test Resource Website More...
New York: Governor Cuomo Considers $2 Billion In Cuts To Medicaid Program
In his plan to overhaul the New York Medicaid program, Governor Cuomo is considering reducing state spending on the program by about $2 billion in the next fiscal year. With matching funds from the federal government, this cut totals more than $4 billion. The governor also appointed a Medicaid Redesign Team, charged with finding ways to reduce costs while improving quality for a program that costs $53 billion annually while providing health care to 4.7 million New Yorkers. A recent report by the United Hospital Fund analyzed Medicaid rate of service use and levels of spending per recipient across New York State and found that spending in New York City accounts for 66% of long-term care spending statewide. New York City also had a significantly lower level of nursing home spending (52%) and higher share of spending on home health services (80%) and personal care (84%). For more information, visit:
Wall Street Journal "Cuomo Targeting Medicaid Spending"
New York State Medicaid Redesign Team Website
United Hospital Fund: "Medicaid Long-Term Care in New York: Variation by Region and County"
California: Governor's Proposed Budget Eliminates And Reduces Services For Elderly And Disabled
Governor Jerry Brown released his budget proposal earlier this month and it calls for massive cuts to programs serving the elderly and disabled. While the budget passed in 2010 called for a 3.6% cut to In Home Supportive Services (IHSS) program, Governor Brown's proposed budget includes an additional 8.6% reduction for IHSS. Adult Day Health Care (ADHC) services would be eliminated as a Medi-Cal benefit and all optional benefits in the Multipurpose Senior Services Program would also be eliminated, including housing assistance, personal care and chore assistance, protective supervision, respite, transportation, meal services, social service and communication devices. Medi-Cal beneficiaries would also have copayments of $50 for ER visits and $100 co-pays ($200 maximum) for hospital stays. Lydia Missaelides, director of the CA Association for Adult Day Services, interviewed in a New American Media
article covering the cuts, explained that eliminating the Adult Day Health Care program may be short-sighted on several levels. First, California will lose the matching federal payment by cutting this program. Second, without ADHC, some of the current program participants (estimates range from 27,000 to 37,000) may move to institutional care, however, there are only 2,000 nursing home beds available at any time in California with price tags of $70,000 a year. Third, if the 330 ADHC program sites are dismantled, then re-creating them and re-licensing them (for example, to address the influx of baby boomers) will be inordinately costly and difficult. Missaelides also points to a 2010 analysis of a similar plan by Governor Schwarzenegger that found eliminating ADHC would cost (not save) the state $51.6 million in 2010-11 with that expense rising to over $412 million by 2040-2041. For more information, visit:FCA Blog: "CA Proposed Budget: Sweeping Cuts in Support Services"
SCAN Foundation: California's Proposed 2011-2012 Budget: Impact to Senior-Related Programs
New America Media: "California Health Advocates Decry "Painful" Cuts for Seniors
Lewin Group: "Projected Economic Impact of Eliminating California's Medi-Cal Adult Day Health Care Program"
Massachusetts: Plans To Make $15 Million In Cuts For Elderly/Disabled
Massachusetts state officials announced plans earlier this month to make $15 million in cuts to MassHealth, the state Medicaid program. The proposed cuts would take effect in March 2011, and include cuts to the rates paid to long-term care providers, adult day health programs and day habilitation programs. A series of "listening sessions" have been scheduled for February. The executive director of Mass Home Care, Al Norman, explained: "We've unfortunately been through this before with programs that unfortunately are targeted to poor people... They tend to be some of the first victims of these type of cutbacks ... The antidote is to go to the Legislature." For more information, visit:
The Boston Globe
The United ARC of Franklin and Hampshire Counties
State Budget Revenues Sank 30% In 2009
A recent report from the U.S. Census Bureau found that state revenues dropped 30.8% between FY 2008 and FY 2009. In a Washington Post
