Tag Archives: GAO

Surge Seen in Number of Homeless Veterans

Surge Seen in Number of Homeless Veterans

 Oldtimer’s Comment:  I’ve seen a number of these types of articles.   Although the estimates vary depending on the subject area from 400 to about 1500, the word on the street is that the returning soldiers from Iraq and Afghanistan are showing up in shelters much faster than in previous wars.  The problem stems from higher rates of PTSD and TBI (traumatic brain injury) which still take too long to diagnose, and which are resulting from the combined effect of IED’s and higher survival rates.    The VA has long under diagnosed these problems and only recently, after much heat, begun to actively pursue it. 

Photo by Jeff Swensen for The New York Times
Frederick Johnson, a veteran of the Iraq war, lives in temporary housing provided by the V.A. after spending a year on the streets.

By ERIK ECKHOLM

WASHINGTON, Nov. 7 – More than 400 veterans of the Iraq and Afghanistan wars have turned up homeless, and the Veterans Affairs Department and aid groups say they are bracing for a new surge in homeless veterans in the years ahead.

 

Photo by Brendan Smialowski for The New York Times
Joe Williams lives in a homeless shelter in Washington.

Experts who work with veterans say it often takes several years after leaving military service for veterans’ accumulating problems to push them into the streets. But some aid workers say the Iraq and Afghanistan veterans appear to be turning up sooner than the Vietnam veterans did.

“We’re beginning to see, across the country, the first trickle of this generation of warriors in homeless shelters,” said Phil Landis, chairman of Veterans Village of San Diego, a residence and counseling center. “But we anticipate that it’s going to be a tsunami.”

With more women serving in combat zones, the current wars are already resulting in a higher share of homeless women as well. They have an added risk factor: roughly 40 percent of the hundreds of homeless female veterans of recent wars have said they were sexually assaulted by American soldiers while in the military, officials said.

“Sexual abuse is a risk factor for homelessness,” Pete Dougherty, the V.A.’s director of homeless programs, said.

Special traits of the current wars may contribute to homelessness, including high rates of post-traumatic stress disorder, or PTSD, and traumatic brain injury, which can cause unstable behavior and substance abuse, and the long and repeated tours of duty, which can make the reintegration into families and work all the harder.

Frederick Johnson, 37, an Army reservist, slept in abandoned houses shortly after returning to Chester, Pa., from a year in Iraq, where he experienced daily mortar attacks and saw mangled bodies of soldiers and children. He started using crack cocaine and drinking, burning through $6,000 in savings.

“I cut myself off from my family and went from being a pleasant guy to wanting to rip your head off if you looked at me wrong,” Mr. Johnson said.

(…)  Read more about Fredrick at the link above

Poverty and high housing costs also contribute. The National Alliance to End Homelessness in Washington will release a report on Thursday saying that among one million veterans who served after the Sept. 11 attacks, 72,000 are paying more than half their incomes for rent, leaving them highly vulnerable.

Mr. Dougherty of the V.A. said outreach officers, who visit shelters, soup kitchens and parks, had located about 1,500 returnees from Iraq or Afghanistan who seemed at high risk, though many had jobs. More than 400 have entered agency-supported residential programs around the country. No one knows how many others have not made contact with aid agencies.

More than 11 percent of the newly homeless veterans are women, Mr. Dougherty said, compared with 4 percent enrolled in such programs over all.

Veterans have long accounted for a high share of the nation’s homeless. Although they make up 11 percent of the adult population, they make up 26 percent of the homeless on any given day, the National Alliance report calculated.

Oldtimer’s comment:   My studies show that homeless male veterans make up 43% of the homeless male population, far in excess of what would be expected.

According to the V.A., some 196,000 veterans of all ages were homeless on any given night in 2006. That represents a decline from about 250,000 a decade back, Mr. Dougherty said, as housing and medical programs grew and older veterans died.

Oldtimer’s comment:  Oops!  That is a deliberately misleading statement.   A GAO report states that the drop from 250,000 a decade ago was due to a major change in how homeless veterans are counted.   While it is true that our older veterans are dieing off, many more veterans are joining the ranks of the homeless and make up for it.  There has been no real decline, and actually there has been a steady increase in the percentage of homeless veterans vs the overall population of veterans.

