ACC Care Center Earns Best Nursing Home Rating

ACC Care Center Earns Highest Rating from U.S. News & World Report

U.S. News & World Report rated ACC Care Center one of its Best Nursing Homes in the country for 2021 and 2022. Our short-term rehabilitation and long-term care earned the High Performing status rating, making the Care Center among the top 13 percent of the nation’s facilities for these types of care. 

This award reinforces what we already know about our Care Center, that it sets the gold standard for compassionate, culturally appropriate healthcare. It opened in 1987 as the first skilled nursing facility in Sacramento to address the culture, language, and dietary needs of elderly Asians. Today, ACC Care Center serves everyone. 

Our staff and volunteers take pride in the stellar care our residents receive and are thrilled to see our team’s hard work rewarded on a national level.

“Congratulations to Care Center Administrator Tamara Kario and the Care Center staff,” ACC board chair Jean Shiomoto said about the ratings. “We are extremely proud of this national recognition by U.S. News & World Report accomplished by the leadership of Tamara and the dedicated staff. Their unwavering commitment to the residents and their families is deeply appreciated by the ACC Board of Directors and the ACC Community.”

This year’s ratings carried additional requirements, making the award even more prestigious. U.S. News & World Report required at least 75 percent staff vaccination rate. Of more than 15,000 skilled nursing facilities evaluated in the ratings, barely 2,000 earned a single High Performing rating. ACC Care Center’s 100 percent staff and resident COVID-19 vaccination rate earned it both ratings for short-term rehabilitation and long-term care.

As part of ACC’s 50th anniversary celebration, Jean Shiomoto and Ted Fong have written an article about how the Care Center got started.  Their article is on page 6. 

Congratulations to the Care Center team for these much-deserved awards! 

ACC Senior Services Staff

Three New Directors Join ACC Senior Services

ACC is pleased to introduce Michael Selland, CPA, as ACC’s new Director of Finance. Michael was the Controller at Agency on Aging Area 4, the funding agency for the Federal Older Americans Act programs in Sacramento and six other counties. As a result, he is familiar with ACC fiscal operations and our staff. Michael obtained his Bachelor of Science in Business Administration from the California State University, Sacramento and is a CPA.

One thing that Michael did not know about ACC is how popular pickleball is. “Now I know, because the courts are right outside my window,” he says. Michael loves to travel and has been to six of the seven continents. He adds, “I still need to check Antarctica off of my list.”

ACC also welcomes Kala Haley-Clark, MPA, MNM, as the new Marketing and Development Director. Kala leads ACC’s philanthropic giving, grant proposals, and sponsorship programs. She also manages the donor services staff who are responsible for processing and acknowledging thousands of annual gifts for ACC Senior Services and Meals on Wheels by ACC. Kala obtained her Master of Non-Profit Management and Master of Public Administration from the University of Oregon, Eugene, and her Bachelor of Arts in Linguistics from UC Davis.

Prior to ACC, Kala ran development and marketing for Integrative Healers Action Network, an emergency response nonprofit helping wildfire survivors and first responders. She was inspired by her grandmother, who earned a master’s degree in gerontology and worked with older adults.

Outside of work, Kala trains for triathlons, watches rugby and hockey, plays Dungeons and Dragons, and is an avid reader. 

Finally, ACC welcomes Moses Momoh, RN, who joined the ACC Care Center as its new Director of Nursing. Working under the Care Center Administrator, Tamara Kario, Moses oversees the nursing staff and overall nursing operations. 

Moses has worked in skilled nursing for most of his career, including 17 years at the VA hospitals in Dallas, Houston, and Mather. His experience also includes mental health, telemetry, trauma, and staff development. 

Moses likes to play Scrabble. He is also an avid tennis and ping pong player. But when asked if he plays pickleball, he said he had not heard of it before. Welcome to ACC, Moses, our pickleball courts await you!

Susan Sarina Retires from ACC Senior Services

Susan Sarinas Retires after 12 Years of Service

ACC Senior Services congratulates Susan Sarinas on her retirement from ACC Senior Services. Susan was our Lifelong Learning and Wellness and TEAM & CHANGES program manager. She played a vital role in developing many of our programs and services at ACC, helping build our Community of Caring. We’re going to miss her in our HCBP Division!  

