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Community Affairs References Committee
Future of Australia's aged-care sector workforce

ESPUIS, Ms Melanie, Senior Human Resources Adviser, Australian Regional and Remote Community Services

STEPHENSON, Mr Paul, General Manager, Australian Regional and Remote Community Services

TREACY, Mrs Sylvia Aletta, Residential Service Manager, Southern Cross Care for Facility Pearl Supported Care


CHAIR: Welcome. Has each of you been given information on parliamentary privilege and the protection of witnesses and evidence?

Mrs Treacy : Yes.

Mr Stephenson : No.

CHAIR: Okay, we will hand that to you right now. I would like to invite each of you—whoever wants to—to make an opening statement, and then we will ask you some questions.

Mr Stephenson : Firstly, thank you for the invitation to this. I had prepared some documents rather than a submission. I think there are some important aspects to consider in the delivery of residential and community aged care in remote and regional Northern Territory, Far North Queensland and probably Far North Western Australia as well. Some of those relate to workforce training and the workforce available, and also specifically to delivering aged and community care for Aboriginal and Torres Strait Islander people, particularly in the Norther Territory, as my experience has been for the last 12 months.

CHAIR: Do you want to expand on those?

Mr Stephenson : Sure. Firstly, our experience in delivering residential and community care for Aboriginal and Torres Strait Islander people in the remote settings of Docker River, Mutitjulu, Tennant Creek and Katherine—which is three hours down the road from here—is that it is challenging in the workforce space, in that we seem to be able to attract a number of overseas migrants to work in that space as opposed to attracting a local workforce, for instance. We have a target for employing Aboriginal and Torres Strait Islander people in the services settings, but we have not been able to meet that in the last 12 months. We do have a nine per cent Aboriginal and Torres Strait Islander workforce. They are not necessarily specifically doing personal care; more the surrounds or community visiting or community support programs and some of the domestic services.

I am not sure that we have taken the step of asking the big question: what is the obstacle or what is the challenge for local workforces in relation to personal care?

It is not something that people adopt.

I think that the wage that we offer needs to be seriously considered going forward. I also think that we are to a degree at the mercy of having overseas migrants working in our industry in order to attain the points related to visas for living in Australia. We certainly experience that with some professional registered nurses. There are two facilities that we have where one of them is all overseas 457 visas and the other one, I think, has three of the four RNs on 457 visas. We may need further exploring about why that is so. I am not saying that we have all the answers but we do have some recommendations that I put forward. We are certainly willing as a service and as an industry to participate in that exploration.

Mrs Treacy : Thank you for this opportunity to talk to you. I have prepared something and I hope you do not mind me just reading from it this morning.

CHAIR: You can table it afterwards, if you like.

Mrs Treacy : I will speak from my perspective as the manager of Pearl Supported Care, which is a residential aged care facility in Darwin. Pearl is comprised of a nursing home with 81 permanent residential beds and four dedicated respite beds, which have only just been implemented in our nursing home. We also have a co-located retirement village resort of 63 units and we have a community home care service office based on site as well. The three services work closely together. Pearl is owned by Southern Cross Care and is one of four residential aged care facilities in Darwin.

I would like to briefly talk about what I see as good in aged care and why I have chosen a profession in aged care and what I see as the challenges and also what I see as the future needs in the aged care sector. What is good? Working in the aged care sector can be a very rewarding experience hence my decision to leave the acute sector and enter the aged care sector. Many of our residents stay with us for a very long time so the staff are privileged to build very strong relationships with the residents, and we tend to attract therefore a workforce that enjoys regular interaction and building relationships. With the ongoing changes and improvements currently in the aged care sector, with compliance and quality assurance, we are able to ensure that our residents are receiving really good care. As a result, many of our workers at Pearl are held in high regard, not just by the residents but also by the community, family and friends. That is the really good part about it.

What are the challenges? For me, I can only speak for myself and for Pearl, our greatest challenge is recruiting and retaining staff. This impacts not only the longevity of the staff but also the stability of the workforce. The factors contributing to this include: firstly, that our workers are often transient in the Northern Territory and frequently move either to other job opportunities or to other places to live. Secondly, the nature of the work can be very demanding both physically and emotionally. For example, our personal care workers often have to care for large numbers of residents with very high-care needs or with cognitive deficits which can lead to some expressions of behavioural difficulties, which is taxing on care workers particularly if they are doing it day in and day out.