The most troubling face of homelessness has been the chronic cases, those who live in the streets or shelters for more than year. Some 44,000 to 64,000 veterans fit that category, according to the National Alliance study.

On Wednesday, the Bush administration announced what it described as “remarkable progress” for the chronic homeless. Alphonso R. Jackson, the secretary of housing and urban development, said a new policy of bringing the long-term homeless directly into housing, backed by supporting services, had put more than 20,000, or about 12 percent, into permanent or transitional homes.

Oldtimer’s comment:  I’m not sure where these numbers come from.  It appears the HUD secretary is talking about all chronic homeless, not just veterans.   20,000 is 12% of 166,000, which is about right for the chronic homeless for the entire homeless population. To get a feel for progress among veterans, see the following two paragraphs.

Veterans have been among the beneficiaries, but Mary Cunningham, director of the research institute of the National Alliance and chief author of their report, said the share of supported housing marked for veterans was low.

A collaborative program of the Department of Housing and Urban Development and the V.A. has developed 1,780 such units. The National Alliance said the number needed to grow by 25,000.

Mr. Dougherty described the large and growing efforts the V.A. was making to prevent homelessness including offering two years of free medical care and identifying psychological and substance abuse problems early.

Oldtimer’s Comment:  ‘Bout Time!

(…)

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How many homeless youth are there?

How many Kids are Homeless?

There is a  Congressional Research Service (CRS) Report to Congress with information on this subject titled Runaway and Homeless Youth: Demographics, Programs, and Emerging Issues which was published in January 2007.  This link is to their 37 page report. 

I think they are being honest when they say this:

The precise number of homeless and runaway youth is unknown due to their residential mobility and overlap among the populations. Determining the number of these youth is further complicated by the lack of a standardized methodology for counting the population and inconsistent definitions of what it means to be homeless or a runaway.

Estimates of the homeless youth population range from 52,000 to over one million.  Estimates of runaway youth – including “thrownaway” youth – are between 1 million and 1.7 million.

Part of the problem of counting homeless youth is that they often avoid shelters and more or less hide in inaccessable areas where they avoid counters.  Some hide out with friends, others take to the woods and alleys, even the rails.  You may have seen an earlier post of mine (Homeless Youth Project) where loose groups of homeless youth ride the rails around the country.  Youth that do come into contact with census counters are reluctant to admit that they are homeless.    

The 52,000 to over 1 million estimates are based on a series of counting attempts through the decades.    A 1987 GAO report estimated 52,000 to 170,000 homeless on any one night.  CDC’s 1992 National Health Interview Survey of youth ages 12 to 17 determined that 5% of those they surveyed had been homeless during some part of the prior year.  That estimate came to more than a million youth that experienced homelessness during that year.

The latest federal survey was conducted by NISMART – (National Incidence Studies of Missing, Abducted, Runaway and Throwaway Children) which was conducted in 1999.  That study found that 1.8 million youth under age 18 left home or were asked to leave home in 1999 (at some time during the year). 

The NISMART-2 study for 1999 shows that:

1.8 million youth under age 18 experienced homelessness

68% were between the ages of 15 and 17 (1,224,000)

32% were 14 or younger (612,000) 

20% reported sexual abuse in the home (360,000)

33% reported family conflict in the home (600,000)

there were about an equal number of males and females

57% were White, 17% Black, 15% Hispanic

about 11,000 were runaway foster children

more than half left home for more than 1 to 6 days

30% traveled 1 to 10 miles from home

30% traveled 11 to 50 miles from home

nearly 99% were returned to their homes

That leaves more than 18,000 that never came back that year.

Another study, reported by Jan Moore,  Unaccompanied and Homeless Youth Review of Literature (1995-2005)  ,  reported 1 million to 1.3 million homeless youth.   I reported on this study earlier, see How many of the Homeless are Youth? 

Also see a forum report I presented in 2006 on the Cobb Faith Partnership site titled:  Homelessness Among Children and Youth – Basic Facts in which 1.35 million homeless children are reported homeless in a given year, according to the National Law Center.    The numbers seem to be centering around 1.3 million with a spread of 300,000 either way.   I feel that the numbers probably fluctuate wildly on any given day in any given year, much like trying to get the average level of a raging river.

