Welcome to TCN Talks. The goal of our podcast is to provide concise and relevant information for busy hospice and palliative care leaders and staff. We understand your busy schedules and believe that brevity signals respect. And now here's our host, chris.
Speaker 2:Como. Hello and welcome. Our guest today is Mark Cohen. This is really becoming my favorite time of the month and I'm looking forward to it each time where you and I go back over all the top news stories of the month. So this is our top news stories for July, but before we jump in, mark, I always like to hear something new about you. So what does our audience need to know?
Speaker 3:Thanks, chris. It's good to be back. I was trying to think of something interesting and I thought back to my first days in hospice in 1996, 1995. I have what I think was a genuinely unique orientation to hospice. I was VITAS's first ever VP of communications. I was coming to VITAS after five years as Chief Spokesperson for one of the nation's largest, busiest hospitals, jackson Memorial in Miami. But I had no hospice background At the time.
Speaker 3:The VITAS standard for orientation for non-clinical directors and above was to spend a week shadowing in the field.
Speaker 3:But the VITAS CEO, hugh Westbrook, thought it was really important for me to see every aspect of the operation so he literally banished me from the corporate office in Miami for a month and other than the Monday morning VP meetings I was not allowed to step foot in the corporate office after 8 am or before 5 pm on a weekday, and it was great. I shadowed a nurse on the AIDS team who took care of homeless patients in Miami. I shadowed admissions nurses doing visits in both hospitals and at home. I followed sales reps as they called on discharge planners in hospitals, physicians back in the days when you could actually see a physician skilled nursing. I spent the graveyard shift with the phone call triage team. I spent a Friday with the folks who handled commercial insurance approvals as they navigated the Friday dumps from hospitals. I learned so much and carry so much of that with me even today, almost 30 years later. So when I hear that some hospice admin staff never shadow in the field, I do worry about our collective futures.
Speaker 2:Yeah, boy, mark, I did not know that part of your story and maybe it's because I was in Florida and maybe I had heard about it from my old CEO, delny. But it started in the beginning and I would actually require all of my business office staff because I had HR, finance, it, medical records. Everyone once a year had to go out and at least do one visit as part of their kind of a check off for their annual evaluation, and I have carried that forward every year until COVID. In the last couple of years I was taking about three days, because now we have this beautiful network and TCM where I try to go with a couple of our members as well. So anyway, I had no idea that was part of your story. When I look back on it, it's actually some of my most precious times in this work that we've done and I feel like you can't get an ivory tower if you at least go out and do it at least once a year at a minimum.
Speaker 3:Absolutely, it's essential.
Speaker 2:Well, Mark, let's jump in. So what are your top news stories for the month of July?
Speaker 3:Well, it was generally a slower news month for counting clips in hospice. In the post-acute sector, july lacked the headline grabbing stories, like we saw in June, with the kerfuffle over the fate of a live hospice, the fight over the acquisition of a metisys that was eventually won by Optum and the concerted attacks on the nation's largest hospital operator, hca, which, as we recall, bled over into the hospice sector. We simply did not see those kinds of compelling stories this past month. We also saw some subject areas that had been trending in May and June dropping significantly, if not entirely, out of the top 10, and even my honorable mentions. The boomlet and pace coverage that I mentioned in June subsided to a great degree in July. The intense focus on physician-assisted suicide, medical aid and dying lessened as most state legislatures that were considering the issue wrapped up their work for the year. Similarly, the coverage of legalization of medical marijuana lessened as the legislatures in the remaining states that have not passed it again wrapped up their work for the year. Silicide and magic mushrooms lost steam is an issue that was covered more greatly by the general media and trade press in months previous to July. As for trends, while it was a minor one, one issue that caught my eye was the attention that hospice care and of life care for the urban homeless population saw a little bit of a boost in July with really substantive articles on that subject. That ran in Akron, ohio, sacramento, california and Toronto, ontario. So the top 10 again. Not as exciting as in the last couple months. My top story was long-term care, assisted living and senior living news. I ran 49 articles about those subjects and hospice news today in July and with a quantity like that it's no surprise the coverage was widespread. But there were a few common themes that stood out Increased regulation and scrutiny of skilled nursing in some states, continued slow growth in census recovery among skilled nursing and senior living. Nursing homes were still closing their doors, either for quality reasons in some states or staffing issues in other states, and there was continued pushback significant pushback from the industry on the proposed staffing mandates from the Biden administration.