Thirdly, there is at present very little in the way of a career path for many staff working in aged care particularly for our personal care workers and many of them cannot afford to pay for study to expand to become a nurse or something like that. Many of the staff also view these positions as a stepping stone into something better or to a different area in health such as nursing, social work or physiotherapy. Fourthly, many of our care workers are international university students enrolled in other courses and they use their carer position to financially support themselves during their studies here in Australia. They are employed on restricted employment visas, which limits them to only 20 hours a week. I think they would like to work more hours to be able to financially support themselves, but we need to understand that they are here to study as well and they need that time.

Lastly, employment in the aged-care sector is usually significantly lower paid than in the acute-care sector. I can give you an example, and I hope I am not entering the wrong territory here. Twice a year the hospital here recruits a large number of personal-care workers, and we have a mass exodus of care workers at that time. It then takes us another six months to recoup and train up new carers. That is a significant problem, and when I to exit interviews I hear that the primary reason for leaving is financial.

So, what do I see as the future or some of the issues that we can address? For us to maintain and increase not only our staff numbers but also the quality of the staff we employ we need to be able to provide a meaningful and rewarding career path with prospects for promotion and recognition of a job well done. To retain staff we need initiatives and incentives, such as a five-yearly recognition of service with matching financial or salary rewards, and we need to narrow that gap that exists between the payment in the aged-care sector and the acute sector. In order for the aged-care private sector to do this, though, we would need support from our government.

At present there is often a significant gap between the activities in home support, the programs run by the community and the residential care services. I would like to see that gap narrowed by increasing the cooperation and collaboration between all three services. Perhaps a workforce could even work across the three services and not just pick one stream. I would also like to see increased access by our residents to community activities and events that are available to older people who are not in residential care. But transport, staffing and financial resources are obstacles for us to be able to send our residents out to these events.

I also think that we need to promote and strengthen the involvement of both the families and the community at large with residents in aged care. When a person enters a facility, a busy family often reduces their involvement with the resident physically, emotionally and spiritually. Often the relatives leave their loved ones in the hands of the workforce. Whilst we can provide most of the physical care, it is the emotional side that is often a little bit neglected, so I would like to see more family involvement. The workforce and the family should be working together to complement their activities. We need to reduce the difficulties that many families have in supporting their loved ones—I am talking especially about the Northern Territory, where a lot of the families that live down south cannot afford travel and accommodation. If there was financial ability to support families to come up, I think that would also provide assistance. There are also other minor things such as IT support, getting Skype or something like that, so families are able to interact with their loved ones.

We need to encourage more community-based activities run within the aged-care facility, because the problem is that we cannot get them there, so if they could come to us that would be good, and also getting our residents to engage more with the community. Our society, I think, can be appropriately judged by how we look after our disadvantaged and those who are not able to look after themselves, particularly for the residents in aged care. Thank you for your time today.

Senator POLLEY: Thank you for your submission and your evidence this morning. I want to tap into what you were speaking about earlier with regard to the three streams and being able to work across those. Would you elaborate on that a little more for us?

Mrs Treacy : Currently the carers choose to work in home care or a community-based organisation such as Anglicare or COTA or choose residential care. But I think if we had one workforce pool we could say that there is a need today in community and a person could go over and support the community, and vice versa.

Senator POLLEY: And this is the vexing question that no-one seems to be able to answer adequately for me. Remuneration is without a doubt an issue. What should a carer earn, looking after older Australians and some of the most vulnerable people? Where does the pay rate need to be?

Mrs Treacy : Where is it currently?

Senator POLLEY: We know where it is currently. Where does it need to be? That is a big part of the struggle of attracting people into the workforce. It is not just about money—there are certainly other issues—but it is a key component.

Mrs Treacy : For me, I would say between the $25 and $28 marks would be a lot better.

Senator POLLEY: That is the first figure we have had.

Mr Stephenson : I agree, to be honest. We are seeing people cared for at $19. What are we really expecting? This is people that are being cared for. Some of the most vulnerable people in society are being cared for at $19. So I agree with her. It should be sitting at between the $25 and $30 an hour marks.

