A Primer on Dementia and RVNAhealth Support Services

Dementia and Alzheimer's

While former President Jimmy Carter has made headlines about his current journey on hospice care, the former First Lady, Rosalynn, has also been notably in the news. In May of this year, the family announced that Mrs. Carter has dementia. Like her husband’s hospice news, the former First Lady’s diagnosis shines a further light of awareness on the topic of dementia and, in particular, on caregivers. Carter has been a long-term advocate for mental health and caregiving issues, including dementia.

Understanding the Basics…Dementia vs. Alzheimer’s

Dementia is a broad term used to describe a group of cognitive impairments (including Alzheimer’s disease) that interfere with an individual’s daily life and functioning. It is not a specific disease itself, but rather a syndrome characterized by a decline in cognitive function beyond what might be expected as a result of normal aging. Common symptoms of dementia include memory loss, difficulties with problem-solving, language and communication problems, and changes in mood and behavior.

What Causes Dementia?

There are various underlying causes of dementia, with Alzheimer’s disease being the most common. The exact cause of dementia depends on the specific type, but in general, it often involves damage to brain cells or a decrease in the brain’s ability to function correctly. This can result from various factors, including:

  • Alzheimer’s disease: Abnormal protein deposits in the brain, such as amyloid plaques and tau tangles, contribute to cognitive decline.
  • Vascular dementia: Reduced blood flow to the brain, often due to strokes or small vessel disease, leads to cognitive impairments.
  • Lewy body dementia: Accumulation of abnormal protein deposits (Lewy bodies) in the brain.
  • Frontotemporal dementia: Degeneration of the frontal and temporal lobes of the brain, leading to changes in behavior and personality.
  • Other causes: Dementia can also result from conditions like Parkinson’s disease, Huntington’s disease, traumatic brain injury, or infections.

The Statistics

Many find the staggering statistics around dementia surprising. According to the Alzheimer’s Association, some of the statistics include:

  • One in three of seniors, ages 65+, dies with a form of dementia.
  • It is the fifth leading cause of death for older adults in the U.S.
  • Specific to just Alzheimer’s, the lifetime risk at age 45 is 1 in 5 for women and 1 in 10 for men.
  • In 2023, all dementias will cost the nation $345 billion and by 2050, costs could rise to nearly $1 trillion.

RVNAhealth Dementia offerings

Caregiving in the Dementia Equation

At the announcement of the former First Lady’s dementia diagnosis, the family stated “As the founder of the Rosalynn Carter Institute for Caregivers, Mrs. Carter often noted that there are only four kinds of people in this world: those who have been caregivers; those who are currently caregivers, those who will be caregivers, and those who will need caregivers.”

The Alzheimer’s Association estimated that in 2022, unpaid caregivers (family, friends, neighbors) provided an estimated 18 billion hours of care (or an average of ~26 hours/week) for individuals with dementia. While the impact and care needs for individuals affected by dementia are multifaceted, we cannot forget the needs of dementia caregivers. Caring for a loved one with dementia can be an emotionally, physically, and mentally challenging experience, and it can take a significant toll. It’s crucial for caregivers to prioritize self-care and seek assistance when needed to maintain their own health and well-being.

RVNAhealth Dementia Services and Support

Dementia is a progressive condition, meaning that symptoms tend to worsen over time. There is no cure for most types of dementia, but some medications and therapies can help manage symptoms and improve the quality of life for individuals with dementia. Caregiver support and appropriate healthcare are crucial for those affected by dementia.

Early diagnosis and intervention can make a significant difference in managing the condition and improving the well-being of both patients and their families. RVNAhealth offers a variety of patient and caregiver support services for dementia. Please see some of our patient and caregiver support services below. Click here if you would like to join our dementia-specific mailing list for updates on RVNAhealth dementia education, events and support offerings. Or, if you have any questions, please contact us by email: intake@rvnahealth.org, or phone: 203.438.5555.