article about the drop in revenues, Nicholas Johnson, director of the state fiscal project at the Center on Budget and Policy Priorities (CBPP), suggested that next year "will actually be the most difficult budget year for states ever...If you look at the gap between the cost of providing public services and the revenue available to provide them, it remains very large." State Health Facts, a project of the Kaiser Family Foundation, recently posted a "Measure of State Economic Distress" that includes data for each state on the number of homes in foreclosure, unemployment rates, and utilization of SNAP (new name for Food Stamp program). Higher enrollments in Medicaid has increased strain on state budgets, and 33 Republican governors recently signed a letter to President Obama, requesting the ability to cut Medicaid enrollments without losing federal money. Under current law, states won't be able to change eligibility rules until 2014 when health-insurance exchanges are operating. For more information, visit:
Washington Post: "Recession-bruised states' revenue sank 30 percent in 2009, Census Bureau reports"
Kaiser Family Foundation: "Measure of State Economic Distress"
Wall Street Journal: "GOP Governors Seek Leeway to Cut Medicaid Rolls"
Kentucky: Advocate Suggests 1% Increase In Sales Tax To Pay For Elderly Services
A recent article in the Courier Journal
focused on a proposal suggested by Kentuckians for Nursing Home Reform to increase the state's six percent sales tax by one percent, which the organization suggests could generate $500 million a year to fund services for the elderly. Bernie Vonderheide, the founder of the organization, explained that he is suggesting the proposal because of concerns about potential cuts to the state Department of Aging and Independent Living. This department funds services including Meals on Wheels, housekeeping and personal care. According to the article, the department has already experienced cuts of about $6 million since 2008, causing waiting lists to swell to more than 25,000 people. For more information, visit:
Courier Journal: "Advocate for elderly urges tax hike for services"
Minnesota: State Alzheimer's Plan Released
On January 13th, 2011, the Minnesota Alzheimer's Disease Working Group released a report entitled "Prepare MN for Alzheimer's 2020." The working group of 20 members was created as part of a state law that passed in May of 2009. The report includes 23 recommendations for the state legislature, state agencies, and the University of Minnesota. Proposals within the report include training and encouragement for doctors to detect Alzheimer's disease earlier, cognitive screening for all Minnesotans 65 and older in state-paid health programs, and a "dementia clearinghouse website." A number of states have also completed Alzheimer's state plans or are in the process of completing the plans. For more information or to see if you state has an Alzheimer's plan, visit:
"Preparing Minnesota for Alzheimer's: The Budgetary, Social and Personal Impacts"
Alzheimer's Association: "State Government Alzheimer's Disease Plans"
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Advanced Care Planning Won't Be Funded By Medicare
The Obama administration reversed course on a policy and announced earlier this month that Medicare would not pay for discussions about advanced care planning as part of the annual Medicare wellness visit. Advanced care planning can include creating an advanced directive which allows a patient to communicate his or her health care preferences if they become unable to make these decisions for themselves. Several recent studies have analyzed end-of-life care and advanced directives. A study in the January issue of Annals of Internal Medicine (Volume 154, Number 2), analyzed legal issues with Advanced Directives that may prevent a patient's preferences from being followed. Some of the issues include poor readability (all laws were written above a 12th grade reading level) and restrictions on health care agent or surrogate restrictions (40 states don't include same-sex or domestic partners as default surrogates). Another study by the CDC found that care recipients under age 65 were less likely to have any advanced directives than recipients aged 85 and over and that the most common type of advanced directives were living wills and do not resuscitate orders. For more information, visit:
Kaiser Health News: "Making End-Of-Life Decisions Is Hard On Family Members"
Annals of Internal Medicine: "Lost in Translation: The Unintended Consequences of Advance Directive Law on Clinical Care"
CDC: "Use of Advance Directives in Long-term Care Populations"
Medicare Expenditure For Patients With Advanced Dementia