Speaker 3:In second place, hospice general hospice news articles. I ran 35 of those in July. While there were some positive articles, the medias articles were about problems in the hospice field. There was good coverage, pretty good coverage of the reintroduction of the Palliative Care and Hospice Education Training Act. That generated a fair amount of coverage. But there was also coverage of various CMS initiatives to better audit and monitor hospice quality. The journalist Ava Kaufman, whose article for ProPublica that ran in New Yorker last in the New Yorker last December kicked off such a firestorm, she was back with an update on the CMS initiative to focus on hospices in California, arizona, nevada and Texas. The Washington DC must read political newspaper Politico jumped on Ava's bandwagon, jumping into the fray with an item that led their nightly newsletter headline. Hospice has a big problem. But Jimmy Carter's hospice admission continued to spur good coverage of hospice, especially with this article that ran in another political publication, the Hill, and was titled how Jimmy Carter has changed the conversation around hospice.
Speaker 3:In third place, news about hospice providers total 29 articles. Most of them were reasonably positive. There were those three articles that looked at caring for the homeless that I mentioned earlier. There was also a great profile of the children's hospice in Minnesota, which is one of only three such facilities in the nation. While one rural hospital owned hospice announced closure of its inpatient units, several other hospices in every region of the country announced plans either to open or expand or to study reopening inpatient care centers. So that was a positive hit. In July there was also an interesting look at the challenges to sustaining hospice operations in the state of Alaska, which once again puts the whole issue of rural hospice deserts, you know, if not on the front burner, certainly on the back burner, for everybody in the industry, really not just the folks in rural areas.
Speaker 3:General coverage of end-of-life care and palliative care news was in fourth place with 27 articles. It's interesting, though, that among those 27 articles there was barely any mention of death doulas or death cafes in the month of July. Instead there were a lot of articles about how palliative care ought to fit into the CMMI models. There were also several articles that looked at palliative care in relation to specific chronic and terminal diagnoses cardiac, renal, parkinson's, oncology and then, continuing a theme palliative care in rural areas took a positive turn. One article I ran that actually got a couple of queries from readers or comments was an article about rolling out a five-year plan for palliative care that was produced by the state of Kansas and policymakers there. I also ran an article about an innovative model mobile palliative care clinic that was launched in western North Carolina by Four Seasons, one of your teleos collaborative network members. So, again, interesting that rural issues related to end-of-life care, palliative care, hospice care continue to percolate throughout the coverage.
Speaker 3:M&a news was in fifth place with 26 articles. Even though there were no blockbuster deals announced in the last month, there were several articles that quoted various data crunchers. The deal volume in hospice and home health is starting to creep back up after a bit of a lull over the last couple last quarter or two. The biggest hospice specific M&A news in July was the announcement by two central Pennsylvania not-for-profits hospice and community care and hospice of central Pennsylvania that they have entered into active merger discussions. Home health, private duty and related fields came in six with 26 articles. Payment cuts to home health is proposed by CMS and the move by the National Association of Home Care and Hospice to sue CMS over the methodology they used to calculate those rate cuts were the with the big stories, the dominant stories for the home health news. Labor news was number seven with 25 articles that I ran in hospice news today.
