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On behalf of those who have the disease, a caregiver offers requests for how to treat people with dementia.
A woman who works with people with dementia knows how she would want to be treated if she had the disease and offers her own list of “16 Things I Would Want, If I Get Dementia.” Rachael Wonderlin, the director of Memory Care at Blue Harbor Senior Living, specializes in long-term dementia care. Her first request:
“If I get dementia, I want my friends and family to embrace my reality. If I think my spouse is still alive, or if I think we’re visiting my parents for dinner, let me believe those things. I’ll be much happier for it.”
— Rachael Wonderlin
She would also ask that you “ask me to tell you a story from my past” and wants you to know that she “still likes receiving hugs or handshakes.” Whatever you do, “don’t talk about me as if I’m not in the room.”
For a list of all 16 requests for how to treat people with dementia, visit the Alzheimer’s Reading Room.
These small dwellings in residential neighborhoods provide a family environment with individualized care for the same price as an institution.
While surveys show that most older people want to live in their homes as they age, for many this is unworkable, as they face loneliness and lack of support for health and physical issues. Often, seniors don’t want to leave their homes because they fear losing their independence if they move into care facilities such as assisted-living or nursing homes.
That’s where the Green House Project comes in. For older adults who can no longer live on their own, this alternative nursing home provides shared living and 24-hour support, but with the ability to live as independently as you desire. A Green House (which is not green in color, doesn’t provide a place to grow plants and doesn’t refer to an environmentally progressive place) is a large house generally shared by seven to 10 adults (although some places have more). Each resident has their own room and bathroom, but shares a communal kitchen and living room.
The Green House Project describes itself as providing long-term and post-acute care. In the words of its founder, William H. Thomas, the Green House Project aims to create “a real home that provides care but also supports those seeking to redefine the worth and meaning of late life. [It] represents a massive shift toward the deinstitutionalization of older people. It generates human warmth, as opposed to institutional coldness, through its commitment to small size (seven to 10 residents in each house), its de-emphasis on hierarchy and its complete dedication to fostering a new expression of elderhood” (fromNext Avenue).
How It Started
Film Documents One Town’s Efforts
With a strong desire to take care of their elderly, a group of citizens in the small town of Sheridan, Wyo., went through a 12-year struggle to establish a Green House project. The effort involved finding land and funding, having to change the local laws to make this kind of care possible and raising millions of dollars during the 2008 economic crisis.
A documentary, Homes on the Range, captured the struggle and ultimate success: the only independent, not-for-profit, purely grassroots skilled nursing facility in the United States, not affiliated with or dependent on a larger corporation or hospital. Four cottages were opened in 2013, with 48 residents and 65 support staff, and plans are to add more houses, including cottages for veterans’ groups.
The film has been shown on PBS stations around the country, and is available as a DVD. A short clip is available from the Media Policy Center
Thomas, a geriatrician, international authority on elder care and author of four books on the subject, cofounded Eden Alternative in the 1990s. The nonprofit organization partners with nursing homes and other long-term care facilities with the aim of deinstitutionalizing them. In 2003, he started the Green House Project, also a nonprofit organization, which puts into reality the philosophy of the Eden Alternative. The Green House Project partners with the Robert Wood Johnson Foundation, which provided a $10 million grant in 2005, and Capital Impact Partners, which provides technical assistance and coordinates financing. The first Green House Project home was constructed in 2003 in Tupelo, Miss. In December 2008, the project reached its goal of completing 50 houses by 2010. As of February 2015 there are 174 Green House homes in 27 states with another 186 in development (Wikipedia).
How a Green House Works
Unlike traditional nursing homes, which can be huge institutions, Green Houses are literally homes, usually situated in a neighborhood. They are centered on a large living room, dining room and kitchen in one great room, which encourages communication and community. Rather than residents eating at different, smaller tables, they share one large table, emphasizing the sense of a family or community eating together. Each resident, called “elder,” can furnish and decorate their room and bathroom how they want (unlike institutionalized rooms with largely bare walls).
Residents can get up in the morning and to go to sleep when they want, which provides a lot of freedom and flexibility. In contrast, nursing homes enforce a strict sleeping and eating schedule. In Green Houses, residents can eat when they want, although meals are often shared.