I got a chance to talk with Susan over lunch and learned so much.  Here’s an excerpt of our conversation:

JS:  Talk about your early days at ACC.

SS: When I first started across the street at Park City, I worked for $12/hour.  I had no office, no cell phone, no extension.  Doreen had a desk with a typewriter extension and I would sit next to her and use that as my desk. I’d do outreach, flyers, bill reviews, all of that. Later I took a position at GT assisting the residents, answering calls, giving tours, doing marketing. Then Bridge to Healthy Families came along.  They needed someone for outreach, education, and workshops. No one else was doing outreach and marketing except Kory at the Care Center. Some years I did 20 or more events on behalf of all of ACC and MoW.

JS: What about LLWP?

SS:  LLWP was always ongoing.  When I took over, we were across the street at the Meals on Wheels building and we had the Computer Lab, two conference rooms, the lobby and the Wong and Kiyama room for classes. After we moved to this building in 2014, we could have lots more classes.

JS: Talk about the classes.

SS: We had lots of language, taichi and yoga classes, different levels and different times so people could come after work too.  Yoga pilates was really popular.  We tried to have something for everybody.

JS: When did you start bringing Buster to ACC?

SS: I found him 11 years ago on Franklin Blvd. at night. I opened my car door and he jumped into my lap! I got a letter from Kaiser designating him as a comfort dog for mental health (laughs). So, Buster has been here since my 2nd year.  He’s seen it all!

JS: Over all these years, what stands out the most to you?

SS: Helping all the seniors and how grateful some of them are.  That means the most, especially TEAM and CHANGES.  

JS: What makes TEAM and CHANGES special?

SS: I think because everybody that does the program really wants to help people and occasionally, you have someone who really, really needs that help.  There was a woman with a special needs son who didn’t have money to replace a broken heater in the middle of winter.  I called the ESAP and they replaced it at no cost.

JS: Well, Susan, I’m going to miss our late afternoon chats.  All of us at ACC will miss Buster, who charmed everyone with his jaunty walk and no-nonsense attitude. Thank you, Susan, for 12 years of service. Your legacy will endure for many years to come! 

SS: Thank you, Jeri!

Tributes to Susan

Bill Tom: “I have accompanied Susan on many outreach visits in the community promoting ACC. She was always a great advocate promoting ACC with the utmost professionalism. I will cherish the outreach visits I worked with her on and hope she will find time to volunteer with ACC.

Jo Fong: “I will miss the cute holiday favors you gave to the staff and volunteers and definitely will miss Buster asking for his daily snacks and then taking his afternoon potty-walk.” 

Nora & George: “It was a pleasure to work with you as your Japanese interpreter,  going to the Japanese Buddhist Church to help Japanese speaking Nisei with bills.   We know Nisei appreciated your hard work very much.     Yes, it was a hard work,  but we also had fun,  didn’t we? Wherever you go and whatever you do,  may sunshine follow you.

George Connor: “The music scene at ACC thrived and flourished, largely due to Susan’s encouragement and support. Being one of the many musicians who grew and developed under that loving support, I will miss Susan immensely. Please stay in touch, Susan, and visit often. Your warm smile lifts us up.

Susan and Buster

Alfred Yee: “Happy trails to you, until we meet again. Happy trails to you, keep smiling until then. Who cares about the clouds when we’re together?  Just sing a song, and bring the sunny weather. Happy trails to you, until we meet again.” (These are the lyric of “Happy Trails,” the closing song from the Roy Rogers Show broadcasted on TV in the 1950s.  Happy Trails to Susan!)

Krystal and Joanne: “Your work ethic inspires us to go above and beyond. You have blessings and appreciations from numerous clients you have helped. It may now be the time to just doing something for yourself and your family! Don’t bother to spend the time even on your own utility bills, bring them in!”

Haroon Abasy: “Thank you for everything you’ve done for me directly and indirectly; it’s much appreciated. The few cases that I worked with you for TEAM, I learned a valuable lesson, which I am grateful for. Best wishes for a very happy retirement; and never give up on your physical activity.” 

Mary Nakamura: I hope you’ll enjoy retirement with the knowledge of the ways you have helped me and countless others over the years, from reviewing phone plans to supporting the ACC Lifelong Learning program, especially the music clubs that met at night.  Take care!