RVNAhealth Dementia Support Services:

  • Dementia Caregiver Support Group: In support of the challenges and needs facing the caregiving population, RVNAhealth offers a Dementia Caregiver Support group monthly, in coordination with the Alzheimer’s Association. Held on the fourth Monday of every month from 11:00am-12:00pm at the RVNAhealth Ridgefield office, the caregiver support group aims to create a safe, confidential, supportive environment and a chance for participants to develop informal mutual support and social relationships. They also educate and inform participants about dementia and help participants develop methods and skills to solve problems.
  • Personal Medical Alert Services: At the early stages of a dementia diagnosis, when round the clock care may not be necessary, a personal medical alert device can provide caregiver peace of mind for the health and well-being of a loved one. RVNAhealth offers a variety of in-home and on-the-go Lifeline device options.
  • Rehabilitation Services: Rehabilitation services help patients extend their independence in activities and speech.  Occupational and Speech Therapists help to stimulate cognitive and fine motor skills while providing practical tools to maximize activity, safety, and enhance quality of life.
  • Nutrition ServicesNutrition services for dementia, offered by our Registered Dietitian, are aimed at promoting appetite, healthy body weight, and positive engagement with food, while balancing each patient’s unique nutritional needs.
  • Private Duty Caregivers: Available as hourly or live-in, our private duty caregivers can provide a variety of non-medical personal and house-hold assistance based upon a patient’s evolving need.
  • Private Duty NursingProviding immediate access to care for medical needs and treatments not covered by insurance.  From medical care in the home, to medication preparation and administration, to peace of mind medical assessments and vital sign checks when getting to the doctor is too difficult – Private Duty Nurses provide immediate and customized care in coordination with a patient’s doctor.
  • Palliative & Hospice Care: For advanced dementia disease, palliative and hospice care with RVNAhealth provides in-home comfort care and peace to patient and family. An experienced team consisting of medical, social, spiritual, and family support volunteers bring their expertise and experience in dementia care to families and their loved ones.
  • Certified Dementia Practitioner (CDP) Program : RVNAhealth proudly offers Certified Dementia Practitioner training to its staff. CDPs are equipped with training and tools to help deliver appropriate and effective communications with patients. This additional expertise enables improved communication and assistance between our team, the caregiver, patient, and family.

 

Have You Seen Us? Thank You to Fairfield County Bank for the Billboard Space!

Thank you to Fairfield County Bank for donation of their billboard space to RVNAhealth

Thank you to Fairfield County Bank for generously donating time on their billboard space again. Next time you are traveling on I95 South past Norwalk, be sure to look up!  The Bank has been a loyal supporter of RVNAhealth for more than 25 years. Use of this billboard is another example of the many ways in which the Bank partners with RVNAhealth to support and help expand our services in the region.

RVNAhealth’s success has been gratefully supported over the years by the steadfast assistance by Fairfield County Bank, its dedicated staff, and board members. From financial services, insurance, and investments to invaluable counsel, guidance, and tireless volunteer efforts, Fairfield County Bank’s influence on RVNAhealth has been beyond measure. They are genuine allies and collaborators of our organization, and we deeply appreciate their unwavering dedication to our support of the well-being of the communities we serve.

Thank you Fairfield County Bank!

A Celebration of Health, Wellness, and Friendship at the 2023 Autumn Dinner

On September 30th, RVNAhealth held its annual Autumn Dinner at Silver Spring Country Club. Great fun was had by all, enjoying cocktails and hors d’oeuvres, scotch tasting, dinner, our amazing “Date Night for a Year” raffle, an exciting live auction, and heartwarming generosity in support of our vital programs and services. We are proud to offer home health and hospice care, Well-Child Clinics for children and families in need, and our Chronic Care program to help vulnerable uninsured and underinsured neighbors.

Jeanette Rizzo, this year’s impact speaker, shared a personal story about how RVNAhealth was “without a doubt, the best decision” she made when choosing health and home care for her mother. Her story highlights the very special bond that was created between her family and her mother’s RVNAhealth caregiver – a relationship which reflects the experience RVNAhealth strives to create for every patient and family member in their care.

Theresa Santoro, the President & CEO, delivered an inspiring address, underscoring RVNAhealth’s mission and both its commitment to and profound role it plays in the community’s well-being.

RVNAhealth serves a diverse range of people across 35+ Connecticut communities, from uninsured children to those in need of sports medicine, to elderly individuals with varying medical requirements, and those requiring end-of-life care. Mrs. Santoro highlighted the organization’s broad-reaching impact and its commitment to enhancing the quality of life for all.