A study published on the Archives of Internal Medicine website in January examined Medicare expenditures for 323 nursing home residents with advanced dementia. The authors find that the largest percent of Medicare expenditures were for hospitalizations (30.2%) and hospice (45.6%). For participants who passed away, mean Medicare expenditures increased by 65% in each of the last four quarters prior to death. The authors conclude that expenditures varied substantially and that strategies to promote high-quality palliative care may help shift spending away from aggressive treatments for patients at the end of life. For more information, visit:
Archives of Internal Medicine: "Medicare Expenditures Among Nursing Home Residents With Advanced Dementia"
EurekAlert Summary of Study: "Aggressive care raises Medicare costs in end-stage dementia"
Changes For Older Adults Under Affordable Care Act
A recent announcement by the Administration on Aging includes information on changes in the Medicare program under the Affordable Care Act. Under this law, as of January 1, 2011, Medicare beneficiaries will have access to a new, "Annual Wellness Visit," and cost-sharing is also eliminated for preventive services rated an A or B by the US Preventative Services Task Force. In addition, a "Physician Compare" Website now provides information on doctors, including whether or not they accept Medicare. Medicare beneficiaries who purchase drugs while in the "doughnut hole" will also benefit from reduced cost sharing, including a 50% savings on covered brand name prescriptions and a seven percent discount on generic drugs. The Administration on Aging has also created a newsletter dedicated specifically to changes under the Affordable Care Act. For more information, visit:
Administration on Aging Announcement About Improvements To Medicare
Administration on Aging "Affordable Care Act News" December 2010-January 2011
Medpac Recommends Instituting Copay For Home Health Care Services
Earlier this month, members of the Medicare Payment Advisory Commission (MedPAC) recommended to Congress creating a copay for home health care services provided through Medicare. Members of the Commission agreed on a copayment of $150 for each 60-day home care treatment period or episode. The chairman of MedPAC, Glenn Hackbarth, explained that evidence suggest copays have the potential to reduce health care use. Staff members from MedPac suggested that there was a 17.7% profit margin in 2009 for free-standing home health agencies. For more information, visit:
Commonwealth Fund: "Washington Health Policy Week in Review MedPAC Backs a Copay for Home Health"
Associated Press: "Seniors may have to pay for Medicare home health"
Study Finds Large Variation In Medicare Spending
A recent study by the Medicare Payment Advisory Commission (MedPac) analyzed variation in spending and service use among Medicare beneficiaries. This issue had gained increased attention after a 2009 article by Dr. Atul Gawande in the New Yorker that highlighted McAllen, Texas, as the city with one of the highest costs per beneficiary for Medicare at $15,000 a year in 2009, which he pointed out was nearly twice the national average. The MedPac study controlled for differences in labor costs, yet still found wide variation in spending. "Specifically, service use in higher use areas (90th percentile) is 30 percent greater than in lower use areas (10th percentile); the analogous figure for spending is about 55 percent." For more information, visit:
MedPac: "Report to the Congress: Regional Variation in Medicare Service Use"
Commonwealth Fund: "Washington Health Policy Week in Review MedPAC Study Finds Variations in Use of Post-Acute Care in Medicare"
New Yorker: "The Cost Conundrum-What a Texas town can teach us about health care"
Chinese Consider Law Requiring Children To Visit Parents
A recent commentary in the Globe and Mail examined a legislative proposal being considered in China to require children to visit their parents or face fines or jail time. The author explains that China's "one-child policy" may have reduced the number of potential caregivers to care for an aging population. In addition, economic changes have forced children to move away from their parents, and the author cites the example of a 35-year old mother who would like to visit her parents, but is troubled by the cost of a train ticket that would consume one-third of her monthly budget. The author concludes: "Legislating relationships is a tricky business. If it takes the threat of a lawsuit to get your delinquent kids to visit, what exactly do you hope to chat about over tea?" For more information, visit:
Globe and Mail: "China trying to force children to visit aging parents"
Poll In Canada Find Many Lacking In Knowledge About Alzheimer's