Speaker 3:Typical stuff unionization efforts, nursing strikes, contract settlements dominated the coverage. There was a real interesting explainer. They put an exclamation point on the month's coverage. The headline was why the pandemic was a turning point for nurses, flexing union power. That story likely is not going away anytime soon started to see a drop-off after that. Seventh category the eighth category, physician and nursing news, had 18 articles. Nothing really knew there. Articles that addressed the nursing shortage, efforts to roll back provider dependence on travel, nursing initiatives to expand nursing education. Most interesting article was probably the state of Connecticut sued a for-profit nursing school that had abruptly closed, leaving hundreds of students in the lurch without an education, a completed education or a degree.
Speaker 3:Ninth category physician assisted suicide, medical aid and dying. As I mentioned earlier, coverage of this category declined significantly as the legislative battles over this issue mostly dried up for the year. But there were 16 articles. Most of those articles instead were first person accounts by people who were either arguing to have the option themselves or talking about how beneficial the option was for a loved one. Typical of those was a column which ran at the end of the month in the Houston Chronicle I'm dying. Texas should. Let me choose how. I can't remember the last time I saw a medical aid and dying article from Texas and obviously the political prospects After that issue in Texas are not good, but the Chronicle ran the article anyway.
Speaker 3:My tenth category was general news of hospitals 14 articles last month. Coverage was a bit confusing Articles about how hospital operating margins were positive for the third consecutive month, quoting a Kaufman Hall study. Other articles about how dwindling margins are pushing hospitals toward a possible financial crisis. And an article about HCA and tenant seeing increased EBITDA in Q1 while nonprofit hospitals continued to struggle. There were also a handful of articles about continuing hospital layoffs and this article which probably got a lot of people both in the healthcare sector and the public policy sector angry. Many hospitals posted record margins during the pandemic study fines.
Speaker 3:My honorable mentions were news about for-profit providers Nothing really striking, but there were 13 articles. 12 articles about grief and bereavement, memory bears, grief camps, butterfly releases and byline accounts of personal grief journeys. News about elder care and aging news, wishing dream fulfillment articles. They saw a comeback with seven articles in the past month. Venture capital and private equity news lead article there. The private equity takeover of hospice care, medicare and Medicaid news and really taking a big fall from previous months. Medical marijuana news down to just five articles. And news about HIPAA, ehrs and compromised data, also with five articles. So not a big news month.
Speaker 2:So, mark, this is always fascinating. It's funny. I feel like I'm starting to live my life like slow down, try to smell the flowers and you notice more things. Taking this project with you, I just feel like it's opening my eyes to things I've never noticed before. And I was asking you in pre-show prep I've been around hospice now almost 28, 29 years and we've always hypothesized is there some interesting rhythm when you have a lot of deaths? Whatever I've learned recently is the only real time is January. You really do see it in the data. So what I'm wondering is is there a rhyme or rhythm to the volume of what's going on in articles? Like you, I feel like, okay, I'm picking up similar themes, so that makes me feel like, okay, mark's the master If I'm catching those, I'm getting a better idea of the gestalt of what's going on in our segment. But is there something that drives? Is it like people are on vacation or is there something else going on there?
Speaker 3:I think there's some of that continuing cutbacks in news coverage in general because newspapers are shrinking, but that has an impact, although online news is actually growing in a lot of ways. So I think that balances out. I think one of the biggest factors is just the diminution of the number of people out there pitching stories for hospice. When I went to VTAS almost 30 years ago, every major not-for-profit provider had a VP level person who was either directly responsible for public relations and communications or had a senior director reporting to her or him. Nowadays, that provider more likely than not has a manager or maybe a director doing that level of work and of course, the bulk of their work now is focused on social media as opposed to traditional media.
Speaker 3:You see it in the quality of the press release, the quality of the writing in the press releases that come out. I see press releases that will get an F in a journalism 101 class for the way they write, the leads, the use of passive voice, the lack of attribution, the weak attribution, and that does have an impact. On the other hand, you do have close to 50 not-for-profit news organizations out there at the state and national level, either covering health care news or covering policy news that are digging into health care issues to the greater degree or as greater degree as the best newspapers did 25 years ago. So it's hard to put an exact cause on it and you know some. You know things like Ava Kaufman's article from ProPubica in December. You know that article drove coverage for a couple of months and you know you still have that potential in the in the field.