Robert Nakashima: “Congratulations to Susan on her well-deserved retirement! I know that we are all deeply appreciative and grateful for her outstanding efforts on behalf of the ACC and the larger Asian community which it proudly serves. Here’s wishing Susan (and Buster!) clear skies and smooth sailing in all their adventures yet to come.”

Jeri Shikuma: “Here’s to long walks with Buster (and maybe new furry friends too), conquered home improvement lists, and time for whatever comes next.  Here’s to you!  Congratulations, Susan, and salud!”

The Rides Team: “The JILL of all TRADES! Congratulations, Susan

Pickleball Program: We would like to thank Susan for her leadership, input, guidance and patience in developing a system that satisfied government and ACC’s requirements during uncertain times to re-open the Pickleball program on June 25, 2021. We want to wish Susan a well deserved retirement.

There Will Never Ever Be Another Susan

Lyrics modified by Ted Fong from “There Will Never Be Another You” written by Harry Warren and Mack Gordon

There will be many other days like this,
And we’ll be standing here with someone new,
There will be programs in the spring,
Like yoga class and other things,
But there will never be another you.

There will be other dogs that hate me too,
But they won’t growl like Buster used to do,
We’ll miss his nights at ACC,
How will the moon stay blue?
If there will never ever be another you?

There will be other livestreams we can do,
With Dani, Krystal, Sean and Soojin Yoo,
Wieneke has the Rides team,
And Shikuma has Haroon,
But there will never be another you.

There have been special people just like you,
Like Linda, Khonnie, Chia, and Anna Su,
But one thing Susan you should know,
We all agree it’s true,
That there will never ever be another you!

SCSEP Job Club

SCSEP Job Club Provides Extras for Senior Job Seekers

ACC Senior Services is the Sacramento County office for the NAPCA Senior Community Service Employment Program (SCSEP), a federally funded program that assists low-income seniors with job training and finding employment. 

Last October, we started a job club to provide a supportive and positive learning experience in which members are empowered to develop job search and networking skills, resulting in employment opportunities.  There are two groups serving a total of 12 people. Each group meets two hours a week in the ACC Computer Lab.

Our activities include resume-building workshops, mock interviews, and job searching. Since our participants are older adults, we also include discussions about how the pandemic has impacted their lives, discuss ageism in the workplace and provide supplemental technology training. The pandemic has disproportionately affected older adults in the workforce, as they were the first to leave positions, be put on medical leave or furloughed indefinitely due to their high risk of contracting COVID-19. Despite this risk being mitigated with vaccines and improved safety measures, older adults are finding it difficult to reenter the workforce. 

Ageism is the root cause of many barriers our participants encounter in their job search. Beliefs about the productivity and skills of older workers are based on outdated views of aging that create negative stereotypes. The most common stereotype is that older workers are not able to use technology. In job club, our participants learn how to navigate the internet and other forms of office software that are needed in the modern job market. Being in a group setting helps motivate program participants and provides much needed networking that can lead to a job opportunity. 

We are excited to work with our partners, including American Job Centers, to support our senior job seekers in all possible ways to exit for unsubsidized employment. We are also grateful for the financial support of Bank of America and the RBC Foundation. 

Naichin-Koo-1200B

ACC to Sponsor Virtual “Our Life Stories” Conference on Saturday, April 30, 2022

While you may be familiar with Maeley Tom’s beautiful rendition of many favorite standards at ACC concerts, she has also written and published a well-received memoir, I’m Not Who You Think I Am: An Asian American Woman’s Political Journey.  Maeley will be sharing her writing techniques and tips as the keynote speaker at the Our Life Stories Virtual Conference on Saturday, April 30, 2022.

Since 2007, the Sacramento Hart Senior Center and Cosumnes River College (CRC) have co-sponsored a very well attended annual one day intergenerational writers conference at CRC.  Last year, ACC also became an event sponsor. The conference workshops, readings, and panel discussions focus on encouraging individuals of all ages, but particularly older adults, to create their memoirs. While some attendees have been actively writing for years, many more are just getting started.  The Conference is an outgrowth of the ongoing Our Life Stories workshops that the Hart Center has hosted for years and ACC is also now offering.

This event will be held again virtually this year via Zoom to ensure everyone’s health and safety.  Enrollment is limited so we encourage you to register soon.  For presenter information and further details please visit www.OurLifeStories.org.

Lora Connolly is an ACC Board member and the instructor for ACC’s Your Life Story Workshop.