A recent survey commissioned by the Alzheimer Society of 1,006 adults aged 45-65 found that many Canadians are lacking in their knowledge of dementia. Twenty-five percent of respondents could not name any of the symptoms of the degenerative brain illness, and only 50% identified memory loss as a key warning sign. While more than one-third of the respondents said they had been personally impacted by Alzheimer's, their knowledge level was only slightly higher than those who had been unaffected by Alzheimer's. For more information, visit:
Globe and Mail: "Canadians know way too little about dementia, survey finds"
Alzheimer Society: "Alzheimer's disease...it's more than you think Canadian Society"
Study Finds Flexible Working Conditions Facilitate Caregiving
A recent survey of 1,600 workplaces in Britain that included a random sampling of up to 25 employees in each workplace finds two flexible working practices are most associated with employees providing informal care. Flextime and the ability to reduce working hours were associated with about 10% more hours of informal care for both men and women. The ability to reduce working hours appeared to facilitate care mostly among full-time workers, while flextime seemed to help with small amounts of care, but did not affect employees who were providing intensive caregiving. For more information, visit:
Institute for Social and Economic Research University of Essex "Access to Flexible Working and Informal Care"
Report Suggests Australia Aged Care System Will Need To Adapt
A draft report by an Australian government commission suggests that Australia will need to make some dramatic changes in order to provide care for an aging population that will need complex care for diseases including dementia and diabetes. The authors project that the number of people aged 85 and older will increase from 400,000 in 2010 to 1.8 million by 2050. An article in the Sydney Morning Herald covering the report quoted Doctor Germaine Greer, a public health advocate, who pointed out that women are disproportionately impacted by caregiving because most of the women in residential care are women and most of the informal and professional caregivers are also women. For more information, or to provide feedback on the draft report visit:
Australian Government Productivity Commission "Caring for Older Australians"
Sydney Morning Herald: "Productivity report on aged care welcome start to debate"
Doctor's Role In Posthospital Care Is Critical For Smooth Transitions
In a recent "Clinician's Corner" in the Journal of the American Medical Association, Dr. Robert Kane suggests that doctors play a critical role in helping families understand their available posthospital care options. Dr. Kane suggests that doctors have two crucial roles, including ensuring a seamless delivery of primary care, and to advocate for and facilitate better decision making. He explains that informed, sound decision-making can be hampered by the time-pressure associated with hospital discharges. He also suggests that doctors should have a basic knowledge of the options available to a patient being discharged and if they can't serve as the planning facilitator then they should at least make sure that the planning is completed competently. For more information, visit:
Journal of the American Medical Association "Finding the Right Level of Posthospital Care 'We Didn't Realize There Was Any Other Option for Him'"
Report On California's Paid Family Leave Program
California was the first state in the nation to pass a comprehensive Paid Family Leave (PFL) program in 2002. A recent research report surveyed 500 employees and 253 employers to determine the law's impact. The authors report: "Most employers report that PFL had either a "positive effect" or "no noticeable effect" on productivity (89 percent), profitability/performance (91 percent), turnover (96 percent), and employee morale (99 percent)." In terms of employees, the authors find that exempt employees (mainly managers and professionals) have more access than non-exempt employees to employer-provided benefits like paid sick leave, vacation, disability, and parental leave. From the sample of 500 survey respondents, the researchers also interviewed 50 employees who had experienced a "qualifying event" that should have been covered by the program, yet more than half of respondents didn't know about the existence of the program and low-wage workers, immigrants, and Latinos were least likely to be aware of the program. For more information, visit:
Center for Economic and Policy Research: "Leaves That Pay: Employer and Worker Experiences With Paid Family Leave in California"
Los Angeles Times: "California family leave program gets high marks in study"