Speaker 2:Wow, thanks for that answer, because it shows that you know there's no one thing right, it's multiple things. Well, let me jump in and I'll have you comment at the end, and so this is always interesting. Recently, I wrote a blog and I feel like you and I doing this show is indicative of the subject that I put in that blog, which is a Stephen Covey quote from years ago, that he says no one looks at the world as the way it is. We look at the world as the way we are, and I put a visual on there that every person has a window strapped to their forehead by which they look at the world. If you come to appreciate that fact, that's why that's why I love working with you. First off, you have standards and grammar standards and writing that I just think you're masterful there and I think it's making me better in that area. But how you look at it and how I look at it is different, and kind of putting it together, I think we have a better chance of making what is really going on in the world. So with that, I've got about ten themes.
Speaker 2:I actually had only about 50 articles this month, so as you were calling out the volume, it did feel less. So here are my themes and I'll go through each one individually, a grouping that I would call. There were several futuristic articles and I really loved because they were very innovative and forward-thinking. So that was my first category. A lot of regulatory impacts, several power of care articles. One that actually was related to our work at Four Seasons on CMMI, a Medicaid article that really jumped out at me for what it talked about Cyber threats, which is something I just want to kind of ring the clocks in on that one. And so not that it's new, but gosh, the volume seems a lot more. A lot of M&A strategic moves category. The private equity impact on health care, another kind of category of financial woes. And then the biggest category that now I'm seeing this theme every month a large volume of staffing articles. The good thing that I'm starting to see in a trend is, I feel like people are starting to work more on solutions, and it's not just woes us. We're short staffed, whether the government can fix it the way they seem to be fixing it. Well, we're going to mandate staffing ratios. Well, that's interesting to mandate something where there's not enough people.
Speaker 2:And then just the last kind of category that I'll wrap up with is what I would call innovative remembrance services. So let me kind of go into all ten of those. So the first one again, was about kind of futuristic and here's several that just jumped out at me. First off, senior living. Former shopping malls are being repurposed for senior housing. Interesting, I got a call from a family friend who actually sold his assistant living facility. Business was being brought back in because the actual occupancy is so low and they're trying to figure out how did they repurpose those facilities? And then I quite often I'll drive by shopping malls and think you know what are those things going to become? And it's interesting, in certain markets they're repurposing it to senior housing.
Speaker 2:Now another New York Times article that jumped out at me as cases soar for dementia. Dementia villages are looking at the future of home care. And it actually talks about a village and I think it was overseas. Was it in Amsterdam? Fascinating? It looked like a typical Dutch town with a restaurant, theater, pub, a cluster of quaint two-story brick town homes. Many of the people here don't realize that they're living in the world's first so-called dementia village and it could be difficult for visitors to tell the difference between residents and the plainclothes staff and I thought that is super innovative and I think we're hopefully going to see more type of innovation like that. In fact I think we're going to do a podcast later this year about innovations in Alzheimer's dementia care.
Speaker 2:Next one was former CMS administrator Andy Slavitt considers PACE the ultimate senior care model and so, coming from Andy Slavitt, that really jumped out at me. And then the article that you cited Jimmy Carter has changed the conversation around hospice and that was actually in the Hill. And man Jimmy Carter's been with us five months in hospice care and you and I talked several times. Mark, just the blessing. I always loved the adage from secondhand lines, that movie about going out with your boots on, in other words, making an impact right to the end. And man kudos to Jimmy Carter because he is using every part of his life to make the world a better place and helping change the conversation of what hospice is. So that article was calling that out.