Senator POLLEY: We have had other evidence to this inquiry throughout numerous submissions that there is not a standardised training for carers in particular—that too often people will go through training but then are really not job ready. We do understand that there has got to be some training on-site, but there is certainly a disadvantage for people being able to go on and do any further training. Do you think there needs to be a national level that is recognised Australia-wide? Do we need to have a licensing of people working within this sector so they can move from state to state?

Mrs Treacy : I think that is a really good idea. With the training for the carers I think the course for the personal carer is standardised, but it is the organisation delivering that course. We would find some university based ones where interaction with the tutor on site is a lot better than for people who just do their courses online and have no practical. It is more around the practical components than the theory. The theory is there; it is the practical side of it.

Mr Stephenson : Our experience , in addition to that, is that there are limitations in emotional intelligence. We are actually producing people doing online courses that are theory based, human-body-element exposed but not training in the development of dealing with human behaviour and being emotionally intelligent. We do not see that exercised well. Once again we go back to the fact that we are actually caring for very vulnerable people.

Senator POLLEY: What you are saying today is, I am sorry, not uncommon around the country. When it comes to a career path, there is no defined career path for anyone working in the sector, I do not think. Could you elaborate a little more? We have had evidence that people have started off in the kitchen and ended up running the place. There are some people who seek out the additional qualifications. What do we need to do better?

Mrs Treacy : That is a good question. I know one of the things in the Northern Territory is the carers are not allowed to give out medications even though it is part of the course, and that is not empowering your carers. In every other state, the carers are allowed to give medications. Am I speaking out of turn here? I do not think so.

Senator POLLEY: I do not think they can in Tasmania.

Mr Stephenson : In some environments they do.

Mrs Treacy : In some environments. But we have some very good carers. I think that, if they were given a little bit more responsibility and accountability, we could say, if you are a carer not giving out meds, you would be a certain level. If you were giving out medications, you would get a little bit more. If you were specifically trained for dementia, you would get more recognition. It would be having tiers of carers, perhaps, giving them an incentive to study a little bit further and a little bit further. Then, if they get to a certain level, maybe the organisation could say, 'How about putting you through the enrolled nurses course?' and supporting them through that. I would like to see a stream like that perhaps.

Senator POLLEY: Dementia is certainly a huge issue with our ageing population. It astounds me that there is no recognition for those people who have trained and skilled up to be able to work with and assist people who are living with dementia. I visited a facility yesterday when I first arrived, and the comments to me were that there is a real issue around dementia in the Northern Territory. I was wondering if you could speak to what is happening in your facilities.

Mrs Treacy : We have what we call a primary care model. We only have certain staff working in that area for continuity of care. They do go through training. We tap into Alzheimer's Australia and NT DBMAS. We have close relationships. They will come in and train the staff, but those staff are basically paid at the same level. I would not say it is a lot harder, but it is a more challenging role to be involved in, so I guess staff opt out of it. They opt to not work with those challenging environments, because there is no incentive for them to.

Ms Espius : And there is staff burnout. With the emotional labour involved in working with dementia and challenging behaviours, they can only give so much, and I think this is where Paul is reflecting. The cert. III course needs to build in these emotional intelligence and emotional resilience skills to better support them and prepare them for what they are going to be exposed to. It is not just behaviours; our workforce is continually in a process of grief. Our residents pass away. So it is quite taxing over time.

Mrs Treacy : The carers currently do a six-month or 12-month course, and then they have got to do 100 hours in a nursing home facility. There is no real standard of what they should learn or what they should do while they are there; they are just there observing, doing a few things and becoming part of the workforce. Maybe there could be a set module—'You need to achieve this, this and that'—and some support for what you can expect when you go into the dementia unit with a module around that emotional intelligence. I am just thinking off the top of my head right now.

Mr Stephenson : There are ways to do it, yes.

Senator POLLEY: That is fantastic. Primarily from where do you source those migrants that you employ?

Mrs Treacy : We do not do sponsorship at the moment, so we just get applications when we put out an expression of interest. I will get a whole lot of applications, and usually more than 50 per cent will be students on visas who have come here to study in Australia.

Senator POLLEY: I was amazed to learn that there are a lot of Irish and English nurses who come to Australia to work in this sector. Obviously some of the challenges is trying to break down the barriers between Australian trained nurses who need to have exposure to this sector to understand that you are going to build a relationship and care for someone, which is very different from working in the acute setting, where you may just care for someone for two or three days. What else can we do to attract our own nurses into this sector?