To ensure quality, Green House homes are trademarked and built to strict certifications. These dwellings meet federal and state licensing requirements and operate within existing regulatory and cost frameworks.
How the House Is Staffed
Green House homes are staffed by a nurse 24 hours a day. Other staff include certified nursing assistants who perform all the duties found in a traditional nursing home, including dressing, bathing and toileting. Green Homes also provide physical, occupational and speech therapy, but often in a Green Home dedicated for that purpose. For example if an organization built six green homes, it would dedicate one to short-term rehabilitation, in order not to disrupt the routine of the main homes, according to Scott Brown, director of the Green House Project.
Residents with Alzheimer or other forms of dementia are integrated into the home, although some organizations have built homes specifically for those with Alzheimer’s. Although Brown was unable to provide a figure for the staff-resident ratio, he said the “time dedicated to direct care exceed ratios in traditional nursing homes.”
The relationship between the staff and residents is viewed as a partnership rather than the traditional nursing-home role of caretaker and patient. For example, the Eden Alternative’s definition of care is “that which helps another to grow. . . . It acknowledges that opportunities to give and receive are abundant and experienced by everyone involved in the care relationship.” Residents are encouraged to interact with staff and even develop personal relationships.
To emphasize the more informal relationship with residents, staff members are given playful names. The Shahbaz works with the clinical support team of nurses, therapists and dietary professionals to provide individualized care for each elder. The Guide is responsible for the operations of the home, while the Sage is a local elder who volunteers to be a mentor and adviser.
How Much It Costs
Despite the smaller residences, independent research has found that Green Houses cost the same or less to operate than traditional nursing homes, while delivering four times more personal and social contact (Next Avenue). One study found Green Houses cost $1,300 to $2,300 less in total Medicare and Medicaid costs per resident over 12 months than traditional nursing homes. At a Green House in Grand Rapids, Mich., a monthly stay is $10,230, comparable to a good nursing home (New York Times).
Organizations are making an effort to help low-income seniors get into Green Houses. Thanks to a $2.2 million loan through Age Strong, an initiative of the AARP Foundation, Capital Impact Partners and Calvert Foundation, a new Green House in Akron, Colo., plans to have 60 percent low-income residents who are covered by Medicaid. The Green House, expected to open this year, will replace an outdated traditional nursing facility.
Green House Project homes that are licensed as traditional nursing homes are eligible for the same Medicaid and Medicare reimbursements as a traditional nursing home. If the facility is licensed as assisted living, Medicaid reimbursement depends on the state’s assisted-living provisions. For Medicaid, the expenses are equivalent to the traditional Medicaid costs for nursing homes. For private pay, each facility determines its own cost structure.
What Research Has Shown
Several studies have favorably compared Green Houses to traditional nursing care. The Robert Wood Johnson Foundation Green House Workflow Study found that nursing home residents were hospitalized more often (more than 7 percentage points higher per resident over a 12-month period) than Green House residents. As such, annual Medicare hospitalization expenditures per resident were less in the Green House unit relative to traditional units.
A 2009 evaluation of the Green House Project’s care found it provided higher direct care (23–31 minutes more per resident per day) than traditional nursing homes and more than four times as much staff engagement with elders outside direct-care activities (Wikipedia). In a 2004 report presented to Congress, researchers from the University of Minnesota School of Public Health found that elders in a Green House Project home were able to perform daily functions longer than those in traditional nursing facilities. Among those living in Green House homes, there have been increased reports of mobility and social interaction, and fewer reports of weight loss and depression.
“New Homes on the Range: Better Care for Elders,” Dec. 1, 2014, Next Avenue
“Homes on The Range–Change our elder care!“, Indiegogo
“GreenHouse in Akron, CO will offer homelike care,” Age Strong
“A Revolution in Life Beyond Adulthood,” July 31, 2012, Next Avenue
“Green House Project,” Wikipedia
“Culture Change Goes Mainstream,” May 2010, Robert Wood Johnson Foundation
“The Green House Project: The Next Big Thing in Long-Term Care?,” July 30, 2015, A Place for Mom
“Small Residences for the Elderly Provide More Personal, Homelike Care,” Nov. 20, 2015, New York Times
Blog posting provided by Society of Certified Senior Advisors
According to new research, stereotypical views on aging can negatively affect our hearing and memory skills, according to University of Toronto researchers. In a study of 301 adults ages 56-96, scientists assessed each person’s view on aging, the perception of one’s memory and hearing abilities, and actual hearing and memory performance on tests. Those with negative views about aging who believed they had hearing and memory challenges performed poorly on tests. Dispelling stereotypes about aging could improve confidence in hearing and memory abilities, researchers say.