Factors Influencing Homelessness and Leaving Home:  Youth most often cite family conflict as the major reason for their homelessness or episodes of running away. A literature review of homeless youth found that a youth’s relationship with a step-parent, sexual activity, sexual orientation, pregnancy, school problems, and alcohol and drug use were strong predictors of family discord.  14% of Foster kids that age out of the system experience homelessness the first year and 25% at sometime overall.   Another report shows 20%.

Of those callers who used the National Runaway Switchboard (a federally-sponsored call center for youth and their relatives involved in runaway incidents) one third attributed family conflict as the reason for their call.  Runaway and homeless youth also describe abuse and neglect as common experiences.  Over 20% of youth in the NISMART-2 reported being physically or sexually abused at home in the prior year
or feared abuse upon returning home.

Congress has funded 102 million dollars for three federal funded programs:

Basic Center Program: To provide outreach, crisis intervention, temporary shelter, counseling, family unification, and after care services to runaway and homeless youth under age 18 and their families.

Transitional Living Program: To support projects that provide homeless youth ages 16 to 21 with stable, safe longer-term residential services up to 18 months (or longer if the youth has not reached age 18), including counseling in basic life skills, interpersonal skills building, educational advancement, job attainment skills, and physical and mental health care. 

Street Outreach Program: To provide street-based outreach and education, including treatment, counseling, provision of information, and referrals for runaway, homeless, and street youth who have been subjected to or are at risk of being subjected to sexual abuse and exploitation.

Those are the facts on homeless youth, the best that I can report at this time.   You can select whatever set of data suits your purpose, but it appears the most current data comes in somewhere between 1 and 1.8 million kids that experience homelessness in any given year, centering around 1.3 million youth.  

There is no good estimate as to how many that amounts to on any given night, but if you are one of those kids, it is way too many. 

Those are our kids out there

Some Special Links:

Click to see all Oldtimer Speaks Out homeless youth articles (35 so far).

Click here if you came here to find Oldtimer’s articles on Homeless Veterans (75 so far)

Grace and Peace,

Oldtimer

GAO Testimony – DOD and VA

Transition Field Unit staffingGAO Testimony – DOD and VA

This is a troubling situation.  We have our kids off at war and they become severely injured, physically and mentally.   Our country has pulled out all stops to provide the best possible care for them and still we have problems.  Due to the protective gear and terrific and speedy medical care, thankfully more and more are surviving.  This shift in the severity and long term recovery needs requires major adjustments in our programs for treatment and rehabitation, for our benefits and compensation programs.  The cause and effect has driven the case loads and delays out of sight at the expense of our wounded heroes.

The good news is that that there is a scramble going on to correct these problems as soon as possible. There are people in high places capable of fixing the problem that have a heart for our heroes and are working very hard to fix the problems.  There are people in our VA and in militray trauma centers that are just as frustrated as we are.  There is a continuum of care mentality for our soldiers starting at the battlefield and continuing through our VA system. There are programs under development to reduce the time required to make determinations before our heroes get the treatment and benefits they need.

The bad news is there are still more than 150,000 cases more than 6 months old among the pending 600,000 cases in the VBA system, and we have no idea how old these cases really are.  The GAO found that new programs designed to correct the problems are not yet fully off the ground and there are severe staffing problems in key places, both on the active duty side and the veteran side of the picture. It appears to me that some of it is due to needing to move physicians from one program to staff another, leaving both under staffed. 

(Download Here)

What the GAO found

Warrior Transition Unit

Challenges have emerged for staffing the Warrior Transition Unit in which servicemembers are assigned to three key staff – a physician care manager, a nurse care manager, and a squad leader. For example, as of mid-September 2007, over half the U.S. Warrior Transition Units had significant shortfalls in one or more of these critical positions. In addition the number of recovery coordinators and how many servicemembers each would serve have yet to be determined.

Transition Field Unit staffing

This table shows that in actuality we have only 35% perminent staffing for these teams.  More than 450 of the existing staff (19%) have been borrowed from elsewhere, likely reducing the staff, already short, in othere facilities.   The table below shows where those with less than 50% staffing are located. 