Sacramento Bee Viewpoints: "Family leave program has proved its value, but it could do more"
Research Links Depression And Belly Fat To Dementia
Two recent studies in the Journal of the American Geriatric Society focused on dementia. One study of 6,376 post-menopausal women aged 65 to 79 years old found that the 508 women who had significant depressive symptoms had about twice the risk for developing mild cognitive impairment and probable dementia as women who weren't depressed. In another study of 7,163 post-menopausal women aged 65 to 80, researchers found that excess weight on belly or hips is a risk factor for cognitive impairment and probable dementia in normal-weight women. Dr. Diana Kerwin, one of the authors of the study, explained that every one point increase in a woman's body mass index meant a decrease of one point in her cognitive test score. For more information, visit:
American Geriatric Society: "Older Women who are Depressed Have Twice the Risk for Developing Mild Cognitive Impairment and Dementia Later in Life"
American Geriatric Society "Belly Fat" Raises Cognitive Impairment and Dementia Risks for Older Women"
Report Provides Updated Statistics On Older Americans
A recent report produced by the Federal Interagency Forum on Aging-Related Statistics provides data on the status of the US population aged 65 and older. The report includes 37 indicators, grouped into five sections, including population, economics, health status, health risks and behaviors, and health care. The older population in the US is expected to double from an estimated 35 million aged 65 and older in 2000 to 72 million in 2030, which will be almost 20% of the US population. The percentage of people aged 65 and over who are obese increased since 1988-1994 from 22% to 32% of the population in 2007-2008. Health care costs for older Americans experienced a dramatic upsurge, from $9,224 in 1992 to $15,081 in 2006. Increased health care costs also drove out-of-pocket spending for health care, which grew from 12% in 1977 to 28% in 2006. For more information, visit:
Federal Interagency Forum on Aging-Related Statistics: "Older Americans 2010: Key Indicators of Well-Being"
Applications Being Accepted For New Ventures In Leadership Program
The American Society on Aging's New Ventures in Leadership program, a 12-month leadership program for professionals of color working in the aging community, is accepting applications for the 2011-2012 class. The program is in its 19th year and has graduated more than 330 leaders since its inception in 1993. Applications are due by February 15th, 2011. For more information about the program or to apply, visit:
American Society on Aging New Ventures in Leadership
Webinar: How To Select An In-Home Care Provider
On February 9th at 1pm (Eastern time) the American Society on Aging will present a webinar providing an overview of issues in hiring in home care. The presenter for the webinar is Dr. Amy D'Aprix, for more information or to register, visit:
American Society on Aging: "How to Select an In-Home Care Provider"
Webcast: "Public Policy, Elder Abuse, And Adult Protective Services"
The National Center on Elder Abuse and the National Adult Protective Services Association will jointly host a webcast focused on January 31 at 1pm Eastern time. The speaker, Paula Mixon will discuss the role of national and state policies related to Adult Protective Services (APS) and will also discuss significant public policy issues. For more information or to register, visit:
The National Center on Elder Abuse and the National Adult Protective Services Association "Public Policy, Elder Abuse, and Adult Protective Services"
NASW Releases Standards For Social Work Practice With Family Caregivers
The National Association of Social Workers (NASW) recently announced the release of the NASW Standards for Social Work Practice with Family Caregivers of Older Adults. According to the authors, the standards are designed to enhance social workers' awareness of the skills, knowledge, values, methods, and sensitivity needed to work effectively with family caregivers. The standards were developed as part of an initiative with the AARP Foundation, the US Administration on Aging, Family Caregiver Alliance, and the National Association of Social Workers, with funding support from the John A. Hartford Foundation. For more information, visit:
National Association of Social Workers
Lifespan Respite Care Program Reauthorization Input Requested