The evening’s program included a scotch tasting sponsored by Compass Box Whiskey, live musical entertainment by singer/songwriter Nick DePuy, and autumnal centerpieces generously donated by Mary Jones at Rodier Flowers. The charismatic Tom Pesce guided guests through an engaging live auction and paddle raise to raise funds in support of RVNAhealth’s mission.

On behalf of the Board of Directors and the dedicated RVNAhealth staff, we extend our deepest gratitude to Jeanette Rizzo for her valuable contributions as the evening’s guest speaker, our sponsors and advertisers for their unwavering support, and every member of the Autumn Dinner committee for their tireless efforts, enthusiasm, and dedication in planning and organizing this unforgettable event.

Celebrating Our Nurse-Family Partnership National Award Winner

NFP's Laura Shulman Cordeira

Congratulations to RVNAhealth’s Laura Shulman Cordeira, MPH, on her receipt of the 2023 Tenacious Caregiver Award presented by the National Service Office at their National Symposium in Seattle on September 12th.  Shulman Cordeira, RVNAhealth’s Community Health & Wellness Director, was recognized for her role as a program Administrator for her leadership in growing Nurse-Family Partnership at RVNAhealth.

About RVNAhealth’s Nurse Family Partnership

Nurse-Family Partnership (NFP) is a national program offered through the National Service Office (NSO) that serves first-time pregnant people affected by economic inequality and their children. Each program participant is paired with a nurse home visitor from pregnancy until the child turns 2.

Nurse-Family Partnership at RVNAhealth launched in 2020 and is only the second NFP program in the state of Connecticut.  Funded by the Connecticut Office of Early Childhood, the program has served 98 moms and 65 babies and celebrated 8 graduates from the 2.5-year-long program. This voluntary free program is for people pregnant with their first child, who meet income guidelines, and reside in Western Connecticut.

When combined with traditional medical care, national program statistics show that families participating experience a 48% reduction in child abuse and neglect, a 56% decrease in ER visits for accidents and poisonings, an 18% decrease in pre-term births, and an increase in breastfeeding initiation. There are also several long-term benefits to participants, including 67% reduction in behavioral/intellectual challenges at age 6, 61% fewer arrests of the mother, and 59% reduction in child arrests at age 15.

2023 Tenacious Caregiver Award for NFP Administrator

RVNAhealth's Laura Cordeira Wins National NFP Award
Shulman Cordeira, 4th from left, 2023 Tenacious Caregiver – NFP Administrator. National Symposium, Seattle, Washington

The Tenacious Caregiver Award for NFP Administrator is given to an exceptional Network Partner leader who advocates for Nurse-Family Partnership in their community and supports high performance from their team.

Shulman Cordeira has led the RVNAhealth NFP program since right after it launched in 2020. Despite the challenges that came with starting up during the pandemic, the program has grown impressively in a short time thanks to her dedication and leadership. She has been a steadfast advocate for NFP– using her voice to testify for increased funding and working to build a strong community of support behind NFP in her community and across Connecticut.

“Your selection is a testament to your passion for NFP’s mission and values and your commitment to your team. We have been so impressed by your dedication to the program – growing your implementation in the face of the pandemic; building strong relationships across your community and state in support of the program; and tirelessly advocating for sustainable funding streams,” said Charlotte Min-Harris, President & CEO of the National Service Office for Nurse-Family Partnership.

Congratulations to the Entire RVNAhealth NFP Team!

Congratulations again to Laura, as well as the entire NFP team. The successful growth of the NFP program is a testament to their collective hard work. One of our NFP moms best summed up the impact their work, “[They have provided] amazing support to help guide me through this journey to motherhood. The peace of mind this program provides is outstanding.”

To learn more about our program, please visit the RVNAhealth Nurse-Family Partnership website.

Breast Cancer Awareness and Support at RVNAhealth

breast cancer awareness

One in eight women in the United States will be diagnosed with breast cancer in her lifetime. In 2023, nearly 300,000 women and 3,000 men will be diagnosed with invasive breast cancer. Chances are, you know at least one person who has been personally affected by breast cancer. In support of Breast Cancer Awareness month in October, RVNAhealth would like to encourage everyone to proactively support their health through nutrition, exercise, and regular checkups.

RVNAhealth Breast Cancer Resources

RVNAhealth offers a number of experts in nutrition, rehabilitation therapy, nursing and more to help answer your questions and provide expert guidance and care for your specific needs. Whether you are concerned with breast cancer risk reduction, treatment or surgical recovery, or health and wellness during and after cancer, we are there for you every step of the way.