Leonard Williams 2

Leonard Williams Turns Disability Into Ability at ACC Care Center

“One day, the doctor told me I was legally blind,” says Leonard Williams, aged 62. “I had no idea, because my vision loss happened so slowly.”

With his big smile and warm “hello,” Leonard makes his rounds at ACC Care Center delivering laundry to residents and several linen supply closets around the facility. I met him in the laundry room at ACC Care Center to hear his unusual story. 

As a young man, Leonard was the picture of health. He was a runner and he loved to play basketball. He had tremendous physical energy and an irrepressible personality to match. But that changed.

“I got glaucoma when I was 35 or 36. I didn’t feel anything when this was happening,” says Leonard. He worked for 15 years, including a job in construction, until he was declared legally blind. “My left eye has only 9% vision, and I only see 30% in my right eye.” 

Leonard became a statistic. The labor force participation rate for working-age people with no disability was 76% in 2021, according to the U.S. Bureau of Labor Statistics. For people with disability, the rate was 37%. Employer bias is a big factor in this discrepancy. 

Last fall, Leonard entered ACC’s paid job training program (see next story below) and was assigned to work in the laundry room at ACC Care Center. At first, I couldn’t tell he had a disability because he seemed to function like anyone else in that job. Leonard hauls laundry from the washing room to the folding room without missing a step. He folds the laundry fast and with machine-like precision.

“I have to turn my head to see through the narrow part of my right eye that still has some vision. So, right now, I can’t see you,” Leonard tells me. Then his turns his head slightly. “Now I can see your face, but I can’t see your hands or any other part.”

Fortunately, the sliver of vision Leonard still has is enough to get around ACC.  “I’ve pretty much adapted to the space here. I don’t have to count steps or use my blind stick. When I fold laundry, I look and feel my way through the task. Most of the clothes are repetitious like towels, face towels, sheets, blankets, fitted sheets, flat sheets. They showed me how to fold them and I picked it up pretty good.”

Marissa Belmes, the Billing Manager, works next door to the laundry room. “Leonard has such a positive attitude,” she says. “It’s my honor to meet him, knowing that his disability doesn’t stop him from doing his work and other activities of daily living. He gives me the inspiration to come into work every day.”

Your Life Story with Lora Connolly

Age and Distance Pose No Barrier to Writing A Good Life Story

When I began hosting the ACC Writing Your Life Story Zoom Workshop last year, I had no idea whether anyone would sign up.  But we have had a Spring, Summer and now a Fall series and wonderful participation.

Jean Iyeki

Jean Iyeki, who is in her 90s, has been a faithful weekly participant in the Workshop since we began, and she shared childhood remembrances of her family’s time at the Topaz Internment Camp during WWII in the ACC Spring 2021 Newsletter.  She continues to be a weekly participant.

This summer, Jean asked if she could invite her friend, Sada Hatanaka, to join the group although she noted that Sada was traveling during most of the summer and moving to live with family members in Kentucky in the Fall.  I talked with Sada by phone and sent her the Writing Guide.  She told me she was 94 and she really wanted to write the story of her family’s internment at Heart Mountain because she had not talked about it with her children or grandchildren but now feels that “it’s really important that they know what happened and I’m not getting any younger!”  Honestly, it was hard for me to imagine that she would have the time to settle into writing her experiences given the travel and transitions she was going through and that our class meets during dinner time in her new time zone.

Sada Hatanaka

Nonetheless, Sada has been a regular participant in our weekly Zoom group and has begun writing and sharing her family’s experiences from that infamous December 7, 1941 morning, to their temporary settlement at the Pomona Fair Grounds, and then on to Northern Wyoming where they were interned until the end of the War.  Since Sada is a few years older than Jean, and was a teenager when her family was interned, she has more detailed recollections of having to leave their Los Angeles home, the initial internment processing, and the long train trip to the Heart Mountain Relocation Camp.  Her sharing often leads other workgroup participants to ask questions and provide supportive feedback–all of which can be helpful to her in imagining what additional questions her family might have as they begin reading her story.

The Writing Your Life Story Guide includes a variety of topic areas.  Some weeks Jean and Sada have share reminiscences of their time living here in the Sacramento Valley, starting back in the 1990’s.  Recently, when our writing topic focused on our hobbies, leisure time activities, and other things we look forward to doing, Jean shared what she had written about the wonderful times she and her husband had with a group of friends that included Sada and her husband.  This group would go to each other’s homes throughout the year for dinner parties. They were memorable times that were great fun and that they both still remember vividly.