Speaker 2:And then the last one in that kind of futuristic category why life spark and alleric hearing, or addressing patient and caregiver wellness. And so usually those of us in the serious illness space, people think that oh, we just kind of help, people accelerate the demise, but kind of changing the conversation with home-based primary care and wellness, but not just for the patient, for the caregiver as well. Thought that was very innovative. So that was my first category. The second category I call regulatory impacts. You cite it. One of them knock is suing CMS because the home health payment cuts almost up to 6%, and so I imagine I don't want to say it's an act of desperation but it's a very aggressive act because a 6% cut in this inflationary environment would be disastrous for them.
Speaker 2:And then a couple articles about the 36 month rule to curb hospice license flipping, and so again I love the analogy used earlier. Ava Kaufman's article has created a wake and I didn't even think about how you said the volume of that wake really drove a lot of our first quarter. But it's driven a lot of regulatory conversation and I think this is one of the ones that's a good side effect of the article that she brought about not allowing people just to kind of create a license and try to flip it and just create a profit, almost like there were little properties on the monopoly board. Hospice leaders to lawmaker strengthen CMS oversight of the accreditors, so that way accreditation actually means something and so consistency among the accreditors. That was a great article.
Speaker 2:And then the political one that you pointed out, mark, about hospice care has a big problem, and then they actually talked about 325 prominent doctors in the field wrote that in recent years we observed an increasing prevalence of serious deficiencies in hospice care and high variability in quality of care. And of course, arab Iyak is one. Cited instances of poor care increasingly common the signature of some of these are retired include pioneers in the field, including two thirds of the living former presidents of the American Academy Hospice and Pout Care Medicine Professional Society for Physicians. But they asked, saying the journal cited litany of wrongs not enough physician involvement at patient care managed being large nurse caseloads and adequate interdisciplinary care teams. Nurse, doctor, social workers, chaplains, others. The core generally takes place in patients homes or overwork not properly trained.
Speaker 2:Again, I think about where you started, about. You know even in your role that you had to go out in the field in the beginning. So that was my second category regulatory impacts. Third category was Pout of Care. A good volume of articles on Pout of Care that jumped out, but one that was really made me smile because I almost felt like our work was forgotten. There were two CMI grants in the country to prove Pout of Care. One was Sutter and one was the other and it was Four Seasons. We partnered with Carolina Caring and a lot of kind of acute care providers, but it was also home-based Pout of Care and also clinic-based Pout of Care, but citing the great data showing that we actually did save money and that Pout of Care is a good model and it might be a good place for the government to put future healthcare dollars, so I was pretty stoked about that one.
Speaker 2:And then there was one about Medicaid expansion. So this is my fourth category of Medicaid. Medicaid expansion improves outcomes and here was, to me, the line that really caught my eye without crowding out other patients. Now that's a headscratcher for me because it talks about how more people are getting access to Medicaid and that basically saying part of the I guess, debate against expanding Medicaid is you're gonna have those patients crowding out healthcare and throughout is. I guess those people are not going for care today. Some of them are showing up in free clinics et cetera, but, based upon this study, they're not crowding out other patients, which is interesting because we have all these healthcare workforce shortages et cetera. But I thought that was a great data point and a pretty good study.
Speaker 2:Next category I will call cyber threats and so kind of grouped this one into there. But basically next year and I had a $31 million false claim act allegations. I've never seen that against an EHR provider. Mark, maybe you have. You've been kind of paying attention this longer than I have. I didn't know if that's an interesting harbinger source, but I have had many CEO friends of mine that say, when you look at a lot of these EHR vendors and what they sell and charge, and my heart goes out to them because it's a hard job to create a good software program, but you kind of trust that the programs are supposed to work and just the issues that a lot of them have in terms of performance et cetera. So that one jumped out at me. But then the vast majority HCA has hit with lawsuits following a massive data breach. In fact I've seen a lot of almost like what do you call it like spam email related to that. And then modern healthcare had an article. The hacking price problem is nearing a crisis in healthcare and so we've tried to call that out to our T-SEM members. I gotta imagine cybersecurity insurance is gonna continue to go up just because of the just the volume of attacks or ransomware attacks, phishing attacks, et cetera.