Mr Stephenson : I would say remuneration. Quite frankly, that is the biggest ticket. When you have a conversation at a ACSA level or a service level, the responses you get are that it is about not just job reward but also financial reward for doing the job. There is a 20 per cent difference between what we are actually paying and what registered nurses able to get if they are working in the acute-care sector. That also takes into account the PDI—the salary sacrifice opportunity. So it is quite significant.

Mrs Treacy : I think it is also prestige. I remember when I left the acute sector a few years ago my friends were saying to me, 'Why are you going into aged care?' It is not seen as a prestigious position, and I think that needs to change. People need to think aged care is a privilege and it is also a great field to be involved in.

Senator POLLEY: Thank you. I am going to hand over to someone else.

Senator DUNIAM: Mr Stephenson, you raised the point about the target for the number of Indigenous employees. What is the target? You said you currently have nine per cent. What is the target?

Mr Stephenson : The target for next year was to be around 30 per cent. Our services are delivering to 65 per cent Aboriginal residents or community clubs. For instance, here in Darwin our main facility, Terrace Gardens, is 30 per cent people from Aboriginal background, and in Juninga—Senator Polley, I am not sure if you visited yesterday? Was it you that visited Juninga yesterday?

Senator POLLEY: Yes.

Mr Stephenson : And Juninga is 95 per cent. You can get to Alice Springs, and it is around 50 per cent. That is Old Timers, one of the longest-standing nursing homes in Central Australia. Then you go to Mutitjulu and it is 100 per cent. Docker River is 100 per cent in terms of the background of residents. So it makes sense to employ locally for the economy of the communities, but the challenge is getting local people to work in that area. I have done very much a personal exposure with this in Tennant Creek and tracked how three local people from the employment agency who were being channelled into doing personal care fared over their first and second week. It was very interesting. Three people presented, two people were there two days later and one person was there five days later. We are of course putting in strategies to help retain those Aboriginal and Torres Strait Islander people that we do have in our system, and we have found the most successful to be actually having a work care coordinator role at a local level or shared between a cluster of services. That seems to have worked quite well. Hetti Perkins was the example where we had up to nine local Aboriginal and Torres Strait Islander people working at one stage. She is down to about seven.

Senator DUNIAM: Of the workforce in Hetti Perkins?

Mr Stephenson : In Hetti Perkins the workforce is around—you're testing me!

Ms Espius : I think it is a head count of 68.

Mr Stephenson : Yes, it is a head count of about 65.

Ms Espius : Not FTE.

Mr Stephenson : Right, that is not FTE. That is the number of people working there.

Senator DUNIAM: So it is about a tenth.

Mr Stephenson : Yes.

Senator DUNIAM: Okay.

Ms Espius : One of the challenges in aged care is that there are very few jobs that can wait. Every day, service has to be delivered. People have to be fed and cleaned. When we have a large engagement of local Indigenous staff, if sorry business occurs in the community, that workforce is wiped out—gone. So we have to be very careful that we can provide the service on a daily basis, and that has been quite challenging in some communities, especially at Mutitjulu and Docker River, where we have lost a great deal of our local staff very quickly, very suddenly for two months and all of a sudden have to fly staff in with limited accommodation to provide the service.

Senator DUNIAM: So there is incredible difficulty there. You have the local Indigenous employees, but are there also local non-Indigenous people you are trying to attract? Is there a different percentage in terms of the local members of the community that are not from an Indigenous background as well? Obviously there are different challenges presented in trying to attract different cohorts.

Mr Stephenson : Yes, there are.

Senator DUNIAM: I see why you are doing it, given the clients you are catering for.

Mr Stephenson : Yes, given the percentages. We are attracting local people. We want local people to work in the aged-care facilities or in the community care services that we have. Tennant Creek is an example that I can use. It has 100 per cent residential Aboriginal and Torres Strait Islander facilities. It has 22 beds with a respite or two. We deliver to about 40 community clients. You would be aware that Tennant Creek is a pilot site for NDIS, so it has been through the two years. I will submit this after we finish, and I did not read from it to start with. We experienced competition with other disability services providers for workforce. Even as the general manager I have jumped in, without a service manager there—and having a nursing and registered nurse background as well—and gone and done the floor and done the service managing there. I have done probably about 20 days in total. A lot of people walk in off the street looking for jobs. However, they are of African or Indian background—not local.