In the event that you or someone you love is facing a new or existing breast cancer diagnosis, please explore RVNAhealth’s breast cancer care and support services here. You can also reach us for questions at 203.438.5555 or email: intake@rvnahealth.org.

RVNAhealth Happenings for Breast Cancer Awareness Month

Cooking for breast cancerMark your calendar and register for our upcoming cooking class on October 6th: “Flavors of Resilience: Cooking for Breast Cancer.” Explore the role of nutrition in breast cancer prevention, recurrence reduction, and treatment optimization. Discover nourishing recipes with immune-boosting ingredients.

And if you are up for some food, fun and shopping, join RVNAhealth in New Milford on Thursday, October 12th to support Candlewood Valley Health & Rehabilitation’s 5th annual Breast Cancer Fundraiser. RVNAhealth is a proud sponsor of this annual event, held indoors at Candlewood Valley’s facility at 30 Park Lane East, New Milford, CT. Attendees will enjoy an afternoon of food, drink, music, shopping, raffles and massage, Candlewood Valley Annual Breast Cancer Fundraiser 2023along with many health and wellness information tables. And did we mention a gently-used designer handbag auction? Stop by RVNAhealth’s table to say hi and support this great community event in support of all of those affected by breast cancer. 100% of the funds raised by the event goes to the American Cancer Society.

 

 

 

 

 

Grief, Healing and the Holidays

Grief, healing and the holidays. Presentation at RVNAhealth

This holiday season might mark the initial one following the loss of a loved one. The holidays can become hard for many as grief tends to cling to us. It doesn’t just affect us personally; it also becomes intertwined with specific moments and locations.

“Instead of the usual holiday traditions evoking feelings of ‘comfort and joy’ in us, they tend to resurface memories and emotions that can also bring forth feelings of sorrow and heartache,” says Garrett Walkup, RVNAhealth Manager of Bereavement, Social Work, and Pastoral Care Services.

Special Presentation: Grief, Healing and the Holidays

To provide additional support during this time of year, RVNAhealth will host “Grief, Healing and the Holidays” on Tuesday, Nov. 14th from 1:00-2:30pm, at its 27 Governor Street, Ridgefield office. The lecture will include “how to cope with the emotions and feelings of the season, how to handle holiday traditions, and what to do differently – and the same,” says Walkup.

Walkup will cover a number of helpful suggestions to help you with coping and healing.  Strategies such as mindset, being kind to yourself, asking for support, creating boundaries, and more will be covered.  Following Walkup’s discussion, there will be an optional opportunity to stay and enjoy fellowship over coffee and cookies.

This program is open to all members of the community and is intended to offer support through the holiday season for those who have experienced a loss. As we will be serving refreshments, please register HERE to help us with planning. Please contact Garrett Walkup, at 475-529-6118, or gwalkup@rvnahealth.org if you have any questions.

Ongoing Monthly Grief/Bereavement Support Groups Available

RVNAhealth also offers monthly support groups at both its Ridgefield and New Milford offices. These are open to anyone needing a space for comfort, and guidance on grief and healing. Please see current dates available below. Check out the RVNAhealth calendar / support groups tab for the latest information and offerings.

RVNAhealth Earns Top Workplace Award for 11th Time

RVNAhealth wins Hearst Media CT Top Workplace Award 2023

RVNAhealth has once again achieved the prestigious Top Workplaces award by Hearst Connecticut Media for 2023, marking the 11th time since 2011 that they have received this recognition. This accolade is bestowed upon local businesses that excel in fostering an outstanding workplace culture, as determined through confidential employee surveys. The survey participants at RVNAhealth encompass a diverse range of roles, including clinical staff, rehabilitation therapists, and certified nursing assistants, as well as non-medical caregivers and administrative personnel. RVNAhealth falls into the mid-sized company category, which includes enterprises with employee counts ranging from 100 to 999.

Theresa Santoro, MSN, RN, CHCA, President and CEO of RVNAhealth, reflects on the significance of this achievement, stating, “I am immensely proud to witness the unwavering strength and dedication exhibited by our employees. This award serves as a validation of RVNAhealth’s resolute mission and underscores our employees’ commitment to the patients and communities we serve. It’s truly an honor to work alongside this exceptionally talented team.”

