I have been providing in home health caregiving and medical oversight for the continuous 25 years. 30 years ago I worked as a CNA in a sub-acute level facility. After I had children I became full-time caregiver for my grandparents, my grandfather died at 94 and I took care of him full-time for 5 years with congestive heart failure. When he passed, I took over as part time caregiver to my quadriplegic sister... this continued for 18 years. This care overlapped into parttime care of my father who has Parkinson's. I have been his primary care giver for the past 3 years. He has end -stage with a traeceostomy, feeding tube, and catheter. My sister had a feeding tube and catheter for 18 years. I also designed my parents'/sister's home for complete handicap accessibility with two bedroom bathroom wheel-in showers. I have interacted with physicians, visiting nurses, and pharmacies. I have managed two patients care at one time. I have done round the clock hands-on sub-acute care.