The reason I mention NDIS is that in Tennant Creek five of the staff work in the disability sector. They are working up to 15 hours a day doing two shifts. That leads to fatigue, that leads to mistakes and that leads to limited-quality care if you are not careful. We do have that challenge. I have put that in this paper. It is a challenge we have to think about going forward. And you can earn more in the disability sector than in the aged-care sector. The hourly rate is different. If you are purchasing your carer you will get paid more than you will get paid in the aged-care sector.

Senator POLLEY: I will just correct the record. I am visiting that facility this afternoon. My apologies: I visited somewhere else yesterday. I just checked to make sure I was in the right place.

Mr Stephenson : My apology to you then, Senator. It was a presumption on my behalf.

Senator POLLEY: I have just one quick question. We spoke about dementia. I was wondering if you could elaborate on the early-onset dementia, as it is quite common in the Northern Territory, I am led to believe.

Mrs Treacy : That is a big problem. I have just come from another meeting yesterday where it was discussed with the HammondCare group people and DBMAS. Pearl is accepting some younger-onset dementia clients on a trial basis at the moment to see what the differences are in the care that they need. It is more the social and emotional aspects that are different. Physically they still need to be cared for in the same way anyone else would be, but it is the emotional and social side of things. So far we have had three clients, and all three have been successful, but then they have not had really challenging expressions. I do not like calling them behaviours; I like calling them expressions rather than behaviours. There is not currently a dedicated facility or organisation that looks after or cares for residents with early onset. I know that the families' need for respite care is the biggest demand in the Northern Territory at the moment. It is being looked at locally.

Senator DUNIAM: Mr Stephenson, you mentioned that you had some recommendations, which I assume are part of the document you will table a little later on?

Mr Stephenson : Yes.

Senator DUNIAM: I will move on to a different question. I presume that in those recommendations there is some idea of how we go about attracting more local Indigenous employees? Do you have anything to add to that at this point?

Mr Stephenson : I think that the successful strategy has been putting in a reasonably intensive coordinating role to maintain the network, working with individuals who know the family, and being able to support that engagement on an ongoing basis. It is an engagement and employment strategy that seems to be effective.

Senator DUNIAM: On the issue of training, you talked about emotional intelligence in response to a previous question about standardised training and churning out people with qualifications that are gained from online programs. What is the answer there?

Mr Stephenson : I have to admit I have nursing as a trade, as well as management. I think nursing is a demonstration of how you increase an individual's resilience and capability in dealing in the human services space. Regarding some of the other professions, medicine certainly has some demonstrations in it. With allied health, I was listening to the earlier speakers on occupational therapy, and I absolutely agree with much of what they said. There is great scope for occupational therapists in aged care and disability services, going forward. To get back to your question, those types of training actually prepare you well to deal with the challenges of dealing with difficult situations.

Senator DUNIAM: Is it fundamentally because a lot of the training is not available here?

Mr Stephenson : No, I think that regarding the curriculum related to the Certificate III and Certificate IV in Aged Care and individual care—where there is a new course out and so forth—they actually do not have enough in them on the human element of care.

Mrs Treacy : The emotional side of things.

Mr Stephenson : Which boils back down to emotional intelligence.

Senator McCARTHY: Mr Stephenson, I am going to take you back to the dementia discussion you had with Senator Polley. Are you saying there are three clients in the Northern Territory, or is that just the three that you are dealing with? Can you elaborate on that.

Mr Stephenson : Sorry, that was Sylvia's.

Mrs Treacy : Three clients have come to us on respite care for the early onset. It was a short period of time, I think it was two weeks, and then we had a lot of involvement and support from other organisations, such as DBMAS and Alzheimer's Australia, and the geriatricians from the hospital. They were very heavily involved in helping us support those clients. All three clients needed a secure unit—a locked area. It was successful, so we are looking at providing more respite care. But it will be individual based. The client will come on a trial, we will see how they go, and then we can offer them respite care down the track.

Senator McCARTHY: Where are those locations, for the three?