On Wednesday, May 18th we held our semi-annual Tour of Senior Communities event! This fun-filled event featured tours of 4 unique communities in the Greensboro area, breakfast, lunch, door prizes, and LOTS of great information about Senior Living!
Choice Connections of NC wants to thank the participating communities, Heritage Greens, Spring Arbor, The Carillon, and Brookdale Lawndale Park, for giving the group a great tour. We also want to thank the event sponsors who help make the day happen: Home to Home in Guilford, Realty 55+, and Gate City Advisors.
Keep an eye out for our next Tour of Senior Communities event!
Decreased fluid intake can exacerbate age-related problems, such as declining kidney function, causing seniors’ health to worsen and sometimes landing them in the hospital.
When Walter, 94, got the stomach flu, he became so weak from vomiting that he was taken to the hospital, where he received fluids. A week later he was back in the hospital after falling in his assisted-living apartment. After the second hospital visit, unable to stand on his own, he entered a nursing care facility. It’s likely that, in the intervening week between hospital visits, Walter, who suffers from early dementia, didn’t know to keep drinking water or other fluids and stay hydrated. In a two-week period, he lost 20 pounds and had to start using a wheelchair.
Dehydration, which occurs when someone loses more water than they take in, is a serious problem, and a frequent cause of hospitalization, especially for the elderly. Depending on the definition of dehydration, between 6 and 30 percent of people aged 65 years and older who are hospitalized are dehydrated (International Journal of Preventive Medicine). In a related study, researchers found that 48 percent of older adults admitted into hospitals after treatment at emergency departments showed signs of dehydration (Parent Giving).
Causes of Dehydration
As we age, several bodily functions decline that make us more susceptible to dehydration. When you add in other outside factors, such as the stomach flu, the combination can turn an otherwise healthy person, like Walter, into someone suffering from various medical issues. Causes of dehydration include:
Water loss. As we age, the body doesn’t hold as much water because we lose muscle mass, while our fat cells increase. By the time we’re 80, we have 15 percent less water than when we were 20, making our bodies more vulnerable to dehydration from even minor fluid loss.
Kidney decline. Starting around age 50, and becoming more serious around age 70, the kidneys begin to lose some of their ability to remove toxins from the blood. Because kidneys are less able to concentrate urine, we expel water more quickly as we age.
Less sensation of thirst. Older people lose the sensation of being thirsty, much as our taste buds decrease as we age. Also, some seniors may drink less because they fear incontinence.
Medications. Drugs such as diuretics, laxatives and angiotensin-converting enzyme inhibitors (used to treat high blood pressure, among other conditions) can cause more frequent urination or perspiration, which interferes with fluid balance. Psychotropic medications, such as antipsychotics, cause dryness of the mouth, constipation or urinary retention, which can affect hydration. Additionally, older adults are often taking several medications at once, further complicating the problem.
Illness. Vomiting is a major cause of dehydration, because of fluid loss. A fever has the same effect, and generally the higher your fever, the more dehydrated you may become. A combination of diarrhea and vomiting, as in Walter’s case, can increase the risk of serious health issues.
Older adults also tend to eat less, which can also mean less liquid intake. Nursing homes present their own challenges for hydration of elderly residents (see sidebar).
Severe Consequences of Dehydration
Dehydration can lead to serious complications, including (from the Mayo Clinic):
- Swelling of the brain (cerebral edema). Sometimes, when you’re getting fluids after being dehydrated, the body tries to pull too much water back into your cells. This can cause some cells to swell and rupture. The consequences are especially grave when brain cells are affected.
- Seizures. Electrolytes—such as potassium and sodium—help carry electrical signals from cell to cell. If your electrolytes are out of balance, normal electrical messages can become mixed up, which can lead to involuntary muscle contractions and sometimes a loss of consciousness.
- Low blood volume shock (hypovolemic shock). This is one of the most serious, and sometimes life-threatening, complications of dehydration. It occurs when low blood volume causes a drop in blood pressure and a decrease in the amount of oxygen in your body.