The Top Workplaces distinction was conferred upon 61 local Connecticut companies for 2023. To be eligible for consideration, a company must be situated in Fairfield, Litchfield, or New Haven County, and maintain a workforce of at least 35 employees. Employees complete a comprehensive survey about their organization, with the results analyzed to determine the recipients of the awards.

In addition to the rewarding and mission-driven work environment, RVNAhealth offers its employees an array of benefits, including medical and dental insurance, company-sponsored life insurance, a robust retirement plan with generous matching contributions, flexible work arrangements, ongoing training, opportunities for professional development, and well-defined career paths. For those interested in becoming part of the RVNAhealth family, more information can be found at rvnahealth.org/careers/.

Thanking our StayingWELL Caregivers

RVNAhealth caregiver appreciation week 2023

Last week RVNAhealth celebrated Caregiver Appreciation Week for our StayingWELL non-medical caregivers. The RVNAhealth StayingWELL caregiver team is a group of exceptional individuals who work tirelessly for our clients, bringing tremendous skills, compassion, and pride to their job. We are proud to recognize this team of over 200 individuals.

Caregiver Appreciation Week 2023

As part of the celebration, caregivers were treated to a drop-in buffet lunch and snack bar, raffle, and gift bags at our New Milford and Ridgefield, CT offices. “I and the StayingWELL staff team are so proud of our caregivers. They are simply the best and we love the opportunity to celebrate their hard work, compassion, and overall contribution to our clients’ lives. During our event, some clients even came along with their caregiver – which was a wonderful surprise and extra special way to capture the gratitude we all felt,” said Melissa Woodhouse, Director of RVNAhealth StayingWELL Services.

Celebrating Caregivers Year-Round with Our Above & Beyond Program

While we formally celebrate this appreciation week just one time annually, we are honored to have our caregivers recognized by our clients continuously throughout the year. Our StayingWELL Caregiver Above & Beyond Program is a monthly recognition program to highlight and recognize those caregivers who go above and beyond in their jobs. There is no better way to celebrate these amazing individuals than by sharing a few of the appreciative words we’ve received recently.

“Although only with Dad one day a week, Isaac and Vilma became comforting and consistent presences, rarely missing a Saturday and developing their own special rhythm for this weekend day. Isaac gave Dad a good shave and watched sports games with him, helping to keep him awake and interested, when sleeping was really his go-to preference. Vilma was amazingly encouraging and soothing when Dad felt overwhelmed and missed my mom or needed that extra motivation to get out of his comfortable recliner.” – Daughter, Katy L.

“Meisie has been a live-in aide for me for the past few months. Not only is she a great cook; she is a wonderful companion. She makes sure I eat well-made and nutritious meals. She also drives me to any appointments I may have and always helps me in and out of the car and wheels me in the wheelchair to the appointment. When a family member can’t accompany me to an appointment, she always writes down the questions that need to be asked to keep my care current.” – Judy V., Danbury

“Karen exemplifies what this nomination is all about. She goes “above and beyond” what her job description calls for. Karen is tireless – always anticipating my husband’s needs. Karen also helps me to keep up with household chores. Karen is always professional and lives up to the standards of RVNAhealth at all times” – P.C., Southbury

To all our StayingWELL caregivers, you are an invaluable part of our RVNAhealth family. A heartfelt thank you – your dedication is genuinely cherished! To read more caregiver Above & Beyond testimonials, visit our Meet the Caregivers webpage.

Caregiver Appreciation Week 2023 Photo Gallery:

Highlighting the Hospice Conversation

highlighting the hospice conversation

Jimmy Carter and his decision to enter hospice care has taken prominent placement in national news over the past six months. His decision to make public his election for hospice care has had a profound impact on how people perceive and discuss end-of-life care. Despite assumptions that hospice care is a short-term arrangement primarily for individuals at the brink of passing away, Carter’s case has demonstrated that hospice care can extend for a longer period and truly focuses on patient quality of life.

Current statistics show that only slightly more than half of those patients eligible for hospice care opt to receive it. At the age of 98, the former president’s choice to enter hospice care has led to a shift in public understanding. His family’s reports of him enjoying simple pleasures, such as ice cream and staying engaged with the activities of the Carter Center, highlight that hospice care can provide comfort and maintain a sense of normalcy for patients, rather than solely concentrating on medical interventions.