Mrs Treacy : The secured unit is in one wing of our nursing home. It is called Dinah. It is a 14 bed, secured unit with a large outdoor area so residents can venture in and out—they are not stuck inside the unit. We have a full-time lifestyle assistant who works in there as well to provide those clients with social support and activities and to keep them active.

Senator McCARTHY: You may have already answered these questions prior to me coming in, but I wanted to explore a bit with you about the regions, in terms of aged care. What areas do you have responsibility for across the Northern Territory?

Mr Stephenson : In the Northern Territory ARRCS—that is the organisation that I am the general manager for and Melanie is the senior HR adviser for—we have two residential facilities and we have around 350 community clients in the Darwin region. We have two residential facilities and around 50 community clients in the Katherine region—that is the next region down. In the Barkly region, which is Tennant Creek, we have a 23-bed facility and around 40 community clients. In Alice Springs we have three facilities equalling about 150 beds. I cannot do the number of community clients off the top of my head. Then we have a 22-bed facility in Mutajulu and we have a 19-bed facility in Docker River. They are flexi care—they are called Aboriginal and Torres Strait Islander flexi care services, so we do residential and community care packages in those environments. Sylvia made comments earlier about having staff that can operate across residential and community based service delivery—we do that in Tennant Creek, Mutajulu and Docker River.

Senator McCARTHY: What percentage of your clients are Aboriginal?

Mr Stephenson : ARRCS's services are 65 per cent of our residential clients, so it is 30 per cent at Terrace Gardens here in Darwin and it is 100 per cent in Mutajulu. So the client base is about 65 per cent overall; in residence the client base is around 70 per cent. For instance, in Katherine 80 per cent of all our residential clients are Aboriginal or Torres Strait Islander.

Senator McCARTHY: How do clients come to your residence? Do they walk in, or are they referred?

Mr Stephenson : They are referred by other services. We may have family visit. Twice in the times I have been there family have walked in—not the client but their family—and asked me to put their family member on the waiting list.

Senator McCARTHY: Do you have quite a large waiting list of people needing to come into the residence?

Mr Stephenson : In Darwin we would have the highest waiting list, and ARRCS is establishing an additional 32 beds at Terrace Gardens over the next two years. In Alice Springs, there are only four or five people on the waiting list. In Tennant Creek there are three. They are just examples across the whole spectrum. In the Katherine region we are still not able to meet residential care needs. The Katherine hospital has between eight and 10 longstay nursing home type patients that need residential care placement. They constantly have between eight and 10 there. I have just secured an additional six licences for Katherine, taken from the Barkly region, where we are not using those licences, so that we can expand Rocky Ridge to be able to cater for those clients.

Senator McCARTHY: What else do you have in Katherine?

Mr Stephenson : Katherine Hostel and Rocky Ridge. Katherine Hostel is 30 beds; Rocky Ridge is 29.

Senator McCARTHY: What would a non-Indigenous person need to do to go into Rocky Ridge, for example?

Mr Stephenson : Be referred, or have their relative come to the front door. The same.

Senator McCARTHY: What are the costs involved for them?

Mr Stephenson : There is a daily fee that comes from the person's pension, which equates to around 80 per cent, I think, or 85 per cent, of the pension. That is done through Centrelink payments, traditionally, for just about anybody, because it is easier. Some people prefer to manage their own money and pay their bill on a monthly basis.

Senator McCARTHY: Is their superannuation touched in any way?

Mr Stephenson : Assets assessment does occur, and if there are assets then that is negotiated with the individual.

Senator McCARTHY: Are superannuation and general income means-tested?

Mr Stephenson : Yes.

Senator McCARTHY: Thank you.

CHAIR: We have run out of time—again. Mr Stephenson, you have been referring to a document and some recommendations. Are you in a position to give us that now?

Mr Stephenson : Yes.

Senator POLLEY: Perhaps I could just put one question on notice: how have the government cuts to the aged-care sector over the past three years impacted on the workforce? I mean, $3 billion has been taken out of the sector. It has to have an impact. Thank you.

CHAIR: If both organisations could take that on notice, that would be really appreciated. And the secretariat will be in contact. If you are able to table that now, that would be fantastic. Or would you rather send it in? It is up to you.

Ms Espuis : I can do both.

Mr Stephenson : I think we will try to include the question on notice and send it in, if that is acceptable for you.

CHAIR: It is totally acceptable. Thank you for your time today. It has been extremely valuable for us.