- Kidney failure. This potentially life-threatening problem occurs when your kidneys are no longer able to remove excess fluids and waste from your blood.
- Coma and death. When not treated promptly and appropriately, severe dehydration can be fatal.
- Heat injury. If you don’t drink enough fluids when exercising vigorously and perspiring heavily, you may end up with a heat injury, ranging in severity from mild heat cramps to heat exhaustion, or potentially life-threatening heatstroke.
One researcher compares dehydration to a pump trying to work with less fluid, which puts a greater strain on the heart. For older adults with serious medical conditions, dehydration has been linked to increased rates of death. Despite what seems a trivial matter, the costs of not treating dehydration early can be high: a U.S. study in 1999 evaluated the avoidable costs of hospitalizations due to dehydration at $1.14 billion (from Hydration for Health).
How to Avoid Dehydration
To make sure you or someone you’re caring for is staying hydrated, the most important factor is to drink plenty of fluids. Standard advice is to drink at least five 8-ounce glasses of water daily. One formula is to drink the number of ounces of water daily that is equivalent to one-third of the person’s body weight in pounds. For example, a 150-pound woman would need 50 ounces of water daily, or about six 8-ounce glasses of water.
Although water is the best beverage choice, to motivate someone to drink, you may need to cater to their preferences, such as fruit juice. (However, if the individual is diabetic, caution should be used because of blood glucose values and dietary restriction of sugars) or decaffeinated coffee and tea. Avoid alcohol and caffeine, which have a diuretic effect, causing the kidneys to excrete more water. Caregivers should ensure the older person they are caring for has water by their side at all times—for example, on a bed stand or next to their favorite chair—especially if they do not walk much.
In addition, if the individual has a swallowing problem and needs thickened fluids, this needs to be watched carefully to avoid aspiration of liquids into the lungs. If dehydration is suspected, because the person is not drinking or does not have a normal urine output, a temporary solution could be a sports drink, which has electrolytes needed by the body. However, caution needs to be taken to not over-consume because of the sports drink’s higher sodium content.
Eat high-water-content fruits such as watermelon, berries, grapes and peaches. Water-rich vegetable options include tomatoes, lettuce and summer squash. Soups are also a good way to sneak extra liquid into a diet.
Check urine color to make sure it is clear or pale yellow. Dark urine or infrequent urination is a classic sign of dehydration, as is decreased urination and urine output.
Other signs of dehydration to watch for are:
- Dry and sticky mouth
- Dry skin
- Confusion and irritability
- Sunken eyes
- Unconsciousness or delirium
- Difficulty walking
- Dizziness or headaches
- Inability to sweat or produce tears
- Rapid heart rate
- Low blood pressure
“Oral Hydration in Older Adults: Greater awareness is needed in preventing, recognizing, and treating dehydration,” June 2006, American Journal of Nursing
“Hydration and the elderly,” Hydration for Health
“Prevention of Dehydration in Independently Living Elderly People at Risk: A Study Protocol of a Randomized Controlled Trial,” Oct. 19, 2015, International Journal of Preventive Medicine
“Dehydration,” Nursing Home Abuse Guide
“Dehydration: Risk factors,” Mayo Clinic
“Dehydration: A Hidden Risk to the Elderly,” Parent Giving
“Elderly Dehydration: Prevention & Treatment,” April 21, 2015, A Place for Mom
Blog posting provided by Society of Certified Senior Advisors
In tribal societies, older adults are valued because they have useful skills. A scholar suggests ways we can appreciate seniors in the modern world.
Traditional hunter-gatherer societies treat their elderly better than modern society does for several reasons, says Jared Diamond, a “civilization scholar.” In tribal societies, elders continue to perform useful services such as producing food and babysitting grandchildren, which frees the adults to hunt and gather. In our modern culture, we have books and Google that serve as our sources for knowledge, but in tribal societies, elders serve as the repository for information about medicine, politics and food, among other topics. Their knowledge can mean the difference between survival and death.
In the modern world, older adults are devalued in a Puritan-based culture that places worth on self-reliance, work and youth. Diamond offers suggestions for how to improve seniors’ lives in a youth-based culture. Listen to his informative talk on “How Societies Can Grow Old Better.”