Speaker 2:Sixth category I would actually call M&A strategic moves, and one that was in North Carolina, mark. So Blue Cross, blue Shield, north Carolina got state legislature, a law they got approved that allowed them to take I think the number is five billion off their balance sheets, so nonprofit insurance company and basically create a separate holding company and what they're trying to do is position themselves to compete against the United, the Humanas, et cetera. So that was a big deal. So it was not only in North Carolina but it looks like New Jersey as well. That was a big move. One that I felt was encouraging is Walgreens is shifting its focus to strategic home-based care partnerships where, as CVS, etna seems to be more of, we gotta own it all, walgreens looking for more strategic partnerships. I thought that was encouraging. Three pillars of radiant health, hospice, senior living partnership with CareSource so my good friend and your good friend, kent Anderson and at Ohio's and then United Church Homes and how they're aligning with the payer, caresource and then up home-based primary care, why hospices are pursuing home-based primary care. And then the articles about UnitedHealthcare going all in on the Metasys. Unitedhealthcare's profits are up despite higher Medicare Advantage costs and I think, yep, that's it for that category. So that was kind of all my kind of merger acquisition strategic move category.
Speaker 2:Next category I'll call the financial woe category. So senior living healthcare bankruptcy filings are set to triple. This was in the Triangle Business Journal. Dwindling margins are pushing hospitals towards potential financial crisis and you and I kind of did an off the record for just the TSM membership about that mark.
Speaker 2:And I love your adages. You know, if hospitals catch a cold, do we catch the flu? Or have we kind of positioned ourselves in such a way where we're not as dependent upon hospitals maybe as we were in the past? And then a Wall Street Journal article about some hospitals that spent big on nursing during the pandemic are now short on cash. So I think you mentioned about kind of record high margins for hospitals during COVID, maybe artificially inflated, and now they're really in a world of hurt. I think the statistic is something. I think Kaufman Hall maybe 60% mark 56% of hospitals in America in negative margin territory, although I think that was starting to tick up just slightly in the last quarter. This is a category onto its own. I even know how to. I guess it's really sub under the financial woes, but just like hmm, this is interesting.
Speaker 2:But Papa is an organization I've watched with interest, mark. You know it kind of comes out of South Florida. It actually inspired my boys to start their own company called Elders Angels, where they were doing chores for elderly people as a summer job. But Papa is an app where you basically gather all these needs for elderly people, but it was also a lot of home care, private duty etc. But basically a senator is pursuing abuse allegations against Papa, and so on one hand, certainly that's never acceptable. You're putting people in someone's home, so how do you credential those people? But providing that level of organization, because home care is such a tough business, to talk about shortage of staff, you're competing against Chick-fil-A, walmart, all these other places. So I worry about that one, or maybe what is the future implications of that? And so just something that really jumped out at me.
Speaker 2:And then this next category I would call kind of the private equity impact on health care, and you cited some of those, mark. But regulators and lawmakers need to act on the growth of private equity in health care. Health care merger guidelines update would increase scrutiny of health care deals. So there are increasing those merger guidelines. Health care private equity ownership worsens quality and raises costs, according to a study. And then private equity who employs your doctor? So private equity is who is employing your doctor is increasing and, interestingly, in a project I'm involved in, we just bumped into that and a great doctor, a great heart, had this great promise of what private equity is going to do for his practice and the disenchantment and literally having to shut down his firm. A lot of overpromise and under deliver. And then the last one I think you called out specifically, the private equity takeover of hospice care.