Having Jean and Sada sharing their stories is very special to all of us who are participating in the Writing Your Life Story Workshop.  And while I know many of us wish we could get back to in-person group gatherings, it’s Zoom that’s made it possible for these longtime friends now over 2,000 miles away from each other to be writing and sharing their stories with each other and all of us. And for that we are grateful.

The next ACC Writing Your Life Story Workshop will begin on January 26. You can sign up at accsv.org/online. 

Phone Bills

Don’t Let Your Phone and Utility Bills Get the Best of You

ACC runs two programs that have helped seniors and non-native English speakers in the greater Sacramento region with their phone, internet, and other utility bills. Funded by the California Public Utilities Commission,  Telecommunications Education and Assistance in Multiple-languages (TEAM) and Community Help and Awareness of Natural Gas and Electricity Services (CHANGES) help  older adults sustain their independent and lifestyle. Or more simply, save money and avoid unwanted charges.

Our programs provide a wide range of services, ranging from as simple as setting up a new phone to resolving complicated disputes with utility companies. We also hold utility education workshops in different languages to educate consumers. 

On resident at ACC Greenhaven Terrace was very happy with ACC for the help received in setting up and using his brand new smartphone. He is now an expert. Another client was shocked to discover a “Core Transport Agent” charge on his PG&E bill. He was overpaying his gas bills for five years without realizing it! Many people are happy to enroll in our assistance program that helps them reduce their monthly utility bills. 

Utility bills are part of everyday life and paying them is an “activity of daily living.” However, everyone has the right to fully understand what they are being charged and question anything that does not make sense. 

According to the TEAM and CHANGES 2019-2020 annual reports, over 2,700 consumers received assistance for issues related to telecommunication and over 5,400 consumers received assistance for issues related to utilities from June 2019 to May 2020 in California. 

ACC’s utility assistance program protects the rights of consumers including those with limited English literacy. Our staff works hand in hand with interpreters of different languages to ensure the highest quality of service.

Looking forward to a new year of 2022, we continue to serve as many people in need as we can. It has been announced that 3G wireless network is scheduled to shut down in 2022. This not only impacts older cell phones but also certain medical devices, life alert systems, and security systems.

Are your cell phones or other devices part of the 3G network? Our utility assistance program offers free consultation if you are worried about being impacted by this 3G network shut down.  You can schedule an appointment with us if you have questions about your phone service or have other utility bills you don’t understand. 

Mr. and Mrs. Chow learned about ACC utility assistance program from one of the virtual education workshops ACC hosted. They found it useful and have referred the program to many of their friends in need. 

“All my friends are grateful for our referral. They all said the program staff is helpful and friendly.” said Mrs. Chow. “We will continue recommending this program to those in need for utility assistance!” 

Maeley and Tony Image

As Summer Transitions to Fall, ACC Keeps Moving Foward

By Jeri Shikuma, Administrator, ACC Home and Community Based Programs

July marked the beginning of our Home and Community Based Programs’ Welcome Back Summer, and all indications are that summer was in full swing…. Laughter on the pickleball court, people groovin’ to aqua aerobics in the GT pool, expressions of consternation, then delight in iPhone and computer classes in our redesigned computer lab, plus a myriad of participants tuning in to a full slate of online classes like Zumba Gold with Linda Taylor and creative programming like The Mystery of Willmina Sloppye.  In one way or another, people are getting fit, staying active, and having fun. 

Unfortunately, though, the uptick in COVID-19 cases due to the Delta variant is making our reopening go a little slower than we hoped.  This is frustrating for all of us, but especially for folks who are feeling the mental and physical impacts of nearly 18 months of COVID-related isolation.

The link between social participation (for example, church, sports, cultural, recreational, and volunteer activities) and good health is intuitive and well-documented.  It’s no wonder that recent studies have shown that older adults experiencing social isolation during pandemics are likely to report increased levels of anxiety, depression, poor sleep quality and physical inactivity.  

Maeley Tom and Tony Waterford performed at ACC Greenhaven Terrace.