 Staffing problem locations

PTSD and TBI 

Three independent review groups examining the deficiencies found at Walter Reed identified a range of complex problems associated with DOD and VA’s screening, diagnosis, and treatment of TBI (Traumatic Brain Injury) and PTSD, signature injuries of recent conflicts. Both conditions are sometimes referred to as “invisible injuries” because outwardly the individual’s appearance is just as it was before the injury or onset of symptoms. In terms of mild TBI, there may be no observable head injury and symptoms may overlap with those associated with PTSD. With respect to PTSD, there is no objective diagnostic test and its symptoms can sometimes be associated with other psychological conditions (e.g., depression).

TBI and PTSD chart
 
This table outlines what is being implimented (or planned) for handling TBI and PTSD better.   However, according to Army officials and the Independent Review Group report, obtaining qualified health professionals, such as clinical psychologists, is a challenge, which is due to competition with private sector salaries and difficulty recruiting for certain geographical locations. 

Data Sharing

In addition, the Dole-Shalala Commission noted that while VA is considered a leader in PTSD research and treatment, knowledge generated through research and clinical experience is not systematically disseminated to all DOD and VA providers of care.

Data Sharing

This table shows the efforts being taken to improve the data sharing between organizations. 

Disability Evaluations

As GAO and others have previously reported, providing timely and consistent disability decisions is a challenge for both DOD and VA. To address identified concerns, the Army has taken steps to streamline its disability evaluation process and reduce bottlenecks.   To address identified concerns, the Army has taken steps to streamline its disability evaluation process and reduce bottlenecks. The Army has also developed and conducted the first certification training for evaluation board liaisons who help servicemembers navigate the system. To address more systemic concerns, the Senior Oversight Committee is planning to pilot a joint disability evaluation system. Pilot options may incorporate variations of three key elements:

(1) a single, comprehensive medical examination;

(2) a single disability rating done by VA; and

(3) a DOD-level evaluation board for adjudicating servicemembers’ fitness for duty.

DOD and VA officials hoped to begin the pilot in August 2007, but postponed implementation in order to further review options and address open questions, including those related to proposed legislation.

Fixing these long-standing and complex problems as expeditiously as possible is critical to ensuring high-quality care for returning servicemembers, and success will ultimately depend on sustained attention, systematic oversight by DOD and VA, and sufficient resources.

You are invited to download and read the entire report here:  GAO Report (pdf – 32 pages)

Oldtimer

REFORM NEEDED: Brain-injured vets getting lost in the VA

REFORM NEEDED:

Brain-injured vets getting lost in the VA

I found this in the Opinion Section of the Atlanta Journal Constitution.  It dovetails with an article I was already writing and  nicelly illustrates the enormous problem of finding enough doctors and specialists to adequately care for our heroes that need treatment NOW.  I’ve decided to post it now and follow up with just released GAO testimony relating to the problem which will appear in my next post.  “Stay tuned.”  

Oldtimer

By Kevin Ferris
Philadelphia Inquirer

Published on: 11/12/07

Allen McQuarrie is looking for a few good doctors.  He wants them to volunteer their time and talents to their local Veterans Administration hospital.  Nothing against the quality of the folks already working there. The problem is. there simply aren’t enough doctors and specialists to go around for diagnosis and treatment — or to guide vets through the bureaucratic maze.

Worse, one of the current conflict’s signature wounds — brain injuries — makes it difficult for some vets to juggle the appointments, record-keeping and other demands the VA puts on them.

“We’re doing a wonderful job of getting the wounded off the battlefield and into a hospital in Germany and then back here,” McQuarrie says. “But continuing care once they’re out of the military is what needs systemic change.”

McQuarrie learned of the system’s shortcomings because of his son Doug, a 21-year veteran of the Navy SEALs who has back and brain injuries sustained in combat and training.

Doug McQuarrie has shuttled from the VA to civilian doctors, while trying to hold down a job and support his family in Virginia. The civilians say he needs immediate care, but the VA can’t see him for months — although he can call daily, hoping for a cancellation.

Allen McQuarrie has tried to help from his home in Doylestown, Pa., calling the VA but also seeking assistance from senators and representatives. In the process, he’s learned that Doug’s case isn’t unique — and that the VA desperately needs help.

Despairing and angry, he wrote to Sen. Bob Casey (D-Pa.): “It may be better for our men and women to come home dead than to suffer such painful and ultimately mortal deterioration.”

In the same letter, he asked for emergency legislation to encourage civilian doctors to “adopt” vets and provide the immediate neurological care many need. He suggested tax incentives and improved military insurance to help offset the volunteers’ costs.