Blog provided by Certified Senior Advisors (www.csa.us)
Seniors are in a good position to take advantage of this new model, either by finding a “gig” job or sharing their house, car or bicycle
—while making money.
When it comes to being thrifty and saving money, seniors could learn from the younger generation. Millennials are paving the way to what is known as a shared economy, where we don’t have to own our own car or lawnmower but can share the resources and therefore consume and spend less. At the same time, older adults are in a good position to benefit financially from the “gig economy,” the other side of the shared economy, in which you can rent out a room or give rides to strangers—all for money, of course.
What makes the shared economy possible is the Internet, which provides a communal database where you can find and connect with a service or person. You can also post reviews and read others’ opinions of the driver you’re using or the Airbnb room you want to rent.
What Is a Shared Economy?
At its purest form, a shared economy is individuals sharing with other individuals: whether a power saw, car or house. However, a shared economy usually involves a business, which sets up a mutual platform for sharers and seekers to find each other. While some websites have no charges, others, such as car-sharing company Uber and home-sharing organizationAirbnb, have fees or commissions.
In fact, Uber, backed by Google and Goldman Sachs, is valued at $18 billion, while Airbnb is valued at $10 billion respectively (Great Transition), and are treading into the area of big business. A PricewaterhouseCoopers report estimated that the sharing economy, which totaled about $15 billion in 2014, could grow to $335 billion by 2025. It’s a big enough industry that cities are grappling with how to control some aspects. Taxi drivers are up in arms over Uber’s ability to charge less, while cities are setting up new laws to manage or tax Airbnb rooms.
Yet advocates of the shared economy like to point out that we don’t use—24 hours a day–all the possessions we have accumulated: cars, bicycles, blenders, chainsaws, a two-car garage. By sharing our unused items with someone else, we’re saving resources. The shared economy also lets you save money because you are dealing more directly with the seller or service provider and sharing expenses. For example, even with Airbnb’s cost and fees, it’s still less expensive than a hotel.
For older adults, the gig economy lets you work how much and when you want. Seniors who feel isolated can meet new people by giving them a ride or walking their dogs. In addition, seniors have accumulated a lot of assets over their lifetime: a house that once held children is big enough to rent out a room. A garage that had two cars only holds one now, so you can lease the extra space. You can even temporarily rent out a car that’s not used much anymore.
At its most idealistic, advocates say the shared economy satisfies a human need for interaction. In one study of conversations with Lyft riders and drivers, practically everyone said some version of the following: “I like dealing with real ¬people” (Wired.com).
Here are some of the better known companies and their services:
Companies such as Uber and Lyft are different from traditional taxi services because an individual uses their own car to give rides. You need a smartphone to access and pay for a ride. The Lyft or Uber’s app stores your credit card information, so no cash is involved.
Uber is also proving to be an attractive job for seniors, especially retirees, who want to pick up some extra income. Nearly 25 percent of Uber’s drivers are over age 50, according to a study commissioned by the company. In fact, Uber recently partnered with AARP in an effort to attract older drivers, who are perceived as more reliable.
Other services, such as Turo, link car owners to individuals who want to rent a car, either for an hour or a day. On average in the U.S., cars are idle for 22 hours of the day (Casual Capitalist), so there’s plenty of inventory for those who would rather not own a vehicle.
Airbnb and HomeAway use their websites to connect a homeowner with someone who wants a less expensive and more personal place than a hotel to stay. Websites post pictures of the rental unit plus reviews from previous tenants, so you can get a good idea of what you’re getting. You pay online to Airbnb, which then passes your payment to the host, after taking a 3 percent commission.
For seniors with bigger houses than they can use and/or with financial needs, Airbnb and Home Away allow you to rent out all or part of your house. If you decide to winter in Arizona, you can rent out your house for those few months and make some extra money. More than 10 percent of Airbnb’s hosts are over age 60.
Several sites, including TaskRabbit andFiverr, offer a shared place for work opportunities: either providing the job or finding someone to do the task. Fiverr is oriented toward technical work, such as building a website, while TaskRabbit is geared to chores such as repairing a door or shoveling a sidewalk.
For those selling their work, Fiverr takes $1 for every $5 worth of work you sell. Buyers must pay a processing fee of 50 cents on purchases up to $10, and 5 percent on purchases above $10. TaskRabbit charges by the hour and takes a fee for every job.