Carter’s openness about his journey has prompted conversations about hospice care’s benefits and debunked common misconceptions. Hospice care isn’t solely about imminent death; it centers on enhancing a patient’s well-being, managing pain, and emotional support for both patient and family. Carter’s situation underscores that hospice care can offer a higher quality of life for patients who opt to prioritize comfort and quality of life over aggressive medical treatments.

By openly sharing his care choice, Jimmy Carter has contributed to breaking down barriers surrounding discussions on death and end-of-life care. His example encourages a broader dialogue about the importance of making informed decisions regarding care options, advocating for individual preferences, and recognizing that hospice can offer solace, dignity, and a higher quality of life during one’s final stages.

For more information from RVNAhealth on myths and frequently asked questions about hospice care, visit our page.

Celebrate and Support RVNAhealth at Autumn Dinner 2023

RVNAhealth Autumn Dinner 2023

RVNAhealth will host its annual Autumn Dinner on Saturday evening, September 30 at Silver Spring Country Club in Ridgefield, CT. The Board of Directors, Autumn Dinner Committee, and friends of the organization look forward to celebrating the meaningful work of RVNAhealth and the continuum of care the agency provides throughout 35+ Connecticut communities.

Guests will enjoy evening cocktails and live music by Nick DePuy on the patio, bourbon tasting sponsored by Ancona’s Wines & Liquors, and dinner. A live auction hosted by entertainer, Tom Pesce, will include spectacular prizes, including tickets to a NY Giants game in a fully catered suite, a Loon Mountain ski vacation package, dinner for 8 catered by renowned local chefs Sarah and Bernard Bouissou and more!

Our ever-popular “Date Night for a Year” raffle is back! The always exciting date nights include a spa experience for two at Adam Broderick Salon & Spa, ACT of Connecticut and Danbury Hat Tricks tickets, and gift certificates to fabulous area shops, inns, and restaurants from Ridgefield to Litchfield, to name just a few!

The evening is hosted in support of RVNAhealth’s home health and hospice care, and the agency’s mission-driven public health services and wellness programs. This year’s impact speaker will be Jeanette Rizzo, who will share a personal story about how RVNAhealth was “without a doubt, the best decision” she made when choosing health and home care for her mother. Her story includes the very special bond that was created between her family and the RVNAhealth caregiver who was honored to attend Jeanette’s daughter’s wedding even though her mother passed prior to the event. This relationship reflects the experience RVNAhealth strives to create for every patient and family member in their care.

We would like to provide a tremendous thank you our sponsors, including:

  • Presenting Sponsor: Bill Lichtenberger
  • Diamond Sponsors: The Bossidy Foundation, Fairfield County Bank, Joseph and Shelley O’Connor, Eileen and Jay Walker
  • Platinum Sponsors: Chipman Mazzucco Emerson LLC, Robert H. Martinsen, Mutual of America
  • Gold Sponsors: BMW of Ridgefield, Cramer & Anderson, LLP, The Donnelly Family, Liz and Steven Goldstone, Starr and Harvey Herscovitch, Christopher and Mary Joyce, Meadow Ridge, Reynolds & Rowella, LLP, Savings Bank of Danbury, SimiTree Healthcare Consulting, Wilton Meadows and The Greens at Cannondale
  • Silver Sponsors: Adam Broderick Salon & Spa, John and Lori Berisford, Jill Bornstein/Upnext Leadership Coaching, Gaetano Castellano, Kevin and Elaine Cox, Anita and Nick Donofrio, Elizabeth Murray Ellis, Hamlet Hub, Adam and Glori Norwitt, Dan and Annette O’Brien, On the Mend Medical Supplies & Equipment, Donna and Joe Pastore/Pastore LLC, John and Joanne Patrick, Thomas and Michele Quindlen, Ridgebury Riders, Rodier Flowers, Union Savings Bank, Peter and Lisa Vanderminden, Barbara and William Wyman, Young’s of Ridgefield.

If you are interested in supporting the RVNAhealth Autumn Dinner, you may purchase sponsorships, program book advertising, or tickets at RVNAhealth.org.  If you would like more information, please contact Debbie Campbell at 203.438.5555, x1249 or dcampbell@rvnahealth.org.