McQuarrie’s hopes for a more responsive, faster-acting VA are shared by others including Congress’ Veterans Disability Benefits Commission.

One commission member, retired Marine Corps Maj. Gen. James E. Livingston, a Medal of Honor recipient, emphasizes three required changes.

Have a single review for disabilities. Now there are two.

Streamline the record-keeping process as vets move from care by the Defense Department to the VA.

Adopt the technology that will improve efficiency and speed up treatment.

And don’t worry about the costs.

(there is more to this story in the AJC – click on the link above and read the rest)

Now you have a flavor of the problem:  Not enough doctors to go around, too much paperwork, not enough technology – as viewed from the patient/family side of the problem.   Stay tuned for the recent GAO Testimony on the problem, coming up in my next post.

Oldtimer

Homeless Veterans – Recent Study

How Many Homeless Veterans Are There?

Unless otherwise noted, the data in this article came from: “Ending Homelessness Among Veterans Through Permanent Supportive Housing

The most recent estimate of the number of homeless veterans comes from the FY2005 report of the Community Homelessness Assessment, Local Education and Networking Groups (CHALENG) for Veterans.  

CHaling reports that the number of homeless veterans counted during the point in time count was 195,254.

The VA estimates that nearly 200,000 veterans may be homeless on any given night and 400,000 veterans experience homelessness during a year.

The National Survey of Homeless Assistance Providers and Clients (updated in 1999) found that  23% of all homeless clients and 33% of homeless men are veterans.   Compare that to the 2000 Census that estimates 12.7% of the general population are veterans.  Veterans are 2 to 3 times as likely to be homeless than the general population.

Characteristics of Homeless Veterans

• 45% suffer from mental illness
• 50% have substance abuse problems
• 67% served three or more years
• 33% were stationed in a war zone
• 25% have used VA Homeless Services
• 89% received an honorable discharge

Homeless Veterans vs. Non-Veterans

Homeless male veterans are more likely to be chronically homeless than homeless male non-veterans.  “32 percent of homeless male veterans report that their last homeless episode lasted 13 or more months, compared to 17 percent of male nonveterans.”

They are also more likely to abuse alcohol than homeless non-veterans.

Homeless veterans are better educated than homeless non-veterans, less likely to have never married, and more likely to be working for pay.

Why Do Veterans Go Homelessness?

A study of Vietnam-era veterans by Rosenheck and Fontana demonstrated that the two factors with the greatest effect on homelessness were 1) (lack of) support in the year after discharge from military service and 2) social isolation.

This is consistent with the results of a study by Tessler and Rosenheck which showed that homeless veterans experiencing the longest current episodes of homelessness were those who also had “behavioral risk factors with possible early onset, and those who were lacking in social bonds to civilian society that are normally conferred by employment, marriage, and support from family of origin.”

 Veterans Returning from Iraq and Afghanistan

Initial data indicates rates of mental health disorders that could surpass those seen among Vietnam Veterans. A study by Charles Hoge et al found that:

19 percent of soldiers who served in Iraq screened positive for a potential mental health disorder, including PTSD compared with 11 percent for veterans of the war in Afghanistan. National Guard soldiers, one study found, were about 2 percentage points more likely to experience problems.

This is particularly distressing when coupled with the fact that among veterans “whose responses were positive for a mental disorder, only 23 to 40 percent sought mental health care” and the GAO finding that the “[Department of Defense] cannot provide reasonable assurance that OEF/OIF (Operation Enduring Freedom/Operation Iraqi Freedom) servicemembers who need referrals receive them.”

Homeless Veterans from Iraq and Afghanistan

Although many Vietnam veterans did not experience homelessness until 10-15 years after they left the service, homeless service providers are seeing veterans of OEF/OIF already. Social workers fear that “the trickle of stunned soldiers returning from Baghdad and Kabul has the potential to become a tragic tide.” Homeless OEF/OIF veterans themselves are saying “they [are] surprised how quickly they slid into the streets.”

Hypotheses for this quicker descent into homelessness include a tighter housing market than existed during the Vietnam era and a higher percentage of troops exposed to trauma during their service.