If you need to borrow money and don’t want to deal with banks, several online networks will lend you funds—to be repaid with interest, of course.LendingClub claims to be the world’s largest online marketplace connecting borrowers and investors. It provides a lower interest rate than credit cards for borrowers and a higher interest rate than savings accounts for lenders. LendingClub offers loans up to $40,000 for financial issues such as debt consolidation, paying off credit cards and elective medical and dental procedures. The service says its borrowers reported an average interest rate that was 35 percent lower than they were paying on their outstanding debt or credit cards. Prosper is another peer-to-peer lending service.
DogVacay connects pet sitters with pet owners. It’s generally cheaper than a kennel and offers the kind of personal service a kennel can’t. For example, most kennels don’t provide a daily update, with photo, of the cute things your dog has been doing while you’ve been gone, as DogVacay does. If the sitter encounters problems, they can phone DogVacay’s 24-hour hotline for help.
If you’re worried about leaving your dog with the wrong person, DogVacay puts all its sitters through an approval process. Boarding rates start at $25 per night, which includes pet insurance that covers up to $25,000 in vet bills per pet.
Operating on the premise that we trust our neighbors more than strangers, several websites connect people who live in the same area—whether subdivision, town or section of a city. NeighborGoods and Peerby offer websites to share goods, such as power tools or a punch bowl. Advocates of the shared economy like to point out that sharing resources, such as a lawnmower that we might only use once a week, cuts down on our consumption of goods. Peerby says it has processed more than 100,000 transactions and has 500,000 users.
Nextdoor does more than offer a place to trade items. Neighbors can share information also—about lost dogs, a new development going up or the name of a good handyman. Before signing up, an individual must verify their home address and provide a real name (also verified). Each Nextdoor website is encrypted.
Other sharing services are Spinlister, which connects bicyclists, skiers, surfers or snowboarders who want to share their sports equipment; Etsy.com, an international marketplace for handmade and vintage items; and Guru.com and Freelancer.com for finding freelance work and workers.
To find other sharing-economy websites, check out Collaborativeconsumption.com, which lists about 1,400 companies in 16 categories.
How Safe Is It?
In a shared economy, we do something that we’ve been warned about our whole lives: Don’t trust strangers. In fact, the National Opinion Research Center’s 2012 poll found that only 32 percent of respondents agreed that people could generally be trusted, down from 46 percent in 1972.
Many shared-economy services work to ease consumers’ fears and make sure your experience is a safe one. Big companies like Uber and Airbnb do background checks on drivers and renters, respectively. More than most shared-economy platforms, Airbnb tracks each step of the booking process looking for suspicious signs. TaskRabbit says its “taskers go through an extensive vetting process before they can join our community.”
Online reviews and ratings make it easier to spot potential problems with vendors or buyers. You can use Facebook and other social networks to find a profile or other information about the stranger who wants to rent your car or bedroom.
At the same time, insurance doesn’t always cover all aspects of this new economy. Airbnb offers liability coverage, but it’s secondary to your own homeowners insurance, which may not cover damage caused by a guest. Similarly, your personal auto insurance might not be enough if you are driving strangers around.
Before embarking on a gig in this new economy, you should find out what you are liable for and what the company and your insurance will cover. Otherwise you might find yourself having to pay for expenses that surpass the extra income you earned.
“Seniors gear up for the sharing economy,” Aug 20, 2015, Reuters
“How Retirees Can Make Money in the Sharing Economy,” Aug. 20, 2015, U.S. News: Money,
“The Digital Senior Part 1: Sharing Economy Secrets to Independent Living & Earning In Retirement,” The Casual Capitalist
“The Sharing Economy Attracts Older Adults,” Sept. 25, 2015, New York Times
“On the internet, everything is for hire,” March 9, 2013, The Economist
“Debating the Sharing Economy,” October 2014, Great Transition Initiative
“How Airbnb and Lyft Finally Got Americans to Trust Each Other,” April 23, 2014, Wired
“The 6 Risks for Sharers in the Sharing Economy,” June 21, 2014, Huffington Post
Blog posting provided by Society of Certified Senior Advisors
If you are familiar with the Diane Rehm show on NPR, you know she does a great show. Recently, she covered the cost of caring for a loved one with Alzheimer’s. It is an excellent show. Take a listen here. Enjoy!