Speaker 2:And then my last and 10th category, which I think is going to probably be almost every month, is just the staffing challenges. So there are about 10 interesting articles. One from Fortune these companies are serious about keeping older employees, so now they're offering grandparent leave. Mark, I think technically you're a baby boomer, right, I guess, more than technically you're a baby boomer and I don't know what you think. Right in the middle there's another article here about how people are going to work way past. Yeah, here it goes almost half a baby boomer's workers are expected to work past 70 and not retire, which makes me smile. I think that's definitely going to be me, but I think the baby boomers are actually part of the solution to our staffing challenges, but not in a more traditional sense and a much more flexible thinking in a much different way about your workforce sense. So, anyway, in fact, thinking about companies are thinking about grandparent leave.
Speaker 2:There was another term, maybe it was a grand maternity leave or something like that you and I read about last month. Alright, in this one, the Kaiser Family Foundation 29% of nursing homes would meet the four hour federal staffing mandate Just the third. So, government, by mandating something that doesn't actually solve the problem of a shortage of people, you actually have to have adult conversations about things like immigration and things like that. Or how do you incentivize people to go into healthcare? But just mandating the staffing is a bit of a disaster, especially for our long term care brothers and sisters. Home care daily congressman this is a home care daily congressman introduces task force to address the nursing shortage.
Speaker 2:Isolation and loneliness linked to death. But it was an actual McKnight's article just talking about isolation and loneliness, and the reason why I put that one under kind of staffing is, I mean, a lot of people working in healthcare, going into homes or kind of the solution to loneliness, but yet we know we have this huge shortage of people. Let's see the baby boomers. When I called out they're going to work past the age of 70 and not retire, this was in McKnight's Latino workers, underrepresented in healthcare, so another great segment. How do we recruit more people, latinos into healthcare? What do we do to reach out to those communities and show, hey, it's a great career, it's a great way to spin your kind of life on a good purpose, if you will. In this one, the next generation, new nurses have more options and more burnout, and so, and then North Carolina nursing homes is, complaints jump almost 40% due to surveyors, but it's because of scarcity of workers. And then senior living balancing cost benefits, challenging recruiting and retaining workers. And then another one about a career pathway programs can actually mitigate workforce shortages. And then I think I'll say today article about the doctor shortage. I think the projection of a shortage of primary care physicians is anywhere from, seems like 40,000 to 125,000, based upon kind of projected needs. Yeah, up yet 37,800 to 124,000. Demand will exceed supply. And I think that's it, mark, on my top 10.
Speaker 2:And then I had a couple that were actually in just real quick under kind of my honorable mention category, the two that were kind of a similar theme I would call innovation and remembrance services.
Speaker 2:A great article in the Boston Globe that you pulled out the unexpected intimacy of a Zoom Memorial service, and it was a well thought through article about how just the blessing of how people who couldn't have been at that Zoom service people chose to dress up Some people didn't dress up in just ways they help people who can get over the technology but just how meaningful it was of a Zoom Memorial service.
Speaker 2:And then one that actually came out of here in western North Carolina in the Mountaineer, a funeral before death. Gratitude parties surround a dying love one with families and friends, and so instead of waiting for the love one to die, actually having a gratitude party and they specifically didn't call it a remembrance of life ceremony or celebration of life, since that's kind of got a connotation of post death, and so I thought that one was great. And then one that always I keep my eye on, mostly because you're the first one to bring it to my attention, as this was in KFF. So Kaiser Family Foundation, a non-profit hospital's big tax breaks state scrutinized the required charity spending. So that's my mark. So any final thoughts from you?
Speaker 3:I think we covered just about everything this month. It was in much easier month to cover and we'll see whether August continues to downturn or whether things pick up again. If they pick up again, let's hope it's on the positive side, not the negative side.
Speaker 2:Yep, absolutely Well, I was actually going through my gosh. I want to call it. I think it's Golden Leaf. It's a book of poems and writing. The two things jumped out at me made me think about you, mark. So this is our quote in today. Two quotes clear riders, like clear fountains, do not seem so deep as they are. The turbid look the most profound, and that's by Landor. And then this one I really thought about, mark Pit. These sentences are like sharp nails which force truth upon our memory, and that's by Dittorat. Thanks for listening to TCN Talks.
Speaker 3:Music.