The Administration on Aging is seeking input concerning the reauthorization of the Lifespan Respite Care Program (LRCP) that is expected to be reauthorized in 2011, effective for FY 2012. While legislation creating the program was passed in 2006 with appropriations of $289 million for FY 2007 through FY 2011, Congress did not fund the program for FY 2007 or 2008, and funding for FY 2009 and FY 2010 was $2.5 million each year. In addition, Vice President Biden's Caregiver Initiative, which would have provided additional funding to provide an estimated additional three million hours of respite, was not passed because Congress passed a Continuing Resolution bill instead of passing the Senate Appropriations Bill funding the Departments of Health, Labor, and Human Services. Input is due by March 31st, 2011, and Family Caregiver Alliance strongly encourages family caregivers to provide input on how their lives have been affected by the Lifespan Respite Care Program. For more information, or to provide input, visit:
Administration on Aging
Congressional Research Service: "Family Caregiving to the Older Population: Legislation Enacted in the 109th Congress and Proposals in the 110th Congress" (Jan, 2008)
National Association of Area Agencies on Aging Legislative Update (8/4/2010)
Vice-President Biden's "Caregiving Initiative"
N4a Announces 17th Annual Aging Policy Briefing April 11-12
The National Association of Area Agencies on Aging (n4a) recently announced that it will sponsor its Aging Policy Briefing in Washington DC on April 11-12. The briefing will provide attendees with information about federal policymaking and detailed policy information on a range of issues. During the second day advocates will travel to Capitol Hill for visits with their lawmakers. For more information or to register, visit:
National Association of Area Agencies on Aging
Contracts For States To Integrate Care For Dually Eligible Individuals
The Innovation Center at the Center for Medicare and Medicaid (CMS) announced a contracting opportunity (not grant) for states to "support the design of innovative service delivery and payment models for dual eligible individuals." CMS plans to award contracts to up to 15 states with contracts of up to $1 million each. The applications are due February 1, 2011. For more information, visit:
The Innovation Center at the Center for Medicare and Medicaid (CMS)
PBS NewsHour Focuses On Explosion Of Baby Boomers
A recent episode of PBS NewsHour focused on the implications of some of the first of 79 million baby boomers turning 65 in 2011. Judy Woodruff interviews Ted Fishman, author of "Shock of Gray" and Nicholas Eberstadt of the American Enterprise Institute about some of the impacts including increased utilization of Medicare and Social Security. For more information or to view the program, visit:
PBS NewsHour: "U.S. Faces 'Explosion of Senior Citizens': Will Baby Boomers Strain Economy?"
Professor In New Jersey Explains Importance Of Direct Care Aides And Contemplates Medicaid
Michael Ogg, a retired, 56-year old physics professor with primary progressive multiple sclerosis (PPMS) described his experience with professional caregivers in a recent article in
Health Affairs. Through a county program, he qualifies for 28 hours of care a week but only uses 21 hours in order to stretch his funding. While he has long-term care insurance, he expects that it will run out in five years, and he explains that he is preparing to eventually enroll in Medicaid when he has depleted all of his resources. Depending on New Jersey's budget situation, he may be able to use Medicaid to pay for services that allow him to remain in his home, or he may be forced into institutional care. For more information, visit:
Health Affairs: "Running Out Of Time, Money, And Independence"
Oregon Center Of Applied Science Seeks Caregiver Participants To Test Resource Website
The Oregon Center for Applied Science, Inc. is designing a new website to support families and friends of seniors with heart failure. The website offers tips about daily weighing, when to call the doctor, eating less salt and asking for help.
To join the study, you must be caring for a loved one who is 65 years or older and has heart failure. You also need an email address and access to a computer with a high-speed Internet connection. Those who qualify will earn $50 for visiting the website and completing two online surveys.
This research is being conducted by the Oregon Center for Applied Science with funding from the National Institute on Aging. All names are kept confidential. There are no sales or mailing lists involved. For more information, contact: email@example.com or call 1(866)730-3211 ext 3Content goes here. For more information, visit:
Oregon Center Of Applied Science
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