There Are Homeless Heroes Out There 

GPD – Grant and Per Diem Program for Homeless Vets

GPD Transitional Housing Program

for Homeless Veterans

The GAO did a study of the Grant and Per Diem Program in 2005 and reported it in late 2006.  The information below came chiefly from that study – a 59 page PDF file.

GPD flowchartThe Grant and Per Diem Program (GPD)–VA’s major transitional housing program for homeless veterans–spent about $67 million in fiscal year 2005. It became VA’s largest program for homeless veterans after fiscal year 2002, when VA began to increase GPD program capacity and phase out national funding for the more costly contracted residential treatment-another of VA’s transitional housing programs. To operate the GPD program at the local level, nonprofit and public agencies compete for grants. The program provides two basic types of grants-capital grants to pay for the buildings that house homeless veterans and per diem grants for the day-to-day operational expenses.

 cup of coffeecup of coffed quote

 

 

 

 

 

                                                                                                                                    

Capital grants cover up to 65 percent of housing acquisition, construction, or renovation costs and require that agencies receiving the grants cover the remaining costs through other funding sources. Generally, agencies that have received capital grants are considered for subsequent per diem grants, so that the VA investment can be realized and the buildings can provide operational beds.

Per diem grants support the operations of about 300 GPD providers nationwide. The per diem grants pay a fixed dollar amount for each day an authorized bed is occupied by an eligible veteran up to the maximum number of beds allowed by the grant. Generally under this grant, VA does not pay for empty beds.

VA makes payments after an agency has housed the veteran, on a cost reimbursement basis, and the agency may use the payments to offset operating costs, such as staff salaries and utilities.  By law, the per diem reimbursement cannot exceed a fixed rate, which was $29.31 per person per day in 2006.  Reimbursement may be lower for providers receiving funds for the same purpose from other sources.

On a limited basis, special needs grants are available to cover the additional costs of serving women, frail elderly, terminally ill, or chronically mentally ill veterans. Although the primary focus of the GPD program is housing, grants may also be used for transport or to operate daytime service centers that do not provide overnight accommodations. 

 According to VA, in fiscal year 2005, GPD grants supported about 75 vans that were used to conduct outreach and transport homeless veterans to medical and other appointments. Also, 23 service centers were operating with GPD support.

Barracks Style Bunk BedsMost GPD providers have 50 or fewer beds available for homeless veterans, with the majority of providers having 25 or fewer.  Accommodations vary and may range from rooms in multistory buildings in the inner city to rooms in detached homes in suburban residential neighborhoods. Veterans may sleep in barracks-style bunk beds in a room shared by several other participants or may have their own rooms.

In fiscal year 2005, VA had the capacity to house about 8,000 veterans on any given night. However, over the course of the year, because some veterans completed the program in a matter of months and others left before completion, VA was able to admit about 16,600 veterans into the program. 

Homeless vets per yearOldtimer’s Comments:  The GAO found that the VA’s GPD program was the VA’s largest homeless program beginning in 2005, spending $67 million on 194,000 veterans, a whopping 94 cents a day per homeless veteran – you can’t buy a vet a cup of coffee for that.   It assigned a van to outreach more than 2500 homeless vets per van.   It provided support to 23 service centers with an average of 25  or fewer beds, something like 600 beds total while in actuality much of the money went to vans and administrative costs, so the figure per vet is quite low. 

The curious thing about the chart above, provided by the GAO, is the sudden disconnect between 2003 and 2004.   A sudden loss of 121,000 homeless vets in one year!  The VA says it “improved its counting methods,” now relying on the Continuum of Care program under HUD.   The CoC program is a count of all homeless.  Unfortunately, there is no consistent query relating to veterans in their survey.   There is no consistant directive requiring VA centers to use a particular counting method.  The GAO says that, “in 2005, more than twice as many local VA officials used HUD counts as was the case in 2003.”  That indicates some do and some don’t.   No one knows within tens of thousands how many homeless veterans there are.

Considering The VA has capacity to house 8000 veterans on any given night in 2005, the other 186,000 homeless veterans on those same nights had to fend for themselves.  Considering that 8000 beds times $29.31 per night means the VA should have spent $85 million on the bedded veterans over a year’s time, but could not as they only had $67 million to spend, much of which went to the vans and overhead.  Obviously there were considerable empty beds during the year due to underfunding or inefficient turnover in available beds.

More on this report later.

Oldtimer

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