The staff at ACC understand the importance of social participation; that’s why from the very beginning of the pandemic, we have made it our business to support older adults living alone in the community by providing safe opportunities for being active and engaged, for learning, and having fun, all at no cost to participants.  The Delta variant is causing us to be cautious and prudent in our reopening efforts, but we are still moving forward!  

Our Rides trips taking seniors to their appointments, shopping, and field trips have increased by 200 rides since May.  Participants in our Senior Employment Program are returning to in-person training at their host agencies and provided over 2,700 hours of community service in July.  As part of a Senior Safety Collaborative, we launched a new Senior Escort Program in June to help seniors feel comfortable and more confident to be out and about exercising, doing errands, and going to appointments.  

The Senior Escort Program, as well as our Friendly Visitor Caregiver Support program, needs more volunteers to keep serving seniors in need, and many of our classes and services are open for new participants, so if you want to get more active (and maybe do something that might improve your own physical and mental health too!), call us or visit our website at accsv.org for more information on how to get involved. 

Darricka and Jean

A Message from Darrick Lam and Jean Shiomoto

We are pleased to share that the rollout of the COVID-19 vaccine has enabled a handful of in-person activities, classes, and visits to resume at ACC Senior Services. The light at the end of the tunnel is shining brighter as people in the ACC community connect once again. 

That being said, this is not the time to relax our diligent efforts to protect our staff, volunteers, residents, and our community.  With the spread of the Delta variant, we have continued to employ best practices and follow guidance from the CDC and health department.  We have successfully vaccinated over 90% of our current staff and require new employees and volunteers to be fully vaccinated. In doing so, we have joined the growing number of companies, educational institutions, and government agencies determined to win the battle against COVID-19 once and for all. 

The data has shown that vaccines are extremely safe and effective in preventing sickness and death. Pfizer’s COVID-19 vaccine received full FDA approval, and the others are not far behind. Please get vaccinated if you have not done so already.

The pandemic has led to staffing shortages across many industries, including healthcare, retail, transportation, and restaurants. ACC Maple Tree Village and ACC Care Center have been hit especially hard because we are required to maintain specific staffing ratios. When these cannot be met, we have to limit new admissions and forego revenue. 

To improve our competitiveness, ACC recently approved equity and retention pay adjustments for staff members who are currently working at our skilled nursing and assisted living facilities. We are also developing new recruiting messages and tools. You might have seen Jay Sloan, our Talent Acquisition Specialist, in a new video describing why ACC is a great place to work, focusing on how healthcare workers can develop their professional connections and advance their careers. 

ACC continues to explore the home and community-based services. Lynda Tanner, President & CEO at VNA Health in Santa Barbara, and Judy Thomas, CEO at Coalition for Compassionate Care for California gave a special presentation on hospice and palliative care, services that are commonly delivered at home. This quarter, we are meeting with an expert from an investment firm to discuss the declining demand for institutionalized care and new business models for providing assisted living and skilled nursing services in-home. ACC had been studying these trends well before the pandemic began. The pandemic only made them more important and underscored the urgency to act.

One type of in-home service is ACC online programs. Thanks to the work of Jeri Shikuma, Susan Sarinas, Ted Fong, and Krystal Wu, we have held more than 415 virtual concerts, classes, and workshops in the last 12 months! In September, we asked registrants if they would like to continue with online classes or in-person classes after the pandemic. Out of 173 respondents, 63% said both, 30% said online-only, and 7% said in-person only. In other words, 93% want to keep online classes going! But to continue our online and in-person programs free of charge, we need sponsors. Our goal is to raise $250,000 per year in sponsorships to pay for instructors, production staff, and studio facilities. As you have seen, the ACC Community Room doubles as our production studio. If you or your company would like to help ACC achieve this goal, you can contact Jeri Shikuma at jshikuma@accsv.org or 916-393-9026. Jeri and her team can give you a tour of the ACC production studio and discuss ways we can recognize your gift and/or promote your business during our live broadcasts.

Welcome Betsy Donovan, new ACC Board Member!

Last but not least, we are happy to announce the appointment of Betsy Donovan to the ACC Board of Directors. Betsy was the Chief Operating Officer at Eskaton from 2010 to 2020, overseeing 30 communities and programs including affordable housing, skilled nursing, assisted living, memory care, continuing care retirement communities, home healthcare, adult day healthcare, and quality and compliance.  Welcome on board, Betsy!